DaVita RN Final Exam 2026/2027
Complete Questions & Verified Correct Answers | Graded
A+ | Hemodialysis Nursing
EXAM OVERVIEW
This comprehensive final exam assesses competency in hemodialysis nursing for
DaVita RNs, aligned with 2026/2027 DaVita Clinical Services Policies and Procedures,
NNCC certification standards, and AAMI/CDC guidelines. The exam emphasizes clinical
application, safety-critical decision making, and evidence-based practice in the dialysis
setting.
Passing Standard: 80% (120/150 questions)
SECTION 1: PRE-TREATMENT ASSESSMENT & VASCULAR ACCESS (25 Questions)
Q1: During pre-treatment assessment of a patient's left forearm radiocephalic AV fistula,
the nurse notes a strong, palpable thrill but a barely audible bruit. What is the nurse's
priority action?
A. Proceed with cannulation as planned; this is a normal finding.
B. Notify the charge nurse or nephrologist immediately, as this may indicate a stenosis.
[CORRECT]
C. Use a smaller gauge needle for cannulation.
D. Apply a warm compress to the access site.
,Correct Answer: B
Rationale: B is correct. [CORRECT] Access Assessment Principle: A strong thrill with a
weak bruit is a classic sign of venous stenosis downstream from the palpated thrill. The
turbulent blood flow (causing the thrill) is hitting a narrowed area, dampening the
audible bruit. This requires immediate evaluation (possibly with a fistulogram) as it
threatens access longevity and can lead to high venous pressures during treatment.
Cannulating a stenotic access can worsen the stenosis. Why others are wrong: (A) This
is NOT a normal finding. (C) Needle size does not address the underlying pathology. (D)
A warm compress is for vasodilation pre-cannulation, not for assessing pathology.
Q2: A patient presents with a tunneled dialysis catheter (TDC) in the right internal
jugular vein. During pre-treatment assessment, the nurse observes erythema, warmth,
and purulent drainage at the exit site. The patient's temperature is 38.2°C (100.8°F).
What is the priority nursing action?
A. Hold dialysis and notify the nephrologist immediately for catheter-related
bloodstream infection (CRBSI) evaluation [CORRECT]
B. Cleanse the site with chlorhexidine and proceed with dialysis
C. Administer prescribed heparin and begin treatment
D. Remove the catheter at the bedside
Correct Answer: A
Rationale: A is correct. [CORRECT] Infection Control Priority: The presentation
(erythema, warmth, purulent drainage, fever) is consistent with catheter-related
bloodstream infection (CRBSI) or exit site infection. Per DaVita infection control
protocols and CDC guidelines, dialysis should be delayed pending physician evaluation,
, blood cultures, and possible catheter removal. Dialysis through an infected catheter can
cause bacteremia, sepsis, and endocarditis. Why others are wrong: (B) Cleansing does
not address systemic infection. (C) Heparinization and dialysis can disseminate
infection. (D) Catheter removal requires physician order and sterile technique in
appropriate setting; not a nursing independent action.
Q3: When assessing a patient's arteriovenous graft (AVG) in the upper arm, the nurse
palpates a pulsatile thrill that feels "water-hammer" like, with a loud, continuous bruit.
What does this assessment indicate?
A. Normal graft function
B. Arterial stenosis proximal to the graft [CORRECT]
C. Venous stenosis distal to the graft
D. Graft thrombosis
Correct Answer: B
Rationale: B is correct. [CORRECT] Graft Assessment: A pulsatile, "water-hammer" thrill
with a loud, continuous bruit suggests high-flow, turbulent arterial inflow often seen with
arterial stenosis proximal to the graft. The stenosis creates a pressure gradient, causing
the pulsatile quality. A normal graft should have a soft, continuous thrill and soft bruit.
Venous stenosis would cause a weak thrill distal to the stenosis. Thrombosis would
have no thrill or bruit. Why others are wrong: (A) Normal grafts do not have
water-hammer pulses. (C) Venous stenosis causes dampened flow distal to the lesion.
