NURS 126 HEME

NURS 126 HEME A 4-year-old child is seen at the clinic for a mild iron deficiency anemia caused by a poor diet. The parents ask the nurse what type of treatment to expect. What is the most appropriate response by the nurse? a) Preparation for bone marrow transplant b) Splenectomy and steroid therapy c) Iron replacement and change of diet d) Transfusion of packed red blood cells Because the main etiological factor is diet, treatment would focus on addressing the iron deficiency in the diet, rather than more drastic options such as blood transfusion, bone marrow transplant, splenectomy, and steroid therapy. A client in sickle cell crisis has been hospitalized during her pregnancy. After giving discharge instructions, the nurse determines the client needs further teaching when she makes which statement? a) “I will need to take an iron supplement even if my laboratory values are normal.” b) "At the earliest signs of a crisis, I need to seek treatment." c) "Signs of any type of infection must be reported immediately." d) "I will need more frequent appointments during the remainder of the pregnancy." Sickle cell disease is an autosomal recessive disorder requiring both parents to have a sickle cell trait to pass the disease to a child. Deoxygenated hemoglobin cells assume a sickle shape and obstruct tissues. Tissue obstruction causes hypoxia to the area (vasoocclusion) and results in pain, called sickle cell crisis. This type of anemia in the diet. Iron supplementation is needed only if there is laboratory evidence of iron deficiency anemia. Self-monitoring for any type of infections or sickle cells crisis and increased frequency of antenatal care visits are part of the teaching plan of care. When discussing appropriate iron-rich food selections with the mother of an 11-month-old infant with iron deficiency anemia, which food choices verbalized by the mother indicates successful teaching? a) eggs, fruits, milk, and mixed vegetables b) eggs, fortified cereals, meats, and green vegetables c) juices, fruits, fortified cereals, and milk d) fruits, cereals, milk, and yellow vegetables Relatively high amounts of iron are contained in eggs, fortified cereals, meats, and green vegetables. Although fruits, nonfortified cereals, milk, and yellow vegetables contain iron, they are not the best choices for iron-rich foods. Although eggs are an appropriate choice for iron-rich foods, fruits, mixed vegetables, and milk contain less iron. Fortified cereals are excellent sources of iron; however, juices, fruits, and milk contain less iron and are not the best choices. A client with anemia has been admitted to the medical-surgical unit. Which assessment findings are characteristic of iron deficiency anemia? a) Nights sweats, weight loss, and diarrhea b) Itching, rash, and jaundice c) Dyspnea, tachycardia, and pallor d) Nausea, vomiting, and anorexia Signs of iron deficiency anemia include dyspnea, tachycardia, and pallor, as well as fatigue, listlessness, irritability, and headache. Night sweats, weight loss, and diarrhea may signal acquired immunodeficiency syndrome. Nausea, vomiting, and anorexia may be signs of hepatitis B. Itching, rash, and jaundice may result from an allergic or hemolytic reaction A child with iron deficiency anemia is ordered ferrous sulfate, an oral iron supplement. When teaching the child and parent how to administer this preparation, the mother asks why she needs to mix the supplement with citrus juice. Which response by the nurse is best? a) "There isn't a specific reason for it." b) "The citrus juice counteracts the unpleasant taste of the iron." c) "The vitamin C in the citrus juice helps with iron absorption." d) "Having food and juice in the stomach helps with iron absorption." Administering an oral iron supplement such as ferrous sulfate with citrus juice or another vitamin C source enhances its absorption. Preferably, doses should be administered between meals because gastric acidity and absence of food promote iron absorption. Although citrus juice may improve the taste of an oral iron supplement, this isn't the primary reason for mixing the two together. Telling the mother that there isn't a specific reason for mixing the supplement with citrus juice is inappropriate and inaccurate A client with iron deficiency anemia is taking iron supplements. The nurse emphasizes to the client that the drug will have increased absorption if taken with: a) beta-carotene. b) orange juice. c) food. d) milk. The nurse teaches the client with iron deficiency anemia that food sources with high iron content include: a) cheese. b) squash. c) beef. d) apples. The nurse is caring for a 3-year-old child with iron deficiency anemia and providing dietary instructions to the parents. Which of the following should be a priority for the nurse to include in the teaching? a) Urging pasta with tomato sauce b) Recommending lean meats c) Insisting on a banana each day d) Encouraging milk products An adolescent is diagnosed with iron deficiency anemia. After