Certified Dialysis Nurse (CDN) Practice Exam 100 Multiple-Choice
Questions with Answers and Rationales
Practice Questions
1. A patient with kidney failure develops palpitations and peaked T waves.
What is the priority?
A. Offer a potassium-rich snack
B. Wait until the next routine clinic visit
C. Escalate immediately for suspected hyperkalemia and urgent treatment
D. Encourage strenuous exercise
Correct answer: C. Escalate immediately for suspected hyperkalemia and urgent
treatment
Rationale: Peaked T waves can accompany dangerous hyperkalemia; rapid
assessment and treatment are needed to prevent lethal dysrhythmias.
2. What does an arteriovenous fistula thrill indicate?
A. Adequate dialysis clearance by itself
B. Absence of all infection
C. Blood flow through the access
D. That cannulation is unnecessary
Correct answer: C. Blood flow through the access
Rationale: A palpable vibration suggests access flow, but it does not establish
adequate treatment or rule out other complications.
3. An established fistula no longer has a palpable thrill. What should the nurse
do?
A. Apply a tight tourniquet and wait
B. Assume this is expected after dialysis
C. Use the arm for repeated blood pressures
D. Promptly notify the access team
Correct answer: D. Promptly notify the access team
Rationale: A newly absent thrill suggests thrombosis or loss of flow and requires
rapid evaluation to preserve the access.
,4. Which action protects a hemodialysis fistula arm?
A. Wear a tight wristband over the access
B. Sleep with prolonged pressure on the access
C. Avoid routine blood pressure measurements and venipuncture in that arm
D. Apply heating pads continuously
Correct answer: C. Avoid routine blood pressure measurements and venipuncture
in that arm
Rationale: Avoiding compression and unnecessary punctures helps protect blood
flow and reduces access injury.
5. A patient becomes dizzy and hypotensive during hemodialysis. What is the
initial response?
A. Increase ultrafiltration immediately
B. Discontinue all monitoring
C. Place the patient upright and leave the room
D. Assess the patient and follow the unit protocol for intradialytic hypotension
Correct answer: D. Assess the patient and follow the unit protocol for intradialytic
hypotension
Rationale: Intradialytic hypotension warrants prompt assessment, supportive
measures, and adjustment of fluid removal according to the prescribed protocol.
6. Why are pre- and postdialysis weights useful?
A. They diagnose access infection
B. They help estimate fluid removal and assess trends
C. They replace blood pressure monitoring
D. They determine all medication doses independently
Correct answer: B. They help estimate fluid removal and assess trends
Rationale: Comparing weights helps estimate changes in fluid volume, while clinical
assessment and the treatment prescription remain important.
,7. Which finding during peritoneal dialysis requires urgent reporting?
A. Clear pale-yellow drainage
B. Mild thirst after eating
C. A prescribed dwell time
D. Cloudy effluent with abdominal pain
Correct answer: D. Cloudy effluent with abdominal pain
Rationale: Cloudy drainage with abdominal pain raises concern for peritonitis and
requires prompt assessment, cultures, and prescribed treatment.
8. What is the most important infection-prevention practice for peritoneal
dialysis exchanges?
A. Opening all supplies far in advance
B. Reusing disposable connectors
C. Touching the sterile connector to clothing
D. Careful hand hygiene and aseptic connection technique
Correct answer: D. Careful hand hygiene and aseptic connection technique
Rationale: Hand hygiene and aseptic technique reduce the introduction of
organisms into the peritoneal cavity.
9. What does ultrafiltration remove during dialysis?
A. Excess fluid
B. All medications selectively
C. Only red blood cells
D. Only calcium from bones
Correct answer: A. Excess fluid
Rationale: Ultrafiltration removes fluid across a dialysis membrane; solute removal
and fluid removal are related but distinct processes.
10. Which symptom can suggest fluid overload in kidney disease?
A. Improved exercise tolerance
B. New shortness of breath and crackles
C. A lower-than-usual weight after diarrhea
D. Dry mucous membranes alone
Correct answer: B. New shortness of breath and crackles
Rationale: Dyspnea and crackles can indicate pulmonary congestion, especially
when accompanied by weight gain or edema.
, 11. Which finding is most consistent with hypovolemia after excessive fluid
removal?
A. Elevated jugular venous pressure
B. New pulmonary crackles
C. Dizziness with hypotension
D. Rapid unexplained weight gain
Correct answer: C. Dizziness with hypotension
Rationale: Excessive fluid removal may lower circulating volume and cause
hypotension and dizziness.
12. Why is sodium restriction often recommended for patients on dialysis?
A. It eliminates the need for dialysis
B. It cures kidney failure
C. It prevents every infection
D. It can reduce thirst and interdialytic fluid gain
Correct answer: D. It can reduce thirst and interdialytic fluid gain
Rationale: Dietary sodium can increase thirst and fluid retention;
recommendations should be individualized with the renal dietitian.
13. What is a common manifestation of anemia in chronic kidney disease?
A. Fatigue and reduced exercise tolerance
B. Sudden improvement in endurance
C. Persistent high oxygen saturation alone
D. Excessive red blood cell production
Correct answer: A. Fatigue and reduced exercise tolerance
Rationale: Reduced erythropoietin production and other factors can contribute to
anemia and fatigue in chronic kidney disease.
14. What laboratory trend is commonly used to monitor kidney filtration?
A. Estimated glomerular filtration rate
B. Platelet count alone
C. Serum amylase alone
D. Serum bilirubin alone
Correct answer: A. Estimated glomerular filtration rate
Rationale: Estimated GFR helps describe kidney filtration, although trends and
limitations of the estimating equation must be considered.
