CERTIFIED DIALYSIS NURSE(CDN) EXAM – QUESTIONS AND
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1. A patient undergoing hemodialysis suddenly complains of lightheadedness, nausea, and a
sharp drop in blood pressure from 140/80 mmHg to 90/50 mmHg. Which of the following is
the most appropriate immediate nursing intervention?
A. Administer a 500 mL normal saline bolus rapidly
B. Place the patient in the Trendelenburg position and temporarily decrease the blood flow rate
C. Administer intravenous midazolam to reduce patient anxiety
D. Immediately discontinue the hemodialysis treatment and remove the needles
Intradialytic hypotension is a common complication. Placing the patient in the Trendelenburg
position enhances venous return to the heart, and reducing the blood flow rate slows
ultrafiltration, helping stabilize hemodynamics without immediately wasting the
extracorporeal circuit. Normal saline boluses may be given if ordered or per protocol, but
postural adjustment and slowing blood removal are standard immediate first-line nursing
actions.
2. Which of the following laboratory values is most indicative of adequate dialysis
adequacy (Kt/V) for an adult patient receiving standard thrice-weekly hemodialysis?
A. Kt/V of 0.8
B. Kt/V of 1.2
C. Kt/V of 0.5
D. Kt/V of 0.3
The National Kidney Foundation Kidney Disease Outcomes Quality Initiative (KDOQI)
guidelines recommend a minimum single-pool Kt/V of 1.2 for patients undergoing thrice-
weekly hemodialysis to ensure adequate clearance of urea and uremic toxins. Values below
1.1 indicate underdialysis.
3. During pre-treatment cannulation of an arteriovenous (AV) fistula, the dialysis nurse
notes an absence of the usual thrill and a high-pitched, bounding bruit upon auscultation.
What is the primary implication of this assessment finding?
,A. The fistula is maturing normally and is ready for safe cannulation
B. There is a strong suspicion of inflow stenosis or thrombosis within the access
C. The patient is experiencing systemic hypertension requiring medication adjustment
D. The fistula is infected and requires immediate systemic antibiotic therapy
A normal functioning AV fistula presents with a continuous, low-pitched bruit and a palpable
thrill. The loss of a thrill combined with a high-pitched, whistling or bounding bruit typically
indicates a significant stenosis, narrowing, or impending thrombosis within the vascular
access that requires immediate vascular surgery referral.
4. A patient with end-stage renal disease (ESRD) presents with serum potassium of 6.8
mEq/L, peaked T waves on the electrocardiogram (ECG), and muscle weakness. What is
the immediate pharmacological intervention to protect the myocardium against lethal
arrhythmias?
A. Intravenous regular insulin combined with 50% dextrose
B. Intravenous calcium gluconate
C. Oral sodium polystyrene sulfonate
D. Intravenous furosemide
Intravenous calcium (gluconate or chloride) acts immediately to stabilize the cardiac cell
membrane against the arrhythmogenic effects of severe hyperkalemia, even though it does not
lower serum potassium levels. Insulin/dextrose and other agents are subsequently used to shift
potassium intracellularly or eliminate it.
5. Which component of the water treatment system is primarily responsible for removing
dissolved ionic contaminants, heavy metals, and fluoride from municipal water used for
hemodialysis?
A. Sediment filter
B. Reverse osmosis (RO) membrane
C. Carbon adsorption tank
D. Ultraviolet sterilizer
The reverse osmosis membrane is the primary purification component that rejects up to 95-
99% of dissolved inorganic ions, minerals, bacteria, and endotoxins. Carbon filters remove
chlorine/chloramines, sediment filters remove particulate matter, and UV systems control
microbial growth.
, 6. A patient receiving peritoneal dialysis (PD) reports cloudy dialysate outflow
accompanied by diffuse abdominal pain and a low-grade fever. What is the nurse's priority
action?
A. Reassure the patient that this is a normal finding during the early dwell phase
B. Collect a sample of the effluent fluid for cell count, Gram stain, and culture
C. Flush the peritoneal catheter forcefully with heparinized saline
D. Instill hypertonic dialysate to increase ultrafiltration volume
Cloudy effluent combined with abdominal pain and fever are classic clinical indicators of
peritonitis, the most common and serious complication of peritoneal dialysis. Immediate
diagnostic workup via effluent analysis and prompt initiation of empiric antibiotic therapy are
critical.
7. Which of the following medications is classified as an erythropoiesis-stimulating agent
(ESA) commonly prescribed to manage anemia of chronic kidney disease?
A. Cinacalcet
B. Epoetin alfa
C. Sevelamer carbonate
D. Calcitriol
Epoetin alfa is an erythropoiesis-stimulating agent used to stimulate red blood cell production
in patients with anemia secondary to decreased endogenous erythropoietin synthesis by failing
kidneys. Cinacalcet manages secondary hyperparathyroidism, sevelamer is a phosphate
binder, and calcitriol is active vitamin D.
8. A patient complains of painful muscle cramps in the calves and feet during the final hour
of a hemodialysis session. Which factor is most frequently associated with this
complication?
A. Rapid fluid removal and reaching below estimated dry weight
B. Elevated dialysate sodium concentration above serum levels
C. High dialysate temperature settings
D. Inadequate heparinization of the extracorporeal circuit
Intradialysis muscle cramps are frequently triggered by rapid intravascular volume depletion
and aggressive ultrafiltration that pulls fluid too quickly from the interstitial space, or by
ANSWERS | VERIFIED AND WELL DETAILED ANSWERS PLUS
RATIONALES | GUARANTEED PASS | LATEST EXAM UPDATE |
EXAM PREP | STUDY GUIDE | PRACTICE TEST| DOWNLOAD
INSTANT PDF
1. A patient undergoing hemodialysis suddenly complains of lightheadedness, nausea, and a
sharp drop in blood pressure from 140/80 mmHg to 90/50 mmHg. Which of the following is
the most appropriate immediate nursing intervention?
