A nurse is caring for a client with acute kidney injury (AKI). The client's urine output is significantly reduced, and laboratory tests show elevated levels of blood urea nitrogen (BUN) and creatinine. Which of the following is the primary indication for initiating dialysis in this client?

A. Incorrect. Instructing the client to increase fluid intake may not address the underlying cause of abdominal pain and fever in a client on peritoneal dialysis.

B. Incorrect. Assisting the client with a peritoneal fluid exchange is not the priority when the client is experiencing abdominal pain and fever, as it may exacerbate the symptoms.

C. Incorrect. Administering an over-the-counter pain reliever may provide temporary relief, but it does not address the underlying cause of the symptoms.

D. Correct. Abdominal pain and fever in a client on peritoneal dialysis may indicate peritonitis, an infection of the peritoneal cavity. Obtaining a peritoneal fluid sample for testing is essential to confirm the diagnosis and initiate appropriate treatment promptly.

A. Correct. Using the arm with the AV fistula for blood pressure measurements can compress the vascular access and compromise blood flow. It is important to avoid using the fistula arm for blood pressure measurements and venipuncture.

B. Incorrect. The AV fistula should not be used for intravenous catheter insertion to prevent potential damage and infection to the access site.

C. Incorrect. Self-cannulation of the AV graft is typically performed by healthcare professionals, and clients should not attempt to self-cannulate their vascular access.

D. Incorrect. If an AV fistula starts bleeding, the client should not apply pressure to the site. Instead, they should immediately elevate the arm and apply pressure to the bleeding site with a clean cloth or bandage while seeking medical attention.

QUESTIONS