# A nurse is preparing to administer IV iron dextran. Which preparation step most reflects safe practice given the FDA boxed warning?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391820&lang=en  
> language: en  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PPT

## Question

A nurse is preparing to administer IV iron dextran. Which preparation step most reflects safe practice given the FDA boxed warning?

## Option

1. Administer the full dose without test dose
2. Administer a small test dose first and monitor for 30-60 minutes with anaphylaxis emergency supplies (epinephrine, diphenhydramine, O2) at bedside **✔ Correct answer**
3. Push the dose over 30 seconds
4. Mix with KCl in the same line

**Correct answer: 2**

## Explanation

Correct (2): Iron dextran carries an FDA boxed warning for anaphylaxis. A test dose is required, with 30-60 min monitoring and anaphylaxis kit at bedside. Newer formulations (iron sucrose, ferric carboxymaltose, ferumoxytol) have lower risk but still need monitoring. (1,3,4) Dangerous.

## In-depth explanation

Memory Tip Iron dextran IV = "Dextran-Danger" — test dose mandatory. Lower-risk: iron sucrose, ferric carboxymaltose. Always have epi at bedside.

## Clinical scenario

Scenario 52-year-old female with severe IDA refractory to oral iron; ordered iron dextran IV. Pre-infusion preparation.

## Key concepts

- **IV iron** — Used when PO iron fails or absorption impaired (e.g., CKD, IBD, GI surgery).
- **Iron dextran anaphylaxis** — FDA boxed warning; test dose + 30-60 min observation required.
- **Newer IV iron formulations** — Iron sucrose, ferric carboxymaltose, ferumoxytol; lower anaphylaxis risk than iron dextran.

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