The client's hemoglobin 7.8: what action should the nurse take?

• A. Initiate a blood transfusion
• B. Obtain an order to start an erythropoietin stimulating agent (ESA)
• C. Begin iron supplementation alone
• D. Schedule immediate dialysis

Answer: (B)

In CKD-related anemia, the main approach is to stimulate red blood cell production with an erythropoiesis-stimulating agent (ESA) and to ensure iron stores are adequate so the ESA can work effectively. When a client’s hemoglobin is as low as 7.8 g/dL, the nurse should arrange for an order to start ESA therapy. This addresses the underlying deficiency in erythropoietin production by the kidneys and reduces the need for transfusions.

Starting an ESA requires a provider prescription, plus assessment of iron status and ongoing monitoring for risks such as hypertension and thrombosis. Iron alone might help if stores are insufficient, but it won’t correct the anemia due to lack of erythropoietin by itself. Scheduling immediate dialysis isn’t a direct fix for the anemia, and transfusion is reserved for urgent situations or symptoms, not the routine management of CKD-related anemia at this level.