CDN Dialysis Nursing 5 — Questions and Answers
Question 1: A home peritoneal dialysis patient reports that their dwell time has been shortened due to work. The nurse's priority concern is:
- Increased risk of peritonitis
- Inadequate solute clearance and underdialysis (Correct answer)
- Excessive ultrafiltration leading to dehydration
- Catheter exit site infection
Correct answer: Inadequate solute clearance and underdialysis
Shortened dwell times reduce equilibration and solute clearance, leading to inadequate dialysis and uremic toxin accumulation.
Question 2: Which clinical finding most strongly suggests air embolism during hemodialysis?
- Sudden hypotension with bradycardia
- Cyanosis, dyspnea, and millwheel murmur over the precordium (Correct answer)
- High arterial pressure alarm with access pain
- Fever and shaking chills after 30 minutes
Correct answer: Cyanosis, dyspnea, and millwheel murmur over the precordium
Air embolism classically presents with cyanosis, respiratory distress, and a churning millwheel murmur caused by air in the right heart.
Question 3: A patient's spKt/V result is 1.1. According to KDOQI guidelines, the appropriate nursing response is:
- Document as adequate; target is met
- Notify the care team; the minimum target of 1.2 has not been achieved (Correct answer)
- Increase heparin dosing for next session
- Reduce treatment time to improve patient tolerance
Correct answer: Notify the care team; the minimum target of 1.2 has not been achieved
KDOQI guidelines recommend a minimum spKt/V of 1.2 per treatment; a result of 1.1 falls below this threshold and requires intervention.
Question 4: A dialysis patient on warfarin for atrial fibrillation has an INR of 4.8 before treatment. The nurse should:
- Proceed with dialysis using standard heparin protocol
- Hold dialysis until INR normalizes to therapeutic range
- Notify the physician and withhold heparin during dialysis (Correct answer)
- Administer vitamin K and begin dialysis immediately
Correct answer: Notify the physician and withhold heparin during dialysis
A supratherapeutic INR increases bleeding risk; the physician should be notified and heparin withheld to minimize hemorrhagic complications during access cannulation.
Question 5: Which parameter best guides the adjustment of a peritoneal dialysis patient's dry weight (target weight)?
- Serum albumin level
- Clinical signs of fluid status: blood pressure, edema, and lung sounds (Correct answer)
- Weekly BUN and creatinine trends
- Peritoneal equilibration test (PET) results
Correct answer: Clinical signs of fluid status: blood pressure, edema, and lung sounds
Dry weight in PD is determined clinically by assessing blood pressure, presence of edema, and auscultation for fluid in the lungs.
Question 6: The nurse notes that a hemodialysis patient's blood urea nitrogen (BUN) is 95 mg/dL pre-dialysis but 88 mg/dL post-dialysis. The URR is approximately:
- 7% (Correct answer)
- 8%
- 65%
- 92%
Correct answer: 7%
URR = (pre-BUN minus post-BUN) / pre-BUN × 100 = (95−88)/95 × 100 ≈ 7%, indicating severely inadequate dialysis.
Question 7: A nurse is educating a new dialysis patient about signs of access failure at home. Which symptom should prompt immediate medical attention?
- Mild warmth along the fistula after exercise
- Loss of thrill or bruit over the AV fistula (Correct answer)
- Minor bruising at old needle sites
- Skin darkening over the fistula over several months
Correct answer: Loss of thrill or bruit over the AV fistula
Loss of thrill or bruit indicates cessation of blood flow through the fistula, signaling thrombosis requiring immediate vascular intervention.
CDN Dialysis Nursing 5
A home peritoneal dialysis patient reports that their dwell time has been shortened due to work.
The nurse's priority concern is: