Which finding would the nurse expect to see in a patient with a hemoglobin level of 8 g/dL? Select all that apply.
One, some, or all responses may be correct.

Choice A rationale:

Fullness from ascites is a symptom associated with conditions like liver cirrhosis, not directly related to chronic heart failure. Ascites is the accumulation of fluid in the abdominal cavity, causing a feeling of fullness and abdominal discomfort.

Choice B rationale:

Hypoproteinemia, a condition characterized by low levels of proteins in the blood, can lead to fluid retention and edema. However, it is not a direct cause of frequent urination. Frequent urination in this context is more likely related to increased fluid volume in the body, which can be caused by increased renal perfusion in the supine position due to fluid redistribution from the lower extremities to the kidneys.

Choice C rationale:

Hypoperfusion to the brain can lead to neurological symptoms, but it does not directly cause frequent urination. Frequent urination is often related to the kidneys' ability to filter excess fluid and excrete it as urine.

Choice D rationale:

Increased renal perfusion in the supine position can cause frequent urination, especially at night. When a person with chronic heart failure lies down, fluid that has accumulated in the lower extremities (edema) during the day is redistributed to the kidneys due to the change in body position. This increased renal perfusion results in an increased production of urine, leading to nocturia (frequent urination at night) and disrupting the patient's ability to sleep well. This symptom is characteristic of heart failure-related fluid overload and is an important clinical sign indicating worsening heart failure.

Choice A rationale:

Increased bilirubin levels can occur in thalassemia major due to the destruction of red blood cells, leading to elevated bilirubin, which is a breakdown product of hemoglobin. This elevation can contribute to jaundice and other symptoms.

Choice B rationale:

Thalassemia major leads to the destruction of red blood cells, causing the bone marrow to release more reticulocytes (immature red blood cells) into the bloodstream. Therefore, an increased reticulocyte level is expected in thalassemia major.

Choice C rationale:

Increased mean corpuscular volume (MCV) is not a typical finding in thalassemia major. Thalassemia major is characterized by microcytic (smaller than normal) red blood cells, leading to a decreased MCV.

Choice D rationale:

Thalassemia major causes increased iron absorption by the intestines, leading to elevated total iron-binding capacity (TIBC) TIBC measures the body's capacity to bind and transport iron in the blood, and elevated levels are seen in conditions with increased iron demand, such as thalassemia major.