CDN: CERTIFIED DIALYSIS NURSE REAL QUESTIONS +
DETAILED ANSWERS - LATEST VERSION - TOP RATED
2026/2027
1. A patient with chronic kidney disease (CKD) stage 4 has a glomerular
filtration rate (GFR) of 25 mL/min/1.73m². Which metabolic abnormality is
MOST likely present?
A. Hypokalemia
B. Metabolic alkalosis
C. Hypophosphatemia
D. Metabolic acidosis
ANSWER : D
Explanation: As GFR declines below 30 mL/min, the kidneys lose ability to
excrete acid and regenerate bicarbonate. Metabolic acidosis develops due to
retention of sulfates, phosphates, and organic acids. Hyperkalemia (not
hypokalemia), metabolic acidosis (not alkalosis), and hyperphosphatemia (not
hypophosphatemia) are characteristic of advanced CKD.
2. Which electrolyte imbalance poses the GREATEST immediate risk for
cardiac arrest in ESRD patients?
A. Hyponatremia
B. Hypocalcemia
C. Hyperkalemia
D. Hypomagnesemia
ANSWER : C
Explanation: Hyperkalemia is the most life-threatening electrolyte imbalance
in ESRD. Potassium levels >6.5 mEq/L can cause peaked T-waves, widened
QRS complexes, and progress to ventricular fibrillation. While other imbalances
are serious, hyperkalemia requires immediate intervention with calcium
gluconate, insulin/glucose, or dialysis.
,3. A dialysis patient presents with pericardial friction rub, chest pain, and
low-grade fever. Which condition is MOST likely?
A. Myocardial infarction
B. Uremic pericarditis
C. Pulmonary embolism
D. Dialysis disequilibrium syndrome
ANSWER : B
Explanation: Uremic pericarditis occurs when BUN >60 mg/dL, resulting from
inflammation of the visceral and parietal pericardium due to uremic toxins.
Classic findings include friction rub, pleuritic chest pain, and fever. This is a
medical emergency requiring intensive dialysis.
4. Which bone disease results from chronic kidney disease-mineral and
bone disorder (CKD-MBD)?
A. Osteoporosis
B. Osteitis fibrosa cystica
C. Paget's disease
D. Osteogenesis imperfecta
ANSWER : B
Explanation: CKD-MBD causes secondary hyperparathyroidism due to
hyperphosphatemia and hypocalcemia. This leads to osteitis fibrosa cystica
(high-turnover bone disease) characterized by increased bone resorption,
marrow fibrosis, and cystic bone changes. Other CKD-MBD manifestations
include adynamic bone disease and osteomalacia.
5. A patient develops muscle weakness, paresthesias, and EKG showing
prolonged PR interval and widened QRS. Which electrolyte disturbance
should be suspected?
A. Hyperkalemia
B. Hypermagnesemia
C. Hypercalcemia
D. Hyponatremia
ANSWER : A
Explanation: Hyperkalemia produces characteristic EKG changes: peaked T-
waves (early), prolonged PR interval, widened QRS, loss of P-waves, sine wave
,pattern, and cardiac arrest. These neuromuscular and cardiac manifestations
require immediate treatment.
6. Which complication is MOST commonly associated with secondary
hyperparathyroidism in ESRD?
A. Osteosclerosis
B. Vascular calcification
C. Hypotension
D. Polycythemia
ANSWER : B
Explanation: Secondary hyperparathyroidism causes calcium-phosphate
product elevation, leading to metastatic calcification in blood vessels, soft
tissues, and cardiac structures. Vascular calcification contributes to
cardiovascular mortality in dialysis patients. Phosphate binders and vitamin D
analogs help control this process.
7. A patient with ESRD develops progressive dyspnea, orthopnea, and
bibasilar crackles. Which fluid-related complication is occurring?
