A client with chronic kidney disease (CKD) is experiencing severe metabolic acidosis, which is not responding to medical management. Which of the following is the primary indication for initiating dialysis in this client?

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

A) The client's symptoms of dizziness and weakness may indicate hypotension (low blood pressure). The nurse should first check the client's blood pressure and pulse rate to assess for hypotension before implementing further interventions.

B) This statement is incorrect. Administering an antiemetic medication would not address the reported symptoms of dizziness and weakness, which may be related to changes in blood pressure.

C) This statement is incorrect. Increasing the rate of fluid removal during dialysis may exacerbate the client's symptoms of dizziness and weakness and may lead to hypotension (low blood pressure).

D) This statement is incorrect. Elevating the client's legs may help improve blood flow, but it does not address the underlying cause of the reported symptoms. The nurse should first check the client's blood pressure and pulse rate to assess for hypotension before implementing further interventions.