# Before hemodialysis, the nurse cannot feel a thrill or hear a bruit over a client's arteriovenous fistula. Which action should the nurse take?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=497916&lang=en  
> language: en  
> subject: Postsurgical Complications  
> category: ROR

## Question

Before hemodialysis, the nurse cannot feel a thrill or hear a bruit over a client's arteriovenous fistula. Which action should the nurse take?

## Option

1. Apply a blood pressure cuff to the access arm and compare both arms
2. Massage the fistula firmly until a vibration becomes easy to feel
3. Proceed with cannulation and reassess the access after dialysis begins
4. Stop access use and notify the dialysis team about possible occlusion **✔ Correct answer**

**Correct answer: 4**

## Explanation

An absent thrill and bruit suggest loss of blood flow from stenosis or thrombosis. The access should not be cannulated; the nurse should protect the arm and notify the dialysis team promptly so patency can be evaluated and restored.

## In-depth explanation

Quick answer
Do not use the fistula and notify the dialysis team promptly. The missing thrill and bruit indicate that blood flow may be critically reduced or absent.

Why this is correct
A functioning fistula produces a palpable vibration and an audible flow sound. Their absence can indicate thrombosis or severe obstruction, and needle insertion could injure the access or fail to provide adequate dialysis while delaying time-sensitive evaluation.

Easy analogy or mental picture
The thrill and bruit are like the vibration and sound of water moving through a pipe. When both disappear, check for blockage rather than puncturing the pipe; the image does not identify the exact lesion without clinical evaluation.

Memory hook
No thrill and no bruit means no access use: protect the arm and report possible occlusion now.

NCLEX decision rule
Assess hemodialysis access by looking, listening, and feeling before use. If flow findings are absent or markedly changed, avoid cannulation and pressure on the arm and notify the dialysis team for urgent assessment.

Why the other choices are wrong
A blood pressure cuff adds compression to the access arm. Firm massage can damage a compromised fistula, and proceeding with cannulation risks infiltration, access injury, and ineffective dialysis.References

- [1]NCSBN: 2026 NCLEX-RN Test PlanNational Council of State Boards of Nursing

- [2]National Kidney Foundation: Hemodialysis AccessNational Kidney Foundation

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