A pregnant client at 16 weeks' gestation has a hematocrit of 35%. Her prepregnancy hematocrit was 40%. Which of the following statements by the nurse best explains this change?
1. "Because of your pregnancy, you're not making enough red blood cells."
2. Because your blood volume has increased, your hematocrit count is lower."
3. This change could indicate a serious problem that might harm your baby."
4. "You're not eating enough iron-rich foods like meat."
2
Rationale:
1. The pregnancy would not cause a decrease in the production of red blood cells.
2. The increase in plasma volume during pregnancy averages about 50%, and because the plasma volume increase (50%) is greater than the erythrocyte increase (30%), the hematocrit, which measures the concentration of red blood cells in the plasma, decreases slightly.
3. This is referred to as physiologic anemia of pregnancy, and is not harmful to the fetus.
4. It does not mean that the woman is not eating enough iron-rich foods, although it might be necessary to add supplemental iron to her diet to meet the expanded red blood cell and fetal needs.
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