The nurse plans care for a client with end-stage renal failure who has an arteriovenous fistula in the left arm for vascular access during hemodialysis. Which nursing actions should the nurse include in the plan of care? Select all that apply.

Rationale: A. Vital signs are critical to assess the client’s hemodynamic status before, during, and after hemodialysis. Hypotension, tachycardia, or changes in oxygen saturation can indicate complications such as fluid shifts, bleeding, or cardiovascular instability. Continuous monitoring allows for timely interventions to maintain safety and stability throughout the procedure. B. Blood pressure and any venipuncture or intravenous access should never be performed on the arm with the AV fistula, as these actions can damage the fistula, increase the risk of thrombosis, or compromise future dialysis access. The contralateral arm should be used for these procedures to protect the integrity of the vascular access. C. The nurse should palpate for a thrill and auscultate for a bruit at the AV fistula site before each dialysis session. A palpable thrill and audible bruit indicate the fistula is patent and functioning. Absence or changes in these findings may signal clotting, stenosis, or other complications, requiring prompt evaluation to prevent loss of vascular access. D. Accurate pre- and post-dialysis weights are essential for calculating the ultrafiltration goal, which determines how much fluid should be removed during dialysis. This helps prevent complications such as hypotension, fluid overload, or electrolyte imbalances. Daily weights also assist in monitoring trends in fluid status between dialysis sessions. E. Many antihypertensive medications are withheld before hemodialysis because the procedure itself can lower blood pressure. Administering antihypertensives pre-dialysis increases the risk of intradialytic hypotension, which can lead to dizziness, syncope, or organ hypoperfusion. The provider may adjust the medication schedule based on the client’s hemodynamic status.