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.
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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Relief of depression Incorrect because anticholinergics do not have antidepressant effects and may worsen depression by causing sedation, confusion or hallucinations.
Decreased tremors Correct because anticholinergics block the action of acetylcholine in the brain and reduce the imbalance between dopamine and acetylcholine that causes tremors in Parkinson's disease.
Delay in disease progression Incorrect because anticholinergics do not modify the underlying pathology of Parkinson's disease and do not prevent neuronal degeneration or dopamine depletion.
Improved bladder function Incorrect because anticholinergics may impair bladder function by causing urinary retention, hesitancy or incontinence due to their antispasmodic effects on the detrusor muscle.
Correct Answer is C
Explanation
a) Assess the client for side effects of carbamazepine:
- This option might seem reasonable as monitoring for side effects is essential with any medication, especially one with a narrow therapeutic range like carbamazepine. However, the client's level of 8.4 mcg/L is within the therapeutic range (4 to 12 mcg/mL), so there's no immediate indication that side effects are likely to occur solely based on this level.
b) Notify the healthcare provider of the carbamazepine level:
- While it's important to keep the healthcare provider informed about the client's condition, in this case, the carbamazepine level is within the therapeutic range. There's no urgent need to notify the provider unless there are other concerning factors not mentioned in the scenario.
c) Administer the carbamazepine as prescribed:
- This is the correct answer. The client's morning carbamazepine level of 8.4 mcg/L falls within the therapeutic range (4 to 12 mcg/mL). Therefore, the evening dose should be administered as prescribed to maintain therapeutic levels and control the client's condition.
d) Withhold this dose of the carbamazepine:
- Withholding the dose based solely on the morning carbamazepine level of 8.4 mcg/L, which is within the therapeutic range, would not be appropriate. Withholding the dose without consulting the healthcare provider could potentially lead to suboptimal management of the client's condition.
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