As the nurse caring for a patient with chronic kidney disease, you know that one of the causes of anemia in CKD is which of the following?

A. Increase IV fluids to improve cerebral perfusion is incorrect as the immediate priority. While maintaining cerebral perfusion is important, IV fluids alone do not address the life-threatening airway and respiratory compromiseoccurring in this patient.

B. Notify the neurosurgeon immediately is important, but it is not the first action. The patient is showing signs of impending brain herniation and respiratory failure, so addressing the airway takes precedence over notification.

C. Administer mannitol as prescribed is incorrect as an immediate action. Mannitol may help reduce intracranial pressure, but the patient must first have a patent airway and adequate oxygenationbefore administering medications.

D. Ensure a patent airway and apply oxygen is correct because the patient is unresponsive with irregular respirations, indicating potential hypoxia and risk of respiratory arrest. According to the ABC (Airway, Breathing, Circulation) principle, airway management and oxygenation are the highest priority interventionsin a patient with neurological deterioration. Once airway and oxygenation are secured, the nurse can then notify the neurosurgeon and prepare for interventions to reduce ICP, such as mannitol or surgical evacuation.

A. Calcium: 8.5 is incorrect because this value is within the normal reference range (approximately 8.5–10.5 mg/dL). Calcium levels, unless critically abnormal, do not affect the decision to start insulin in DKA.

B. Phosphorus: 4.0 is incorrect because this is also within the normal reference range (2.5–4.5 mg/dL). Although phosphorus levels can drop during DKA treatment due to insulin shifting phosphorus into cells, an initial normal phosphorus level does not preclude starting insulin.

C. Potassium: 2.8 is correct because hypokalemia is a major safety concern when initiating insulin therapy. Insulin promotes the movement of potassium from the extracellular space into cells, which can further lower already low potassium levels. Severe hypokalemia can lead to life-threatening cardiac arrhythmias, including ventricular tachycardia or fibrillation. For this reason, current guidelines recommend holding insulin until potassium is corrected to ≥3.3 mEq/Land administering potassium replacement as ordered. The nurse must communicate this lab result to the healthcare provider before starting the insulin dripto prevent serious complications.

D. Glucose: 275 is incorrect because hyperglycemia is expected in DKA. While high glucose confirms the need for insulin therapy, it is not a contraindicationto starting treatment.