A. Pulmonary embolism
B. Uremic pneumonitis
C. Fluid overload/pulmonary edema
D. Dialysis-related amyloidosis
ANSWER : C
Explanation: Fluid overload is common in anuric ESRD patients. Symptoms
include dyspnea, orthopnea, JVD, peripheral edema, and pulmonary crackles.
This requires ultrafiltration during dialysis. Uremic pneumonitis is rare and
presents with "butterfly" pattern on chest X-ray.
8. Which neurological complication is characterized by confusion, asterixis,
and seizure activity in ESRD patients?
A. Dialysis disequilibrium syndrome
B. Uremic encephalopathy
C. Wernicke's encephalopathy
D. Normal pressure hydrocephalus
, ANSWER : B
Explanation: Uremic encephalopathy results from accumulation of uremic
toxins affecting the CNS. Manifestations include confusion, asterixis (flapping
tremor), myoclonus, seizures, and coma. Symptoms improve with dialysis but
may not fully resolve until BUN <100 mg/dL.
9. A patient with CKD has hemoglobin of 8.2 g/dL. Which mechanism
PRIMARILY causes anemia in this population?
A. Iron deficiency
B. Vitamin B12 deficiency
C. Erythropoietin deficiency
D. Folate deficiency
ANSWER : C
Explanation: The kidneys produce 90% of erythropoietin. In CKD, reduced
EPO production causes normochromic, normocytic anemia. While iron
deficiency is common, the primary driver is EPO deficiency. Treatment
includes EPO-stimulating agents (ESAs) and iron supplementation.
10. Which gastrointestinal complication is MOST common in ESRD
patients?
A. Gastric ulcers
B. Uremic gastropathy
C. Pancreatitis
D. Bowel obstruction
ANSWER : B
Explanation: Uremic gastropathy causes anorexia, nausea, vomiting, and
dysgeusia due to uremic toxin accumulation. It results from mucosal
inflammation and delayed gastric emptying. These symptoms often improve
with dialysis initiation.
11. A patient develops acute onset of unilateral leg swelling, pain, and
warmth. Which complication should be suspected?
A. Arterial insufficiency
B. Deep vein thrombosis
DETAILED ANSWERS - LATEST VERSION - TOP RATED
2026/2027
1. A patient with chronic kidney disease (CKD) stage 4 has a glomerular
filtration rate (GFR) of 25 mL/min/1.73m². Which metabolic abnormality is
MOST likely present?
A. Hypokalemia
B. Metabolic alkalosis
C. Hypophosphatemia
D. Metabolic acidosis
ANSWER : D
Explanation: As GFR declines below 30 mL/min, the kidneys lose ability to
excrete acid and regenerate bicarbonate. Metabolic acidosis develops due to
retention of sulfates, phosphates, and organic acids. Hyperkalemia (not
hypokalemia), metabolic acidosis (not alkalosis), and hyperphosphatemia (not
hypophosphatemia) are characteristic of advanced CKD.
2. Which electrolyte imbalance poses the GREATEST immediate risk for
cardiac arrest in ESRD patients?
A. Hyponatremia
B. Hypocalcemia
C. Hyperkalemia
D. Hypomagnesemia
ANSWER : C
Explanation: Hyperkalemia is the most life-threatening electrolyte imbalance
in ESRD. Potassium levels >6.5 mEq/L can cause peaked T-waves, widened
QRS complexes, and progress to ventricular fibrillation. While other imbalances
are serious, hyperkalemia requires immediate intervention with calcium
gluconate, insulin/glucose, or dialysis.
,3. A dialysis patient presents with pericardial friction rub, chest pain, and
low-grade fever. Which condition is MOST likely?
A. Myocardial infarction
B. Uremic pericarditis
C. Pulmonary embolism
D. Dialysis disequilibrium syndrome
ANSWER : B
Explanation: Uremic pericarditis occurs when BUN >60 mg/dL, resulting from
inflammation of the visceral and parietal pericardium due to uremic toxins.
Classic findings include friction rub, pleuritic chest pain, and fever. This is a
medical emergency requiring intensive dialysis.
