A nurse is assessing a client's arteriovenous fistula prior to hemodialysis, but does not hear a bruit or feel a thrill. Pulses distal to the fistula are not palpable, and the capillary refill is slow. Which of the following actions is the nurse's priority?

Proceed with hemodialysis.

Notify the provider immediately.

Raise the arm above the level of the patient's heart.

Apply warm packs to the fistula site and reassess.

Answer and Explanation

The Correct Answer is B

A.   This is incorrect and potentially dangerous. A non-functioning fistula will not provide adequate blood flow for dialysis and can lead to complications.
B.   This is the correct action. The nurse should immediately inform the healthcare provider about the compromised fistula. The provider can order further diagnostic tests or interventions as needed.

C.   This might improve blood flow temporarily, but it is not a definitive solution and does not address the underlying issue.
D.   While warm packs can sometimes improve circulation, it is unlikely to resolve the serious issues found in this case.

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Correct Answer is D

Explanation

A. Hyperkalemia and hypernatremia are generally not associated with the diuretic phase of AKI. In the diuretic phase, the primary issue is excessive loss of electrolytes and fluid, rather than their accumulation.
B. Hypokalemia can occur during the diuretic phase because diuretics increase the excretion of potassium along with water. Hypernatremia is not typical of the diuretic phase. Instead, sodium levels might decrease or remain normal due to the loss of fluid and electrolytes.
C. Hyperkalemia is unlikely during the diuretic phase as diuretics often lead to increased potassium loss. Hyponatremia is a more likely outcome during the diuretic phase due to the loss of sodium and fluid through increased urine output.

D. During the diuretic phase of AKI, there is significant loss of electrolytes, including potassium and sodium. Diuretics increase urine output, leading to the loss of potassium and sodium, which can occur as a result of excessive fluid and electrolyte loss.

A. A prostate examination B. A blood glucose check C. Genetic testing D. Antistreptolysin-O titers

Correct Answer is D

Explanation

A. A prostate examination is typically performed for issues related to the prostate, such as benign prostatic hyperplasia or prostate cancer. It is not relevant to diagnosing or managing acute glomerulonephritis, which is related to kidney inflammation rather than prostate issues.
B. A blood glucose check is used to diagnose and manage diabetes. While diabetes can contribute to chronic kidney disease, it is not the primary test for diagnosing acute glomerulonephritis or identifying its most common cause.
C. Genetic testing is useful for diagnosing inherited conditions or genetic predispositions to diseases. However, acute glomerulonephritis is typically caused by an infection or an autoimmune reaction, and genetic testing is not the primary diagnostic tool for this condition.
D. Antistreptolysin-O (ASO) titers are tests used to detect antibodies produced in response to a streptococcal infection. Elevated ASO titers indicate a recent streptococcal infection, which is the most common cause of post-infectious acute glomerulonephritis.

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A nurse is assessing a client's arteriovenous fistula prior to hemodialysis, but does not hear a bruit or feel a thrill. Pulses distal to the fistula are not palpable, and the capillary refill is slow. Which of the following actions is the nurse's priority?

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Naxlex Comprehensive Predictor Exams

During the diuretic phase of acute kidney injury, the nurse understands that the client is at risk for which of the following electrolyte imbalances?

Correct Answer is D

Explanation

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Correct Answer is D

Explanation

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A nurse is assessing a client's arteriovenous fistula prior to hemodialysis, but does not hear a bruit or feel a thrill. Pulses distal to the fistula are not palpable, and the capillary refill is slow. Which of the following actions is the nurse's priority?