CDN Dialysis Nursing 2 — Questions and Answers
Question 1: A hemodialysis patient's access site shows redness, warmth, and purulent drainage. What is the priority nursing action?
- Increase the dialysis flow rate
- Notify the physician and obtain cultures before starting antibiotics (Correct answer)
- Apply a warm compress and continue dialysis
- Document findings and reassess in 2 hours
Correct answer: Notify the physician and obtain cultures before starting antibiotics
Signs of access infection require prompt physician notification and cultures before antibiotic initiation to guide targeted therapy.
Question 2: Which electrolyte imbalance most commonly causes muscle cramps during hemodialysis?
- Hyperkalemia
- Hypernatremia
- Hypocalcemia (Correct answer)
- Hyperphosphatemia
Correct answer: Hypocalcemia
Hypocalcemia during dialysis causes neuromuscular irritability leading to muscle cramps.
Question 3: A peritoneal dialysis patient develops cloudy effluent with abdominal pain and fever. The most likely diagnosis is:
- Catheter malposition
- Peritonitis (Correct answer)
- Ultrafiltration failure
- Tunnel infection
Correct answer: Peritonitis
Cloudy effluent with abdominal pain and fever is the classic triad of peritoneal dialysis-related peritonitis.
Question 4: When calculating Kt/V for hemodialysis adequacy, what does 'K' represent?
- Dialysate potassium concentration
- Urea clearance of the dialyzer (Correct answer)
- Patient's body weight in kilograms
- Duration of dialysis in minutes
Correct answer: Urea clearance of the dialyzer
In the Kt/V formula, K represents the dialyzer's urea clearance rate in mL/min.
Question 5: A dialysis patient's pre-treatment blood pressure is 85/50 mmHg. The appropriate nursing action is to:
- Begin dialysis at a reduced ultrafiltration rate
- Hold dialysis and notify the physician (Correct answer)
- Administer a fluid bolus of normal saline per protocol
- Begin dialysis at standard settings
Correct answer: Hold dialysis and notify the physician
Symptomatic hypotension before dialysis initiation requires physician notification before proceeding with treatment.
Question 6: The target hemoglobin range for most dialysis patients receiving erythropoiesis-stimulating agents (ESAs) per KDIGO guidelines is:
- 8–9 g/dL
- 10–11.5 g/dL (Correct answer)
- 12–13 g/dL
- 14–15 g/dL
Correct answer: 10–11.5 g/dL
KDIGO guidelines recommend maintaining hemoglobin between 10–11.5 g/dL to balance anemia correction with cardiovascular risk.
Question 7: Which finding during the arteriovenous fistula assessment indicates adequate maturation for cannulation?
- Fistula diameter ≥ 6 mm with flow ≥ 600 mL/min at 6 weeks (Correct answer)
- Presence of a bruit only, without thrill
- Fistula visible at skin surface within 2 weeks of creation
- Blood pressure equal in both arms
Correct answer: Fistula diameter ≥ 6 mm with flow ≥ 600 mL/min at 6 weeks
A mature fistula should have a diameter of at least 6 mm and blood flow of at least 600 mL/min, typically assessed at 6 weeks post-creation.
CDN Dialysis Nursing 2
A hemodialysis patient's access site shows redness, warmth, and purulent drainage.
What is the priority nursing action?