A nurse is reviewing the medical record of a client. The client has a hemoglobin of 9.5 g/dL, platelets of 75,000 mcL, and a BUN of 22 mg/dL. The client reports increased fatigue and shortness of breath when ambulating, and weight has decreased by 10 lbs over the past month. The abdomen is distended and tender to palpation with hypoactive bowel sounds. Which of the following actions should the nurse take?

Choice C rationale The client presents with a hemoglobin level of 9.5 g/dL, which is below the normal range of 12 to 16 g/dL for females or 14 to 18 g/dL for males. This anemia reduces the oxygen-carrying capacity of the blood, explaining the reported shortness of breath and fatigue during ambulation. Increasing the monitoring of oxygen saturation is vital to ensure adequate tissue perfusion. The low platelet count of 75,000 mcL, below the normal 150,000 to 450,000 mcL, also necessitates careful assessment. Choice A rationale While the client has abdominal distension, initiating a fluid restriction is not indicated without a confirmed diagnosis of fluid volume excess or heart failure. The BUN of 22 mg/dL is slightly elevated above the normal range of 10 to 20 mg/dL, which could suggest mild dehydration or decreased renal perfusion rather than fluid overload. Restricting fluids could potentially worsen the client's hemodynamic status and exacerbate the tachycardia often associated with symptomatic anemia and decreased blood oxygenation. Choice B rationale An incentive spirometer is primarily used to prevent atelectasis and improve lung expansion in postoperative patients or those with restricted mobility. While the client reports shortness of breath, the underlying cause is likely hematological due to the hemoglobin of 9.5 g/dL rather than a primary restrictive or obstructive pulmonary issue. Using an incentive spirometer does not address the oxygen-carrying deficit caused by the anemia. The nurse must focus on interventions that monitor or improve systemic oxygen delivery. Choice D rationale Administering high-dose corticosteroids is an intervention typically reserved for acute inflammatory processes or spinal cord compression. There is no evidence in the medical record provided that suggests spinal inflammation is the cause of the client's symptoms. Corticosteroids carry significant side effects, including increased risk of infection and electrolyte imbalances. Given the low platelet count of 75,000 mcL and anemia, the nurse should focus on monitoring for bleeding and ensuring adequate oxygenation rather than unindicated steroid therapy.