(D) Thrombosis = absent flow signals.
Complete Questions & Verified Correct Answers | Graded
A+ | Hemodialysis Nursing
EXAM OVERVIEW
This comprehensive final exam assesses competency in hemodialysis nursing for
DaVita RNs, aligned with 2026/2027 DaVita Clinical Services Policies and Procedures,
NNCC certification standards, and AAMI/CDC guidelines. The exam emphasizes clinical
application, safety-critical decision making, and evidence-based practice in the dialysis
setting.
Passing Standard: 80% (120/150 questions)
SECTION 1: PRE-TREATMENT ASSESSMENT & VASCULAR ACCESS (25 Questions)
Q1: During pre-treatment assessment of a patient's left forearm radiocephalic AV fistula,
the nurse notes a strong, palpable thrill but a barely audible bruit. What is the nurse's
priority action?
A. Proceed with cannulation as planned; this is a normal finding.
B. Notify the charge nurse or nephrologist immediately, as this may indicate a stenosis.
[CORRECT]
C. Use a smaller gauge needle for cannulation.
D. Apply a warm compress to the access site.
,Correct Answer: B
Rationale: B is correct. [CORRECT] Access Assessment Principle: A strong thrill with a
weak bruit is a classic sign of venous stenosis downstream from the palpated thrill. The
turbulent blood flow (causing the thrill) is hitting a narrowed area, dampening the
audible bruit. This requires immediate evaluation (possibly with a fistulogram) as it
threatens access longevity and can lead to high venous pressures during treatment.
Cannulating a stenotic access can worsen the stenosis. Why others are wrong: (A) This
is NOT a normal finding. (C) Needle size does not address the underlying pathology. (D)
A warm compress is for vasodilation pre-cannulation, not for assessing pathology.
Q2: A patient presents with a tunneled dialysis catheter (TDC) in the right internal
jugular vein. During pre-treatment assessment, the nurse observes erythema, warmth,
and purulent drainage at the exit site. The patient's temperature is 38.2°C (100.8°F).
What is the priority nursing action?
A. Hold dialysis and notify the nephrologist immediately for catheter-related
bloodstream infection (CRBSI) evaluation [CORRECT]
B. Cleanse the site with chlorhexidine and proceed with dialysis
C. Administer prescribed heparin and begin treatment
D. Remove the catheter at the bedside
Correct Answer: A
Rationale: A is correct. [CORRECT] Infection Control Priority: The presentation
(erythema, warmth, purulent drainage, fever) is consistent with catheter-related
bloodstream infection (CRBSI) or exit site infection. Per DaVita infection control
protocols and CDC guidelines, dialysis should be delayed pending physician evaluation,
, blood cultures, and possible catheter removal. Dialysis through an infected catheter can
cause bacteremia, sepsis, and endocarditis. Why others are wrong: (B) Cleansing does
not address systemic infection. (C) Heparinization and dialysis can disseminate
infection. (D) Catheter removal requires physician order and sterile technique in
appropriate setting; not a nursing independent action.
Q3: When assessing a patient's arteriovenous graft (AVG) in the upper arm, the nurse
palpates a pulsatile thrill that feels "water-hammer" like, with a loud, continuous bruit.
What does this assessment indicate?
A. Normal graft function
B. Arterial stenosis proximal to the graft [CORRECT]
C. Venous stenosis distal to the graft
D. Graft thrombosis
Correct Answer: B
Rationale: B is correct. [CORRECT] Graft Assessment: A pulsatile, "water-hammer" thrill
with a loud, continuous bruit suggests high-flow, turbulent arterial inflow often seen with
arterial stenosis proximal to the graft. The stenosis creates a pressure gradient, causing
the pulsatile quality. A normal graft should have a soft, continuous thrill and soft bruit.
Venous stenosis would cause a weak thrill distal to the stenosis. Thrombosis would
have no thrill or bruit. Why others are wrong: (A) Normal grafts do not have
water-hammer pulses. (C) Venous stenosis causes dampened flow distal to the lesion.
(D) Thrombosis = absent flow signals.
