The nurse receives a prescription for ciprofloxacin 400 mg intravenously (IV) every 12 hours to be infused over an hour. The IV bag contains ciprofloxacin 400 mg in dextrose 5% in water (D5W) 200 mL. The nurse should program the infusion pump to deliver how many mL/hr? (Enter numerical value only.)

Choice A reason: Assessing for orthostatic hypotension before administering the dose is not necessary, as labetalol does not cause orthostatic hypotension. Orthostatic hypotension is a condition where the blood pressure drops significantly when changing positions from lying to sitting or standing. Labetalol is a beta-blocker that lowers blood pressure by reducing the heart rate and cardiac output.

Choice B reason: Administering the dose and monitoring the client's B/P regularly is not appropriate, as labetalol may cause further bradycardia (slow heart rate) in this client. The client's heart rate is already below normal (48 beats/minute), which may indicate that labetalol is overdosed or contraindicated. Bradycardia can lead to decreased perfusion, dizziness, fatigue, and fainting.

Choice C reason: Applying a telemetry monitor before administering the dose is not sufficient, as labetalol may cause serious cardiac arrhythmias (irregular heart rhythms) in this client. The client's heart rate is already below normal (48 beats/minute), which may indicate that labetalol is affecting the electrical conduction system of the heart. Arrhythmias can cause palpitations, chest pain, shortness of breath, and cardiac arrest.

Choice D reason: Withholding the scheduled dose and notifying the healthcare provider is the best action for the nurse to take in this situation. The client's heart rate is already below normal (48 beats/minute), which may indicate that labetalol is causing adverse effects or interactions with other medications. The healthcare provider should be informed of the client's vital signs and medication history, and decide whether to adjust or discontinue labetalol.

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.