The nurse is providing education to a client prescribed an oral iron supplement for anemia. Which statement should the nurse include (Select all that apply)

Introduction: Iron supplements, such as ferrous sulfate, are essential for the production of hemoglobin in patients with iron-deficiency anemia. However, their bioavailability is highly dependent on the gastric pH, and they frequently cause significant gastrointestinal distress and alterations in bowel elimination patterns that require proactive nursing education. A. Iron is best absorbed in an acidic environment. Ascorbic acid, found in high concentrations in orange juice, enhances the absorption of non-heme iron by facilitating its conversion to the more soluble ferrous form. Instructing the patient to take iron with vitamin C optimizes the therapeutic efficacy of the supplement. B. Milk and other dairy products contain high levels of calcium and phosphorus, which bind to iron and form insoluble complexes. This significantly inhibits the absorption of the iron supplement in the duodenum. Patients should be advised to avoid consuming dairy products within 2 hours of taking their iron dose. C. Constipation is a very common and bothersome side effect of oral iron therapy. The iron that remains unabsorbed in the intestinal lumen can lead to hardened stools and decreased peristaltic activity. Increasing fluid intake, dietary fiber, or utilizing a stool softener can help the patient maintain regular bowel movements. D. It is important to warn patients that iron supplements will cause stools to turn a dark green or black color. This is a harmless and expected pharmacological effect caused by the oxidation of unabsorbed iron. Providing this information prevents unnecessary anxiety or confusion with melena related to gastrointestinal bleeding. E. Antacids increase the pH of the stomach by neutralizing gastric acid. Since iron requires an acidic environment for optimal absorption, taking an antacid at the same time as an iron supplement will significantly reduce the drug's bioavailability. These medications should be spaced apart by at least 2 hours. Question 45