CDN Dialysis Complications and Emergency Management 1 — Questions and Answers
Question 1: A patient on hemodialysis suddenly develops nausea, headache, and altered consciousness near the end of treatment. What condition should the nurse suspect?
- Air embolism
- Dialysis disequilibrium syndrome (Correct answer)
- Hemolysis
- Hypersensitivity reaction
Correct answer: Dialysis disequilibrium syndrome
Dialysis disequilibrium syndrome (DDS) occurs due to rapid solute removal causing osmotic cerebral edema, typically in new or high-BUN patients.
Question 2: What is the first action when an air embolism is suspected during hemodialysis?
- Administer 100% oxygen and clamp the venous line (Correct answer)
- Increase blood flow rate
- Notify the physician and continue dialysis
- Reduce ultrafiltration immediately
Correct answer: Administer 100% oxygen and clamp the venous line
Clamping the venous blood line immediately stops air from entering the patient while 100% oxygen helps reabsorb nitrogen bubbles.
Question 3: A patient develops pink-tinged blood in the dialysate port during hemodialysis. What does this most likely indicate?
- Dialyzer membrane leak (Correct answer)
- Air embolism
- Heparin overdose
- Hypersensitivity reaction type A
Correct answer: Dialyzer membrane leak
Pink or red-tinged dialysate indicates a dialyzer membrane rupture, which can allow blood to leak into the dialysate compartment.
Question 4: Intradialytic hypotension is most effectively prevented by which of the following interventions?
- Increasing the dialysate temperature
- Using a higher sodium dialysate concentration
- Limiting the ultrafiltration rate to ≤13 mL/kg/hour (Correct answer)
- Administering IV albumin before each session
Correct answer: Limiting the ultrafiltration rate to ≤13 mL/kg/hour
Limiting ultrafiltration to ≤13 mL/kg/hour reduces the rate of fluid removal, allowing adequate plasma refilling and preventing hemodynamic instability.
Question 5: Which set of symptoms is most consistent with a Type A hypersensitivity reaction to the dialyzer?
- Chest pain, back pain, and pink dialysate
- Fever, chills, and rigors 30 minutes into dialysis
- Burning, flushing, dyspnea, and anaphylaxis in the first few minutes (Correct answer)
- Hypotension, nausea, and muscle cramps mid-treatment
Correct answer: Burning, flushing, dyspnea, and anaphylaxis in the first few minutes
Type A (anaphylactic) reactions occur within the first few minutes of dialysis due to IgE-mediated sensitivity to ETO sterilization or membrane components.
Question 6: A patient receiving hemodialysis develops severe chest pain and dyspnea. The nurse suspects hemolysis. What is the characteristic appearance of the blood in the extracorporeal circuit?
- Dark maroon, thick blood
- Cherry-red, translucent blood (Correct answer)
- Bright red, frothy blood
- Pale pink, watery blood
Correct answer: Cherry-red, translucent blood
Hemolysis causes red blood cells to rupture and release hemoglobin, making the blood appear cherry-red and translucent rather than opaque.
CDN Dialysis Complications and Emergency Management 1
A patient on hemodialysis suddenly develops nausea, headache, and altered consciousness near the end of treatment.
What condition should the nurse suspect?