A nurse is assessing a client with an AV fistula. Which of the following assessments should the nurse perform to evaluate the function of the AV fistula? (Select All that Apply.)

Observe the client's skin color and temperature in the affected arm

Measure the blood pressure in the affected arm

Auscultate for the presence of a bruit over the fistula

Palpate the fistula for a thrill

Assess the client's cognitive status

Assess the client's respiratory rate

Answer and Explanation

Correct Answer : A,C,D

A: Monitoring the skin color and temperature can help identify complications such as thrombosis or infection in the fistula arm.
B: Blood pressure measurement in the fistula arm should be avoided because it may cause damage to the fistula.
C: A bruit indicates proper blood flow through the fistula, which is essential for function.
D: A thrill is a palpable vibration that should be present if the fistula is functioning correctly.
E: Cognitive status is not relevant to evaluating the function of the AV fistula.
F: Respiratory rate is unrelated to assessing the fistula's function.

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Correct Answer is B

Explanation

A. This statement describes hemodialysis, not CAPD. CAPD uses the peritoneal membrane to filter blood.
B. CAPD typically requires fewer dietary and fluid restrictions than hemodialysis because it is done continuously, providing more stable fluid and electrolyte balance.
C. Clients with a history of abdominal surgery may have adhesions or other issues that make CAPD less suitable.
D. While CAPD requires exchanges to occur several times a day, it does not require a rigid schedule of exchange times as hemodialysis does.

A. Delegating tasks to appropriate team members B. Prioritizing patient care tasks based on urgency C. Documenting patient care thoroughly after each task D. Frequently checking personal phone during shifts

Correct Answer is D

Explanation

A: Delegating tasks to appropriate team members is an essential skill for time management and ensures that patient care is completed efficiently.
B: Prioritizing tasks based on urgency is crucial for effective time management and ensures that patient care is provided in a timely manner.
C: Documenting patient care is important for legal, medical, and communication purposes. It ensures that care is well-documented and can be referenced if needed.
D: Checking a personal phone frequently during shifts is a time waster as it distracts from patient care and reduces focus on responsibilities.

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A nurse is assessing a client with an AV fistula. Which of the following assessments should the nurse perform to evaluate the function of the AV fistula? (Select All that Apply.)

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