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 C

Explanation

A. This is a common symptom of uremia, which is the buildup of waste products in the blood due to kidney failure. It is expected in a patient with ESRD who has discontinued dialysis.
B. As the body accumulates waste products, fatigue and lethargy are common symptoms of uremia. This is expected in a patient with ESRD who has discontinued dialysis.

C. Polyuria is excessive urination. With kidney failure, the kidneys are unable to concentrate urine, leading to oliguria or anuria, not polyuria. Therefore, polyuria would not be expected in this patient.
D. This is a white, crystalline deposit on the skin caused by the accumulation of urea and uric acid. It is a sign of severe uremia and would be expected in a patient with ESRD who has discontinued dialysis.

A. Milk B. Liver C. Spinach D. Chocolate

Correct Answer is B

Explanation

A. Milk is low in purines and is not associated with an increase in uric acid levels or the formation of uric acid stones. In fact, dairy products like milk can be beneficial in a diet for managing kidney stones because they are low in purines and provide calcium, which may help prevent stone formation.

B. Liver is very high in purines. High-purine foods increase the levels of uric acid in the body, which can lead to the formation of uric acid stones in the kidneys. Therefore, clients with recurrent kidney stones due to excessive purine intake should avoid liver and other organ meats.
C. Spinach is considered to have a moderate level of purines. While it is not as high in purines as organ meats, it still contains a notable amount. However, in comparison to foods like liver, it is less of a concern for individuals who need to strictly limit purine intake.
D. Chocolate contains a moderate amount of purines, but it is not as high in purines as organ meats like liver. While it’s not completely free from purines, its purine content is generally lower compared to foods such as liver.

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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

Correct Answer is C

Explanation

A client has had recurrent kidney stones. Upon lab analysis of the client's urine, it is found that excessive purine intake is the underlying cause. Which of the following high-purine foods should the nurse instruct the client to avoid?

Correct Answer is B

Explanation

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