A client with end-stage renal disease (ESRD) has been experiencing persistent pruritus (itching) that is not responding to conservative management. Which of the following is the primary indication for initiating dialysis in this client?

A. Incorrect. Instructing the client to increase fluid intake may not address the underlying cause of abdominal pain and fever in a client on peritoneal dialysis.

B. Incorrect. Assisting the client with a peritoneal fluid exchange is not the priority when the client is experiencing abdominal pain and fever, as it may exacerbate the symptoms.

C. Incorrect. Administering an over-the-counter pain reliever may provide temporary relief, but it does not address the underlying cause of the symptoms.

D. Correct. Abdominal pain and fever in a client on peritoneal dialysis may indicate peritonitis, an infection of the peritoneal cavity. Obtaining a peritoneal fluid sample for testing is essential to confirm the diagnosis and initiate appropriate treatment promptly.

A) This statement is incorrect. Serum calcium levels are not directly related to ESA therapy for anemia management. ESA therapy focuses on increasing red blood cell production.

B) This statement is incorrect. Blood urea nitrogen (BUN) levels are indicators of kidney function and may be monitored for other reasons in a client on peritoneal dialysis. However, they are not directly related to ESA therapy for anemia management.

C) This statement is accurate. During ESA therapy, the nurse should closely monitor the client's hemoglobin and hematocrit levels. ESAs stimulate the production of red blood cells and can increase hemoglobin and hematocrit levels. Regular monitoring is essential to prevent anemia or excessive increases in these values.

D) This statement is incorrect. Serum potassium levels may be monitored for a client on peritoneal dialysis due to the potential for electrolyte imbalances, but they are not the primary concern during ESA therapy for anemia management.