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1. What is considered the advantage of coiled catheters for peritoneal dialysis? A. Improve patient comfort B. Better fluid flow C. Less kinking ✅ Correct Answer: A. Improve patient comfort Rationale: Coiled catheters reduce discomfort by allowing better positioning inside the abdomen. 2. Which complication of peritoneal dialysis should the technician report when observing cloudy effluent? A. Tunnel infection B. Fibrin formation C. Peritonitis ✅ Correct Answer: C. Peritonitis Rationale: Cloudy effluent is a hallmark sign of peritonitis, a serious infection. 3. Which patient complaint may indicate air has entered the peritoneal cavity? A. Shoulder pain B. Swelling in the neck C. Scrotal edema ✅ Correct Answer: A. Shoulder pain Rationale: Referred pain to the shoulder is typical when air irritates the diaphragm. 4. What is the most frequent complication of peritoneal dialysis? A. Formation of fibrin strands B. Peritonitis C. Leakage of dialysate ✅ Correct Answer: B. Peritonitis Rationale: Infection of the peritoneum is the most common and serious complication. 5. What are disadvantages of a kidney transplant that should be shared with the patient?
A. Abdominal pain due to incising muscles B. Need for lifelong immunosuppression C. Potential complications of immunosuppression ✅ Correct Answers: B and C Rationale: Patients must take immunosuppressants lifelong, which carry risks such as infection and malignancy.
6. How long does a patient typically stay in the hospital after a kidney transplant? A. 2 to 3 months B. One month C. Three to five days ✅ Correct Answer: C. Three to five days Rationale: Most patients are discharged within 3–5 days post-surgery if stable. 7. Following transplantation, which electrolyte abnormalities are treated with dialysis? A. High potassium level B. Acidosis C. Low magnesium levels ✅ Correct Answers: A and B Rationale: Hyperkalemia and metabolic acidosis are corrected with dialysis post- transplant. 8. Which vaccinations should be avoided post-kidney transplant? A. Flu shot B. Smallpox vaccine C. Bacillus Calmette-Guérin (BCG) ✅ Correct Answers: B and C Rationale: Live vaccines like smallpox and BCG are contraindicated in immunocompromised patients. 9. Which diagnostic indicator suggests transplant rejection? A. Low hemoglobin B. Elevated serum BUN C. Elevated serum creatinine ✅ Correct Answer: C. Elevated serum creatinine Rationale: Rising creatinine levels indicate impaired kidney function and possible rejection. 10. What serum creatinine level would indicate kidney failure in a two-year-old? A. 0.4 mg/dL B. 1.0 mg/dL
Rationale: Frequent latex exposure and congenital conditions like spina bifida increase risk.
16. While performing duties in the dialysis unit, which team member must always be present? A. Registered nurse B. Medical director C. Lab technician ✅ Correct Answer: A. Registered nurse Rationale: An RN must be present for clinical oversight and emergency interventions. 17. Two technicians are arguing about patient care. Who is responsible for disciplinary action? A. Registered practical nurse B. HR manager C. Dialysis nurse manager ✅ Correct Answer: C. Dialysis nurse manager Rationale: The dialysis nurse manager oversees staff conduct and enforces discipline. 18. Which credentialing agency includes water treatment and dialysate prep in its scope? A. BONENT B. NNCC C. NNCO ✅ Correct Answer: C. NNCO Rationale: The National Nephrology Certification Organization includes technical competencies in its exams. 19. What must be verified before starting dialysis? A. Informed consent B. No food for 6 hours C. Patient has a driver ✅ Correct Answer: A. Informed consent Rationale: Written consent is legally required before initiating dialysis treatment. 20. According to AAMI standards, the action level for endotoxin in product water is: A. 2 EU/mL B. 1 EU/mL C. 0.25 EU/mL ✅ Correct Answer: B. 1 EU/mL Rationale: The AAMI action level for endotoxin in product water is ≥1 EU/mL, requiring corrective action.
