A nurse is caring for a client who has chronic renal failure and is receiving epoetin alfa. To check for therapeutic effects, the nurse should monitor which of the following client laboratory tests?

A. The nurse monitors the client for over sedation. Monitoring for over sedation is an essential nursing responsibility when caring for a client using a patient-controlled analgesia (PCA) device. Opioid medications used in PCAs can cause respiratory depression, drowsiness, and decreased level of consciousness, so frequent assessments are necessary to ensure client safety.

B. The nurse reassures the client that the PCA device will not cause an overdose. PCA devices are programmed to deliver a controlled dose of medication at set intervals, reducing the risk of overdose. Educating the client about this built-in safety feature helps alleviate anxiety and encourages appropriate pain management. However, the nurse should also instruct the client to report symptoms of over sedation or inadequate pain relief.

C. The nurse asks the client to demonstrate dose delivery. Encouraging the client to demonstrate how to use the PCA device ensures they understand how to properly self-administer medication. This reinforces client education, promotes effective pain management, and minimizes unnecessary delays in pain relief due to improper use.

D. The nurse administers a PCA dose for the client. Only the client should press the PCA button to self-administer medication. This prevents accidental overdose or over sedation that could occur if the client is too sedated to recognize their own need for pain relief. If the client is unable to use the PCA properly, alternative pain management strategies should be considered, rather than allowing a nurse or family member to press the button.

A. Meperidine. Meperidine is an opioid analgesic used for moderate to severe pain. It does not treat nausea and vomiting and can worsen these symptoms by delaying gastric emptying. Opioids also depress the central nervous system, which may cause dizziness and sedation.

B. Diazepam. Diazepam is a benzodiazepine used for anxiety, muscle spasms, and seizures. It has no antiemetic effects and does not relieve nausea or vomiting. Instead, it can cause dizziness and drowsiness, which may further discomfort the client.

C. Naloxone. Naloxone is an opioid antagonist used to reverse opioid-induced respiratory depression. Since the client’s nausea is not opioid-related, naloxone would not be beneficial. Its administration can also cause withdrawal symptoms in opioid-dependent clients.

D. Promethazine. Promethazine is an antiemetic that blocks histamine and dopamine receptors in the brain, reducing nausea and vomiting. It is commonly used for motion sickness, post-surgical nausea, and gastrointestinal illnesses, making it the appropriate choice for this client.