Questions with Answers and Rationales
Practice Questions
1. A patient with kidney failure develops palpitations and peaked T waves.
What is the priority?
A. Offer a potassium-rich snack
B. Wait until the next routine clinic visit
C. Escalate immediately for suspected hyperkalemia and urgent treatment
D. Encourage strenuous exercise
Correct answer: C. Escalate immediately for suspected hyperkalemia and urgent
treatment
Rationale: Peaked T waves can accompany dangerous hyperkalemia; rapid
assessment and treatment are needed to prevent lethal dysrhythmias.
2. What does an arteriovenous fistula thrill indicate?
A. Adequate dialysis clearance by itself
B. Absence of all infection
C. Blood flow through the access
D. That cannulation is unnecessary
Correct answer: C. Blood flow through the access
Rationale: A palpable vibration suggests access flow, but it does not establish
adequate treatment or rule out other complications.
3. An established fistula no longer has a palpable thrill. What should the nurse
do?
A. Apply a tight tourniquet and wait
B. Assume this is expected after dialysis
C. Use the arm for repeated blood pressures
D. Promptly notify the access team
Correct answer: D. Promptly notify the access team
Rationale: A newly absent thrill suggests thrombosis or loss of flow and requires
rapid evaluation to preserve the access.
,4. Which action protects a hemodialysis fistula arm?
A. Wear a tight wristband over the access
B. Sleep with prolonged pressure on the access
C. Avoid routine blood pressure measurements and venipuncture in that arm
D. Apply heating pads continuously
Correct answer: C. Avoid routine blood pressure measurements and venipuncture
in that arm
Rationale: Avoiding compression and unnecessary punctures helps protect blood
flow and reduces access injury.
5. A patient becomes dizzy and hypotensive during hemodialysis. What is the
initial response?
A. Increase ultrafiltration immediately
B. Discontinue all monitoring
C. Place the patient upright and leave the room
D. Assess the patient and follow the unit protocol for intradialytic hypotension
Correct answer: D. Assess the patient and follow the unit protocol for intradialytic
hypotension
Rationale: Intradialytic hypotension warrants prompt assessment, supportive
measures, and adjustment of fluid removal according to the prescribed protocol.
6. Why are pre- and postdialysis weights useful?
A. They diagnose access infection
B. They help estimate fluid removal and assess trends
C. They replace blood pressure monitoring
D. They determine all medication doses independently
Correct answer: B. They help estimate fluid removal and assess trends
Rationale: Comparing weights helps estimate changes in fluid volume, while clinical
assessment and the treatment prescription remain important.
,7. Which finding during peritoneal dialysis requires urgent reporting?
A. Clear pale-yellow drainage
B. Mild thirst after eating
C. A prescribed dwell time
D. Cloudy effluent with abdominal pain
Correct answer: D. Cloudy effluent with abdominal pain
Rationale: Cloudy drainage with abdominal pain raises concern for peritonitis and
requires prompt assessment, cultures, and prescribed treatment.
8. What is the most important infection-prevention practice for peritoneal
dialysis exchanges?
A. Opening all supplies far in advance
B. Reusing disposable connectors
C. Touching the sterile connector to clothing
D. Careful hand hygiene and aseptic connection technique
Correct answer: D. Careful hand hygiene and aseptic connection technique
Rationale: Hand hygiene and aseptic technique reduce the introduction of
organisms into the peritoneal cavity.
9. What does ultrafiltration remove during dialysis?
A. Excess fluid
B. All medications selectively
C. Only red blood cells
D. Only calcium from bones
Correct answer: A. Excess fluid
Rationale: Ultrafiltration removes fluid across a dialysis membrane; solute removal
and fluid removal are related but distinct processes.
10. Which symptom can suggest fluid overload in kidney disease?
A. Improved exercise tolerance
B. New shortness of breath and crackles
C. A lower-than-usual weight after diarrhea
D. Dry mucous membranes alone
Correct answer: B. New shortness of breath and crackles
Rationale: Dyspnea and crackles can indicate pulmonary congestion, especially
when accompanied by weight gain or edema.
, 11. Which finding is most consistent with hypovolemia after excessive fluid
removal?
A. Elevated jugular venous pressure
B. New pulmonary crackles
C. Dizziness with hypotension
D. Rapid unexplained weight gain
Correct answer: C. Dizziness with hypotension
Rationale: Excessive fluid removal may lower circulating volume and cause
hypotension and dizziness.
12. Why is sodium restriction often recommended for patients on dialysis?
A. It eliminates the need for dialysis
B. It cures kidney failure
C. It prevents every infection
D. It can reduce thirst and interdialytic fluid gain
Correct answer: D. It can reduce thirst and interdialytic fluid gain
Rationale: Dietary sodium can increase thirst and fluid retention;
recommendations should be individualized with the renal dietitian.
13. What is a common manifestation of anemia in chronic kidney disease?
A. Fatigue and reduced exercise tolerance
B. Sudden improvement in endurance
C. Persistent high oxygen saturation alone
D. Excessive red blood cell production
Correct answer: A. Fatigue and reduced exercise tolerance
Rationale: Reduced erythropoietin production and other factors can contribute to
anemia and fatigue in chronic kidney disease.
14. What laboratory trend is commonly used to monitor kidney filtration?
A. Estimated glomerular filtration rate
B. Platelet count alone
C. Serum amylase alone
D. Serum bilirubin alone
Correct answer: A. Estimated glomerular filtration rate
Rationale: Estimated GFR helps describe kidney filtration, although trends and
limitations of the estimating equation must be considered.
