CDN Dialysis Nursing 4 — Questions and Answers
Question 1: A hemodialysis patient experiences sudden onset of chest tightness, back pain, and flushing 5 minutes after starting a new dialyzer. The nurse should suspect:
- Disequilibrium syndrome
- Type A dialyzer reaction (anaphylactic) (Correct answer)
- Air embolism
- Hemolysis
Correct answer: Type A dialyzer reaction (anaphylactic)
Chest tightening, back pain, and flushing early in dialysis indicate a Type A hypersensitivity reaction, often to the dialyzer membrane.
Question 2: Which phosphate binder should be used with caution in dialysis patients with cardiovascular disease?
- Sevelamer carbonate
- Lanthanum carbonate
- Calcium carbonate (Correct answer)
- Ferric citrate
Correct answer: Calcium carbonate
Calcium-based binders like calcium carbonate increase calcium load and can worsen vascular calcification in patients with cardiovascular disease.
Question 3: During CRRT using citrate anticoagulation, which lab value indicates citrate toxicity?
- Elevated serum sodium
- Widening gap between ionized and total calcium (Correct answer)
- Increasing BUN levels
- Declining platelet count
Correct answer: Widening gap between ionized and total calcium
Citrate toxicity causes chelation of ionized calcium while total calcium rises, creating a widening total-to-ionized calcium ratio.
Question 4: A patient's interdialytic weight gain is consistently 4–5 kg. The most effective nursing intervention is:
- Increase ultrafiltration to remove more fluid each session
- Provide education on fluid restriction and sodium reduction (Correct answer)
- Recommend additional dialysis sessions each week
- Decrease the dry weight target
Correct answer: Provide education on fluid restriction and sodium reduction
Education on fluid restriction and dietary sodium reduction addresses the root cause of excessive interdialytic weight gain.
Question 5: The recirculation rate in a functioning AV fistula is measured to be 15%. This finding indicates:
- Normal fistula function
- Significant access dysfunction requiring evaluation (Correct answer)
- Adequate dialysis adequacy
- Need to increase dialysis time only
Correct answer: Significant access dysfunction requiring evaluation
Recirculation above 10% suggests access dysfunction such as stenosis, which reduces dialysis efficiency and requires vascular evaluation.
Question 6: Which complication is most associated with rapid correction of severe hyponatremia in a dialysis patient?
- Cerebral edema
- Osmotic demyelination syndrome (Correct answer)
- Hyperchloremic metabolic acidosis
- Dialysis disequilibrium syndrome
Correct answer: Osmotic demyelination syndrome
Rapid correction of chronic hyponatremia can cause osmotic demyelination syndrome (central pontine myelinolysis) due to abrupt osmotic shifts.
Question 7: A nurse assesses a tunneled dialysis catheter exit site and notes fibrin sheath formation on the catheter tip. The expected consequence is:
- Increased risk of air embolism
- Reduced blood flow and inadequate dialysis (Correct answer)
- Elevated venous pressure alarms only during removal
- Peritonitis development
Correct answer: Reduced blood flow and inadequate dialysis
Fibrin sheath formation around a catheter tip obstructs blood flow, causing poor dialysate delivery and inadequate treatment.
CDN Dialysis Nursing 4
A hemodialysis patient experiences sudden onset of chest tightness, back pain, and flushing 5 minutes after starting a new dialyzer.
The nurse should suspect: