CDN Certified Dialysis Nursing 3 — Questions and Answers
Question 1: A dialysis patient's pre-treatment potassium is 6.8 mEq/L with peaked T-waves on ECG. Which dialysate potassium concentration should the nurse anticipate using?
- 4.0 mEq/L
- 3.0 mEq/L
- 2.0 mEq/L (Correct answer)
- 0 mEq/L
Correct answer: 2.0 mEq/L
A potassium-free or low-potassium (0–1 mEq/L) bath may be needed for severe hyperkalemia, but 2.0 mEq/L is often used to rapidly reduce dangerously elevated levels while avoiding too-rapid correction.
Question 2: Which sign indicates that a newly placed AV fistula has matured and is ready for use?
- Absence of thrill or bruit
- Fistula diameter ≥6mm, flow ≥600 mL/min, depth <6mm (Correct answer)
- Fistula is visible with no palpable thrill
- Edema resolved and skin over fistula intact
Correct answer: Fistula diameter ≥6mm, flow ≥600 mL/min, depth <6mm
The 'Rule of 6s' defines fistula maturity: flow ≥600 mL/min, diameter ≥6mm, and depth ≤6mm from skin surface, typically after 6 weeks.
Question 3: A hemodialysis patient reports headache, nausea, and confusion toward the end of treatment. Which complication should the nurse suspect?
- Air embolism
- Dialysis disequilibrium syndrome (Correct answer)
- Hemolysis
- Hypercalcemia
Correct answer: Dialysis disequilibrium syndrome
Dialysis disequilibrium syndrome results from rapid solute removal causing cerebral edema, presenting with neurological symptoms especially at end of treatment.
Question 4: What is the primary purpose of the dialysate bicarbonate concentration in hemodialysis?
- To prevent hypotension during treatment
- To correct metabolic acidosis common in ESRD (Correct answer)
- To remove excess phosphorus
- To enhance potassium removal
Correct answer: To correct metabolic acidosis common in ESRD
ESRD patients accumulate acid from metabolism; dialysate bicarbonate (usually 35–40 mEq/L) diffuses into the blood to correct metabolic acidosis.
Question 5: A chronic dialysis patient has a serum phosphorus of 7.2 mg/dL. In addition to dialysis, what is the MOST important nursing intervention?
- Restrict potassium intake
- Administer phosphate binders with meals (Correct answer)
- Increase dialysate calcium concentration
- Encourage high-protein diet
Correct answer: Administer phosphate binders with meals
Phosphate binders taken with meals bind dietary phosphorus in the gut, preventing its absorption and are the primary pharmacological management of hyperphosphatemia.
Question 6: Which nursing assessment finding is MOST consistent with catheter-related bloodstream infection in a dialysis patient?
- Bruit over the catheter site
- Fever, chills, and bacteremia without another source (Correct answer)
- Increased ultrafiltration rates
- Elevated BUN only
Correct answer: Fever, chills, and bacteremia without another source
CRBSI presents with fever and chills during or after dialysis with positive blood cultures and no other identifiable source of infection.
Question 7: What does a rising venous pressure alarm during hemodialysis MOST likely indicate?
- Arterial needle dislodgement
- Clotting or kinking in the venous return line or needle (Correct answer)
- Air in the blood circuit
- Low blood flow rate
Correct answer: Clotting or kinking in the venous return line or needle
Rising venous pressure indicates increased resistance to blood return, most commonly caused by clotting, kinking, or positional occlusion of the venous needle or tubing.
CDN Certified Dialysis Nursing 3
A dialysis patient's pre-treatment potassium is 6.8 mEq/L with peaked T-waves on ECG.
Which dialysate potassium concentration should the nurse anticipate using?