A nurse is caring for a client who received chemotherapy the day before. Which of the following items requires the nurse to implement special handling precautions?

• Administer an iron supplement: The client has lab findings and symptoms consistent with iron deficiency anemia, including low hemoglobin (8 g/dL), low hematocrit (24%), and low ferritin (8 ng/mL). An iron supplement is essential to correct the deficiency and restore adequate oxygen-carrying capacity in the blood.
• Restrict fluid intake: There is no evidence of fluid overload, hyponatremia, or heart failure in this client. Fluid restriction may worsen orthostatic hypotension by reducing circulating volume and is inappropriate in anemia and tachycardia.
• Place the client on a low sodium diet: The client’s blood pressure is within normal limits and there are no signs of hypertension or fluid retention. A low sodium diet may be beneficial in some chronic diseases, but it is not relevant or essential to this client’s current issues.
• Refer for a nutritional consult: The client follows a vegan diet and has both iron and borderline low vitamin B12 levels. A referral to a nutritionist will help ensure they are educated on how to meet their micronutrient needs, including iron and B12, through appropriate dietary sources and supplementation.

Rationale for correct choices:

• Infection: Clients with HIV are immunocompromised and already at increased risk for infections. A declining WBC count, especially falling below the normal range (4,100/mm³ from 4,500/mm³), indicates worsening immunosuppression, further elevating the infection risk.
• WBC count: White blood cells are crucial for immune defense. In HIV clients, a low or decreasing WBC count suggests progressing immunodeficiency, making the body less able to fight infections, especially opportunistic ones.

Rationale for incorrect choices:

• Dysrhythmias: The client's potassium level is 3.8 mEq/L, well within normal limits (3.5–5 mEq/L). There is no electrolyte imbalance that would predispose the client to cardiac rhythm disturbances.
• Renal failure: BUN is slightly elevated from 16 to 18 mg/dL, but still within the normal range (10–20 mg/dL). This mild change is not enough to suggest renal dysfunction or failure.
• Bleeding: Platelet count is stable and within normal limits at 162,000/mm³. Thrombocytopenia becomes more concerning at values below 150,000, so there is no immediate bleeding risk.
• Seizures: The sodium level is 139 mEq/L, which is within the normal range. There are no abnormal electrolyte findings or neurological symptoms to indicate seizure risk.