A client is brought by ambulance to the ED after experiencing what the family thinks is a stroke. The nurse caring for this client is aware that which is an absolute contraindication for thrombolytic therapy?

Reasoning:

Choice A reason: Sickle cell disease is a hemolytic anemia caused by a hemoglobin mutation, not low iron. Laboratory findings show normal or elevated iron due to hemolysis, not low serum iron, transferrin saturation, or ferritin, which are specific to iron deficiency, ruling out sickle cell anemia.

Choice B reason: Pernicious anemia results from vitamin B12 deficiency, impairing DNA synthesis and red blood cell maturation. It is not associated with low serum iron, transferrin saturation, or ferritin, which reflect iron stores. Pernicious anemia typically shows megaloblastic changes, not microcytic anemia, unlike iron deficiency.

Choice C reason: Hemolytic anemia involves red blood cell destruction, often increasing iron levels due to hemoglobin breakdown. Low serum iron, transferrin saturation, and ferritin are not typical, as hemolysis does not deplete iron stores. These findings point to iron deficiency, not hemolytic processes.

Choice D reason: Iron deficiency anemia is characterized by low serum iron, transferrin saturation, and ferritin, reflecting depleted iron stores. Iron is essential for hemoglobin synthesis, and its deficiency causes microcytic, hypochromic anemia, leading to fatigue, matching the client’s laboratory findings and clinical presentation accurately.

Reasoning:

Choice A reason: Monitoring weight is essential in Cushing’s syndrome, as excess cortisol promotes fat redistribution and weight gain. Regular weight checks help assess disease progression or treatment response, as weight gain in the trunk and face is a hallmark, and changes may indicate fluid retention or metabolic shifts.

Choice B reason: Administering prescribed diuretics is appropriate in Cushing’s syndrome when fluid retention causes edema or hypertension. Diuretics reduce excess fluid volume due to cortisol’s mineralocorticoid effects, which increase sodium and water retention, helping manage symptoms like swelling and elevated blood pressure effectively.

Choice C reason: A high sodium diet is contraindicated in Cushing’s syndrome, as cortisol’s mineralocorticoid activity causes sodium retention, leading to fluid overload and hypertension. A low-sodium diet is typically recommended to mitigate these effects and reduce the risk of edema and cardiovascular complications.

Choice D reason: Reporting blood pressure above 139/89 mm Hg is critical, as Cushing’s syndrome often causes hypertension due to cortisol’s effects on sodium retention and vascular tone. Elevated blood pressure increases cardiovascular risk, and prompt reporting ensures timely intervention to prevent complications like stroke or heart failure.

Choice E reason: Examining extremities for pitting edema is important, as cortisol’s mineralocorticoid effects cause sodium and water retention, leading to edema. Regular assessment helps detect fluid overload early, guiding diuretic therapy and fluid management to prevent complications like heart failure in clients with Cushing’s syndrome.