A nurse is teaching a client who has chronic kidney disease and a new prescription for epoetin alfa. The nurse should instruct the client to increase dietary intake of which of the following substances?

Rationale: A. Iron is essential for the effectiveness of epoetin alfa, a synthetic form of erythropoietin that stimulates red blood cell production in the bone marrow. Clients with chronic kidney disease (CKD) often have low erythropoietin levels and iron deficiency, which can limit the drug’s effectiveness. Adequate iron intake supports hemoglobin synthesis and ensures that newly produced red blood cells are healthy and functional. The nurse should encourage consumption of iron-rich foods such as lean meats, eggs, legumes, and fortified cereals or the use of prescribed iron supplements. B. Sodium should be restricted in CKD because excess sodium can cause fluid retention, hypertension, and edema, worsening cardiovascular strain and contributing to further kidney damage. Increasing sodium intake would counteract fluid balance goals in these clients. C. Protein intake is usually limited in CKD to reduce the accumulation of nitrogenous waste products such as urea and creatinine. Although protein is essential for maintaining muscle mass, excessive intake can increase the kidney’s workload and accelerate the decline in renal function. D. Potassium should be restricted in CKD because the kidneys cannot adequately excrete it. Elevated potassium levels (hyperkalemia) can lead to dangerous cardiac dysrhythmias or cardiac arrest. Therefore, the nurse should teach the client to avoid potassium-rich foods such as bananas, oranges, and potatoes.