Which statement about proton pump inhibitors (PPIs) should be included in a client education workshop?

Choice A reason: Chronic kidney disease (CKD) does not primarily cause anemia by leaking red blood cells (RBCs) into urine. While hematuria may occur in some renal conditions, anemia in CKD results mainly from reduced erythropoietin production, not RBC loss. This statement is inaccurate, as it misrepresents the primary mechanism of anemia in CKD.

Choice B reason: Inflammation in CKD may contribute to anemia by suppressing erythropoiesis through cytokine release, but it does not directly attack RBCs. The primary cause is erythropoietin deficiency due to impaired renal function. This statement is inaccurate, as it overstates inflammation’s role and ignores the key hormonal mechanism in CKD-related anemia.

Choice C reason: High vascular pressure in CKD can damage kidneys but does not directly cause RBCs to burst (hemolysis). Anemia in CKD stems from reduced erythropoietin, not mechanical RBC destruction. This statement is inaccurate, as it incorrectly links hypertension’s renal effects to direct RBC damage, misrepresenting the anemia’s cause.

Choice D reason: CKD causes anemia due to reduced erythropoietin synthesis by damaged kidneys. Erythropoietin stimulates RBC production in bone marrow. In CKD, impaired renal function decreases erythropoietin, leading to anemia. This statement is accurate, as it correctly identifies the hormonal deficiency as the primary cause of low RBC counts in CKD.

Choice A reason: Humulin R (regular insulin) has an onset of 30-60 minutes and peaks at 2-3 hours. Taking a snack at 0900-0930, immediately after injection, is too early, as insulin action is minimal, and glucose from the meal may cause hyperglycemia before insulin peaks, making this timing inappropriate.

Choice B reason: Humulin R peaks at 2-3 hours (1100-1200 for a 0900 dose), when hypoglycemia risk is highest due to maximum glucose uptake. A snack or meal at 1100-1130 provides glucose to counter insulin’s peak effect, preventing low blood sugar, making this the most appropriate timing.

Choice C reason: By 1400-1430, Humulin R’s effect (duration 5-8 hours) is waning, reducing hypoglycemia risk. A snack at this time is less critical, as insulin’s glucose-lowering action is declining. This timing is less effective for preventing hypoglycemia compared to the peak action period at 1100-1130.

Choice D reason: At 1700-1730, Humulin R’s effect is nearly gone (duration 5-8 hours), making hypoglycemia unlikely from the 0900 dose. A snack this late is irrelevant to the insulin’s action, as glucose levels are stabilized, making this timing inappropriate for preventing hypoglycemia.