CDN Certified Dialysis Nurse 4 — Questions and Answers
Question 1: Which of the following best describes the role of the dialyzer membrane in hemodialysis?
- It actively pumps solutes from blood to dialysate
- It allows diffusion of solutes down concentration gradients (Correct answer)
- It filters only large molecular weight toxins
- It maintains blood pressure by removing excess fluid actively
Correct answer: It allows diffusion of solutes down concentration gradients
The dialyzer membrane allows passive diffusion of solutes from areas of higher concentration (blood) to lower concentration (dialysate).
Question 2: A dialysis patient presents with sudden onset chest pain, dyspnea, and cyanosis during treatment. Air embolism is suspected. The immediate nursing action is to:
- Stop the blood pump, clamp the venous line, and position patient on left side in Trendelenburg (Correct answer)
- Administer oxygen and notify the physician
- Increase the ultrafiltration rate to remove fluid
- Return blood and disconnect the patient from the machine
Correct 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.
Question 3: Which ESRD complication is characterized by elevated PTH, hypocalcemia, and hyperphosphatemia?
- Adynamic bone disease
- Secondary hyperparathyroidism (Correct answer)
- Osteoporosis
- Osteitis fibrosa cystica reversal
Correct answer: Secondary hyperparathyroidism
Secondary hyperparathyroidism in ESRD results from chronically low calcium and high phosphorus stimulating excessive PTH production.
Question 4: When teaching a patient about AV fistula care at home, which instruction is most important?
- Apply ice to reduce swelling daily
- Avoid blood pressure measurement and blood draws in that arm (Correct answer)
- Massage the fistula twice daily to maintain flow
- Wear a tight compression bandage when not on dialysis
Correct answer: Avoid blood pressure measurement and blood draws in that arm
Avoiding BP cuffs, blood draws, and IV access in the fistula arm prevents compression and vessel damage that could compromise the access.
Question 5: A hemodialysis patient develops sudden hypotension during treatment. Which intervention should the nurse perform first?
- Administer antihypertensive medication
- Place the patient in Trendelenburg position and reduce ultrafiltration rate (Correct answer)
- Increase the blood pump speed
- Administer a loop diuretic
Correct answer: Place the patient in Trendelenburg position and reduce ultrafiltration rate
Trendelenburg positioning improves venous return while reducing the ultrafiltration rate addresses the primary cause of intradialytic hypotension.
Question 6: Which type of vascular access has the highest rate of infection among ESRD patients?
- Arteriovenous fistula
- Arteriovenous graft
- Tunneled dialysis catheter (Correct answer)
- Temporary non-tunneled catheter
Correct answer: Tunneled dialysis catheter
Tunneled dialysis catheters have significantly higher infection rates compared to fistulas and grafts due to the direct bloodstream access they provide.
Question 7: The 'KDOQI first' principle recommends which vascular access as the preferred option for new hemodialysis patients?
- Tunneled central venous catheter
- Arteriovenous graft
- Arteriovenous fistula (Correct answer)
- Subclavian catheter
Correct answer: Arteriovenous fistula
KDOQI guidelines strongly recommend the native AV fistula as the first choice due to its superior longevity and lowest complication rates.
CDN Certified Dialysis Nurse 4
Which of the following best describes the role of the dialyzer membrane in hemodialysis?