A nurse is reviewing the medication list of a patient with end-stage renal disease (ESRD) who is receiving hemodialysis. The nurse knows that certain medications are used to prevent complications of this disease. Which of the following medications would the nurse question as part of routine therapy for preventing complications of ESRD?

Choice A reason: Taking blood pressure in the left arm with an AV fistula risks compressing the fistula, potentially causing thrombosis or damage. This can impair dialysis access, leading to inadequate treatment and complications like uremia or fluid overload. Blood pressure should be measured in the opposite arm to protect the fistula.

Choice B reason: Keeping the AV fistula site dry is important to prevent infection, as moisture can promote bacterial growth. However, it is not the priority over ensuring fistula patency, which is critical for effective dialysis. Infection prevention is secondary to confirming the fistula’s functionality to avoid life-threatening dialysis interruptions.

Choice C reason: Wrapping the AV fistula in gauze is not standard practice unless post-surgical or infected. Excessive wrapping may obscure the site, hindering patency assessments, and could increase infection risk if not changed properly. This action is less critical than ensuring the fistula’s functionality for dialysis.

Choice D reason: Assessing the AV fistula for bruit (whooshing sound) and thrill (vibration) confirms patency, ensuring it is functional for dialysis. A non-patent fistula prevents effective toxin and fluid removal, leading to uremia, hyperkalemia, or fluid overload. This assessment is the priority to ensure life-sustaining dialysis can proceed without complications.

Choice A reason: Violating a nurse’s boundaries, such as inappropriate behavior, does not legally mandate breaching confidentiality. Ethical responses involve setting boundaries or reporting within the care team, but confidentiality is protected unless harm to others is threatened, making this situation insufficient for a legal breach.

Choice B reason: Nurses are legally obligated to breach confidentiality when a client makes credible threats to harm an identifiable third party (Tarasoff duty). This protects potential victims by ensuring warnings or interventions occur, balancing patient confidentiality with public safety, as harm prevention takes precedence in mental health law.

Choice C reason: Client aggression does not automatically warrant breaching confidentiality unless it involves specific threats to identifiable individuals. Aggression is managed within the care setting, and confidentiality is maintained unless legal criteria, like imminent harm to others, are met, making this option incorrect.

Choice D reason: Disagreement with the nurse does not justify breaching confidentiality. Ethical care respects client autonomy, and confidentiality is protected unless legal exceptions, like threats or court orders, apply. Disagreement is managed through therapeutic communication, not by disclosing private information, making this an invalid reason for breach.