Which action will the nurse include in the plan of care to maintain the patency of a patient's left arm arteriovenous fistula?

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.

A. Raisins: Raisins are dried fruits that contain high amounts of potassium. In clients with chronic kidney disease, the kidneys are less able to excrete potassium, increasing the risk of hyperkalemia. Limiting intake of raisins helps maintain safer serum potassium levels.

B. Tomatoes: Tomatoes are naturally high in potassium, and consuming them in large amounts can contribute to elevated potassium levels in clients with kidney impairment. Avoiding or limiting tomato-based foods is important for dietary potassium management.

C. Green Beans: Green beans are relatively low in potassium compared with other vegetables and are generally safe for clients with chronic kidney disease when consumed in moderation. They do not pose a significant risk for hyperkalemia.

D. Asparagus: Asparagus contains moderate amounts of potassium but is lower than high-potassium foods such as bananas or tomatoes. It can usually be included in a kidney-friendly diet in controlled portions.

E. Bananas: Bananas are very high in potassium and are considered a high-risk food for clients with chronic kidney disease. Restricting bananas is essential to prevent dangerous increases in serum potassium levels.