A nurse working in an OB/GYN outpatient clinic finds that on a routine anemia screen a pregnant client in her second trimester has a hemoglobin of 10 g/dL and a serum ferritin level of 11 mg/L. The client confirms fatigue, but otherwise feels fine

Question

Which actions by the nurse are appropriate when providing care to this client?
Select all that apply.
A) Complete a further history and exam to carefully assess for any potential cause of bleeding.
B) Review a list of iron-rich foods and explore with the client how she can increase dietary iron.
C) Have the client continue her usual daily prenatal vitamin dose.
D) Stress the importance of complying with an increase in iron supplementation to 100 mg per day.
E) Ask the client to return in 2 months for a repeat check of her serum iron levels.
F) Order a screening for sickle cell anemia.

Answer 1

Answer: A, B, C, D

Iron deficiency anemia is the most common medical complication of pregnancy; thus, low hemoglobin and ferritin levels during pregnancy suggest an inadequate intake of dietary iron as the probable cause of her anemia. Although the client otherwise reports feeling well, the nurse should review her history and physical findings for any other possible causes of decreased hemoglobin levels (e.g., tendency to bruise easily, uterine bleeding, dark stools) to help ensure that another cause is not missed. Given that the client's anemia is likely from iron deficiency, the nurse needs to emphasize the importance of eating iron-rich foods and complying with the increased iron supplementation (from the 27 mg/day typical in prenatal vitamins to between 60 and 120 mg/day) rather than continuing with her usual daily prenatal vitamin dose. A screening for sickle cell anemia is not indicated given the information presented. The client should return in 1 month for a re-check of her hemoglobin levels; if improvement is not seen, then further evaluation is indicated.