21. According to AAMI, the maximum allowable endotoxin level in dialysate is: A. 0.25 EU/mL B. 0.5 EU/mL C. 1.0 EU/mL ✅ Correct Answer: B. 0.5 EU/mL Rationale: Endotoxin levels in dialysate must not exceed 0.5 EU/mL to ensure patient safety. 22. What percentage of body weight does water comprise in adults? A. 60% B. 70% C. 40% ✅ Correct Answer: A. 60% Rationale: On average, adult body weight consists of about 60% water. 23. In a healthy person, how is waste excreted by the body? A. Through the lungs, skin, and kidneys B. Through the liver and spleen C. Through the stomach, pancreas, and bladder ✅ Correct Answer: A. Through the lungs, skin, and kidneys Rationale: These organs handle the excretion of metabolic waste and fluid balance. 24. What is the term for the process where water moves across a membrane from an area of low solute concentration to high concentration? A. Filtration B. Diffusion C. Osmosis ✅ Correct Answer: C. Osmosis Rationale: Osmosis describes water movement toward higher solute concentration across a semipermeable membrane. 25. When a dialyzer is reprocessed, what part of it must be considered and inspected? A. Blood compartment B. Dialysate compartment C. Transducer protector ✅ Correct Answer: A. Blood compartment Rationale: The blood compartment must be thoroughly inspected during reprocessing to ensure safety.
B. Respiratory apnea C. Severe acid base in balance
- Ans - B and C A new client with CKD asks the tech what does nocturnal intermittent peritoneal dialysis mean how do you answer A. The initial volume will be small but will increase to a total volume infused every morning B. The machine will provide 3 to 5 exchanges every night but only minimal or no dwelling during the day C. You will receive dialysis 3 to 4 times a week with dry periods In between treatments - Ans - B. The patient has had an expected progression of CKDN needs urgent start peritoneal dialysis what problems may be present in the patient who has been prescribed urgent start A. Fluid volume overload B. New onset jaundice C. High BUN and creatinine levels
- Ans - A and C Which method/test is most commonly used to check the dialysate composition A. Bicarbonate concentration test B. Total conductivity C. Microbial count - Ans - B. Microbial count How is the temp of the dialysate controlled A. By using one or more sensors and a micro controller circuit on the heater B. By checking accuracy regularly with a certified glass thermometer C. By using a separate center with visual and audible alarms for any out of limit state - Ans - All of the above What can cause a "false" blood leak alarm A. Particulate matter and air bubbles in the dialyzer B. Reduction in the light received by a photo cell C. Change in translucency - Ans - A. Particular matter What are the system requirements for high flux dialysis A. Reliable blood flow rate at at least 200 B. Hi dialysate flow rate C. Precise control of ultrafiltration volume D. Use of synthetic membrane filters - Ans - B C and D
Which factors affect removal of toxins in dialysis A. The higher the temperature of dialysate the greater the removal of solute B. The slower the dialysate flow the greater removal of solute's C. The slower the blood flow rate the greater removal of solute D. The more permeable the membrane the greater removal of solutes - Ans - A and D To accomplish saw you removal and dialysis what is needed A. Mass transfer B. Countercurrent flow C. A difference in concentration - Ans - C. Difference Why is reversed filtration important A. The bicarbonate concentrate encourages and supports bacterial proliferation B. Endotoxins may be carried across the high flux membrane into the bloodstream C. Pyrogens reaction may occur - Ans - All of the above What modifications to the dialysis procedure can be made to prevent intradialytic complications associated with fluid removal A. Lower the temp of the machine B. Extend treatment times C. Check serum sodium levels every 15 min - Ans - A and B Which water contaminants may cause methemoglobinemia in which red cell hemoglobin cannot transport oxygen A. Fluoride and Tin B. Nitrates and chloramines C. Zinc and aluminum - Ans - B. Nitrates and chloramine What is the process utilized when two carbon tanks are used to remove chlorine and chloramine from tank water A. Adsorption B. Absorption C. Diffusion - Ans - A. Adsorption What type of contaminants are removed from water used in dialysis A. Endotoxins B. Aqueous salts C. Water softeners - Ans - A and B When preparing for reverse osmosis what type of membranes should the tech be prepared to utilize A. Peritoneum B. Cellulose acetate C. Thin film composites D. Chlorine resistant polysulfone - Ans - B C and D
