A client reports feeling tired, cold, and short of breath at times. Assessment reveals tachycardia and reduced energy. What would the nurse expect the health care provider to order?

Reasoning:

Choice A reason: Elimination of iron by the body is not a typical cause of anemia in older adults. Iron is tightly regulated, and excessive loss occurs through bleeding, not spontaneous elimination. Anemia in the elderly is more commonly due to chronic blood loss or impaired absorption, not iron excretion.

Choice B reason: Excessive coffee or tea consumption can inhibit iron absorption due to tannins binding dietary iron, but it is not a primary cause of anemia in older adults. Blood loss or chronic disease are more common culprits, making dietary inhibition a less likely contributor in this population.

Choice C reason: Blood loss from the gastrointestinal or genitourinary tract is a common cause of anemia in older adults. Chronic bleeding from ulcers, colon cancer, or urinary tract issues depletes iron stores, leading to iron deficiency anemia, a frequent finding in the elderly due to higher prevalence of these conditions.

Choice D reason: A decrease in total body iron stores with age is not a primary cause of anemia. While absorption may decline slightly, blood loss from gastrointestinal or genitourinary sources is a more significant contributor in older adults, as it directly reduces iron available for hemoglobin synthesis.

Reasoning:

Choice A reason: Oral temperature monitoring is important for detecting infection post-surgery but is not the primary concern in transsphenoidal hypophysectomy. Cushing’s syndrome causes hyperglycemia due to cortisol-induced insulin resistance, and surgical stress may exacerbate this, making glucose monitoring more critical than temperature in the perioperative period.

Choice B reason: Weight monitoring is relevant for long-term Cushing’s syndrome management due to fat redistribution, but it is not the most critical during surgery. Perioperative stress and fluid shifts have minimal immediate impact on weight, whereas glucose fluctuations from cortisol changes are more acute and require close monitoring.

Choice C reason: Assessing urine for blood is not a priority in transsphenoidal hypophysectomy. This surgery involves the pituitary gland, not the urinary tract, so hematuria is unlikely. Blood glucose fluctuations, driven by cortisol changes and surgical stress, are a more immediate concern requiring vigilant monitoring.

Choice D reason: Blood glucose monitoring is critical before, during, and after transsphenoidal hypophysectomy. Cushing’s syndrome causes hyperglycemia due to cortisol-induced insulin resistance. Surgery may alter cortisol levels, exacerbating glucose fluctuations, and postoperative adrenal insufficiency risk necessitates close glucose monitoring to manage metabolic complications effectively.