A nurse is preparing to administer epoetin alfa to an outpatient client with stage 4 chronic kidney disease and anemia of chronic disease. Prior to administering the medication, which assessment finding requires the nurse to withhold the dose and notify the healthcare provider?

Epoetin alfa stimulates erythropoiesis in the bone marrow and frequently induces or exacerbates arterial hypertension, sometimes precipitating hypertensive encephalopathy or seizures. Severe uncontrolled hypertension (e.g., 178/96 mmHg) is a major contraindication to administration until blood pressure is pharmacologically controlled. Furthermore, target hemoglobin levels should generally not exceed 11–12 g/dL during epoetin therapy, as higher thresholds significantly increase the risk of serious cardiovascular events, deep vein thrombosis (DVT), and stroke.