C. Test dialyzer D. Cleanse dialyzer with chemicals and reverse ultrafiltration - Ans - B then D then C then A According to standard precautions when should gloves be changed and hands washed A. When gloves are contaminated B. When going from clean body side to contaminated body site on the same person C. After handling infectious waste containers D. After touching patient as in preforming physical assessment - Ans - A C and D How should hand hygiene be performed A. With bar of soap and scrub brush B. With antiseptic soap and water C. With hand sanitizer D. With waterless alcohol base hand rub with 60-90% alcohol content - Ans - B and D What type of garment should be worn during processes likely to generate droplets of bodily fluids A. Patient gown tied in back B. Weighted lead aprons C. Impervious isolation gowns - Ans - C. Isolation gowns When washing hands with soap and water what's the minimum number of seconds hands should be rubbed together A. 10 B. 15 C. 30 - Ans - B. 15 What are the most common ways Hep B virus is transmitted in a unit A. Skin penetration by contaminated sharps B. Contact of contaminated blood with broken skin C. Pts with Hep B breathing or coughing on others - Ans - A and B Filling the accidental exposure to blood from a pt HIV positive what tx is recommended A. 3 month prescription of med to prevent HIV B. Follow up blood test three months after exposure C. 4 week 2 drug regimen is recommended within 72 hours of exposure - Ans - C. According to the CDC health care workers exposed to needle stick involving HIV infected blood have a 0.23% chance of becoming infected if untreated. After a needle stick or sharps exposure to hep C virus what is the risk of developing infection A. 0.01% B. 0.5%
C. 1.8% - Ans - C. 1.8% What are the recommendations for dialysis personnel caring for patients with clostridium difficile colitis A. Wear gloves when treating patient B. Impervious gowns upon entering room C. Wash hands with soap and water - Ans - All of the above Why is anticoagulation therapy used in dialysis A. To foster good venous blood flow in fingers and toes B. To reduce clotting within the extracorporeal circuit C. To optimize dialyzer efficiency - Ans - B and C How is heparin commonly administered A. Initial loading dose of heparin is given before tx begins B. Directly into arterial needle C. Administered throughout tx by direct injection - Ans - A. Initial dose When blood is transfused into at risk patients during heparin free dialysis what complication should the technician be monitoring for A. Fluid removal overload B. Anaphylaxis reaction C. Increased velocity of the blood in the dialyzer - Ans - C. Increased velocity If a dialysis patient does not have adequate vessels to create an internal fistula what is the remedy A. Veins surgically transferred from other areas of the body B. Wrapping mesh around scarred veins C. Using synthetic grafts - Ans - C. Using synthetic grafts A patient tells the text that she woke up in the morning with her fistula arm underneath her head and that it has been asleep and feeling funny all day knowing this which complication should the tech assess the patient for prior to assessing her site A. Cervical disc pain resulting in nerve damage B. Thrombosis caused by compression of blood flow C. Aneurysm of the official site due to kinking of the artery - Ans - B. After the initial skin prep for cannulation the tech is interrupted by a coworker asking a question when she proceeds to cannulation she noticed the skin prep has dried what action should the tech take A. Proceed with cannulation B. Perform new assessment by palpating the site and then cannulate C. Re-prep the access to ensure the patient has not accidentally touch the site - Ans - C.
