The nurse is planning the home care of a client who is receiving a mydriatic medication. Which environment is best for this client?

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: Notifying the healthcare provider of the carbamazepine level is not necessary, as 8.4 mg/L (35.6 mcmol/L) is within

the normal range of 4 to 12 mg/L (16.9 to 50.8 mcmol/L). The healthcare provider may adjust

the dose based on other factors such as clinical response, seizure frequency, or adverse effects,

but not based on this level alone.

Choice B reason: Administering the carbamazepine as prescribed is the appropriate action to take, as 8.4 mg/L (35.6 mcmol/L) is within

the normal range of 4 to 12 mg/L (16.9 to 50.8 mcmol/L). The nurse should follow the prescribed

dose and schedule of carbamazepine to maintain a therapeutic level and prevent seizures.

Choice C reason: Assessing the client for side effects of carbamazepine is important, as carbamazepine can cause adverse effects such as drowsiness, dizziness, nausea, rash, or blood dyscrasias. However, this action is not related to the carbamazepine level, as side effects can occur at any level and may not correlate with the serum concentration. The nurse should monitor the client for side effects regardless of the carbamazepine level.

Choice D reason: Withholding this dose of carbamazepine is not appropriate, as 8.4 mg/L (35.6 mcmol/L) is withinthe normal range of 4 to 12 mg/L (16.9 to 50.8 mcmol/L). Withholding the dose may cause a drop in the serum concentration and increase the risk of seizures. The nurse should administer the carbamazepine as prescribed unless instructed otherwise by the healthcare provider.