CDN Certified Dialysis Nursing 5 — Questions and Answers
Question 1: A patient receiving erythropoiesis-stimulating agents (ESAs) for CKD-related anemia has a hemoglobin of 13.5 g/dL. What action should the nurse take?
- Increase the ESA dose to maintain higher hemoglobin
- Hold or reduce the ESA dose to keep hemoglobin within 10–11.5 g/dL (Correct answer)
- Continue current dose as 13.5 is within normal range
- Switch to IV iron supplementation instead
Correct answer: Hold or reduce the ESA dose to keep hemoglobin within 10–11.5 g/dL
Targeting hemoglobin >13 g/dL with ESAs increases cardiovascular risk; KDIGO guidelines recommend a target of 10–11.5 g/dL in dialysis patients.
Question 2: Which of the following is a contraindication to using a tunneled dialysis catheter as permanent long-term access?
- Patient is awaiting AV fistula maturation
- Patient has an active bloodstream infection (Correct answer)
- Patient has inadequate peripheral veins
- Patient is on anticoagulation therapy
Correct answer: Patient has an active bloodstream infection
Active bloodstream infection is an absolute contraindication to placing any new tunneled catheter, as it would seed the device and worsen infection.
Question 3: A dialysis patient asks why their residual renal function (RRF) should be preserved. What is the BEST nursing response?
- RRF only matters for PD patients, not HD patients
- RRF contributes to solute and fluid clearance, improves outcomes, and should be protected (Correct answer)
- RRF measurement is used only to determine if dialysis can be discontinued
- Preserving RRF has no impact once ESRD is reached
Correct answer: RRF contributes to solute and fluid clearance, improves outcomes, and should be protected
Even small amounts of residual kidney function significantly improve solute clearance, blood pressure control, and survival in both HD and PD patients.
Question 4: During hemodialysis, the conductivity alarm activates and the bypass alarm sounds. What should the nurse do IMMEDIATELY?
- Slow blood flow rate and continue treatment
- Clamp the blood lines to prevent patient exposure to incorrect dialysate (Correct answer)
- Increase ultrafiltration rate to compensate
- Disconnect the patient and flush lines with saline
Correct answer: Clamp the blood lines to prevent patient exposure to incorrect dialysate
A conductivity alarm indicates the dialysate concentration is incorrect; clamping the blood lines prevents exposure to potentially dangerous dialysate until the issue is resolved.
Question 5: A patient with ESRD secondary to diabetic nephropathy is on HD. Which complication of diabetes requires ADDITIONAL monitoring during dialysis sessions?
- Polycythemia
- Hypoglycemia due to glucose-free dialysate or insulin accumulation (Correct answer)
- Hyperthyroidism
- Respiratory alkalosis
Correct answer: Hypoglycemia due to glucose-free dialysate or insulin accumulation
Diabetic dialysis patients are at risk for hypoglycemia during HD because glucose-free or low-glucose dialysate removes blood glucose, and insulin clearance is reduced in ESRD.
Question 6: What is the MOST common cause of death in patients with end-stage renal disease on dialysis?
- Infection and sepsis
- Cardiovascular disease (Correct answer)
- Malignancy
- Stroke
Correct answer: Cardiovascular disease
Cardiovascular disease (including cardiac arrest, myocardial infarction, and heart failure) accounts for approximately 40–50% of deaths in ESRD patients on dialysis.
Question 7: A patient with a new AV graft reports pain, warmth, and redness along the graft with purulent drainage at the needle sites. What is the priority nursing intervention?
- Apply warm compresses and monitor for 24 hours
- Notify the physician immediately and prepare for possible graft removal (Correct answer)
- Increase the frequency of dialysis sessions
- Administer topical antibiotic ointment and redress the site
Correct answer: Notify the physician immediately and prepare for possible graft removal
Signs of graft infection (pain, warmth, erythema, purulent drainage) require immediate physician notification as infected grafts often require surgical removal to prevent sepsis.
CDN Certified Dialysis Nursing 5
A patient receiving erythropoiesis-stimulating agents (ESAs) for CKD-related anemia has a hemoglobin of 13.5 g/dL.
What action should the nurse take?