CDN Dialysis Nursing 3 — Questions and Answers
Question 1: A patient on continuous renal replacement therapy (CRRT) develops filter clotting after 4 hours. Which intervention should the nurse assess first?
- Increase blood flow rate
- Evaluate anticoagulation adequacy and citrate/heparin dosing (Correct answer)
- Change the replacement fluid type
- Increase the effluent rate
Correct answer: Evaluate anticoagulation adequacy and citrate/heparin dosing
Early filter clotting is most commonly related to inadequate anticoagulation, making assessment of anticoagulant delivery the priority.
Question 2: Which dietary restriction is most critical for a hemodialysis patient between treatments?
- Limit vitamin C intake to prevent oxalate stones
- Restrict fluid intake to 1,000 mL/day plus urine output (Correct answer)
- Avoid all protein-containing foods
- Eliminate all dietary sodium
Correct answer: Restrict fluid intake to 1,000 mL/day plus urine output
Fluid restriction to 1,000 mL plus urine output prevents dangerous interdialytic weight gain and pulmonary edema.
Question 3: During hemodialysis, the venous pressure alarm sounds high. Which cause should the nurse investigate first?
- Kinked or occluded venous blood line (Correct answer)
- Inadequate heparin dosing
- Blood pump speed too low
- Dialysate temperature too high
Correct answer: Kinked or occluded venous blood line
A kinked or occluded venous line creates resistance to blood return, causing high venous pressure alarms.
Question 4: Secondary hyperparathyroidism in dialysis patients is primarily triggered by:
- Vitamin D deficiency and hyperphosphatemia (Correct answer)
- Excess dietary calcium intake
- High aluminum levels from dialysate
- Sodium imbalance during treatment
Correct answer: Vitamin D deficiency and hyperphosphatemia
Reduced kidney activation of vitamin D and elevated phosphate both stimulate PTH secretion, causing secondary hyperparathyroidism.
Question 5: A nurse preparing to initiate hemodialysis discovers the conductivity alarm is reading 17 mS/cm instead of the expected 13–15 mS/cm. The correct action is:
- Begin dialysis at reduced blood flow rate
- Do not initiate dialysis; troubleshoot the conductivity reading (Correct answer)
- Add distilled water to dilute the dialysate
- Notify the patient but proceed with treatment
Correct answer: Do not initiate dialysis; troubleshoot the conductivity reading
Abnormal conductivity indicates incorrect dialysate concentration, which can cause severe electrolyte imbalances and hemolysis if used.
Question 6: Which sign best indicates that an AV graft is functioning adequately during assessment?
- Visible pulsation at the anastomosis site
- Palpable thrill along the graft (Correct answer)
- Equal blood pressure in both arms
- Audible bruits only at the venous end
Correct answer: Palpable thrill along the graft
A continuous palpable thrill throughout the graft length indicates adequate arteriovenous flow and patent graft.
Question 7: A peritoneal dialysis patient using a 4.25% dextrose exchange complains of hyperglycemia. This concentration is most appropriate for which clinical situation?
- Maintenance fluid removal in a stable patient
- Management of severe fluid overload requiring enhanced ultrafiltration (Correct answer)
- Prevention of peritonitis
- Replacement of lost proteins during dialysis
Correct answer: Management of severe fluid overload requiring enhanced ultrafiltration
The 4.25% dextrose solution creates a higher osmotic gradient to achieve greater ultrafiltration in fluid-overloaded patients.
CDN Dialysis Nursing 3
A patient on continuous renal replacement therapy (CRRT) develops filter clotting after 4 hours.
Which intervention should the nurse assess first?