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NCLEX Practice Question of the Week

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Here is the weekly question posted on the NCSBN Learning Extension:

A nurse is caring for a client with end stage renal disease. What action should the nurse take to assess for patency in a fistula used for hemodialysis?

  1. “Observe for edema proximal to the site”
  2. “Irrigate with 5 mL of 0.9% Normal Saline”
  3. “Palpate for a thrill over the fistula”
  4. “Check color and warmth in the extremity”

The correct answer is 3 – Palpate for a thrill over the fistula

No, this has nothing to do with that kind of thrill… silly.

According to an article in the Nephrology Nursing Journal, “Improving arteriorvenous fistula cannula skills,” a thrill is the “sensation that is felt over the anastamosis– where the vein and artery have been surgically joined together.” The vibrations that the nurse may feel when palpating the fistula is due to the blood flow from a high pressure artery to a low pressure vein. The thrill should only be felt at the anastamosis. Anywhere else could be a sign of venous stenosis.

Patency is a measurement of a tube’s opening. Patency is described in percent. Fistula is any abnormal opening or tube.

Ball, Linda K. “Improving arteriovenous fistula cannulation skills.” Nephrology Nursing Journal, Nov-Dec, 2005.


Written by stereotypicalone

June 1, 2009 at 19:33

Posted in NCLEX

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