C. Dehydration - Ans - A. Hypotension In a patient with gross Adema which symptoms of hypotension shared the dialysis tech be watching for A. Shortness of breath B. Flushed face and nose bleed C. Paleness D. Excessive yawning - Ans - A C and D A tech reports to the RN that the blood is transparent in the circuit with a cherry soda pop color what complication should the tech suspect the patient is experiencing A. Hemolysis B. Thrombosis C. Septicemia - Ans - A. Hemolysis Which symptoms will alert the tech a patient is experiencing type a dialyzer reaction A. Dyspnea B. Chest and back pain C. Sense of impending doom D. Numbness around the mouth - Ans - A B and C The dialysis tech knows that reducing intake of this nutrient may be beneficial in delaying the progression of kidney disease A. Water B. Carbohydrates C. Proteins - Ans - C. Albumin is a bio-marker monitored to assess the nutritional status of patients with CKD which patients are likely to have a lower serum albumin A. Patient who is dehydrated B. Patient with fatigue and low energy C. Patient with hair loss and muscle wasting - Ans - B and C According to KDOQI which pre-dialysis albumin level should be the outcome goal for dialysis patient A. Equal to or greater than the normal range of four B. Equal to or greater than the normal range of three C. Equal to or greater than the normal range of one - Ans - A. A 73-year-old dialysis patient is discussing with the tech her desire to convert to a total plant-based diet which statement is important for the tech to share A. There is no way to satisfy a patient's protein needs with a total plant-based diet B. Plant proteins are low biological value proteins and need to be combined to get all building blocks her body needs
C. No plant protein foods are considered high proteins so it will be hard for her to satisfy her protein needs - Ans - B. For a patient with stage 5 CKD phosphorus intake should be limited to what level A. 400 to 800 B. 1200 to 1600 C. 800 to 1200 - Ans - C. A patient with CKD is having difficulty controlling her phosphorus intake why is control of phosphorus challenging A. Phosphorus is abundant in fresh food such as vegetables and fruit B. Phosphorus is found in high amounts of coffee and tea C. Phosphorus additives are commonly found in best-selling processed foods - Ans - C. A patient with stage 5CKD has C Dash reactive protein level of 25 what does this level suggest A. Early onset diabetes B. Inflammation in the body C. Heart attack - Ans - B. Parathyroid hormone helps to regulate calcium and phosphorus levels low serum calcium levels stimulate secretion of parathyroid hormone this results in which change of the body A. Increase calcium absorption from small intestine B. Calcium loss in the urine is minimize C. Movement of calcium out of the bones D. Creation of a urinary buffer for acid base balance - Ans - A B and C How can a dialysis procedure be modified for a CKD patient with severe elevated blood urea nitrogen level A. Shorten dialysis time B. Increase blood flow rate C. Increased time rinsing the equipment D. Use a larger dialyzer - Ans - B and D Which asymptomatic patient meet the criteria for testing for diabetes or prediabetes A. African-American and Latino or Native American B. Triglyceride level of 150 MG/DL C. Patient is on antihypertensive medication - Ans - A and C A pts lab results revealed a significant drop in hemoglobin. Which med would the tech expect the nurse to administer to the pt A. Calcitrol B. Erythropoietin
Which occurs when the machine alarms and goes into bypass A. Arterial pressure increases B. Heparin isn't administered C. Dialysate stops flowing through the dialyzer - Ans - C. Which therapy is recommended for pt with a hemoglobin level of 7.5% who watches her diet and exercises during the week A. Quadratic therapy with metformin and three meds B. Monotherapy and metformin C. Dual therapy with metformin plus one med - Ans - B. KDOQI guidelines recommend screening patients with diabetes for diabetic nephropathy which test will be ordered A. Urine for microalbuminuria B. eGGR for Values below 90 mL/min C. Fasting glucose <100 - Ans - A and B A child who has in just a large amount of poison is brought to the emergency room the tech is preparing the child for dialysis for it to remove the poison the poison must have which characteristic A. High degree of Protein binding B. Water solubility C. Low molecular weight - Ans - B and C While reviewing the latest information on hypertension the dialysis tech notes that a blood pressure of 130/80 mmHg or higher is considered hypertension in which people A. Those with diabetes B. Those with CKD C. Those this cardiovascular disease - Ans - A and B A dialysis patient regularly experiences intradialytic hypotension which medication may be given 15 to 30 minutes before dialysis for blood pressure support A. Amlodipine calcium channel blocker B. Losartan angiontensin receptor blocker C. Midodrine a vasopressor - Ans - C. A dialysis patient asked the technician why am I taking Velphoro what medication does this fall under A. Phosphate binders B. Calcium channel blocker C. Cation exchange resin - Ans - A.
