Question

a 62 - year old man with chronic anemia is experiencing increased fatigue and occasional palpitations at rest. the nurse would expect the client’s laboratory findings to include?
a. hematocrit (hct) of 45%.
b. rbc count of 4.5 x1012/l
c. wbc 6,000/mm3
d. hemoglobin (hgb) of 8.6 g/dl
the nurse is taking care of a client whose blood work comes back as the following:
which of the following orders would the nurse anticipate? select all that apply.
a. apply oxygen as needed for supplementation
b. infuse 1 unit packed rbcs over 3 hours
c. vital signs q4h
d. ambulate in hall tid
e. occult stool sample

Explanation:

• First question:
• Normal hematocrit (Hct) for men is about 40 - 54%. A Hct of 45% (Option A) is normal, so it's not indicative of anemia.
• Normal RBC count for men is \(4.7 - 6.1\times10^{12}/L\). A count of \(4.5\times 10^{12}/L\) (Option B) is slightly low but not extremely so for a chronic anemia case with symptoms like fatigue and palpitations.
• Normal WBC count is \(4000 - 11000/mm^{3}\). A WBC of \(6000/mm^{3}\) (Option C) is normal and not related to anemia.
• Normal hemoglobin (Hgb) for men is \(13.5 - 17.5g/dL\). A Hgb of \(8.6g/dL\) (Option D) is low and consistent with anemia, which causes symptoms like fatigue (due to reduced oxygen - carrying capacity) and palpitations (as the heart compensates for low oxygen by pumping harder).
• Second question:
• Option A: With low hemoglobin (\(6g/dL\)), the client has reduced oxygen - carrying capacity. Applying oxygen as needed for supplementation is appropriate as it helps increase the amount of oxygen available for tissues.
• Option B: A hemoglobin of \(6g/dL\) is a common threshold for considering a blood transfusion (infusing packed RBCs). Transfusion can quickly increase the oxygen - carrying capacity of the blood.
• Option C: Monitoring vital signs (Q4H - every 4 hours) is a standard nursing practice to assess the client's overall condition, especially as the heart may be compensating for low oxygen (related to low hemoglobin) and vital signs can change.
• Option D: With a very low hemoglobin (\(6g/dL\)), ambulating in the hall TID (three times a day) would increase the oxygen demand of the body. The client is already in a state where oxygen delivery is compromised, so this is not an appropriate order.
• Option E: An occult stool sample can help check for gastrointestinal bleeding (a possible cause of anemia).

Answer:

• First question: D. Hemoglobin (Hgb) of \(8.6g/dL\)
• Second question: A. Apply oxygen as needed for supplementation, B. Infuse 1 unit packed RBCs over 3 hours, C. Vital signs Q4H, E. Occult stool sample