The nurse is providing postoperative care for a male client who had a transurethral resection of the prostate (TURP) 4 hours ago and has continuous irrigation.
Which of the following actions should the nurse take to monitor the client for fluid overload?

Choice A rationale

Chronic renal failure results in decreased erythropoietin production, leading to anemia due to poor red blood cell production, not the vitamin B12 deficiency seen in pernicious anemia. Pernicious anemia specifically results from the lack of intrinsic factor causing B12 deficiency.

Choice B rationale

Pregnancy may cause iron-deficiency anemia due to increased iron demands, not pernicious anemia. Pernicious anemia stems from intrinsic factor deficiency, unrelated to pregnancy physiology. Iron supplementation is required in pregnancy-induced anemia, not B12.

Choice C rationale

A high-fat, high-protein diet does not inherently affect vitamin B12 absorption. Pernicious anemia results from the deficiency of intrinsic factor or issues with B12 absorption, not dietary composition. This individual is not at increased risk based on diet alone.

Choice D rationale

Gastric bypass surgery can disrupt intrinsic factor secretion due to altered gastric mucosa. Intrinsic factor is essential for vitamin B12 absorption in the ileum, and its deficiency directly contributes to the development of pernicious anemia in post-gastric bypass patients. .

Choice A rationale

Corticosteroids are used in thrombocytopenia because they suppress the immune response, particularly in immune thrombocytopenic purpura (ITP). They reduce platelet destruction by inhibiting autoantibody formation and increasing platelet lifespan. Normal platelet count ranges from 150,000 to 400,000/µL. Thrombocytopenia occurs when platelets drop below 150,000/µL, increasing bleeding risk. Corticosteroids can also decrease capillary permeability, minimizing petechiae and ecchymoses.

Choice B rationale

Diphenhydramine, an antihistamine, is used for allergic reactions but has no role in treating thrombocytopenia. It does not address the underlying immune or hematologic causes of low platelet counts. Its primary actions include H1 receptor antagonism, reducing histamine-mediated symptoms like itching and swelling. However, it lacks immunosuppressive or hematologic-stimulating effects essential for managing thrombocytopenia.

Choice C rationale

Desmopressin (DDAVP) is a synthetic antidiuretic hormone analog used for certain bleeding disorders like von Willebrand disease or mild hemophilia A. It increases factor VIII and von Willebrand factor levels, improving clotting. However, it is not indicated for thrombocytopenia as it does not address platelet count deficiencies or immune-mediated platelet destruction.

Choice D rationale

Hydrochlorothiazide (HCTZ) is a thiazide diuretic used for hypertension and edema. Its mechanism of action involves inhibiting sodium reabsorption in the distal tubule, promoting diuresis. HCTZ has no effect on platelet counts or immune mechanisms and is not used in thrombocytopenia. Its side effects, like electrolyte imbalances, may complicate patient management.