CDN Certified Dialysis Nurse 5 — Questions and Answers
Question 1: A patient on automated peritoneal dialysis (APD) has gained 5 kg since last clinic visit. Which assessment finding would confirm this is fluid rather than true weight gain?
- Elevated serum albumin
- Pitting edema and hypertension (Correct answer)
- Increased appetite and food intake
- Elevated serum creatinine
Correct answer: Pitting edema and hypertension
Pitting edema and hypertension confirm fluid overload as the cause of weight gain, indicating inadequate ultrafiltration.
Question 2: Which dietary restriction is unique to peritoneal dialysis patients compared to hemodialysis patients?
- Fluid restriction is typically more liberal (Correct answer)
- Potassium restriction is typically stricter
- Protein restriction is more severe
- Phosphate intake is unrestricted
Correct answer: Fluid restriction is typically more liberal
Peritoneal dialysis provides continuous fluid removal, so fluid restrictions are generally more liberal than in intermittent hemodialysis.
Question 3: A dialysis nurse notes the transmembrane pressure (TMP) alarm is triggered repeatedly during treatment. This most likely indicates:
- Arterial line disconnection
- Clotting in the dialyzer (Correct answer)
- Air detector malfunction
- Venous access infiltration
Correct answer: Clotting in the dialyzer
Rising TMP indicates increased resistance to ultrafiltration, most commonly caused by clot formation within the dialyzer fibers.
Question 4: A patient with ESRD on hemodialysis is prescribed cinacalcet. The nurse understands this medication works by:
- Blocking phosphate absorption in the intestine
- Increasing sensitivity of calcium-sensing receptors to suppress PTH (Correct answer)
- Replacing calcitriol deficiency in renal failure
- Chelating phosphate in the gastrointestinal tract
Correct answer: Increasing sensitivity of calcium-sensing receptors to suppress PTH
Cinacalcet is a calcimimetic that increases calcium-sensing receptor sensitivity, reducing PTH secretion in secondary hyperparathyroidism.
Question 5: Which of the following findings during hemodialysis requires the nurse to immediately stop treatment and return blood to the patient?
- Serum potassium of 5.5 mEq/L
- Venous pressure alarm with clotted graft (Correct answer)
- New systolic blood pressure drop of 10 mmHg
- Patient complaint of thirst
Correct answer: Venous pressure alarm with clotted graft
A clotted graft with venous pressure alarm indicates access failure requiring immediate discontinuation to prevent further complications.
Question 6: When a CAPD patient performs an exchange, the effluent appears bloody. After ruling out trauma, the nurse should assess for:
- Peritonitis
- Herniation
- Menstruation or ovulation in female patients (Correct answer)
- Catheter migration into the chest
Correct answer: Menstruation or ovulation in female patients
In female patients, retrograde menstruation or ovulation are common benign causes of bloody peritoneal effluent and should be assessed.
Question 7: The minimum recommended blood flow rate for effective hemodialysis in most adult patients is:
- 100–150 mL/min
- 150–200 mL/min
- 200–300 mL/min (Correct answer)
- 350–500 mL/min
Correct answer: 200–300 mL/min
Adult hemodialysis typically requires blood flow rates of 200–300 mL/min to achieve adequate solute clearance within standard treatment times.
CDN Certified Dialysis Nurse 5
A patient on automated peritoneal dialysis (APD) has gained 5 kg since last clinic visit.
Which assessment finding would confirm this is fluid rather than true weight gain?