A55-yr-old woman admitted for shoulder surgery asks the nurse for a perineal pad, stating that laughing or coughing causes leakage of urine. Which intervention is appropriate to include in the care plan?

A. Compare blood pressures in the left and right arms: Blood pressure should never be measured in the arm with an arteriovenous fistula because the pressure from the cuff can damage the access site and compromise patency.

B. Assess the quality of the left radial pulse: While radial pulse assessment provides information about peripheral circulation, it does not specifically evaluate fistula function. The patency of a fistula is best assessed directly at the site rather than by distal pulses.

C. Auscultate for a bruit at the fistula site: The presence of a bruit, along with palpating a thrill, is the most reliable way to confirm that the arteriovenous fistula is patent and functioning. Regular assessment helps detect complications such as thrombosis or stenosis.

D. Irrigate the fistula site with saline every 8 to 12 hours: Irrigating or flushing the fistula is not an appropriate nursing action. Invasive manipulation can damage the site, increase infection risk, and jeopardize vascular access, which is essential for hemodialysis treatment.

A. Collect a urine specimen for culture and sensitivity: This intervention is indicated when infection is suspected, in cases of fever, dysuria, or cloudy urine. The lab values here suggest hemoconcentration rather than infection, so a culture would not address the client’s fluid balance problem.

B. Continue routine care because the results are within the expected reference range: The results are not all within the expected range. The BUN of 32 mg/dL is elevated, and the hematocrit of 50% is high, both pointing toward dehydration.

C. Decrease the IV fluid infusion rate and limit oral fluid intake: Reducing fluid intake would be inappropriate in this case, since the client shows signs of fluid volume deficit. Decreasing fluids would worsen dehydration, elevate lab abnormalities further, and compromise perfusion.

D. Evaluate urine for amount and for specific gravity: Monitoring urine volume and specific gravity provides important information about hydration status and renal concentrating ability. Since the elevated BUN and hematocrit suggest dehydration, assessing urine helps guide fluid management and ensures appropriate therapy response.