CDN Certified Dialysis Nurse 3 — Questions and Answers
Question 1: 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:
- Fistula stenosis
- Normal fistula function (Correct answer)
- Early fistula thrombosis
- Aneurysm formation
Correct answer: Normal fistula function
A palpable thrill and audible bruit indicate adequate blood flow through a patent, functional AV fistula.
Question 2: Which of the following is a sign of disequilibrium syndrome during hemodialysis?
- Hypotension and bradycardia
- Headache, nausea, and altered consciousness (Correct answer)
- Pruritus and muscle cramping
- Fever and chills
Correct answer: Headache, nausea, and altered consciousness
Disequilibrium syndrome presents with neurological symptoms including headache, nausea, and altered mental status due to rapid osmotic shifts.
Question 3: A patient receiving continuous renal replacement therapy (CRRT) has a filter clotting frequently. Which anticoagulation method is typically used first-line in CRRT?
- Warfarin
- Heparin infusion
- Regional citrate anticoagulation (Correct answer)
- Low-molecular-weight heparin
Correct answer: Regional citrate anticoagulation
Regional citrate anticoagulation is the preferred first-line method for CRRT as it provides effective circuit anticoagulation with minimal systemic effects.
Question 4: The target hemoglobin range for dialysis patients receiving erythropoiesis-stimulating agents (ESAs) per KDIGO guidelines is:
- 8–9 g/dL
- 10–11.5 g/dL (Correct answer)
- 12–13 g/dL
- 13–14 g/dL
Correct answer: 10–11.5 g/dL
KDIGO guidelines recommend maintaining hemoglobin between 10–11.5 g/dL for dialysis patients on ESAs to balance benefit and cardiovascular risk.
Question 5: A peritoneal dialysis patient using automated peritoneal dialysis (APD) reports the machine alarming 'drain incomplete.' The nurse's first intervention is to:
- Replace the PD catheter immediately
- Reposition the patient and check catheter kinks (Correct answer)
- Switch to manual CAPD exchanges
- Increase the dwell time on the next cycle
Correct answer: Reposition the patient and check catheter kinks
Repositioning the patient and checking for catheter kinks addresses the most common mechanical causes of incomplete drainage.
Question 6: Which serum laboratory value is the best indicator of long-term nutritional status in a hemodialysis patient?
- Serum creatinine
- Serum albumin (Correct answer)
- Blood urea nitrogen
- Serum phosphorus
Correct answer: Serum albumin
Serum albumin reflects long-term protein stores and nutritional status, with levels below 3.5 g/dL indicating malnutrition in dialysis patients.
Question 7: A patient's AV graft has a pseudoaneurysm at a needle insertion site. The nurse should:
- Continue using the site with extra care
- Rotate needle sites away from the pseudoaneurysm and notify the physician (Correct answer)
- Apply firm pressure for 30 minutes
- Discontinue dialysis until surgically repaired
Correct answer: Rotate needle sites away from the pseudoaneurysm and notify the physician
Pseudoaneurysms require physician notification and needle sites should be rotated away to prevent rupture while awaiting surgical evaluation.
CDN Certified Dialysis Nurse 3
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: