A client with anemia secondary to chronic kidney disease (CKD) started a prescription for epoetin alfa two months ago. Which client finding best indicates that the medication is effective? Reference Range: Hemoglobin (Hgb) [14 to 18 g/dL (8.7 to 11.2 mmol/L)]

A. Food diary shows increased consumption of iron-rich foods: While iron-rich foods support erythropoiesis, diet changes alone do not confirm the direct effectiveness of epoetin alfa. This finding reflects a supportive measure rather than a measurable treatment outcome. B. Takes concurrent iron therapy without adverse effects: Iron supplementation is often necessary with epoetin alfa to optimize red blood cell production. However, tolerating iron without adverse effects indicates good adherence, not proof of medication effectiveness. C. Hemoglobin level increased to 12 g/dL (7.45 mmol/L): Epoetin alfa stimulates erythropoiesis, and a hemoglobin increase toward the normal range is the most objective indicator of treatment success. This finding directly measures the medication’s intended therapeutic effect. D. Reports of increased energy levels and decreased fatigue: While symptom improvement is valuable, it is subjective and can be influenced by factors other than epoetin alfa therapy. Objective lab evidence provides the most reliable assessment of drug effectiveness.