A client with diabetic nephropathy has end-stage renal disease and is starting dialysis. What should the nurse teach the client about hemodialysis?

Choice A reason: Crohn's disease frequently involves the terminal ileum, the specific anatomical site responsible for the absorption of the vitamin B12-intrinsic factor complex. When the ileum is inflamed or resected, B12 cannot be absorbed enterally, leading to megaloblastic anemia, necessitating parenteral or intranasal cobalamin replacement therapy.

Choice B reason: Iron dextran is an intravenous iron replacement used for iron deficiency anemia when oral intake is ineffective or contraindicated. Megaloblastic anemia in Crohn's disease is typically characterized by macrocytic changes due to B12 or folate deficiency, rather than microcytic changes associated with depleted iron stores.

Choice C reason: Oral ferrous sulfate is used to treat iron deficiency anemia. In patients with active Crohn's disease, oral iron is often poorly tolerated due to gastrointestinal irritation and may be poorly absorbed if there is extensive intestinal involvement. Furthermore, it does not address the underlying B12 deficiency.

Choice D reason: Blood transfusions are reserved for severe, life-threatening anemia or acute hemorrhage. Megaloblastic anemia is a chronic nutritional deficiency that is more appropriately and safely managed through specific vitamin replacement therapy (B12 or folic acid) rather than the risks associated with repeated allogeneic blood product administration.

Choice A reason: The absence of adventitious sounds in the lungs is a normal and desirable finding. It indicates that the client does not currently have pulmonary edema or fluid accumulation in the alveolar spaces. This would suggest that the fluid restriction is effective rather than alerting the nurse to a volume excess.

Choice B reason: Decreased calcium levels (hypocalcemia) are common in chronic kidney disease due to the kidneys' inability to activate Vitamin D and the reciprocal relationship with phosphorus. While it is a significant finding in CKD, it is an electrolyte imbalance rather than a direct clinical indicator of fluid volume overload or excess.

Choice C reason: Increased edema in the legs, especially peripheral pitting edema, is a classic clinical sign of fluid volume excess. In CKD, the kidneys fail to excrete sufficient sodium and water, leading to increased hydrostatic pressure in the venous system, which forces fluid into the interstitial spaces of the lower extremities.

Choice D reason: Increased phosphorus levels (hyperphosphatemia) occur in CKD because the failing kidneys cannot adequately filter and excrete phosphate. Similar to calcium, this is a metabolic and electrolyte complication of the disease process itself and does not serve as a primary clinical marker for the state of fluid volume.