A nurse is caring for a young female adult client who reports weakness, fatigue, and heavy menstrual periods. The client has a hemoglobin level of 8 g/dL and a hematocrit level of 28 g/dL. The nurse suspects which of the following types of anemia?

A. Pleurisy:

Pleurisy is inflammation of the pleura, which is the lining surrounding the lungs. It can cause sharp chest pain that worsens with breathing. While pleurisy can be associated with conditions such as infections, pneumonia, or pulmonary embolism, it is not typically directly diagnosed or investigated using the brain (B-type) natriuretic peptide (BNP) test. The symptoms of pleurisy may include chest pain, especially with deep breathing, coughing, or sneezing.

B. Cardiomyopathy:

Cardiomyopathy refers to diseases of the heart muscle, which can lead to impaired heart function. Cardiomyopathy can cause symptoms such as fatigue, shortness of breath, chest pain, and fluid retention. While elevated BNP levels can be observed in some cases of cardiomyopathy, the BNP test is not specific to cardiomyopathy alone. It is often used to assess and diagnose heart failure, a condition that can result from various cardiac abnormalities, including cardiomyopathy.

C. Valve Dysfunction:

Valve dysfunction refers to abnormalities or malfunctions of the heart valves, such as stenosis (narrowing) or regurgitation (leakage). Valve dysfunction can lead to symptoms such as shortness of breath, chest pain, palpitations, and fatigue. While valve dysfunction can contribute to heart failure by causing pressure and volume overload on the heart chambers, the BNP test is primarily used to assess heart failure itself rather than specifically identifying valve dysfunction.

D. Heart Failure:

Heart failure is a condition in which the heart is unable to pump blood effectively to meet the body's needs. It can cause symptoms such as fatigue, shortness of breath, fluid retention (edema), and exercise intolerance. Elevated BNP levels are commonly observed in patients with heart failure, especially in cases of acute exacerbations or decompensated heart failure. The BNP test is used to assess and diagnose heart failure, as higher BNP levels indicate increased cardiac stress and volume overload.

A. Initiate a peripheral IV:

Initiating a peripheral intravenous (IV) line may be necessary for clients with unstable angina to facilitate the administration of medications and fluids, especially if there is a need for further interventions or if the client's condition deteriorates. However, in this case, the client's chest pain has improved after receiving nitroglycerin, and there is no immediate indication for IV access based on the information provided.

B. Administer another nitroglycerin tablet:

Nitroglycerin is a vasodilator commonly used to relieve chest pain (angina) by dilating blood vessels and improving blood flow to the heart. The initial response of the client's chest pain severity decreasing from 6 to 2 after one sublingual nitroglycerin tablet indicates a positive response to the medication. However, it's important to assess the client's response further before administering additional doses of nitroglycerin, especially considering the potential for hypotension or other adverse effects.

C. Call the Rapid Response Team:

The Rapid Response Team (RRT) is typically called in situations where there is a concern for a critical event or deterioration of a client's condition that requires immediate intervention. In this scenario, the client's chest pain has improved after nitroglycerin administration, and there are no indications of an acute critical event at this time. Therefore, calling the RRT is not warranted based on the client's current status.

D. Obtain an ECG:

An ECG can be helpful to assess for potential ischemia or other cardiac abnormalities. However, it's not the most urgent action when the client is responding positively to nitroglycerin. It can be done while monitoring the client's response to the second dose.