CHT Patient Assessment and Monitoring in Dialysis 1 — Questions and Answers
Question 1: What is the acceptable pre-dialysis systolic blood pressure range that typically allows hemodialysis treatment to proceed without intervention?
- Less than 90 mmHg
- 90–180 mmHg (Correct answer)
- Greater than 200 mmHg
- Exactly 120 mmHg
Correct answer: 90–180 mmHg
Most dialysis centers allow treatment when pre-dialysis systolic BP is between 90–180 mmHg; values outside this range require nursing assessment before proceeding.
Question 2: Which vital sign change most commonly signals the onset of intradialytic hypotension during hemodialysis?
- Sudden increase in body temperature above 38°C
- Drop in systolic blood pressure of ≥20 mmHg accompanied by symptoms (Correct answer)
- Sustained heart rate above 100 bpm for 10 minutes
- Decrease in respiratory rate below 12 breaths per minute
Correct answer: Drop in systolic blood pressure of ≥20 mmHg accompanied by symptoms
Intradialytic hypotension is clinically defined as a drop in systolic BP of ≥20 mmHg associated with symptoms such as dizziness, nausea, or muscle cramps.
Question 3: What is the primary clinical purpose of establishing a patient's 'dry weight' in hemodialysis?
- To calculate the appropriate dose of erythropoiesis-stimulating agents
- To assess the patient's nutritional protein intake between treatments
- To determine the target post-dialysis weight and guide the amount of fluid removal (Correct answer)
- To set the optimal blood flow rate for the treatment session
Correct answer: To determine the target post-dialysis weight and guide the amount of fluid removal
Dry weight (target weight) is the post-dialysis weight at which the patient is considered euvolemic, guiding the ultrafiltration goal for each treatment.
Question 4: Which patient symptom during hemodialysis requires the technician to immediately notify the supervising nurse?
- Patient reports feeling mildly thirsty during treatment
- Patient requests an extra blanket because they feel cold
- Sudden onset of chest pain and shortness of breath (Correct answer)
- Patient asks to use the restroom mid-treatment
Correct answer: Sudden onset of chest pain and shortness of breath
Chest pain and shortness of breath during dialysis may indicate life-threatening complications such as air embolism, cardiac event, or pulmonary embolism requiring immediate nursing intervention.
Question 5: During routine hemodialysis, how frequently should vital signs be monitored at a minimum to meet standard practice requirements?
- Once at the beginning of treatment only
- Only when the patient complains of a symptom
- Every 2 hours throughout the treatment session
- Every 30 minutes throughout the entire treatment (Correct answer)
Correct answer: Every 30 minutes throughout the entire treatment
Standard dialysis practice requires vital signs to be assessed at minimum every 30 minutes throughout treatment to enable early detection of complications.
Question 6: Which vascular access assessment finding before cannulation is most concerning and should prompt notification of the nurse before proceeding?
- Absence of bruit on auscultation over the access site (Correct answer)
- A palpable thrill along the length of the arteriovenous fistula
- Visible, well-distended veins with adequate vessel prominence
- Warm skin temperature of the extremity containing the access
Correct answer: Absence of bruit on auscultation over the access site
Absence of the expected bruit (and thrill) over an AV fistula suggests possible thrombosis or access failure, which requires nursing evaluation before cannulation.
Question 7: A patient's pre-dialysis weight is 75 kg and their established dry weight is 73 kg. What is the patient's interdialytic weight gain?
- 73 kg
- 148 kg
- 0.5 kg
- 2 kg (Correct answer)
Correct answer: 2 kg
Interdialytic weight gain is calculated as pre-dialysis weight minus dry weight: 75 kg − 73 kg = 2 kg, representing fluid accumulated since the last treatment.
CHT Patient Assessment and Monitoring in Dialysis 1
What is the acceptable pre-dialysis systolic blood pressure range that typically allows hemodialysis treatment to proceed without intervention?