A patient with CRF who will begin receiving an erythropoiesis stimulating agent (ESA) is admitted to the hospital
The nurse notes that the patient's heart rate is 82 beats per minute, and the blood pressure is 140/100 mm Hg. A complete blood count reveals a hemoglobin of 8 gm/dL and a hematocrit of 29%. What will the nurse do?
a. Administer the ESA and request an order for a blood transfusion.
b. Withhold the ESA and request an order for an antihypertensive medication.
c. Request an order to increase the dose of ESA to raise the hemoglobin more quickly.
d. Suggest initiating dialysis while giving the ESA.
ANS: B
In patients with CRF, treatment with epoetin alfa is often associated with an increase in blood pressure, so patients with hypertension should be treated before beginning treatment with epoetin alfa. There is no indication for a blood transfusion, an increased dose of ESA, or dialysis.
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