Author Question: A nurse is caring for a patient after hip replacement surgery. The patient has been receiving iron ... (Read 24 times)

NClaborn · **on:** Jul 23, 2018

A nurse is caring for a patient after hip replacement surgery. The patient has been receiving iron replacement therapy for 2 days. The nurse notes that the patient's stools appear black.

The patient is pale and complains of feeling tired. The patient's heart rate is 98 beats per minute, respirations are 20 breaths per minute, and the blood pressure is 100/50 mm Hg. The nurse will contact the provider to:
a. report possible gastrointestinal hemorrhage.
b. request a hemoglobin and hematocrit (H&H).
c. request an order for a stool guaiac.
d. suggest giving a hypertonic fluid bolus.

Question 2

A patient is diagnosed with moderate vitamin B12 deficiency. The nurse reviews the laboratory work and notes that the plasma B12 is low; also, a Schilling test reveals B12 malabsorption.

The provider orders oral cyanocobalamin 500 mcg per day. The nurse will contact the provider to:
a. discuss IM dosing.
b. request an order for folic acid.
c. suggest an increased dose.
d. suggest platelet transfusion therapy.

FergA · **Reply #1 on:** Jul 23, 2018

Answer to Question 1

ANS: B
This patient is showing signs of iron deficiency anemia, as manifested by tachycardia and pallor. Because this patient's blood pressure is low, the anemia probably has occurred secondary to blood loss, a common occurrence with hip replacement surgery. The first response should be to obtain an H&H to assess the anemia. GI hemorrhage is not a concern in this patient; black stools are an expected effect of oral iron administration. A stool guaiac is not indicated. If the patient has blood loss that is causing hypotension, an isotonic fluid bolus and packed red blood cells (PRBCs) are indicated to treat this.

Answer to Question 2

ANS: C
Patients with vitamin B12 deficiency associated with B12 malabsorption need increased doses of oral cyanocobalamin of 1000 to 10,000 mcg/day. It is not necessary to give this drug intramuscularly. Folic acid is indicated when B12 deficiency is severe. Platelets are given when B12 deficiency is severe.