anemia
Identify the specific hormone produced by the kidneys that stimulates the bone marrow to produce red blood cells, and name the primary trigger that causes the kidneys to release it.
Erythropoietin; the trigger is hypoxia (low oxygen levels in the blood).
When administering liquid ferrous sulfate, what two specific nursing actions must be taken to prevent damage to the patient’s teeth?
Use a straw and rinse the mouth to prevent tooth staining.
A nurse is preparing to administer esomeprazole to a patient with GERD. What is the best timing for administration?
Administer 30–60 minutes before the first meal of the day.
Explain the role of mucus production in the stomach.
BONUS if you identify the physiological substance responsible for stimulating its secretion.
Mucus creates a protective barrier against hydrochloric acid and digestive enzymes.
Prostaglandins are responsible for stimulating mucus secretion.
Name three common anticholinergic-like side effects that a nurse should include in the teaching plan for a patient taking antihistamines for nausea.
Dry mouth, blurred vision, urinary retention, constipation, tachycardia, dizziness, decreased sweating, confusion.
What are foods or drinks that a patient should avoid taking simultaneously with their iron replacement therapy because they inhibit absorption.
Milk/dairy (calcium), coffee/tea, or antacids.
Aside from GI upset and constipation, what is a systemic adverse effect of iron? What specific change in stool appearance that is considered a normal, expected finding.
Systemic effects can include CNS toxicity (in overdose); the expected stool change is that it becomes dark, green, or black/tarry.
Identify the three sections of the small intestine in the order that food passes through them and state which section is the primary site for nutrient absorption.
Duodenum, jejunum, and ileum. The duodenum and upper jejunum are the primary sites for absorption.
What is the ending H2 antagonists? How do they work to treat gastroesophageal reflux disease (GERD)?
End in -tidine (like cimetidine). They block H2 receptor sites on parietal cells, which suppresses the secretion of hydrochloric acid.
Describe the clinical scenario in which a provider would prescribe Dronabinol or Nabilone?
BONUS When should they be administered?
These are typically reserved for chemotherapy-induced nausea and vomiting that has failed to respond to first line antiemetics (should be given 1-3 hours before chemo.) Also given for appetite stimulation in patients with AIDS-related wasting.
Explain the clinical danger of administering high-dose Folic Acid to a patient with undiagnosed Megaloblastic Anemia before ruling out a Vitamin B12 deficiency.
Folic acid can reverse the hematologic symptoms of anema, but it does not treat the neurological complications of B12 deficiency. This "masks" the underlying B12 deficiency, potentially leading to permanent nerve damage.
In a patient experiencing an acute GI bleed, explain why the nurse should prioritize blood transfusions over the administration of Epoetin Alfa.
Epoetin Alfa takes days to weeks to stimulate new RBC production, whereas a transfusion provides immediate volume and oxygen-carrying capacity in an acute loss scenario.
A patient has been consuming excessive amounts of sodium bicarbonate to treat "sour stomach". Describe the compensatory respiratory mechanism the body uses during metabolic alkalosis and identify one neurological assessment finding the nurse should prioritize.
The body uses hypoventilation (slow, shallow breaths) to retain CO2. The nurse should prioritize assessing for confusion or irritability.
What is the ending for PPIs? How do they work?
PPIs end in -prazole (like esomeprazole). They work by directly inhibiting the H+/K+ ATPase enzyme system (the "proton pump"), blocking the final step of acid production, leading to a more significant decrease in gastric acid.
Which class of antiemetic is the gold standard for motion sickness, and what are the most common side effects associated with them?
Anticholinergics/Antihistamines (like Scopolamine or Meclizine). Side effects include dry mouth, blurred vision, and drowsiness.
A patient who had a total gastrectomy is diagnosed with megaloblastic anemia. Explain why oral B12 supplements will be ineffective for this patient and identify the necessary route of administration.
Gastrectomy removes the parietal cells that produce intrinsic factor; without intrinsic factor, B12 cannot be absorbed orally, so the patient requires IM, SQ, or intranasal B12 for life.
What is the specific patient population (r/t lifestyle) that is at the highest risk for folic acid deficiency?
Patients with chronic alcoholism are at high risk because alcohol interferes with the folate enterohepatic cycle and inhibits the absorption of folate.
Explain how Sucralfate protects the gastric lining and when should it be administered.
It forms a thick, paste-like barrier that adheres to ulcer sites. It requires an acidic environment to "stick" and must be given before food to coat the ulcer before digestion begins.
Why is Bismuth Subsalicylate contraindicated in a teenager with the flu or chickenpox?
It contains salicylate (aspirin), which increases the risk of Reye’s Syndrome in children and teens with viral infections.
A patient is prescribed IV Ondansetron. Which pre-existing cardiac condition or lab abnormality would make the nurse prioritize an EKG before administration?
A history of prolonged QT interval or electrolyte imbalances like hypokalemia/hypomagnesemia.
A patient with long-term Type 2 Diabetes and chronic renal failure is diagnosed with anemia. Explain the primary physiological reason the kidneys fail to support red blood cell production in this patient and identify the specific lab value that would indicate the need for pharmacological intervention.
The damaged kidneys fail to produce erythropoietin, the hormone that stimulates the bone marrow to produce RBCs. Intervention is indicated when Hgb levels drop below 10 g/dL.
What are foods that aids in the absorption of iron?
What are foods that inhibit the absorption of iron?
BONUS for which medication should not be taken with iron?
foods high in vitamin C (ASCORBIC ACID) such as citrus fruits, bell pepper, broccoli, tomatoes, berries (anything acidic helps absorption)
Dairy products inhibit absorption (alkaline substances will neutralize the environment, decreasing the effectiveness of the iron)
Antacids should not be taken, they will neutralize the env. too
Identify two long-term risks associated with chronic PPI use that the nurse should include in discharge teaching.
Increased risk of bone fractures (due to decreased calcium absorption) and C. diff infections.
What is the biggest safety concern with misoprostol?
It is a prostaglandin that stimulates uterine contractions. It is Category X and can cause unintended pregnancy loss or heavy uterine bleeding if administered to a pregnant patient.
A patient receiving Prochlorperazine for severe nausea begins to experience a shuffling gait and fine tremors. Identify the name for this group of side effects and state the nurse's immediate priority.
Extrapyramidal Symptoms (EPS). The nurse should withhold the drug and notify the provider immediately; an anticholinergic (like diphenhydramine) may be ordered to reverse the symptoms.