A nurse is caring for a client with iron deficiency anemia. Which nursing intervention should be the priority when administering oral iron supplements?

Priority Intervention: Administer oral iron supplements with a source of vitamin C (e.g., orange juice, ascorbic acid supplement) to maximize absorption. Vitamin C reduces ferric iron (Fe³⁺) to the more soluble ferrous form (Fe²⁺) and chelates it, maintaining solubility in the proximal intestine.

• Absorption Enhancers: Give iron with 4-8 oz of orange juice or a 200-500 mg vitamin C tablet. Avoid giving with meals if tolerated, as food components (phytates, tannins, calcium) can inhibit absorption.
• GI Side Effect Management: Common side effects include nausea, epigastric pain, constipation, and diarrhea. If GI distress is severe, administer with a small amount of food (excluding dairy, high-fiber cereals, tea, or coffee). Do not switch to milk or antacids to manage upset, as these inhibit absorption.
• Timing & Interactions: Space iron doses at least 1-2 hours apart from antacids, calcium supplements, tetracyclines, or fluoroquinolones. Liquid iron preparations can stain teeth; instruct the patient to use a straw and rinse the mouth afterward.
• Monitoring: Monitor for dark green or black stools (a benign effect of unabsorbed iron) and differentiate from melena. Assess for therapeutic response: reticulocytosis in 3-7 days, hemoglobin rise in 2-4 weeks, and replenished iron stores in 3-6 months.
• Safety: Warn patients that iron is a leading cause of fatal pediatric poisoning. Store supplements out of reach of children and use child-resistant caps.