A client with end-stage renal disease (ESRD) is experiencing severe fatigue, weakness, and decreased urine output. 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. Correct. Applying pressure to the bleeding site is the first action to control the bleeding and prevent excessive blood loss.

B. Incorrect. Elevating the arm above heart level may not be effective in controlling bleeding from the access site and could cause unnecessary discomfort.

C. Incorrect. Administering a prescribed antiplatelet medication is not the first action to take when the client experiences bleeding from the access site, as it may further increase bleeding risk.

D. Incorrect. While checking the client's platelet count is important, it is not the first action to address active bleeding. Applying pressure to the bleeding site takes priority to control the bleeding.

QUESTIONS

A) This statement is incorrect. Hypernatremia (high sodium levels) is not the primary indication for initiating dialysis in this case. Metabolic acidosis and the inability of the kidneys to excrete acids are the primary concerns.

B) This statement is incorrect. Hyperkalemia (elevated potassium levels) may occur in CKD, but it is not the primary indication described in the scenario. Metabolic acidosis is the primary concern leading to the need for dialysis.

C) This statement is incorrect. Hypocalcemia (low calcium levels) can be a complication of CKD, but it is not the primary indication for initiating dialysis in this scenario. Metabolic acidosis and its associated symptoms take precedence.

D) Severe metabolic acidosis, which results from the kidneys' inability to adequately excrete acids and regulate pH balance, is a critical indication for initiating dialysis in clients with CKD.