The nurse is reviewing the client's medical record.

Exhibits

The nurse is assisting with the care of the client prior to a blood transfusion. Which of the following actions should the nurse take? Select all that apply.

• Chronic kidney disease. The client's laboratory results show elevated BUN and creatinine levels, which are indicative of impaired kidney function. A creatinine level of 4.89 mg/dL (normal range 0.5 to 1.1 mg/dL) and BUN of 70 mg/dL (normal range 10 to 20 mg/dL) suggest a decline in kidney function, which is characteristic of chronic kidney disease (CKD). The increasing creatinine levels and the elevated BUN over time point toward worsening kidney function, which may lead to kidney failure if not managed appropriately.
• Dialysis. In the setting of advanced chronic kidney disease, particularly when kidney function deteriorates to a point where the kidneys can no longer adequately filter waste products from the blood, dialysis is often required. The increasing levels of creatinine and BUN indicate that the kidneys may be unable to function properly without intervention, potentially necessitating dialysis for proper waste management and fluid balance.

Rationale for Incorrect Options:

• Heart failure: While the client has some evidence of fluid retention (1+ bilateral lower extremity edema), this alone is insufficient to confirm heart failure, especially since the heart sounds were noted as normal (S1, S2, no murmur). Further assessment is needed to evaluate the heart's pumping ability, including echocardiogram or other diagnostic tests.
• Hypothyroidism: Although the client has dry, flaky skin and fatigue, these symptoms are not definitive for hypothyroidism. Thyroid function tests would be necessary to confirm the diagnosis.
• Anemia: Although the client has slightly low hemoglobin (13 g/dL, normal is 14 to 18 g/dL) and hematocrit, this may be due to chronic kidney disease, and it does not directly indicate anemia without further evidence, such as low iron levels or additional laboratory findings.
• Diuretic therapy: While diuretics are used in heart failure or fluid overload conditions, they are not indicated here for the management of chronic kidney disease unless there is fluid retention related to heart failure or other conditions.
• Thyroid replacement therapy: There is no evidence from the client's lab results or clinical presentation suggesting hypothyroidism, so thyroid replacement therapy would not be indicated at this time.
• Iron supplementation: While the client has a low iron saturation (24%), this alone does not warrant iron supplementation without a definitive diagnosis of iron-deficiency anemia. Further testing would be required to confirm this.

Volume = Desired Dose / Available Concentration

Desired: 0.5 mg

Available: 2 mg/mL

Calculation:

Volume = 0.5 mg / 2 mg/mL

Volume = 0.25 mL

Answer: 0.25 mL