A nurse is reviewing the medical record of a client who is taking epoetin alfa. Which of the following laboratory tests should the nurse monitor to determine the effectiveness of the medication? (Select all that apply.)

Neonatal abstinence syndrome (NAS) is a group of withdrawal symptoms that occur in newborns who were exposed to drugs, including heroin, in utero. Hyporeflexia, which refers to reduced or diminished reflexes, is one of the key findings in neonates experiencing NAS.

During pregnancy, when the mother uses opioids like heroin, the baby becomes dependent on the drug. After birth, when the drug is no longer available, the baby experiences withdrawal symptoms as the body adjusts to the absence of the drug. Hyporeflexia is a common manifestation of NAS and is observed due to the central nervous system's response to the withdrawal.

Let's go through the other options:

B. Frequent yawning: While yawning can be seen in neonates with NAS, it is not as specific to the condition as hyporeflexia. Yawning can occur for various reasons and may not always be indicative of NAS.

C. Respiratory depression: Respiratory depression can be a severe complication of opioid exposure in utero and can result in life-threatening situations for the neonate. However, it is not specific to NAS. Respiratory depression is more closely associated with opioid overdose in the newborn, which can be a separate concern from NAS.

D. Constipation: Constipation is a possible symptom in neonates experiencing NAS, but it is not as specific as hyporeflexia. Constipation can occur due to various factors and is not unique to NAS.

Neostigmine is a medication classified as an acetylcholinesterase inhibitor. It is commonly used to treat myasthenia gravis and to reverse the effects of non-depolarizing neuromuscular blocking agents used during surgery. Adverse reactions to neostigmine are related to its cholinergic effects, which result from increased acetylcholine levels in the body.

Let's go through the options:

A. Hypoactive bowel sounds: Neostigmine can actually increase gastrointestinal motility and may cause increased bowel sounds or even diarrhea, not hypoactive bowel sounds. Therefore, hypoactive bowel sounds are not an adverse reaction to neostigmine.

B. Sweating: Sweating is a cholinergic effect and can be an adverse reaction to neostigmine. Increased sweating is a common sign of cholinergic stimulation.

C. Respiratory distress: Respiratory distress can occur as an adverse reaction to neostigmine, particularly if the client has a history of asthma or other respiratory conditions. Neostigmine can cause bronchoconstriction and excessive secretions, leading to respiratory distress.

D. Urinary retention: Neostigmine is actually used to treat urinary retention by increasing bladder contraction. Therefore, urinary retention is not an adverse reaction to neostigmine.

E. Bradycardia: Bradycardia (slow heart rate) is a significant adverse reaction to neostigmine due to its cholinergic effects on the heart. Increased acetylcholine levels can lead to excessive stimulation of the vagus nerve, resulting in bradycardia.