A nurse is reviewing the medical record of a client who is taking epoetin alfa. Which of the following laboratory tests should the nurse monitor to determine the effectiveness of the medication? Select all that apply.

Choice A rationale Blood glucose levels are not directly impacted by epoetin alfa. Epoetin alfa stimulates erythropoiesis, the production of red blood cells, and its effectiveness is assessed by parameters related to red blood cell mass and oxygen-carrying capacity, not glucose metabolism. Choice B rationale Iron levels are crucial to monitor when a client is receiving epoetin alfa. Epoetin alfa stimulates red blood cell production, which requires adequate iron stores for hemoglobin synthesis. Insufficient iron can limit the therapeutic response to epoetin alfa. Choice C rationale Alanine aminotransferase (ALT) levels are indicators of liver function. Epoetin alfa does not have a direct hepatotoxic effect, and therefore, monitoring ALT is not a primary method to assess its effectiveness. Liver enzyme levels are not directly related to erythropoiesis. Choice D rationale Thyroid-stimulating hormone (TSH) levels are indicators of thyroid function. Epoetin alfa does not directly influence thyroid hormone production or regulation, and monitoring TSH would not provide information about the medication's effectiveness in stimulating red blood cell production. Choice E rationale Hemoglobin levels are the primary laboratory test to monitor the effectiveness of epoetin alfa. The medication's purpose is to stimulate erythropoiesis, leading to an increase in red blood cell mass and subsequently, a rise in hemoglobin concentration (normal range for adult males: 13.5–17.5 grams/dL; for adult females: 12.0–15.5 grams/dL).