A nurse in dialysis center is caring for a client who has a new diagnosis of end-stage kidney disease. When he arrives for his first dialysis treatment, he tells the nurse, "I decided to come today, but I am not sure if I will need to come back again this week. I am feeling much better since my discharge from the hospital and I think my kidneys are working again." The nurse should identify that this client is demonstrating which of the of the following Kübler-Ross stages of grieving?

Rationale for correct choices:

• Pain assessment: Evaluating the client’s pain level is crucial because pain can limit mobility and participation in rehabilitation activities. Regular assessment allows timely administration of analgesics and adjustment of interventions to promote comfort and safe movement.
• Range of motion exercises: Monitoring and assisting with range of motion exercises helps maintain joint flexibility, prevent contractures, and improve functional mobility. It also supports recovery after surgery and reduces complications associated with immobility.
• Wound care: Inspecting the surgical site for infection or complications is essential in a post-operative client. Proper wound care ensures that swelling, redness, or other changes do not hinder mobility or delay rehabilitation progress.

Rationale for incorrect choices:

• Dietary modifications: While nutrition supports healing, it does not directly assess or improve limited mobility, making it less relevant for evaluating mobility.
• Monitoring vital signs: Although vital signs are important for overall safety, they do not provide specific information about the client’s mobility status or functional limitations.
• Hydration assessment: Hydration status is important for general health but does not directly evaluate mobility or the client’s ability to perform range of motion exercises or transfers.

A. Iron: Epoetin alfa stimulates red blood cell production, but adequate iron stores are necessary for hemoglobin synthesis. Increasing dietary iron supports the effectiveness of epoetin alfa and helps correct anemia associated with chronic kidney disease.

B. Sodium: Clients with chronic kidney disease are typically advised to restrict sodium to control hypertension and fluid retention. Increasing sodium intake would worsen edema and cardiovascular strain rather than support therapy.

C. Protein: Although protein is important for tissue repair, clients with chronic kidney disease are usually placed on a restricted protein diet to reduce nitrogenous waste buildup. Increasing protein would not enhance epoetin alfa’s effectiveness.

D. Potassium: Potassium levels are closely monitored in chronic kidney disease, and most clients are placed on potassium restriction to prevent hyperkalemia. Increasing potassium intake could be dangerous and lead to life-threatening cardiac complications.