emphasizing the importance of consuming dietary iron, the nurse asks him to select iron-rich breakfast items from a sample menu. Which selection demonstrates knowledge of dietary iron sources? a) Grapefruit and white toast b) Pancakes and a banana c) Bagel and cream cheese d) Ham and eggs A 9-year-old child is placed on a liquid preparation of ferrous sulfate for the treatment of iron deficiency anemia. The nurse is teaching the parents about the side effects of ferrous sulfate. Which of the following statements is the most appropriate information for the nurse to convey to the parents? a) “The child’s stool pattern may increase in frequency.” b) “Be sure to use sunscreen while taking this medication.” c) “Have the child take the medicine through a straw.” d) “Watch the child for problems with gait or balance.” Administering an oral iron supplement such as ferrous sulfate with citrus juice or another vitamin C source enhances its absorption. Preferably, doses should be administered between meals because gastric acidity and absence of food promote iron absorption. Although citrus juice may improve the taste of an oral iron supplement, this isn't the primary reason for mixing the two together. Telling the mother that there isn't a specific reason for mixing the supplement with citrus juice is inappropriate and inaccurate The parents of an eight-month-old child with iron deficiency anemia have not been compliant with the administration of oral iron supplements. The child must now receive an iron dextran injection. How should the nurse administer this injection? a) Intramuscularly using the z-track method b) Subcutaneously c) Intradermally d) Intravenous If iron dextran is ordered, it must be injected deep into a large muscle mass, using the z-track method to minimize skin staining and irritation. Neither a subcutaneous nor an intradermal injection would inject the dextran into muscle. The z-track method is preferred over a normal intramuscular injection. Intravenous is not appropriate for this scenario. A child with iron deficiency anemia was prescribed ferrous sulfate. Which statement by the parent would indicate a need for further instruction on proper administration? a) “I give the ferrous sulfate at a different time than my child’s other medications.” b) “I give the medication in the morning before breakfast.” c) “I mix the medication in milk to make it taste better.” d) “I encourage my child to drink lots of fluids.” Ferrous sulfate absorbs better with juices containing vitamin C. However, food containing calcium will decrease the medication’s absorption. Ferrous sulfate should be given on an empty stomach if tolerated. Many medications alter the absorption of ferrous sulfate and they should be administered at least 1–2 hours apart. Drinking lots of fluid will help with constipation, a common side effect of ferrous sulfate. The nurse advises a mother with a 2-year-old child to avoid encouraging excessive milk consumption by the toddler because excess milk consumption can lead to: a) iron deficiency. b) vitamin C deficiency. c) folate deficiency. d) biotin deficiency. Excessive milk consumption can lead to the displacement of iron-rich foods in the diet. This can result in iron deficiency anemia. Drinking excess milk will not cause vitamin C, biotin, or folate deficiencies A parent asks the nurse if a child's iron deficiency anemia is related to the child's frequent infections. The nurse responds based on the understanding of which principle? a) Children with iron deficiency anemia are less susceptible to infection than are other children. b) Children with iron deficiency anemia are equally as susceptible to infection as are other children. c) Children with iron deficiency anemia are more susceptible to infection than are other children. d) Little is known about iron deficiency anemia and its relationship to infection in children. Children with iron deficiency anemia are more susceptible to infection because of marked decreases in bone marrow functioning with microcytosis. A toddler is diagnosed with iron deficiency anemia. When teaching the parents about using supplemental iron elixir, the nurse should provide which instruction? a) "Give the iron preparation before meals." b) "Give the iron preparation with milk." c) "Monitor the child for episodes of diarrhea." d) "Give the elixir with water or juice." Because iron preparations may stain the teeth, the nurse should instruct the parents to give the elixir with water or juice. The iron preparation shouldn’t be given with milk because milk impedes iron absorption. This preparation may darken the stools and cause constipation; parental instruction regarding increased fluid intake and fiber intake can relieve constipation. To prevent GI upset, the nurse should instruct the parents to mix the iron preparation with water or fruit juice and have the child take it with meals. (Giving it with fruit juice may be preferable because vitamin C enhances iron solubility and absorption.) ....Continued.....