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The nurse is reviewing laboratory values for a female patient and notes a hemoglobin level of 8.2 g/100 mL (12-16) and a hematocrit level of 21% (37% -47%). These levels are found in patients with which condition?

A.

Thyroid disease

B.

Anemia

C.

Acute bronchitis

D.

Hemochromatosis

Answer and Explanation

The Correct Answer is B

A. Thyroid disease: While some thyroid diseases may indirectly contribute to anemia, thyroid disease itself does not directly cause low hemoglobin and hematocrit.

 

B. Anemia: Low hemoglobin and hematocrit levels indicate anemia, which can be caused by various factors, including blood loss, iron deficiency, or chronic disease.

 

C. Acute bronchitis: Acute bronchitis typically affects respiratory function and does not directly cause a decrease in hemoglobin or hematocrit.

 

D. Hemochromatosis: Hemochromatosis is characterized by excess iron in the body, often resulting in elevated rather than decreased hemoglobin and hematocrit.


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Correct Answer is C

Explanation

A. Contact the surgeon to obtain orders for a nebulizer treatment from respiratory therapy. A nebulizer is typically not the initial intervention for mild post-operative pain or mild respiratory discomfort due to pain with inspiration.

B. Provide the patient with a heating pad alternated with a cold pack for incisional pain. While heat or cold therapy can help with pain, opioid pain management with encouragement to perform deep breathing exercises is more effective for post-splenectomy patients.

C. Medicate with opioids for pain and assist the patient to deep breathe, cough, and ambulate. Pain management combined with encouraging deep breathing, coughing, and early ambulation helps prevent post-operative complications like atelectasis and pneumonia, which are common after abdominal surgeries.

D. Contact the surgeon to request a chest x-ray and a laboratory draw for CBC with differential. This intervention might be necessary if there were signs of infection or other complications, but mild pain with inspiration on the first day post-op does not typically warrant imaging or labs.

Correct Answer is D

Explanation

A. Pulmonary congestion: Pulmonary congestion is associated more with fluid overload or transfusion-associated circulatory overload (TACO), not an acute hemolytic reaction.

B. Urticaria: Urticaria (hives) is more typical of a mild allergic reaction rather than an acute hemolytic reaction.

C. Vomiting: Although nausea and vomiting may occur in various transfusion reactions, it is not specific to an acute hemolytic reaction like low back pain is.

D. Low back pain: Low back pain, often around the kidneys, is a classic sign of an acute hemolytic reaction due to the breakdown of RBCs and the release of hemoglobin into the bloodstream, which can lead to renal damage. This reaction is a medical emergency requiring immediate intervention.

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