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.
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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Hypertension is a risk factor for kidney disease. However, it can often be managed with medication. Controlled hypertension is not typically a contraindication for a kidney transplant.
B. If the client has maintained sobriety for a significant period, it might not be a contraindication. A history of alcohol abuse would require careful evaluation but doesn't necessarily preclude transplantation.
C. This is a contraindication for kidney transplantation. Severe heart disease can significantly increase the risks associated with surgery and post-transplant care.
D. Hepatitis C can be a challenge but it's not an absolute contraindication. Many transplant centers have protocols for managing hepatitis C-positive recipients.
Correct Answer is C
Explanation
A. While this medication is used to treat hyperkalemia, it is a slower acting treatment. Given the patient's critical condition with altered mental status, hyperkalemia, and elevated BUN, a more rapid intervention is needed.
B. Fluid resuscitation is important in some cases of AKI but it is not the priority in this patient. The patient is already showing signs of fluid overload (crackles in the lungs) and the primary issue is the inability of the kidneys to remove waste products and excess fluids.
C. This is the most appropriate treatment for this patient. RRT, such as hemodialysis or continuous renal replacement therapy (CRRT), can rapidly remove waste products, excess fluid, and electrolytes from the blood, correcting the imbalances and improving the patient's condition.
D. This medication is used for long-term management of hyperkalemia, but it is not effective in an acute setting like this.
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