A client comes to the clinic reporting fatigue. Laboratory findings reveal a low serum iron level, a low transferrin saturation, and a low ferritin level. Which type of anemia does the nurse suspect that correlates with these laboratory findings?

Reasoning:

Choice A reason: Addison’s disease, due to adrenal insufficiency, reduces aldosterone and cortisol production, leading to sodium loss (hyponatremia) and potassium retention (hyperkalemia). These electrolyte abnormalities result from impaired renal sodium reabsorption and potassium excretion, making sodium and potassium monitoring critical for managing complications like hypotension and arrhythmias.

Choice B reason: Calcium and phosphorus abnormalities are not primary concerns in Addison’s disease. These electrolytes are more affected by parathyroid or renal disorders. Addison’s disease primarily disrupts sodium and potassium balance due to aldosterone deficiency, with calcium and phosphorus typically remaining within normal ranges unless other conditions coexist.

Choice C reason: Sodium abnormalities occur in Addison’s disease due to aldosterone deficiency, causing hyponatremia. However, chloride levels are not significantly altered, as chloride follows sodium passively. Potassium imbalances (hyperkalemia) are more critical alongside sodium, making this combination less comprehensive than sodium and potassium monitoring.

Choice D reason: Chloride and magnesium abnormalities are not hallmark features of Addison’s disease. While mild chloride changes may occur with sodium loss, magnesium is typically unaffected. The primary electrolyte disturbances involve sodium (hyponatremia) and potassium (hyperkalemia), making these the focus of monitoring in adrenal insufficiency.

Reasoning:

Choice A reason: Recent blood donation is not a primary cause of secondary polycythemia, which results from chronic hypoxia or erythropoietin excess, not blood loss. Donation may temporarily reduce red blood cell count, but it does not drive the increased erythropoiesis seen in secondary polycythemia, making it less relevant.

Choice B reason: A history of venous thromboembolism is a consequence, not a cause, of secondary polycythemia. Increased red blood cell mass elevates blood viscosity, raising clotting risk, but thromboembolism does not trigger polycythemia. The nurse should assess for underlying causes like hypoxia, not its complications.

Choice C reason: Evidence of lung disease is critical to assess, as secondary polycythemia is often caused by chronic hypoxia from conditions like chronic obstructive pulmonary disease. Low oxygen levels stimulate erythropoietin production, increasing red blood cell mass to enhance oxygen delivery, making lung disease a primary factor to evaluate.

Choice D reason: Impaired renal function is not a primary cause of secondary polycythemia. While kidneys produce erythropoietin, renal disease typically causes anemia due to reduced erythropoietin. Rarely, renal tumors may increase erythropoietin, but lung disease is a more common driver of secondary polycythemia in clinical practice.