This is an extra credit question: A nurse is caring for a client receiving hemodialysis. Exhibits A nurse is for a client who has received hemodialysis. Which of the following assessment findings require follow-up?

A. The arteriovenous fistula site assessment showing warm skin and palpable brachial and radial pulses indicates a functioning fistula, which is expected and does not require immediate follow-up. A functioning AV fistula is critical for effective hemodialysis, and these findings align with normal post-dialysis assessment. B. Lung sounds noted as clear do not indicate an issue requiring follow-up. Clear lung fields suggest no fluid overload or pulmonary complications, common concerns in hemodialysis patients, making this finding normal and not necessitating further action. C. The presence of bruit and thrill at the AV fistula site is a normal finding, confirming patency and adequate blood flow for dialysis. This does not require follow-up, as it indicates the fistula is functioning properly. D. The blood glucose level of 134 mg/dL in a client with type 2 diabetes mellitus requires follow-up. Post-dialysis, patients with diabetes may experience glycemic variability due to insulin clearance changes during hemodialysis. This level, while not critically high, warrants monitoring to prevent hypo- or hyperglycemia, especially given the client's lethargy and vomiting, which could indicate metabolic instability. E. Weight assessment post-dialysis is critical and requires follow-up. Hemodialysis removes fluid, and weight changes reflect fluid status. The client’s weight of 90 kg pre-dialysis is noted, but post-dialysis weight is not provided. Monitoring weight is essential to assess fluid removal adequacy and prevent complications like hypotension or fluid overload, aligning with Maslow’s physiological needs for homeostasis. F. Vital signs, including temperature 36.3°C, heart rate 70/min, respiratory rate 16/min, blood pressure 144/72 mm Hg, and oxygen saturation on room air, are within normal limits post-dialysis. These do not indicate an immediate need for follow-up, as they reflect stable cardiovascular and respiratory status.