# Situation: A 34-year-old woman is brought to the emergency room (ER) because she nearly fainted at work. She reports fatigue, shortness of breath on climbing stairs, and heavy menstrual periods for the past year. Her heart rate is 118/min and blood pressure 104/66 mmHg. She has no chronic illness and no known drug allergies. At discharge she is prescribed ferrous sulfate once daily. She says she stopped a previous iron tablet because taking it before breakfast made her nauseated. She drinks a glass of milk with breakfast at 07:00 and takes an antacid for heartburn at 22:00. When should the nurse advise her to take the tablet?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=629695  
> language: ko  
> subject: Nursing Practice III — Care of Clients with Problems in Surgery, Oxygenation, Fluid and Electrolytes, Infectious, Inflammatory and Immunologic Response, Cellular Aberrations

## 문제

Situation: A 34-year-old woman is brought to the emergency room (ER) because she nearly fainted at work. She reports fatigue, shortness of breath on climbing stairs, and heavy menstrual periods for the past year. Her heart rate is 118/min and blood pressure 104/66 mmHg. She has no chronic illness and no known drug allergies.

At discharge she is prescribed ferrous sulfate once daily. She says she stopped a previous iron tablet because taking it before breakfast made her nauseated. She drinks a glass of milk with breakfast at 07:00 and takes an antacid for heartburn at 22:00. When should the nurse advise her to take the tablet?

## 보기

1. With her breakfast and glass of milk at 07:00
2. At bedtime at 22:00, together with her antacid
3. One hour before breakfast, at 06:00, with water
4. With orange juice right after lunch at 12:00 **✔ 정답**

**정답: 4**

## 해설

Iron is best absorbed on an empty stomach with vitamin C, but when it causes stomach upset it can be taken with or right after food; lower absorption is better than stopping the drug. It must also be separated by about 2 hours from milk, calcium, and antacids. A lunchtime dose with orange juice meets all of these rules.

## 심화 해설

The best time for her iron tablet
Iron is best absorbed on an empty stomach and with vitamin C. However, this client stopped her previous iron tablet because taking it before breakfast made her nauseated. When iron causes stomach upset, it can be taken with or right after food; a little less absorption is far better than not taking the drug at all. It must also be separated by about 2 hours from milk, calcium, and antacids, which reduce absorption. Taking it with orange juice right after lunch at 12:00 meets all of these rules.

Applying the rules to her day

| Option | Problem or benefit |
| --- | --- |
| With breakfast and milk at 07:00 | Milk and calcium reduce iron absorption |
| At bedtime at 22:00 with the antacid | Antacids reduce iron absorption |
| One hour before breakfast at 06:00 with water | Ideal for absorption, but it caused the nausea that made her stop |
| With orange juice right after lunch at 12:00 | Limits nausea, vitamin C aids absorption, well apart from milk and antacid |

Why adherence comes first
Watch out! The before-breakfast option follows the textbook rule for maximum absorption, which makes it tempting. But the question tells you this regimen already failed because of nausea. Iron therapy for iron deficiency anemia needs months of daily doses to correct the hemoglobin and refill iron stores, so a regimen she can actually continue is the priority. Her heavy menstrual bleeding over the past year, tachycardia, and near-fainting show significant anemia that needs consistent treatment.

Other teaching points
The nurse tells her that iron turns stools dark or black, which is expected. Constipation is common, so she should increase fluids and fiber. Tea and coffee taken at the same time also reduce absorption. Liquid iron preparations can stain the teeth and should be taken through a straw. She should keep iron out of reach of children, because iron overdose is dangerous in young children. She is also advised to return for follow-up of her hemoglobin and evaluation of her heavy periods, since treating the cause of blood loss is essential.

Exam takeaway
Take iron with vitamin C, away from milk, calcium, and antacids; if it causes stomach upset, take it with or after food rather than stopping it. Key point! When a stem tells you a past regimen failed, choose the option that solves that problem while keeping the other rules.

## 임상 시나리오

Timing Oral Iron for AdherenceFerrous sulfate after nausea on an empty stomach
Iron is absorbed best on an empty stomach with vitamin C, but if it causes nausea it may be taken with or right after food.

Separate iron by about 2 hours from milk, calcium, and antacids. Tea and coffee also reduce absorption.

Teach that stools turn dark, manage constipation with fluids and fiber, and keep iron away from children.

CautionDo not insist on an empty-stomach regimen that has already caused her to stop the drug.

## 핵심 개념

- **Ferrous sulfate** — An oral iron salt used to treat and prevent iron deficiency anemia.
- **Iron deficiency anemia** — Anemia from inadequate iron, often caused by chronic blood loss such as heavy periods.
- **Vitamin C** — Ascorbic acid, which increases absorption of nonheme iron when taken together.
- **Menorrhagia** — Heavy or prolonged menstrual bleeding, a common cause of iron deficiency in women.

## 같은 주제 문제

- [Situation: A 24-year-old woman with asthma is brought to the emergency room (ER) with whee…](https://mymerci.kr/pages/nclex_q.php?qn_id=629676)
- [Situation: A 24-year-old woman with asthma is brought to the emergency room (ER) with whee…](https://mymerci.kr/pages/nclex_q.php?qn_id=629677)
- [Situation: A 24-year-old woman with asthma is brought to the emergency room (ER) with whee…](https://mymerci.kr/pages/nclex_q.php?qn_id=629678)
- [Situation: A 24-year-old woman with asthma is brought to the emergency room (ER) with whee…](https://mymerci.kr/pages/nclex_q.php?qn_id=629679)
- [Situation: A 36-year-old woman comes to the Rural Health Unit (RHU), which provides free t…](https://mymerci.kr/pages/nclex_q.php?qn_id=629680)
- [Situation: A 36-year-old woman comes to the Rural Health Unit (RHU), which provides free t…](https://mymerci.kr/pages/nclex_q.php?qn_id=629681)
- [Situation: A 36-year-old woman comes to the Rural Health Unit (RHU), which provides free t…](https://mymerci.kr/pages/nclex_q.php?qn_id=629682)
- [Situation: A 22-year-old tall, thin man who smokes is admitted to the surgical ward with a…](https://mymerci.kr/pages/nclex_q.php?qn_id=629683)

---

More free questions: [기출문제](https://mymerci.kr/)

_학습 참고용입니다. 실제 임상은 최신 지침과 소속 기관 프로토콜을 따르세요._