Which client is most likely to require a folic acid supplement to treat anemia?
1. A client who has a forearm arterial-venous shunt and is scheduled for dialysis three times weekly
2. A client who has a history of chronic heart failure with multiple exacerbations
3. A client who has a history of chronic heavy alcohol intake
4. A client who has a history of type 2 diabetes mellitus
Correct Answer: 3
Rationale 1: Folic acid is not primary therapy in the management of kidney-failure anemia, which responds better to epoetin alfa.
Rationale 2: Folic acid is not useful in the management of chronic heart failure. However, folic acid might be ordered for another reason related to its effects on long-term vascular health.
Rationale 3: Folic acid–related anemia is usually associated with poor nutrition. Ethanol interferes with folate metabolism in the liver, and the alcoholic's diet is often low in the nutrient.
Rationale 4: Folic acid is not useful in the management of type 2 diabetes.
Global Rationale: Folic acid–related anemia is usually associated with poor nutrition. Ethanol interferes with folate metabolism in the liver, and the alcoholic's diet is often low in the nutrient. Folic acid is not primary therapy in the management of kidney-failure anemia, which responds better to epoetin alfa. Folic acid is not useful in the management of chronic heart failure. However, folic acid might be ordered for another reason related to its effects on long-term vascular health. Folic acid is not useful in the management of type 2 diabetes.
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