A patient has been diagnosed with acute kidney injury what symptoms might the family notice A. Listlessness B. Dark circles under eyes C. Confusion D. Fatigue - Ans - A c and D What are some of the most common indications for acute dialysis A. Elevated BUN level B. Symptomatic Hypokalemia C. Weakness in one side of body D. Acute pulmonary edema - Ans - A and D A patient with first used syndrome is experiencing severe symptoms including breathing difficulty and cardiac rhythm abnormalities as the tech working which action should be implemented A. Return the blood to patient as quickly as possible B. Ask the RN to dispense Benadryl C. Discard the dialyzer - Ans - C. If a patient is receiving acute dialysis what adjustment to the dialysis machine will help the patient with hypertension lower it to relatively normal reading A. Infusion of normal saline B. Ultrafiltration C. Transfuse one unit of packed cells - Ans - B. Which action by the dialysis staff will help prevent or minimize disequilibrium A. Decrease flow rate B. Implement isolated ultrafiltration to remove fluid C. Utilize a small dialyzer with lower clearance properties D. Lower heparin dose to 250 units/hour - Ans - A and C What are classic s/s of renal failure or uremia? - Ans - Elevated serum levels of BUN/creatinine, phosphorus, and potassium, anemia, fluid overload, lethargy, weakness, edema, high b/p Why are renal failure patients acidotic? - Ans - Kidneys control acid/base balance of the blood by excreting hydrogen atoms and producing a buffer (bicarbonate) What causes renal osteodystrophy (bone disease) - Ans - Kidneys can no longer convert Vit D to its activated form.
What is the normal pH of blood? - Ans - 7.35-7. What is bicarbonate? - Ans - A buffer that helps to maintain a constant pH in a solution even if a acid or base is added. What is metabolic acidosis? - Ans - The state of too much acid in the blood What are symptoms of dehydration? - Ans - Thirst, dry mucus membranes, sunken eyes, poor skin turgor. What are symptoms of fluid overload? - Ans - Edema, cough, SOB, increased b/p, confusion What are 3 types of solutions? - Ans - Hypertonic (containing more particles) Hypotonic (containing less particles) Isotonic (containing equal particles) What is diffusion? - Ans - The movement of solutes from an area of GREATER concentration of solutes to an area of LESSER concentration. What factors affect the rate of diffusion? - Ans - Concentration gradients, Molecular weight, temperature What is osmosis? - Ans - Movement of fluid from an are of LESSER concentration to an area of GREATER concentration. At what point during treatment will diffusion cease to occur? - Ans - Continue until the concentration of each electrolyte found in the patients blood is equal to the electrolyte concentrating in the dialysate. What is dialysate? - Ans - Non-sterile solution, composed of purified water, acid solution, and bicarbonate solution. What is the function of dialysate? - Ans - To remove waste products from the blood and balance electrolytes. What electrolytes are found in the dialysate? - Ans - Sodium (NA), potassium (K), calcium (Ca), magnesium (Mg), and chloride (Cl) Why is dextrose added to dialysate? - Ans - To prevent hypoglycemia
What is the purpose of checking dialysate? - Ans - To verify that the dialysate is compatible with human pH When should conductivity and pH be checked? - Ans - Manually prior to the ignition of every treatment What are normal ranges for temperature? - Ans - 35 - 39 C What are normal ranges for pH? - Ans - 6.9-7. What are normal ranges for conductivity? - Ans - 12.6-15. Why do we use biocompatible membranes in the dialyzer? - Ans - Closely related to the cells and tissues of the human body, less likely to cause allergic reaction What are some factors used in the selection of a dialyzer for a patient? - Ans - Body size, clearance needs, ultrafiltration needs and membrane biocompatibility. What are the compartments of the dialyzer? - Ans - 1) Blood compartment 2) Dialysate compartment What separates the 2 compartments? - Ans - The blood compartment is separated from the dialysate compartment by a semi-permeable membrane. What is a semi-permeable membrane? - Ans - A membrane made from protein, with small pores or holes. Only certain molecules can fit through. What should be checked on a dialyzer before machine set up? - Ans - Checked for sterility, structure damage, and be the size and brand ordered by the Dr How is dialysis delivered? - Ans - The Hemodialysis Machine. How much saline should be infused through the dialyzer and extracorporeal circuit? - Ans - 300 mLs to prime the dialyzer and circuit with normal saline. How much saline is used for a "fresh fill"? - Ans - 50 mLs NS through the arterial and 250 mLs NS through the venous. When should the Hanson connectors be connected to the dialyzer? - Ans - NS has been primed, both lines connected, test passed, and conductivity and pH checked. What position should the dialyzer be in during circulation? - Ans - Venous end up