A. Administer a 500 mL normal saline bolus rapidly
B. Place the patient in the Trendelenburg position and temporarily decrease the blood flow rate
C. Administer intravenous midazolam to reduce patient anxiety
D. Immediately discontinue the hemodialysis treatment and remove the needles
Intradialytic hypotension is a common complication. Placing the patient in the Trendelenburg
position enhances venous return to the heart, and reducing the blood flow rate slows
ultrafiltration, helping stabilize hemodynamics without immediately wasting the
extracorporeal circuit. Normal saline boluses may be given if ordered or per protocol, but
postural adjustment and slowing blood removal are standard immediate first-line nursing
actions.
2. Which of the following laboratory values is most indicative of adequate dialysis
adequacy (Kt/V) for an adult patient receiving standard thrice-weekly hemodialysis?
A. Kt/V of 0.8
B. Kt/V of 1.2
C. Kt/V of 0.5
D. Kt/V of 0.3
The National Kidney Foundation Kidney Disease Outcomes Quality Initiative (KDOQI)
guidelines recommend a minimum single-pool Kt/V of 1.2 for patients undergoing thrice-
weekly hemodialysis to ensure adequate clearance of urea and uremic toxins. Values below
1.1 indicate underdialysis.
3. During pre-treatment cannulation of an arteriovenous (AV) fistula, the dialysis nurse
notes an absence of the usual thrill and a high-pitched, bounding bruit upon auscultation.
What is the primary implication of this assessment finding?
,A. The fistula is maturing normally and is ready for safe cannulation
B. There is a strong suspicion of inflow stenosis or thrombosis within the access
C. The patient is experiencing systemic hypertension requiring medication adjustment
D. The fistula is infected and requires immediate systemic antibiotic therapy
A normal functioning AV fistula presents with a continuous, low-pitched bruit and a palpable
thrill. The loss of a thrill combined with a high-pitched, whistling or bounding bruit typically
indicates a significant stenosis, narrowing, or impending thrombosis within the vascular
access that requires immediate vascular surgery referral.
4. A patient with end-stage renal disease (ESRD) presents with serum potassium of 6.8
mEq/L, peaked T waves on the electrocardiogram (ECG), and muscle weakness. What is
the immediate pharmacological intervention to protect the myocardium against lethal
arrhythmias?
A. Intravenous regular insulin combined with 50% dextrose
B. Intravenous calcium gluconate
C. Oral sodium polystyrene sulfonate
D. Intravenous furosemide
Intravenous calcium (gluconate or chloride) acts immediately to stabilize the cardiac cell
membrane against the arrhythmogenic effects of severe hyperkalemia, even though it does not
lower serum potassium levels. Insulin/dextrose and other agents are subsequently used to shift
potassium intracellularly or eliminate it.
5. Which component of the water treatment system is primarily responsible for removing
dissolved ionic contaminants, heavy metals, and fluoride from municipal water used for
hemodialysis?
A. Sediment filter
B. Reverse osmosis (RO) membrane
C. Carbon adsorption tank
D. Ultraviolet sterilizer
The reverse osmosis membrane is the primary purification component that rejects up to 95-
99% of dissolved inorganic ions, minerals, bacteria, and endotoxins. Carbon filters remove
chlorine/chloramines, sediment filters remove particulate matter, and UV systems control
microbial growth.
, 6. A patient receiving peritoneal dialysis (PD) reports cloudy dialysate outflow
accompanied by diffuse abdominal pain and a low-grade fever. What is the nurse's priority
action?
A. Reassure the patient that this is a normal finding during the early dwell phase
B. Collect a sample of the effluent fluid for cell count, Gram stain, and culture
C. Flush the peritoneal catheter forcefully with heparinized saline
D. Instill hypertonic dialysate to increase ultrafiltration volume
Cloudy effluent combined with abdominal pain and fever are classic clinical indicators of
peritonitis, the most common and serious complication of peritoneal dialysis. Immediate
diagnostic workup via effluent analysis and prompt initiation of empiric antibiotic therapy are
critical.
7. Which of the following medications is classified as an erythropoiesis-stimulating agent
(ESA) commonly prescribed to manage anemia of chronic kidney disease?
A. Cinacalcet
B. Epoetin alfa
C. Sevelamer carbonate
D. Calcitriol
Epoetin alfa is an erythropoiesis-stimulating agent used to stimulate red blood cell production
in patients with anemia secondary to decreased endogenous erythropoietin synthesis by failing
kidneys. Cinacalcet manages secondary hyperparathyroidism, sevelamer is a phosphate
binder, and calcitriol is active vitamin D.
8. A patient complains of painful muscle cramps in the calves and feet during the final hour
of a hemodialysis session. Which factor is most frequently associated with this
complication?
A. Rapid fluid removal and reaching below estimated dry weight
B. Elevated dialysate sodium concentration above serum levels
C. High dialysate temperature settings
D. Inadequate heparinization of the extracorporeal circuit
Intradialysis muscle cramps are frequently triggered by rapid intravascular volume depletion
and aggressive ultrafiltration that pulls fluid too quickly from the interstitial space, or by
