The nurse administers risedronate to a client with osteoporosis at 0700. The client asks for a glass of milk to drink with the medication. Which action should the nurse take?

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: Holding the calcitriol but administering the calcium carbonate as scheduled is not appropriate, as both drugs can increase the serum calcium level and worsen the condition of hypercalcemia. Calcitriol is a synthetic form of vitamin D that enhances the absorption of calcium from the GI tract and promotes bone mineralization. Calcium carbonate is a supplement that provides additional calcium to the body.

Choice B reason: Holding the calcium carbonate, but administering the calcitriol as scheduled is not appropriate, as calcitriol alone can also raise the serum calcium level and cause hypercalcemia. Calcitriol is a synthetic form of vitamin D that enhances the absorption of calcium from the GI tract and promotes bone mineralization.

Choice C reason: Holding both medications until contacting the healthcare provider is the appropriate action to take, as the client's total calcium level is above the normal range of 9 to 10.5 mg/dL or 2.25 to 2.62 mmol/L and indicates hypercalcemia. Hypercalcemia can cause symptoms such as nausea, vomiting, constipation, confusion, lethargy, muscle weakness, cardiac arrhythmias, and kidney stones. The healthcare provider can adjust the dose or frequency of the medications or prescribe other treatments to lower the serum calcium level.

Choice D reason: Administering both prescribed medications as scheduled is not appropriate, as both drugs can increase the serum calcium level and worsen the condition of hypercalcemia. Calcitriol is a synthetic form of vitamin D that enhances the absorption of calcium from the GI tract and promotes bone mineralization. Calcium carbonate is a supplement that provides additional calcium to the body.