Mixed Deck — All CDN Topics Flashcards

Which erythropoiesis-stimulating agent (ESA) is most commonly used to treat anemia of chronic kidney disease in dialysis patients?

Answer: Epoetin alfa

Epoetin alfa is the most widely used ESA for dialysis-associated anemia, stimulating bone marrow production of red blood cells.

During hemodialysis, the blood pump stops and blood is observed to be dark in the arterial line. What is the most likely cause?

Answer: Arterial needle clotting or dislodgement

Dark, de-oxygenated blood backing up in the arterial line suggests the arterial needle has clotted or dislodged, severely limiting blood flow.

What interdialytic weight gain is generally considered the maximum acceptable limit for a hemodialysis patient?

Answer: 3–5% of dry body weight

Interdialytic weight gain up to 3–5% of dry body weight is generally considered acceptable, though lower gains are associated with better outcomes.

IV iron supplementation is indicated in dialysis patients when ferritin is below what threshold despite ESA therapy?

Answer: 200 ng/mL

IV iron is commonly indicated when serum ferritin is below 200 ng/mL or transferrin saturation is below 20%, suggesting functional iron deficiency limiting ESA response.

What is the most common cause of ESA hyporesponsiveness (failure to achieve target hemoglobin despite adequate ESA doses) in dialysis patients?

Answer: Iron deficiency

Iron deficiency is by far the most frequent cause of ESA hyporesponsiveness because adequate iron supply is essential for the bone marrow to respond to ESA stimulation and synthesize hemoglobin.

What is the rationale for timing the administration of intravenous antibiotics in hemodialysis patients?

Answer: Antibiotics should be dosed after dialysis to prevent removal by the procedure

Many antibiotics are dialyzable, so post-dialysis dosing prevents drug removal and ensures therapeutic blood levels persist until the next session.

What is the primary purpose of reverse osmosis (RO) in the dialysis water treatment system?

Answer: Remove dissolved ionic contaminants including heavy metals

Reverse osmosis removes dissolved ionic contaminants such as aluminum, fluoride, and heavy metals by forcing water through a semi-permeable membrane under pressure.

A dialysis patient collapses immediately after leaving the unit post-treatment. Emergency responders find ventricular fibrillation. What is the most likely contributing factor?

Answer: Post-dialysis rebound hyperkalemia combined with post-treatment hemodynamic instability

Post-dialysis VF can result from hypokalemia during treatment (from low-potassium dialysate) followed by rapid potassium rebound, combined with QT prolongation and hemodynamic instability after treatment.

A dialysis patient presents with sudden onset chest pain, dyspnea, and cyanosis during treatment. Air embolism is suspected. The immediate nursing action is to:

Answer: Stop the blood pump, clamp the venous line, and position patient on left side in Trendelenburg

Stopping blood flow, clamping the venous line, and positioning the patient left lateral Trendelenburg traps air in the right ventricle apex away from the pulmonary circulation.

What is the most common cause of intradialytic hypotension?

Answer: Ultrafiltration rate exceeding plasma refilling rate

Intradialytic hypotension most commonly occurs when the ultrafiltration rate exceeds the body's ability to refill the intravascular space from interstitial fluid.

Which dietary restriction is most important for ESRD patients between hemodialysis sessions to prevent life-threatening complications?

Answer: Restrict potassium and phosphorus intake

Limiting potassium prevents fatal hyperkalemia and limiting phosphorus prevents secondary hyperparathyroidism and vascular calcification between dialysis sessions.

What is the minimum white blood cell count in peritoneal dialysis effluent that is diagnostic of peritonitis?

Answer: 100 WBC/mm³ with >50% neutrophils

ISPD guidelines define peritonitis as effluent WBC ≥100/mm³ with >50% polymorphonuclear cells after a minimum two-hour dwell.

A dialysis patient repeatedly misses treatments. What is the most effective first step in addressing non-adherence?

Answer: Explore underlying barriers such as transportation, depression, or financial concerns

Identifying and addressing root causes of non-adherence — such as psychosocial barriers, depression, or logistical obstacles — is more effective than punitive approaches.

Which of the following is a sign of disequilibrium syndrome during hemodialysis?

Answer: Headache, nausea, and altered consciousness

Disequilibrium syndrome presents with neurological symptoms including headache, nausea, and altered mental status due to rapid osmotic shifts.

A patient begins dialysis and their blood in the arterial line appears bright pink or 'cherry red.' What condition should be suspected?

Answer: Carbon monoxide poisoning from hemolysis in water treatment failure

Cherry-red or bright pink blood during dialysis suggests hemolysis, which can occur from water treatment failure with chloramine breakthrough, overheated dialysate, or hypotonic dialysate.

A dialysis patient with diabetes has an AV fistula. When assessing the fistula, the nurse palpates a thrill and hears a bruit. This finding indicates:

Answer: Normal fistula function

A palpable thrill and audible bruit indicate adequate blood flow through a patent, functional AV fistula.

Which laboratory value should be checked monthly in stable hemodialysis patients according to KDOQI guidelines?

Answer: Hemoglobin, serum ferritin, and transferrin saturation

KDOQI recommends monthly monitoring of hemoglobin, ferritin, and transferrin saturation to guide ESA and IV iron therapy adjustments.

Which fluid restriction guideline is commonly recommended for anuric hemodialysis patients?

Answer: Urine output plus 500–750 mL/day

Non-anuric patients are restricted to their urine output plus 500–750 mL/day to account for insensible losses while preventing interdialytic fluid overload.

Heparin is administered at the start of hemodialysis primarily to prevent:

Answer: Clotting in the extracorporeal circuit

Heparin prevents thrombus formation in the blood tubing, dialyzer, and needle during passage of blood through the extracorporeal circuit.

Which intervention is recommended to prevent steal syndrome in a patient with an AV fistula?

Answer: Surgical banding or revision of the fistula

Steal syndrome (ischemia distal to the AV fistula) is managed surgically through banding or revision to reduce blood diversion from the distal extremity.