4. Which bone disease results from chronic kidney disease-mineral and
bone disorder (CKD-MBD)?
A. Osteoporosis
B. Osteitis fibrosa cystica
C. Paget's disease
D. Osteogenesis imperfecta
ANSWER : B
Explanation: CKD-MBD causes secondary hyperparathyroidism due to
hyperphosphatemia and hypocalcemia. This leads to osteitis fibrosa cystica
(high-turnover bone disease) characterized by increased bone resorption,
marrow fibrosis, and cystic bone changes. Other CKD-MBD manifestations
include adynamic bone disease and osteomalacia.
5. A patient develops muscle weakness, paresthesias, and EKG showing
prolonged PR interval and widened QRS. Which electrolyte disturbance
should be suspected?
A. Hyperkalemia
B. Hypermagnesemia
C. Hypercalcemia
D. Hyponatremia
ANSWER : A
Explanation: Hyperkalemia produces characteristic EKG changes: peaked T-
waves (early), prolonged PR interval, widened QRS, loss of P-waves, sine wave
,pattern, and cardiac arrest. These neuromuscular and cardiac manifestations
require immediate treatment.
6. Which complication is MOST commonly associated with secondary
hyperparathyroidism in ESRD?
A. Osteosclerosis
B. Vascular calcification
C. Hypotension
D. Polycythemia
ANSWER : B
Explanation: Secondary hyperparathyroidism causes calcium-phosphate
product elevation, leading to metastatic calcification in blood vessels, soft
tissues, and cardiac structures. Vascular calcification contributes to
cardiovascular mortality in dialysis patients. Phosphate binders and vitamin D
analogs help control this process.
7. A patient with ESRD develops progressive dyspnea, orthopnea, and
bibasilar crackles. Which fluid-related complication is occurring?
A. Pulmonary embolism
B. Uremic pneumonitis
C. Fluid overload/pulmonary edema
D. Dialysis-related amyloidosis
ANSWER : C
Explanation: Fluid overload is common in anuric ESRD patients. Symptoms
include dyspnea, orthopnea, JVD, peripheral edema, and pulmonary crackles.
This requires ultrafiltration during dialysis. Uremic pneumonitis is rare and
presents with "butterfly" pattern on chest X-ray.
8. Which neurological complication is characterized by confusion, asterixis,
and seizure activity in ESRD patients?
A. Dialysis disequilibrium syndrome
B. Uremic encephalopathy
C. Wernicke's encephalopathy
D. Normal pressure hydrocephalus
, ANSWER : B
Explanation: Uremic encephalopathy results from accumulation of uremic
toxins affecting the CNS. Manifestations include confusion, asterixis (flapping
tremor), myoclonus, seizures, and coma. Symptoms improve with dialysis but
may not fully resolve until BUN <100 mg/dL.
9. A patient with CKD has hemoglobin of 8.2 g/dL. Which mechanism
PRIMARILY causes anemia in this population?
A. Iron deficiency
B. Vitamin B12 deficiency
C. Erythropoietin deficiency
D. Folate deficiency
ANSWER : C
Explanation: The kidneys produce 90% of erythropoietin. In CKD, reduced
EPO production causes normochromic, normocytic anemia. While iron
deficiency is common, the primary driver is EPO deficiency. Treatment
includes EPO-stimulating agents (ESAs) and iron supplementation.
10. Which gastrointestinal complication is MOST common in ESRD
patients?
A. Gastric ulcers
B. Uremic gastropathy
C. Pancreatitis
D. Bowel obstruction
ANSWER : B
Explanation: Uremic gastropathy causes anorexia, nausea, vomiting, and
dysgeusia due to uremic toxin accumulation. It results from mucosal
inflammation and delayed gastric emptying. These symptoms often improve
with dialysis initiation.
11. A patient develops acute onset of unilateral leg swelling, pain, and
warmth. Which complication should be suspected?
A. Arterial insufficiency
B. Deep vein thrombosis
