A nurse is reviewing the laboratory data of a client following a hemodialysis treatment. The nurse should expect to find a decrease in which of the following laboratory values?

Choice A rationale Phosphorus levels are expected to decrease after hemodialysis because the procedure effectively filters out excess phosphate from the blood. In chronic kidney disease, the kidneys cannot excrete phosphorus, leading to levels above the normal range of 3.0 to 4.5 mg/dL. Hemodialysis uses a semipermeable membrane and a dialysate solution to pull these electrolytes from the area of high concentration to low concentration, thereby reducing the risk of mineral bone disorders. Choice B rationale Calcium levels often increase or remain stable during hemodialysis rather than decrease. Dialysate often contains calcium to help correct the hypocalcemia typically found in renal failure patients. The goal is to maintain calcium within the normal range of 9.0 to 10.5 mg/dL. Reducing calcium would be detrimental to a patient who already suffers from secondary hyperparathyroidism. Therefore, a decrease in calcium is not an expected or desired outcome following a typical dialysis session. Choice C rationale The red blood cell count does not decrease as a direct result of effective hemodialysis filtering. While some blood loss can occur within the dialysis tubing, the procedure is designed to remove toxins and fluid rather than cells. Patients with renal failure often have low RBC counts, with normal hemoglobin for men being 14 to 18 g/dL and women 12 to 16 g/dL, due to decreased erythropoietin production, but this is a chronic state. Choice D rationale Protein molecules are generally too large to pass through the semipermeable membrane used in hemodialysis. Therefore, the nurse would not expect to see a significant decrease in serum protein levels, such as albumin, which has a normal range of 3.5 to 5.0 g/dL. Maintaining protein levels is vital for oncotic pressure and nutritional status. If large amounts of protein were lost during the procedure, it would indicate a problem with the dialyzer membrane integrity.