Ferrous sulfate is prescribed for a client. She returns to the clinic in two weeks. Which assessment by the nurse indicates that she has NOT been taking iron as ordered?

1. A

   The client's cheeks are flushed

2. B

   The client reports having more energy

3. C

   The client complains of nausea

4. D

   The client's stools are light brown

Appeared in: HP CHO -9 October 2022

Explanation

• A hallmark side effect of oral iron supplementation is the change in stool color to a dark green or black.
• This color change is harmless and occurs because unabsorbed iron is excreted in the feces.
• Therefore, if a client's stools remain a normal light brown color, it is a strong indicator that they have not been taking the ferrous sulfate as prescribed.

Why Other Options Were Wrong

• Option A: Flushed cheeks are not a recognized side effect or therapeutic outcome of ferrous sulfate therapy. This finding is unrelated to medication adherence.
• Option B: Reporting more energy is a sign of a positive therapeutic response to iron therapy. It indicates that the anemia is improving and the client is likely adhering to the medication.
• Option C: Nausea is one of the most common gastrointestinal side effects of oral iron supplements. Its presence suggests that the client is taking the medication.

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to Assessment of adherence to oral iron (ferrous sulfate) therapy to guide bedside assessment, documentation, and the next nursing action.
• Patient education is a key nursing responsibility to promote adherence. Nurses must inform clients about expected side effects like dark stools and nausea, and strategies to manage them (e.g., taking with food).
• Assessing for both therapeutic effects (increased energy) and side effects (nausea, stool color) provides a comprehensive picture of the client's response and adherence to therapy.
• What if? If the client reported black, tarry stools along with significant abdominal pain, dizziness, or coffee-ground emesis, the nurse should not assume it's just from the iron. These are signs of a potential gastrointestinal bleed (melena), which is a medical emergency requiring immediate investigation.

How to Approach the Question

• First, identify that the question is asking for a sign of NON-adherence. This is a negative-framing question.
• Next, recall the common effects of ferrous sulfate. This includes therapeutic effects (resolving anemia symptoms) and side effects (GI upset, stool color change).
• Evaluate each option: 'More energy' is a therapeutic effect, and 'nausea' is a common side effect. Both suggest the client IS taking the medication. 'Flushed cheeks' is unrelated.
• Consider the effect on stool. Oral iron is known to turn stools dark green or black due to excretion of unabsorbed iron.
• Conclude that the ABSENCE of this expected side effect (i.e., having normal, light brown stools) is the most reliable indicator that the client is not ingesting the medication.

Concept Tested & Keywords

• Concept Tested: Assessment of adherence to oral iron (ferrous sulfate) therapy.
• Stem keywords: Ferrous sulfate, assessment, two weeks, NOT been taking
• Lead-in keywords: indicates, NOT
• Negative lead-in flag: The question asks for a negative finding (an indicator of non-adherence).

Question ID

Q-OlysnndwYKJb0fQCHysl

Copy ID

Reference Book

E6 Pharmacology Nursing Lilley 11e Part 3 pp. 222-224, 218-220, 223-225