The nurse is planning client teaching for a client with end-stage kidney disease who is scheduled for the creation of a fistula. The nurse should teach the client what information about the fistula?

Choice A reason: Immobilization of the arm for 4 to 6 days is contraindicated following the creation of an arteriovenous (AV) fistula. While the incision site must be protected, gentle exercise of the arm, such as squeezing a rubber ball, is actually encouraged to increase blood flow and promote the "maturation" or thickening of the vessel walls.

Choice B reason: An AV fistula is created by a surgical anastomosis between an artery (typically the radial or brachial artery) and a vein (typically the cephalic vein). This allows high-pressure arterial blood to flow directly into the vein, causing the vein to dilate and become tough enough to withstand repeated large-bore needle cannulations.

Choice C reason: Hemodialysis requires two needles to be inserted into the fistula for each treatment, not one. One needle (the arterial needle) withdraws blood from the body to be sent to the dialyzer for cleaning, while the second needle (the venous needle) returns the filtered blood back to the patient's circulation.

Choice D reason: An AV fistula cannot be used 5 to 7 days after surgery. It requires a significant "maturation" period, usually lasting 2 to 4 months, before it is ready for use. Using it too early can cause the vessel to collapse or infiltrate. If urgent dialysis is needed, a temporary central venous catheter is used in the interim.

Choice A reason: Joint pain (arthralgia) is a common extraintestinal manifestation of Crohn's disease and can also be a side effect of biologic therapy. While uncomfortable and worth noting, it is not typically an acute life-threatening emergency. It does not carry the same immediate clinical urgency as a sign of systemic infection in an immunocompromised patient.

Choice B reason: Infliximab is a tumor necrosis factor (TNF) inhibitor that significantly suppresses the immune system. Patients taking biologics are at high risk for serious opportunistic infections, including tuberculosis and sepsis. A fever may be the only early sign of a life-threatening infection, requiring immediate cessation of the drug and medical evaluation.

Choice C reason: Headache is a frequently reported side effect of infliximab infusions. While it should be monitored, it is generally considered a minor adverse effect unless it is exceptionally severe or accompanied by neurological deficits. It does not indicate the high level of physiological risk that a fever does in an immunosuppressed individual.

Choice D reason: Nausea is another common side effect associated with many medications, including biologics for inflammatory bowel disease. While it affects the client's quality of life and nutritional status, it is not an indicator of an acute, high-priority safety concern like a potential systemic infection or a severe hypersensitivity reaction.