# 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?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391831&lang=en  
> language: en  
> subject: Medical Emergencies  
> category: PA

## 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?

## Option

1. Administer the dose as ordered
2. Increase the dose for better effect
3. Administer additional antihypertensive only
4. Hold 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**

**Correct answer: 4**

## 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.

## Key concepts

- **Erythropoiesis-stimulating agent** — Epoetin alfa, darbepoetin; treat CKD anemia and chemo-induced anemia.
- **ESA boxed warning** — Hgb >11 or rapid rise: cardiovascular events, thrombosis, stroke.
- **ESA hypertension** — Common dose-related adverse effect; monitor BP at every visit.

## Related questions

- [A nurse is caring for an alert adult client with type 1 diabetes who reports tremors, swea…](https://mymerci.kr/pages/nclex_q.php?qn_id=360524&lang=en)
- [A 68-year-old client with COPD is admitted with shortness of breath and SpO2 86% on room a…](https://mymerci.kr/pages/nclex_q.php?qn_id=362940&lang=en)
- [A 58-year-old client arrives at the emergency department with crushing substernal chest pa…](https://mymerci.kr/pages/nclex_q.php?qn_id=362976&lang=en)
- [A 72-year-old client is brought to the emergency department by family who report that the …](https://mymerci.kr/pages/nclex_q.php?qn_id=363003&lang=en)
- [A 79-year-old client is admitted from a long-term care facility with diarrhea, decreased o…](https://mymerci.kr/pages/nclex_q.php?qn_id=363089&lang=en)
- [A 76-year-old female with chronic heart failure and atrial fibrillation receives digoxin 0…](https://mymerci.kr/pages/nclex_q.php?qn_id=374883&lang=en)
- [A 70-year-old client on long-term digoxin therapy reports new yellow-green halos around li…](https://mymerci.kr/pages/nclex_q.php?qn_id=374884&lang=en)
- [A 58-year-old client with type 2 diabetes mellitus and migraine prophylaxis is taking prop…](https://mymerci.kr/pages/nclex_q.php?qn_id=374893&lang=en)

## Read in another language

- [en](https://mymerci.kr/pages/nclex_q.php?qn_id=391831&lang=en)
- [ko](https://mymerci.kr/pages/nclex_q.php?qn_id=391831&lang=ko)
- [ja](https://mymerci.kr/pages/nclex_q.php?qn_id=391831&lang=ja)
- [zh-TW](https://mymerci.kr/pages/nclex_q.php?qn_id=391831&lang=zh-tw)
- [vi](https://mymerci.kr/pages/nclex_q.php?qn_id=391831&lang=vi)

---

More free questions: [NCLEX-RN Practice](https://mymerci.kr/pages/nclex_bank.php?lang=en)

_For study reference only. Always follow current clinical guidelines and your institution’s protocols._