CDN Certified Dialysis Nursing 4 — Questions and Answers
Question 1: A patient on hemodialysis develops sudden onset of back and chest pain with pink-tinged plasma and falling hematocrit during treatment. What complication is occurring?
- Air embolism
- Hemolysis (Correct answer)
- Anaphylactic reaction to dialyzer
- Ultrafiltration failure
Correct answer: Hemolysis
Hemolysis causes destruction of red blood cells, releasing hemoglobin that turns plasma pink; it is a dialysis emergency caused by heat, kinking, or hypotonic dialysate.
Question 2: Which secondary hyperparathyroidism finding is a consequence of chronic kidney disease and impacts dialysis nursing care?
- Decreased osteocalcin and low bone turnover
- Elevated PTH driving bone disease, hypercalcemia, and vascular calcification (Correct answer)
- Reduced phosphorus reabsorption from the gut
- Suppressed calcitriol production causing hyperphosphatemia only
Correct answer: Elevated PTH driving bone disease, hypercalcemia, and vascular calcification
CKD-MBD involves elevated PTH due to reduced vitamin D activation and hyperphosphatemia, leading to renal osteodystrophy and cardiovascular calcification.
Question 3: A peritoneal dialysis patient's drain effluent is consistently brown or feculent. What does this MOST likely indicate?
- Normal variation in PD effluent color
- Bowel perforation with fecal contamination of the peritoneum (Correct answer)
- Hemoperitoneum from catheter trauma
- Fungal peritonitis
Correct answer: Bowel perforation with fecal contamination of the peritoneum
Brown or feculent effluent strongly suggests bowel perforation with intestinal contents contaminating the peritoneal cavity, requiring emergency surgical evaluation.
Question 4: When assessing for adequate anticoagulation during hemodialysis with heparin, which test is MOST commonly used bedside?
- PT/INR
- Activated Clotting Time (ACT) (Correct answer)
- aPTT drawn every 30 minutes
- Anti-Xa level
Correct answer: Activated Clotting Time (ACT)
The Activated Clotting Time (ACT) is a rapid bedside test used to monitor heparin anticoagulation during hemodialysis, with target typically 150–250 seconds.
Question 5: A dialysis nurse notes the patient's interdialytic weight gain is consistently 4–5 kg between sessions. What is the PRIORITY patient education topic?
- Protein intake and dietary adequacy
- Fluid and sodium restriction (Correct answer)
- Phosphorus-rich foods to avoid
- Exercise between treatments
Correct answer: Fluid and sodium restriction
Excessive interdialytic weight gain (>2–3 kg) reflects fluid and sodium excess, requiring education on fluid restriction and limiting high-sodium foods.
Question 6: What is the significance of a 'thrill' in an arteriovenous fistula?
- It indicates the fistula is infected
- It confirms patent blood flow through the fistula and is a normal finding (Correct answer)
- It signals impending thrombosis
- It indicates aneurysm formation
Correct answer: It confirms patent blood flow through the fistula and is a normal finding
A continuous thrill (vibration felt on palpation) over an AV fistula indicates turbulent, high-flow patent blood through the vessel and is an expected normal finding.
Question 7: Which medication class should be held BEFORE hemodialysis to avoid removal by the dialysis membrane?
- Calcium channel blockers
- Water-soluble vitamins like B-complex and vitamin C (Correct answer)
- Fat-soluble vitamins A, D, E, K
- Proton pump inhibitors
Correct answer: Water-soluble vitamins like B-complex and vitamin C
Water-soluble vitamins are readily dialyzed out; they should be administered AFTER dialysis or replaced with post-dialysis supplementation to ensure therapeutic levels.
CDN Certified Dialysis Nursing 4
A patient on hemodialysis develops sudden onset of back and chest pain with pink-tinged plasma and falling hematocrit during treatment.
What complication is occurring?