A client with anemia secondary to chronic kidney disease (CKD) started a prescription for epoetin alfa two months ago. Which client finding best indicates that the medication is effective?

Reference Range

Hemoglobin (Hgb) [Reference Range: Male: 14 to 18 g/dL (8.7 to 11.2 mmol/L)]

Hemoglobin level increased to 12 g/dL (7.45 mmol/L).

Reports of increased energy levels and decreased fatigue.

Food diary shows increased consumption of iron-rich foods.

Takes concurrent iron therapy without adverse effects.

Answer and Explanation

The Correct Answer is A

A: The primary therapeutic effect of epoetin alfa is to stimulate erythropoiesis, leading to an increase in hemoglobin levels. An increase to 12 g/dL demonstrates that the medication is effectively treating the anemia caused by CKD. Monitoring hemoglobin levels is the most objective and reliable indicator of the medication’s effectiveness.

B: While these subjective improvements can indicate an overall improvement in anemia-related symptoms, they are not the best or most definitive measure of the medication's effectiveness. Objective data, such as hemoglobin levels, provide more concrete evidence.

C: Increased consumption of iron-rich foods is beneficial for clients with anemia, but it is not a direct indicator of the effectiveness of epoetin alfa. Dietary changes can support overall health but do not provide evidence of the medication's impact on hemoglobin levels.

D: Taking concurrent iron therapy is common for clients receiving epoetin alfa, as iron is necessary for the production of red blood cells. However, the absence of adverse effects does not directly indicate the effectiveness of epoetin alfa in increasing hemoglobin levels.

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Correct Answer is B

Explanation

choice A, Drawing the peak level two hours after the IV dose is too late to capture the drug's highest serum concentration. Similarly, drawing the trough two hours before the next dose does not reflect the lowest drug level accurately.
Choice B,Drawing the peak level one hour after completion of the IV dose ensures an accurate measurement of the highest serum concentration, as vancomycin typically peaks within this time frame. Drawing the trough one hour before the next dose ensures the lowest concentration of the drug is measured, providing precise therapeutic monitoring.

Choice C is incorrect because drawing blood 30 minutes into the IV dose would not allow the full dose to circulate and reach peak levels in the bloodstream.

Choice D.Drawing the peak level immediately after the completion of the IV dose is too early, as the drug needs time to distribute in the bloodstream and reach its highest concentration. While drawing the trough 30 minutes before the next dose is appropriate, the incorrect timing of the peak makes this option unsuitable.

A. Administer the dose and monitor the client's BP regularly. B. Withhold the scheduled dose and notify the healthcare provider. C. Apply a telemetry monitor before administering the dose. D. Assess for orthostatic hypotension before administering the dose.

Correct Answer is B

Explanation

Choice A rationale: Administering the dose of labetalol without further assessment may not be appropriate in this situation. The client's heart rate is 48 beats/minute, which is considered bradycardia (heart rate below the normal range of 60-100 beats/minute). Bradycardia can be a potential adverse effect of labetalol, a beta-blocker. Moreover, the client's blood pressure is elevated at 150/90 mm Hg, indicating that the hypertension is not well controlled. Administering the dose without addressing the bradycardia or elevated blood pressure could potentially exacerbate these issues.

Choice B rationale: Withholding the scheduled dose of labetalol is the most appropriate action in this scenario. The client's heart rate of 48 beats/minute is considered bradycardia, which may be a side effect of labetalol or indicative of an underlying issue. Additionally, the client's blood

pressure is elevated, indicating inadequate control of hypertension. Bradycardia can reduce cardiac output and may lead to further complications. Notifying the healthcare provider is essential to obtain further instructions and address the client's bradycardia and hypertension before administering the medication.

Choice C rationale: While telemetry monitoring is appropriate for clients with certain cardiac conditions or when changes in heart rate need close observation, it may not be the most urgent action in this situation. The client's bradycardia and elevated blood pressure are concerning and require immediate attention. Telemetry monitoring may be considered later, but it does not address the immediate need to withhold the medication and seek guidance from the healthcare provider.

Choice D rationale: Orthostatic hypotension refers to a drop in blood pressure when changing positions, such as from lying down to standing up. While orthostatic hypotension is a valid concern for clients taking antihypertensive medications, it is not the primary issue in this scenario. The client's heart rate is 48 beats/minute, indicating bradycardia and the blood pressure is elevated at 150/90 mm Hg, suggesting uncontrolled hypertension. These are the main concerns that require immediate attention and further assessment before administering the labetalol dose.

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A client with anemia secondary to chronic kidney disease (CKD) started a prescription for epoetin alfa two months ago. Which client finding best indicates that the medication is effective? Reference Range Hemoglobin (Hgb) [Reference Range: Male: 14 to 18 g/dL (8.7 to 11.2 mmol/L)]

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client is receiving intravenous (IV) vancomycin and the nurse plans to draw blood for a peak and trough to determine the serum level of the drug. Which collection times provide the best determination of these levels?

Correct Answer is B

Explanation

The nurse prepares to administer a scheduled dose of labetalol by mouth to a client with hypertension. The client's vital signs are temperature 99° F (37.2° C), heart rate 48 beats/minute, respirations 16 breaths/minute, and blood pressure (B/P) 150/90 mm Hg. Which action should the nurse take?

Correct Answer is B

Explanation

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A client with anemia secondary to chronic kidney disease (CKD) started a prescription for epoetin alfa two months ago. Which client finding best indicates that the medication is effective?

Reference Range

Hemoglobin (Hgb) [Reference Range: Male: 14 to 18 g/dL (8.7 to 11.2 mmol/L)]