With a hemoglobin of 7.8 g/dL, what is the most appropriate nursing action?

• A. Increase intravenous fluids
• B. Obtain an order to start an erythropoietin-stimulating agent (ESA)
• C. Start a diuretic
• D. Decrease iron supplementation

Answer: (B)

A low hemoglobin like 7.8 g/dL signals significant anemia, and when anemia is related to reduced erythropoietic drive (as in CKD or chronic disease), management often aims to stimulate red blood cell production. Erythropoiesis-stimulating agents are used to boost the bone marrow’s production of RBCs, which can raise hemoglobin and reduce the need for transfusions. Because ESAs require a provider prescription and careful monitoring (iron status, blood pressure, and potential risks), the nurse’s appropriate action is to obtain an order to start an ESA and coordinate the plan of care.

Increasing IV fluids won’t raise hemoglobin, and a diuretic would not address the underlying issue. Decreasing iron supplementation would worsen anemia if iron is needed, and transfusion decisions depend on symptoms and specific guidelines; the key step here is initiating ESA therapy with an order.