Eric is admitted for acute confusion and has a history of alcohol abuse. Lactulose is listed on the patient’s MAR. However, Eric is having regular bowel movements. As a nurse, you ask yourself, “Why is lactulose ordered for this patient?”
How would you address this concern?
What will you assess for? Explain your answer.
Scenario #2
An 11-month-old who drinks 8-ounce bottles of whole 5 – 6 times a day, is diagnosed with iron-deficiency anemia.
What are the contributing factors to iron-deficiency anemia? Discuss the measures to change these factors.
What should the nurse teach the parents about ferrous sulfate therapy? Be specific.
Scenario #3
Mary is diagnosed with leukemia. She will be starting doxorubicin for chemotherapy.
What is the mechanism of action of this medication?
Discuss the adverse effects.
What will the nurse monitor during Mary’s chemotherapy regimen?
Scenario #4
Ronald has become more anemic because of a lack of erythrocyte production. He is prescribed epoetin alfa to maintain his erythrocyte count. the provider ordered baseline laboratory tests. the patient is tired of “being jabbed” and asks the nurse why these tests have to be done.
Describe the rationale for each laboratory test in a way the patient can understand.
BUN/creatinine
Hemoglobin
Hematocrit
Ferritin
What adverse effects should the nurse assess in this patient?
The nurse is reviewing the laboratory results for this patient? Hemoglobin is 13.5 g/dL. What should the nurse do?
Scenario #5
Lynn takes sucralfate for gastric ulcers. She states that she takes her medication with food; however, she still experiences severe abdominal pain after her meals.
What is causing her abdominal pain?
How could this issue be resolved?
This multi-scenario pharmacology assignment covers lactulose for a confused patient with alcohol history (hepatic encephalopathy), iron-deficiency anemia in an infant on excessive whole milk, and more. Reason through each scenario’s rationale, assessment, and teaching.
Key takeaways
- Lactulose treats hepatic encephalopathy by trapping/removing ammonia — not just constipation.
- Assess mental status and ammonia; titrate lactulose to 2–3 soft stools/day.
- Infant anemia: excessive whole-milk intake displaces iron-rich foods and can cause GI blood loss.
- Teach parents on ferrous sulfate administration.
- Answer each scenario’s specific questions.
Scenario 1: Lactulose
Explain that lactulose is ordered for hepatic encephalopathy (likely from alcohol-related liver disease causing the acute confusion), not simply for constipation. It works by acidifying the gut to convert ammonia to ammonium, which is excreted — lowering the blood ammonia that impairs cognition. Assess mental status/LOC, ammonia levels, and titrate the dose to produce 2–3 soft stools daily. Address the concern by clarifying the therapeutic goal.
Scenario 2: Infant iron-deficiency anemia
Explain the contributing factors: drinking large volumes of whole milk (5–6 eight-ounce bottles) displaces iron-rich foods, whole milk is low in iron and can cause occult GI blood loss, and calcium inhibits iron absorption. Measures: reduce milk intake, introduce iron-rich foods, and start iron. Teach parents on ferrous sulfate — give with vitamin C (juice) to aid absorption, not with milk, use a dropper past the teeth (stains), expect dark stools, and keep it safely stored (overdose risk).
Remaining scenarios
Apply the same approach to the other scenarios — rationale, assessment, and teaching for each.
Format
Answer each scenario’s questions specifically and cite pharmacology sources.
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