The nurse is planning care for a client with chronic kidney disease who is anuric and undergoes hemodialysis three times weekly. Which intervention belongs in the plan of care?

• A. Monitor for signs of anemia
• B. Monitor for hyperkalemia only
• C. Limit all fluid intake to zero
• D. Initiate iron supplementation without lab data

Answer: (A)

Anemia is a common consequence of chronic kidney disease because damaged kidneys produce less erythropoietin, the hormone that stimulates red blood cell production. In a client with CKD who is anuric and on thrice-weekly hemodialysis, this reduced EPO means the red blood cell supply remains low unless specifically addressed, so monitoring for anemia is essential in the plan of care. The nurse should routinely assess symptoms such as fatigue, weakness, pallor, shortness of breath, and rapid pulse, and track lab values like hemoglobin and hematocrit to determine if treatments such as erythropoiesis-stimulating agents or iron supplementation are needed based on current iron stores. While managing potassium is important in CKD, focusing solely on hyperkalemia ignores a common, ongoing problem in these patients. Fluid limits are individualized and not universally zero, and initiating iron without lab data risks iron overload or inappropriate therapy, so iron treatment should be guided by iron studies.