A male patient, admitted with a gastrointestinal bleed and a hematocrit level of 40%, receives fluid resuscitation. In a few hours, the hematocrit level drops to 32%. Which of the following does this indicate to the nurse?
1. continued bleeding
2. hemodilution caused by fluid resuscitation
3. patient has another undiagnosed site of bleeding
4. patient has underlying renal disease
2
Rationale: During acute hemorrhage, the hematocrit may not reflect the volume of blood loss. Prior to fluid resuscitation, the hematocrit may be higher than expected as a result of hemoconcentration from volume loss. The hematocrit may fall precipitously after aggressive fluid resuscitation because of hemodilution effects. It takes up to 72 hours for the hematocrit to equilibriate following a sudden loss of blood. This drop in hematocrit level does not indicate continued bleeding or that the patient has another undiagnosed site of bleeding. Alterations in the blood-urea-nitrogen level could indicate underlying renal disease.
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