# A nurse teaches a client newly prescribed ferrous sulfate 325 mg PO daily for iron deficiency anemia. Which set of instructions is most appropriate?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391819&lang=en  
> language: en  
> subject: Medical Emergencies  
> category: PA

## Question

A nurse teaches a client newly prescribed ferrous sulfate 325 mg PO daily for iron deficiency anemia. Which set of instructions is most appropriate?

## Option

1. Take on an empty stomach or with vitamin C (orange juice); expect dark stools; separate by ≥2 hours from calcium, antacids, and tetracyclines **✔ Correct answer**
2. Take with high-fiber bran cereal
3. Mix with antacid for better absorption
4. Take with milk to soothe the stomach

**Correct answer: 1**

## Explanation

Correct (2): Iron absorption is best on an empty stomach with vitamin C (enhances ferrous form). Dark/black stools are expected and harmless. Separate from calcium, dairy, antacids, tetracyclines, fluoroquinolones, levothyroxine by ≥2 hours. (1,3,4) Reduce absorption.

## In-depth explanation

Memory Tip Iron = "Empty + Vit C + dark stool". Liquid iron stains teeth → use straw. Constipation common — add fiber/water.

## Clinical scenario

Scenario 28-year-old female with iron deficiency anemia starting ferrous sulfate 325 mg PO daily. Outpatient teaching.

## Key concepts

- **Ferrous sulfate** — PO iron salt; vitamin C enhances absorption.
- **Iron-drug binding** — Calcium, antacids, tetracyclines, levothyroxine reduce absorption.
- **Iron supplementation** — Treat IDA; expect reticulocyte rise in 1 week, Hgb increase in 2-4 weeks; continue 3-6 months after Hgb normalizes.

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