The nurse administers naloxone to a client with opioid-induced respiratory depression. One hour later, nursing assessment reveals that the client has a respiratory rate of 4 breaths/minute, oxygen saturation of 75%, and is unable to be aroused. Which action should the nurse implement?

Choice B reason: Epoetin alfa is a synthetic form of erythropoietin, a hormone that stimulates the production of red blood cells (RBCs) in the bone marrow. Epoetin alfa is used to treat anemia, or low RBC count, which can be caused by CKD, chemotherapy, HIV infection, or other conditions. Anemia can cause symptoms such as weakness, fatigue, shortness of breath, pale skin, and chest pain. Hemoglobin is the protein in RBCs that carries oxygen throughout the body. The normal range of hemoglobin for males is 14 to 18 g/dL (8.7 to 11.2 mmol/L). Therefore, an increase in hemoglobin from below normal to within normal indicates that epoetin alfa has been effective in increasing RBC production and improving oxygen delivery. The nurse should monitor the client's hemoglobin level regularly and adjust the dose of epoetin alfa as needed.

Choice A reason:While iron therapy supports the effectiveness of epoetin alfa by providing the necessary substrate for erythropoiesis, tolerating iron therapy is not an indicator of epoetin alfa's efficacy.

Choice C reason: Epoetin alfa is used to treat anemia associated with chronic kidney disease (CKD) by stimulating erythropoiesis (red blood cell production). The primary measure of its effectiveness is an increase in hemoglobin (Hgb) levels toward the target range. The hemoglobin level increasing to 12 g/dL (7.45 mmol/L) reflects a significant improvement from an anemic state and is within the target range for patients receiving epoetin alfa therapy (generally 10–12 g/dL). This is the most objective and definitive indicator of the medication's effectiveness.

Choice D reason: Taking concurrent iron therapy without adverse effects is not a finding that best indicates that the medication is effective, but rather a preventive measure that can reduce the risk of iron deficiency and improve the efficacy of epoetin alfa. Iron therapy refers to taking oral or intravenous iron supplements to increase iron levels in the blood. Iron therapy can cause side effects such as nausea, vomiting, constipation, diarrhea, dark stools, metallic taste, or allergic reactions. The nurse should instruct the client on how to take iron therapy safely and monitor for any adverse effects.

Choice A reason: Encouraging an increase in oral intake is not necessary in this situation, as dark urine is not a sign of dehydration or fluid imbalance. Dark urine may be caused by certain foods, medications, or medical conditions, but it does not indicate a need for more fluids.

Choice B reason: Measuring the client's urinary output is not relevant to this situation, as dark urine is not a sign of urinary retention or obstruction. Urinary output may vary depending on fluid intake, activity level, or other factors, but it does not reflect urine color.

Choice C reason: Explaining that color change is normal is the appropriate action to take, as dark urine is a common and harmless side effect of carbidopa/levodopa, which is a combination drug used to treat Parkinson's disease by increasing dopamine levels in the brain. Carbidopa/levodopa can cause urine to turn brown, black, or red, but this does not affect the function or health of the kidneys or bladder.

Choice D reason: Obtaining a specimen for a urine culture is not necessary in this situation, as dark urine is not a sign of infection or inflammation. A urine culture may be indicated if the client has symptoms such as fever, pain, burning, frequency, or urgency, but it does not diagnose urine color