A nurse is providing teaching to a client who was prescribed ferrous sulfate for iron deficiency anemia Which of the following instructions should the nurse include? (Select all that apply)

Introduction: Ferrous sulfate is a critical mineral supplement used to replenish iron stores required for the synthesis of hemoglobin in patients with microcytic anemia. Because its bioavailability is highly sensitive to the gastric environment, nurses must provide comprehensive education regarding dietary interactions and the management of expected gastrointestinal alterations to ensure therapeutic compliance. A. Ferrous iron is significantly more soluble and better absorbed in the presence of an acidic gastric pH. Consuming ascorbic acid, such as that found in orange juice, facilitates the chemical reduction of iron into its more absorbable form within the duodenum, thereby maximizing the therapeutic efficacy of each dose administered to the patient. B. Dietary calcium found in milk and dairy products acts as a potent inhibitor of iron absorption by competing for the same transport mechanisms in the intestinal mucosa. Patients should be instructed to separate the ingestion of iron supplements from dairy products by at least 2 hours to prevent the formation of unabsorbable complexes. C. Iron supplements are notorious for causing significant constipation due to the irritation of the intestinal lining and the presence of unabsorbed mineral content in the lumen. To mitigate this common adverse effect, nurses often recommend increasing dietary fiber and fluid intake or the prophylactic use of a surfactant stool softener. D. Oxidation of unabsorbed iron within the large intestine typically results in stools that are dark green or black in color. This is a benign and expected side effect of ferrous sulfate therapy; however, patients must be informed of this change to prevent them from mistaking the discoloration for gastrointestinal hemorrhage. E. Antacids increase the pH of the stomach by neutralizing gastric acid, which creates an alkaline environment that impairs the dissolution and absorption of ferrous sulfate. While iron can cause nausea, taking it concurrently with an antacid will fail to treat the anemia effectively; these medications must be timed several hours apart.