A client with chronic kidney disease (CKD) missed dialysis yesterday to attend a funeral. The client's spouse calls the home health nurse and reports that the client is lethargic and hard to arouse. Which instruction is most important for the nurse to provide?

Choice A reason: Applying home oxygen may support oxygenation but does not address the underlying cause of lethargy, which in CKD is often due to toxin buildup, fluid overload, or electrolyte imbalance. Choice B reason: Avoiding salt intake is a long-term dietary strategy for managing fluid retention and hypertension in CKD, but it is not an immediate intervention for acute symptoms like altered mental status. Choice C reason: Checking for a thrill and bruit assesses the patency of the dialysis access site, but it does not address the urgent need for medical evaluation and possible dialysis. Choice D reason: Lethargy and difficulty arousing in a CKD patient who missed dialysis are red flags for uremia, hyperkalemia, or fluid overload. Immediate transport to the emergency department is critical to initiate life-saving interventions such as dialysis and electrolyte correction.