The nurse is explaining to a patient the difference between hemodialysis and continuous renal replacement therapy (CRRT). What statement by the patient leads the nurse to determine that additional education is needed?

A. Escape of red blood cells through damaged glomeruli: Hematuria can occur in some kidney diseases, but the loss of red blood cells through glomerular damage is usually minimal and does not account for the chronic anemia seen in CKD. This mechanism is not the primary cause of anemia in these patients.

B. Minimal production of erythropoietin by the kidney: The kidneys produce erythropoietin, a hormone that stimulates bone marrow to produce red blood cells. In CKD, damaged renal tissue reduces erythropoietin synthesis, leading to decreased red blood cell production and anemia. This is the most common and primary cause of anemia in CKD patients.

C. Decrease absorption of Vitamin B12 and folic acid: Vitamin B12 and folate deficiencies can contribute to megaloblastic anemia, but absorption is usually unaffected by CKD. Nutritional deficiencies are secondary contributors and not the main cause of anemia in chronic kidney disease.

D. Interference with transportation of iron to bone marrow: While CKD may cause functional iron deficiency due to inflammation and hepcidin elevation, iron transport interference is a contributing factor, not the primary cause. The key driver of anemia in CKD remains low erythropoietin production.

A. Administer IV potassium to correct hypokalemia: During the failure stage of acute kidney injury (AKI), hyperkalemia is more common than hypokalemia due to impaired renal excretion. Administering IV potassium without careful monitoring can precipitate life-threatening cardiac arrhythmias. Electrolyte management must be guided by laboratory values.

B. Prepare for hemodialysis to manage fluid and electrolyte imbalances: The failure stage of AKI is characterized by severe reduction in glomerular filtration rate, oliguria or anuria, and accumulation of toxins, electrolytes, and fluid. Hemodialysis provides rapid removal of excess potassium, urea, and fluid, which is critical to preventing complications such as pulmonary edema, hyperkalemia-induced arrhythmias, and severe acidosis.

C. Begin fluid restriction to prevent overload: Fluid restriction may be indicated, especially in oliguric or anuric patients, but it is not sufficient as the primary intervention in the failure stage. Restricting fluid alone does not correct severe electrolyte disturbances or remove accumulated toxins. It is supportive, whereas renal replacement therapy addresses the derangements.

D. Encourage oral intake and high protein to support kidney function: High-protein intake may worsen azotemia in AKI because protein metabolism generates nitrogenous waste that the failing kidneys cannot excrete efficiently. Oral intake is encouraged only if not contraindicated, but promoting protein-heavy intake is not a priority in the failure stage.