The nurse is assessing a client experiencing iron deficiency anemia. Which laboratory findings will the nurse expect for this client? Select all that apply

Sickle cell disease(SCD) involves the production of abnormal hemoglobin S, which causes erythrocytes to become rigid and crescent-shaped under stress. This leads to vaso-occlusive crises, where trapped cells cause ischemia and infarction in tissues and bones. The resulting pain is often excruciating and requires aggressive analgesic managementwith opioids to maintain the patient's functional status and physiological stability during the crisis.

Rationale:

A.Telling the client it is too early for medication ignores the subjective nature of pain and the physiological intensity of a vaso-occlusive crisis. Patients with SCD often develop a high tolerance to opioids and may require frequent dosing to manage breakthrough pain. Dismissing the client's request can damage the therapeutic relationship and lead to uncontrolled pain.

B.Giving the pain medication when the dose is due is the best action. The nurse must prioritize the client's report of pain, as pain is whatever the patient says it is. In a sickle cell crisis, managing the severe ischemia is paramount, and the nurse must advocate for adequate analgesia rather than making judgmental assumptions about drug-seeking behavior.

C.Instructing the client not to request medication early is dismissive and fails to address the underlying cause of the distress. It assumes the client's request is behavioral rather than a reflection of unmet physiological needs. Effective pain management in SCD requires a collaborative approach to ensure the patient's pain is consistently controlled.

D.Requesting a placebo is unethical and a violation of professional nursing standards. Using placebos to "test" for pain or addiction is deceptive and erodes the trust between the patient and the healthcare team. In a sickle cell crisis, the pain is rooted in tissue hypoxia, and the use of placebos is medically and ethically inappropriate.

The fecal occult blood test(FOBT) is a screening tool used to detect microscopic amounts of blood in the stool, which may be an early sign of colorectal malignancyor polyps. The most common form, the guaiac-based FOBT, relies on a chemical reaction that can be triggered by non-human hemoglobin or substances that irritate the gastric mucosa. Proper pre-test preparationis essential to minimize false-positive results that lead to unnecessary invasive procedures.

Rationale:

A.This test does not provide any information regarding genetic risk factors for cancer. Genetic testing, such as looking for mutations in the APC gene for familial adenomatous polyposis, involves blood or saliva samples to analyze DNA. The FOBT is strictly a functional screen for active bleeding within the gastrointestinal tract at the time of the sample.

B.The nurse must instruct the client to avoid red meatand NSAIDsfor 48 hours because they can cause false-positive results. Red meat contains animal hemoglobin that reacts with the guaiac reagent, while NSAIDs can cause minor gastric irritation and bleeding. Following these restrictions ensures that any detected blood is likely of human, colonic origin.

C.Telling a patient they do not need an FOBT because of virtual colonoscopy is inappropriate nursing advice. Each screening modality has specific indications, costs, and levels of invasiveness. The FOBT is a non-invasive, cost-effective annual screen recommended for many patients, and it should not be dismissed without a specific medical directive from the provider.

D.The FOBT is a screening tool, not a diagnostic one; it cannot "determine" if a patient has cancer. A positive result only indicates the presence of occult blood, which could be caused by hemorrhoids, ulcers, or inflammatory bowel disease. If the test is positive, the patient must undergo a follow-up colonoscopy to visualize the colon and obtain a definitive diagnosis.