A nurse is presenting an educational event to a local community group. When speaking about colorectal cancer, what risk factor should the nurse cite?

Choice A reason: Auscultating the fistula with a stethoscope is not contraindicated; it is a mandatory assessment. The nurse must listen for a bruit, which is the sound of turbulent blood flow. The presence of a bruit, along with a palpable thrill, confirms that the arteriovenous fistula is patent and functioning correctly for hemodialysis access.

Choice B reason: Protection of the vascular access is paramount. Taking a blood pressure reading, performing venipunctures, or starting intravenous lines on the affected arm can cause compression, thrombosis, or collapse of the fistula. These actions jeopardize the client's "lifeline" for dialysis and can lead to permanent loss of the access site.

Choice C reason: Clients rarely feel best immediately after dialysis. Hemodialysis often causes "dialysis disequilibrium" or post-dialysis fatigue due to rapid shifts in fluid, electrolytes, and urea. Clients frequently report feeling exhausted, washed out, or dizzy immediately following a four-hour treatment session as their bodies adjust to the sudden physiological changes.

Choice D reason: While the goal is to minimize discomfort, it is incorrect to say the client "should not" feel pain. Initiation of dialysis involves the insertion of two large-bore needles (usually 15 to 17 gauge) into the fistula. This process is inherently painful or uncomfortable, though many chronic patients develop a high tolerance for the sensation over time.

Choice A reason: A poor appetite (anorexia) is a common symptom in patients with renal failure due to the buildup of metabolic waste products (uremia). While this requires nutritional intervention and monitoring over time, it is not an acute emergency that requires an "urgent" contact with the healthcare provider.

Choice B reason: A weight decrease of 3 lb in a patient with AKI is often a positive sign, particularly if the patient was previously in the oliguric phase with fluid retention. It likely indicates the diuretic phase of recovery, though the nurse should monitor for dehydration and electrolyte shifts associated with this weight loss.

Choice C reason: A white blood cell count of 8200/mm3 falls within the normal reference range (5000 to 10000/mm3). This suggests that the patient does not currently have a systemic infection, which is a common complication of AKI. Since this is a normal finding, no urgent action is required.

Choice D reason: A serum potassium level of 2.6 mEq/L indicates severe hypokalemia (normal: 3.5 to 5.0 mEq/L). In AKI, this can occur during the diuretic phase as the kidneys lose the ability to concentrate urine. Severe hypokalemia can lead to life-threatening cardiac arrhythmias and requires immediate replacement therapy and cardiac monitoring.