The main indication for hemodialysis for a client who has chronic renal failure is :

IGNOU PB Bsc Entrance-2022

Medical & Surgical Nursing

Medium

Appeared in: IGNOU PB Bsc Entrance-2022

Explanation

Hyperkalemia (high potassium) is the most life-threatening electrolyte imbalance in chronic renal failure (CRF).
The failing kidneys are unable to excrete potassium, causing it to build up in the blood.
High potassium levels are cardiotoxic and can lead to fatal cardiac arrhythmias, such as ventricular fibrillation or asystole.
Hemodialysis is the fastest and most effective method to remove excess potassium from the body, making it a primary indication for treatment.

Option A: Ascites (fluid in the peritoneal cavity) is more commonly a sign of advanced liver disease (cirrhosis) rather than a primary indication for dialysis in renal failure.
Option B: While CRF does cause metabolic acidosis, it is typically managed with oral alkali supplements like sodium bicarbonate. Dialysis is only indicated for severe acidosis that does not respond to medical therapy.
Option C: Hypertension is a very common complication of CRF, usually resulting from fluid overload and hormonal changes. It is primarily managed with antihypertensive medications and dietary salt restriction.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Indications for hemodialysis in chronic renal failure as background academic context rather than a clinical decision trigger.
A nurse's priority for a patient with CRF and high potassium is continuous cardiac monitoring to detect life-threatening arrhythmias.
Nurses must be prepared to administer emergency medications for hyperkalemia (calcium gluconate, insulin/dextrose) and facilitate urgent transfer for hemodialysis.
Patient education on a low-potassium diet is a crucial nursing role in managing CRF and preventing hyperkalemic emergencies.

How to Approach the Question

First, identify the core of the question: it asks for the 'main' indication for hemodialysis in a patient with chronic renal failure. The word 'main' suggests you must prioritize the options.
Analyze the options provided. All four (ascites, metabolic acidosis, hypertension, hyperkalemia) can be associated with renal failure.
Apply the principle of 'most life-threatening'. Ask yourself which of these conditions, if left untreated, would cause the most immediate harm or death.
Compare the risks: Hypertension and metabolic acidosis are serious but are often managed medically first. Ascites is a sign of fluid overload but not the most direct threat. Severe hyperkalemia directly causes fatal cardiac arrest.
Conclude that hyperkalemia poses the most immediate danger to life, making it the primary or main indication for an urgent intervention like hemodialysis.

Concept Tested & Keywords

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E6 Medicine Harrison 22e Part 2 pp. 294-296, 286-288

E6 Nelson Textbook of Pediatrics(2024) — Volume 2 p. 1049-1051