A healthy 70-year-old patient has low hemoglobin levels and no signs of gastrointestinal bleeding.
The nurse recognizes which item is an effect of aging that could be the reason for the low hemoglobin level?

Choice A rationale:

Enteric-coated iron is designed to be absorbed in the small intestine, not the stomach. Taking it with each meal might decrease its absorption due to interaction with food.

Choice B rationale:

Cobalamin (vitamin B12) deficiency can cause macrocytic anemia, not microcytic hypochromic anemia. Taking cobalamin with green, leafy vegetables does not address the specific iron deficiency seen in microcytic hypochromic anemia.

Choice C rationale:

Take the iron with orange juice 1 hour before meals is the correct answer. Vitamin C enhances the absorption of non-heme iron (the type of iron found in plant-based foods and iron supplements) by reducing it to a more absorbable form. Taking iron supplements with orange juice, which is high in vitamin C, can significantly improve iron absorption. Taking it before meals ensures better absorption due to reduced interaction with other dietary components.

Choice D rationale:

Decreasing the intake of antiseizure medications will not improve microcytic hypochromic anemia. Antiseizure medications do not directly influence iron absorption or the production of red blood cells.

Choice A rationale:

Purpura refers to purple or red discolorations on the skin caused by bleeding underneath the skin. It is larger than petechiae and ecchymosis and could be a sign of a more serious underlying condition. Petechiae are small, red or purple dots that appear on the skin due to minor bleeding from broken capillaries. In the context of leukemia and thrombocytopenia (low platelet count), petechiae are common due to impaired clotting mechanisms.

Choice B rationale:

Bruising occurs due to damage to blood vessels underneath the skin, resulting in the leakage of blood into the surrounding tissues. Bruises are typically larger than petechiae and can occur with various conditions, including trauma. In this case, the small 1-mm red macules are more indicative of petechiae.

Choice D rationale:

Ecchymosis refers to a larger area of subcutaneous bleeding or bruising. It is larger than both petechiae and purpura and often results from more significant trauma or bleeding disorders. The description of multiple 1-mm red macules is characteristic of petechiae rather than ecchymosis.