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
A. It helps to temporarily lower serum potassium levels by driving potassium into the cells. This effect is usually short-lived and is often used in emergency situations to quickly manage hyperkalemia.
B. Calcium Gluconate is used to stabilize the cardiac membrane in the setting of hyperkalemia, especially if there are ECG changes or symptoms of hyperkalemia. It does not lower the serum potassium level but helps protect the heart from the potential arrhythmias caused by elevated potassium levels.
C. Patiromer (Veltassa) is a potassium binder that helps to remove excess potassium from the body through the gastrointestinal tract. It binds potassium in the gut and facilitates its excretion in the stool.
D. Lisinopril is an ACE inhibitor used to treat hypertension and heart failure. It can actually increase potassium levels by decreasing the excretion of potassium through the kidneys.
Correct Answer is A
Explanation
A. BPH is a common condition in older men that causes the prostate gland to enlarge, obstructing the urethra and leading to difficulty urinating, urinary retention, and pelvic pain. The symptoms described, including urinary frequency, weak urinary stream, severe pelvic pain, and a significantly elevated post- void residual urine volume, are consistent with BPH.
B. ESRD can cause urinary symptoms. However, the presentation in this case is more consistent with a urinary obstruction, not a kidney failure issue. ESRD typically involves more systemic symptoms like fatigue, edema, and electrolyte imbalances.
C. This is unlikely given the patient's age and lack of significant comorbidities. Additionally, the primary issue appears to be urinary obstruction, not a decrease in renal perfusion.
D. This is a chronic condition that typically presents with flank pain, and it does not usually cause acute urinary retention.
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