# Clinical context A 68-year-old with stage 4 chronic kidney disease has hemoglobin 8.7 g/dL, controlled blood pressure, adequate iron stores, fatigue, and no current indication for urgent transfusion; darbepoetin alfa is prescribed. Which actions are appropriate when administering darbepoetin alfa for anemia of chronic kidney disease? Select exactly 4 responses.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=602994&lang=en  
> language: en  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PPT

## Question

Clinical context
A 68-year-old with stage 4 chronic kidney disease has hemoglobin 8.7 g/dL, controlled blood pressure, adequate iron stores, fatigue, and no current indication for urgent transfusion; darbepoetin alfa is prescribed.

Which actions are appropriate when administering darbepoetin alfa for anemia of chronic kidney disease? Select exactly 4 responses.

Select exactly 4 responses.

1

Use darbepoetin as an immediate substitute for urgent red blood cell transfusion.

2

Evaluate iron status before and during treatment.

3

Monitor hemoglobin closely after initiation and dose changes.

4

Target hemoglobin above 13 g/dL to eliminate all fatigue.

5

Control blood pressure before and during therapy.

6

Use the lowest dose sufficient to reduce the need for red blood cell transfusions.

## Explanation

ESA safety includes blood-pressure control, iron evaluation, close hemoglobin monitoring, and the lowest effective dose; higher hemoglobin targets increase cardiovascular and thrombotic risk.

## In-depth explanation

Quick answer
Use lowest effective ESA exposure with iron and pressure surveillance.

Why this is correct
Aranesp is contraindicated in uncontrolled hypertension, requires iron and hemoglobin monitoring, and should not be used as immediate transfusion replacement.

Easy analogy or mental picture
Think of medication safety as a control panel: identify the dangerous signal, change the correct control, and verify the response.

Memory hook
Cue, action, response, reassessment.

NCLEX decision rule
Choose the action that prevents the most immediate medication-related harm while preserving the continuing indication.

Why the other choices are wrong
Options that delay escalation, ignore a contraindication, or change therapy without authorization do not close the safety loop.References
1DailyMed: ARANESP (darbepoetin alfa)CKD anemia, iron evaluation, hemoglobin and blood-pressure monitoring, and cardiovascular or thrombotic risk

## Clinical scenario

Clinical context
A 68-year-old with stage 4 chronic kidney disease has hemoglobin 8.7 g/dL, controlled blood pressure, adequate iron stores, fatigue, and no current indication for urgent transfusion; darbepoetin alfa is prescribed.

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