CDN Certified Dialysis Nursing 2 — Questions and Answers
Question 1: A hemodialysis patient develops sudden chest pain, dyspnea, and hypotension during treatment. What is the FIRST nursing action?
- Slow the blood flow rate and notify the physician
- Stop dialysis, return blood to patient, and call for emergency help (Correct answer)
- Administer IV normal saline bolus immediately
- Place patient in Trendelenburg position
Correct answer: Stop dialysis, return blood to patient, and call for emergency help
Sudden cardiopulmonary emergency during HD requires stopping treatment, returning blood to prevent additional fluid/electrolyte shifts, and activating emergency response.
Question 2: Which electrolyte imbalance is MOST commonly associated with muscle cramps during hemodialysis?
- Hyperkalemia
- Hypernatremia
- Hypocalcemia
- Rapid ultrafiltration causing hypovolemia (Correct answer)
Correct answer: Rapid ultrafiltration causing hypovolemia
Muscle cramps during HD are most often caused by rapid fluid removal leading to intravascular volume depletion and tissue hypoperfusion.
Question 3: A patient's dialysis access shows a bruit that has changed from soft to high-pitched. What does this finding indicate?
- Increased blood flow through the access
- Possible stenosis or partial occlusion of the access (Correct answer)
- Normal maturation of a new AV fistula
- Infection at the access site
Correct answer: Possible stenosis or partial occlusion of the access
A high-pitched or harsh bruit replacing a soft, low-pitched one suggests turbulent flow from stenosis, which requires prompt evaluation.
Question 4: What is the recommended target range for dialysis adequacy (Kt/V) in hemodialysis patients per KDOQI guidelines?
- ≥0.8 per session
- ≥1.2 per session (Correct answer)
- ≥1.4 per session
- ≥1.8 per session
Correct answer: ≥1.2 per session
KDOQI guidelines recommend a minimum delivered spKt/V of 1.2 per hemodialysis session to ensure adequate solute clearance.
Question 5: Which peritoneal dialysis complication is characterized by cloudy effluent, abdominal pain, and fever?
- Ultrafiltration failure
- Peritonitis (Correct answer)
- Catheter exit-site infection
- Hernia
Correct answer: Peritonitis
Peritonitis presents with cloudy effluent (WBC >100 cells/mm³ with >50% PMNs), abdominal pain, and fever in PD patients.
Question 6: A patient on peritoneal dialysis has persistent poor ultrafiltration. Which intervention should the nurse anticipate?
- Increase dwell time for all exchanges
- Switch to higher dextrose concentration dialysate (Correct answer)
- Reduce the number of daily exchanges
- Decrease the fill volume per exchange
Correct answer: Switch to higher dextrose concentration dialysate
Higher dextrose concentration (2.5% or 4.25%) creates a stronger osmotic gradient to enhance fluid removal when ultrafiltration is inadequate.
Question 7: When assessing a patient for adequacy of PD, the nurse calculates a weekly Kt/V of 1.5. How should this be interpreted?
- Inadequate — target is ≥2.0
- Adequate — meets the minimum target of ≥1.7
- Inadequate — target is ≥1.7 (Correct answer)
- Adequate — no changes needed as any value above 1.0 is acceptable
Correct answer: Inadequate — target is ≥1.7
KDOQI recommends a minimum total weekly Kt/V of ≥1.7 for peritoneal dialysis; a value of 1.5 is below this target and requires intervention.
CDN Certified Dialysis Nursing 2
A hemodialysis patient develops sudden chest pain, dyspnea, and hypotension during treatment.
What is the FIRST nursing action?