Ferrous iron salts (e.g., ferrous sulfate, ferrous fumarate) are iron supplements given to treat and prevent iron-deficiency anemia, which can result from blood loss, malnutrition, malabsorption, or pregnancy. Manifestations of iron deficiency anemia include fatigue, pallor, and inflammation of the tongue (glossitis) and lips (cheilitis).

Ferrous sulfate teaching includes:
Take on an empty stomach and/or with orange juice to maximize absorption.
Avoid taking with calcium or with a large meal.
Common side effects include gastrointestinal upset and black stools.

Social workers and case managers assist with discharge planning and accessing needed resources for clients (e.g., prescription discounts, affordable housing, medical equipment). They have specialized knowledge and training on community programs and resources designed to assist clients. A social worker or case manager should be contacted to help identify available resources and connect the client to appropriate resources based on the client’s individual needs (e.g., financial support, transportation).

Assistive devices (e.g., canes, walkers, crutches) are important for safe ambulation and are used to assist clients who cannot bear full weight on one or both legs or have problems with balance. Crutches should be positioned 2-3 fingerbreadths below the axilla with elbows flexed 15-30 degrees. The client’s body weight is supported by the arms and hands. As a non-weight-bearing client ambulates, a three-point gait is appropriate and involves extending both crutches and the injured leg together, followed by the unaffected leg.

Epiglottitis is a croup syndrome, often caused by H. influenzae, that results in severe inflammation of the epiglottis (i.e., upper larynx). While croup is characterized by a seal-bark cough, epiglottitis is distinguished by the absence of cough. Other findings of epiglottitis include fever, drooling, agitation, muffled voice, and a swollen, red throat.  If untreated, upper airway swelling in epiglottitis can quickly progress to airway obstruction and respiratory failure. Therefore, the nurse should assess the client’s respiratory status, contact the health care provider immediately, and prepare for possible endotracheal intubation. Stimulating the gag reflex can cause the throat to close and obstruct the airway. Therefore, the nurse should avoid inspecting the throat except immediately before an emergency intubation or tracheostomy.

Hypoglycemia occurs when the blood glucose drops below the normal range, which can cause cell and tissue death. The primary cause of hypoglycemia is excessive use of supplemental insulin. Clients taking insulin are at high risk for hypoglycemia, especially if they overdose on their insulin, skip meals, or engage in unexpected physical activity. Scheduled insulin is given at set times, which can lead to hypoglycemia if clients don’t time meals properly or change their routine.

Choice B: The patient’s ECG shows an atrial regular rhythm with a ventricular rate of 20-60 beats/min. Both atrial and ventricular rhythms are regular but may appear irregular. P waves are present but not consistently connected to QRS complexes, with some hidden in them. The PR interval is inconsistent and varies randomly, and the QRS complex is normal or widened with no connection to P waves. Pulse activity is present, and the summary indicates consistent P-P and R-R intervals with no connection between P waves and QRS complexes.

This ECG pattern is indicative of third-degree atrioventricular (AV) block, also known as complete heart block, a potentially lethal rhythm in which electrical impulses from the sinoatrial (SA) node are blocked from reaching the ventricles, leading to asynchronous atrial and ventricular contractions. Complete heart block can cause life-threatening bradycardia, resulting in decreased cardiac output, severe hypotension, and hypoperfusion. With a pulse rate of 40/min, the patient is severely bradycardic, necessitating immediate notification of the healthcare provider and preparation for transcutaneous pacing with the availability of a defibrillator.

Incontinence-associated dermatitis (IAD) is moisture-related tissue injury from prolonged contact with urine or feces. Moisture causes skin maceration (softened tissue), and digestive enzymes in stool and urea in urine contribute to excoriation (loss of top skin layer), rash, and inflammation. Additionally, incontinence briefs (i.e., diapers) trap heat and sweat that can cause IAD. Identifying clients at risk for skin breakdown and initiating incontinence management decreases the risk for IAD. Cleaning with alcohol-free skin foam or wipes and applying skin barrier cream or ointment after incontinence care protect against IAD and skin infection. Barrier cream provides an occlusive barrier to prevent moisture from urine or feces from damaging the skin.

Varicella (i.e., chickenpox) is a highly contagious viral infection characterized by an intensely pruritic rash that transforms from papules to vesicles and then crusts. When lesions are scratched, they can become infected with secondary bacterial skin infections (e.g., cellulitis). Care for the client with varicella involves isolation precautions, skin care, and fever management.  Acetaminophen or ibuprofen can be used to manage fever in children. Aspirin should never be given to a child with a viral illness because it can cause a serious condition called Reye syndrome.

Coarctation of the aorta (COA) is a congenital heart defect characterized by a narrowed aorta. This narrowing causes higher blood pressure and bounding pulses in the upper extremities proximal to the aorta. Lower blood pressure and weak or absent pulses are often present in the lower extremities distal to the aorta. The nurse should assess a newborn with COA for heart failure symptoms (e.g., cyanosis). Interventions include respiratory support (e.g., mechanical ventilation) and inotropes (e.g., dopamine) to improve cardiac output.

Factors that place clients at risk for falls include impairments in mobility, balance, mental status, sensory perception, and elimination. Clients taking diuretics (e.g., bumetanide, furosemide) are at high risk for falls due to both orthostatic hypotension (dizziness on standing) and urinary frequency and urgency. For this client, the nurse should ensure the pathway to the restroom is clear or provide a bedside commode for easy access. To prevent orthostatic hypotension, the client should rise slowly and dangle at the bedside before standing.