The nurse is caring for clients on a medical floor. Which client should be assessed first?

Choice A reason: Heparin prevents clotting during dialysis but doesn’t reduce hemoglobin or hematocrit directly. It’s not a primary cause of anemia in renal failure, unlike erythropoietin deficiency.

Choice B reason: Kidneys in chronic renal failure fail to produce erythropoietin, a hormone stimulating red blood cell production, leading to low hemoglobin and hematocrit, the key cause here.

Choice C reason: Minor blood loss occurs in dialysis, but it’s not the primary reason for chronic anemia. Erythropoietin deficiency from renal failure has a greater impact on counts.

Choice D reason: Poor protein intake affects overall health but isn’t the main driver of anemia in renal failure. Erythropoietin loss from kidney dysfunction is the dominant factor.

Choice A reason: Diphenhydramine, an antihistamine, treats allergies or sleep issues by blocking histamine, not addressing heart failure’s fluid overload or cardiac dysfunction.

Choice B reason: Epinephrine boosts heart rate and pressure in emergencies like anaphylaxis, but it worsens heart failure by increasing cardiac workload, not reducing fluid.

Choice C reason: Propylthiouracil treats hyperthyroidism by inhibiting thyroid hormone, unrelated to heart failure’s need for fluid management or cardiac support.

Choice D reason: Furosemide, a loop diuretic, reduces fluid overload in heart failure by increasing urine output, relieving pulmonary edema and systemic congestion effectively.