Patho Patho #45

Question

The nurse is caring for a client with the following assessment data: BUN 70 mg/dl, Cre 4.27, HgB 7.0 mg/dl, HcT 22%. What is the most likely explanation for this client’s anemia?

Answers

  1. 1. Hypertension causing red blood cell destruction.
    • Rationale:

      This answer choice is not correct as hypertension does not cause red blood cells destruction. Clients with renal insufficiency are unable to produce adequate amounts of erythropoietin leading to anemia of renal disease.

  2. 2. Acidotic hemolysis of red blood cells.
    • Rationale:

      This answer choice is not correct as acidosis associated with renal disease does not cause red blood cells hemolysis. Clients with renal insufficiency are unable to produce adequate amounts of erythropoietin leading to anemia of renal disease.

  3. 3. Anemia of chronic renal disease.
    • Rationale:

      This answer is correct as clients with long term renal insufficiency are unable to produce adequate amounts of erythropoietin in response to decreased circulating red blood cell levels. This is the underlying etiology for anemia of chronic renal disease.

  4. 4. Polycythemia of compensation for hypoxemia.
    • Rationale:

      This answer choice is not correct as polycythemia is not associated with renal insufficiency. In clients with polycythemia, HgB and HcT would be elevated and not decreased.

Overview

The focus of this question is asking the nurse to identify the underlying etiology for a client’s decreased HgB and HcT levels. Clients with renal insufficiency develop anemia secondary to decreased production of erythropoietin. This client’s BUN and Cre are significantly elevated indicating significant renal insufficiency making anemia of chronic renal disease the most likely etiology for the client’s anemia.

Explanation

Learning Outcomes

The kidneys are responsible for erythropoiesis, or red blood cell production via production of the hormone erythropoietin. The kidneys produce and release this hormone in response to decreased circulating oxygen levels when RBC levels decrease. Clients with long term renal insufficiency are unable to produce adequate erythropoietin in response to decreased circulating RBC levels, leading to anemia of chronic renal disease.

Test Taking Tip

Answer choices #1 and 2 can likely be eliminated as they are very closely associated, both referring to red blood cell destruction or hemolysis. Also, answer choice #3 is the only answer choice that addresses renal insufficiency which links it back to the question stem.

Video Rationale