CDN Certified Dialysis Nurse 2 — Questions and Answers
Question 1: A hemodialysis patient's access site shows redness, warmth, and purulent drainage. What is the nurse's priority action?
- Increase the dialysis flow rate
- Notify the physician and obtain a culture (Correct answer)
- Apply a warm compress and monitor
- Document findings and reassess in 4 hours
Correct answer: Notify the physician and obtain a culture
Signs of access site infection require immediate physician notification and culture collection to guide antibiotic therapy.
Question 2: Which electrolyte imbalance is most commonly associated with muscle cramps during hemodialysis?
- Hyperkalemia
- Hypernatremia
- Hypocalcemia (Correct answer)
- Hyperphosphatemia
Correct answer: Hypocalcemia
Hypocalcemia is a common cause of muscle cramps during dialysis due to calcium shifts across the dialyzer membrane.
Question 3: A peritoneal dialysis patient reports cloudy effluent with abdominal pain and fever. The nurse should suspect:
- Catheter malposition
- Peritonitis (Correct answer)
- Ultrafiltration failure
- Tunnel infection
Correct answer: Peritonitis
Cloudy effluent combined with abdominal pain and fever is the classic triad of peritoneal dialysis-associated peritonitis.
Question 4: The Kt/V value in hemodialysis measures which of the following?
- Blood pressure adequacy during treatment
- Dialysis adequacy by urea clearance (Correct answer)
- Ultrafiltration rate efficiency
- Vascular access flow volume
Correct answer: Dialysis adequacy by urea clearance
Kt/V is the standard measure of dialysis adequacy, representing urea clearance (K) × time (t) divided by urea distribution volume (V).
Question 5: Which medication should be administered with meals to a dialysis patient with hyperphosphatemia?
- Erythropoiesis-stimulating agent
- Phosphate binder (Correct answer)
- Vitamin D analog
- Iron supplement
Correct answer: Phosphate binder
Phosphate binders must be taken with meals to bind dietary phosphate in the gut before absorption.
Question 6: A patient on hemodialysis has a serum potassium of 6.8 mEq/L before treatment. Which dialysate potassium concentration is most appropriate?
- 4 mEq/L
- 3 mEq/L
- 2 mEq/L (Correct answer)
- 0 mEq/L
Correct answer: 2 mEq/L
A 2 mEq/L dialysate potassium creates an adequate gradient to remove excess potassium from a severely hyperkalemic patient.
Question 7: When priming a hemodialysis circuit, the nurse notices air in the venous drip chamber. The correct action is to:
- Begin treatment and monitor the patient closely
- Tap the chamber gently and adjust the blood level (Correct answer)
- Replace the entire blood tubing set
- Decrease the blood pump speed
Correct answer: Tap the chamber gently and adjust the blood level
Gently tapping the drip chamber and adjusting the fluid level removes air bubbles before initiating treatment to prevent air embolism.
CDN Certified Dialysis Nurse 2
A hemodialysis patient's access site shows redness, warmth, and purulent drainage.
What is the nurse's priority action?