A client with CKD on epoetin alfa for anemia has a routine B… | MyMerci
Medical EmergenciesPA
Question
A client with CKD on epoetin alfa for anemia has a routine BP of 162/96 and Hgb 12.5. Which is the nurse's priority action?
1Administer the dose as ordered
2Increase the dose for better effect
3Administer additional antihypertensive only
4Hold the dose and notify the provider — Hgb >11 in CKD and rising BP are boxed-warning concerns; targeting Hgb 10-11 reduces cardiovascular events✓ Correct answer
Explanation
Correct (2): ESA (epoetin alfa, darbepoetin) carries an FDA boxed warning — Hgb >11 g/dL or rapid rise increases cardiovascular events, thrombosis, and stroke; target Hgb 10-11 in CKD. Hypertension is a common dose-related effect. Hold dose, notify provider for adjustment. (1,3) Worsen risk. (4) Need ESA management too.
In-depth explanation
Memory Tip ESA = "Erythropoiesis Stimulating Agent" — TARGET Hgb 10-11 only. Higher = thrombosis/stroke. Monitor BP, iron stores.
Clinical scenario
Scenario 65-year-old male CKD on epoetin alfa SC for anemia. Today: BP 162/96, Hgb 12.5.