CDN: CERTIFIED DIALYSIS NURSE COMPREHENSIVE EXAM 2026/2027 | 100%
VERIFIED QUESTIONS & DETAILED ANSWERS | LATEST | NEPHROLOGY
NURSING PREP | TOP RATED
1. Which of the following best describes the principle of diffusion in
hemodialysis?
A. Movement of solutes from low to high concentration
B. Movement of solutes from high to low concentration across a semipermeable
membrane
C. Movement of water across a membrane due to hydrostatic pressure
D. Removal of solutes through convection only
Answer: B
Rationale: Diffusion is the passive movement of solutes from an area of high
concentration to low concentration across a semipermeable membrane — the
primary mechanism of solute clearance in hemodialysis.
2. Which process in hemodialysis is responsible for fluid removal?
A. Diffusion
B. Osmosis
C. Ultrafiltration
D. Active transport
Answer: C
Rationale: Ultrafiltration refers to the removal of excess fluid from the blood using
transmembrane pressure (TMP) across the dialyzer membrane.
3. Kt/V is used in dialysis to measure:
A. Blood pressure control
B. Adequacy of dialysis
C. Rate of fluid removal
D. Membrane permeability
Answer: B
Rationale: Kt/V is a dimensionless number used to quantify the adequacy of
dialysis. K = clearance, t = time, V = volume of distribution of urea.
,4. The minimum recommended Kt/V for a hemodialysis patient receiving
three sessions per week is:
A. 0.8
B. 1.0
C. 1.2
D. 1.4
Answer: C
Rationale: KDOQI guidelines recommend a minimum delivered Kt/V of 1.2 per
session for patients on thrice-weekly hemodialysis.
5. Which of the following is the most commonly used measure of small solute
clearance in peritoneal dialysis?
A. Kt/V urea
B. URR
C. Creatinine clearance
D. Beta-2 microglobulin
Answer: A
Rationale: Kt/V urea is the standard measure for small solute clearance in
peritoneal dialysis, with a weekly target of at least 1.7.
6. The urea reduction ratio (URR) target for hemodialysis patients is at least:
A. 45%
B. 55%
C. 65%
D. 75%
Answer: C
Rationale: A URR of at least 65% is recommended by KDOQI guidelines as an
indicator of adequate dialysis.
7. Which type of dialyzer membrane provides the highest clearance of middle
molecules?
A. Low-flux cellulose
B. High-flux synthetic
C. Low-flux cuprophane
D. Regenerated cellulose
Answer: B
,Rationale: High-flux synthetic membranes have larger pore sizes, enabling better
clearance of middle molecules such as beta-2 microglobulin.
8. Convection in hemodialysis involves:
A. Passive solute movement across a concentration gradient
B. Solute removal via water movement through the membrane
C. Osmotic pressure-driven fluid shifts
D. Active transport of electrolytes
Answer: B
Rationale: Convection (solvent drag) involves the movement of solutes along with
water through the dialyzer membrane, driven by hydrostatic pressure differences.
9. Which of the following is a contraindication to anticoagulation with heparin
during dialysis?
A. Hypertension
B. Active bleeding or recent surgery
C. Peripheral vascular disease
D. Fluid overload
Answer: B
Rationale: Active bleeding or high bleeding risk (e.g., recent surgery, pericarditis)
are contraindications to heparin use during dialysis. Heparin-free or regional
citrate anticoagulation should be considered.
10. Which dialysis modality provides the most continuous solute removal?
A. Intermittent hemodialysis (IHD)
B. Peritoneal dialysis (PD)
C. Continuous renal replacement therapy (CRRT)
D. Sustained low-efficiency dialysis (SLED)
Answer: C
Rationale: CRRT operates 24 hours a day and provides the most continuous and
hemodynamically gentle solute and fluid removal.
11. The preferred permanent vascular access for hemodialysis is:
A. Central venous catheter
B. Arteriovenous graft
C. Arteriovenous fistula
D. Subclavian tunneled catheter
Answer: C
, Rationale: The arteriovenous fistula (AVF) is the preferred access due to lower
infection rates, longer patency, and fewer complications compared to grafts and
catheters.
12. The minimum blood flow rate recommended through an AV fistula during
dialysis is:
A. 100 mL/min
B. 200 mL/min
C. 300 mL/min
D. 400 mL/min
Answer: C
Rationale: A blood flow rate of at least 300 mL/min is typically required through a
functional AV fistula to achieve adequate dialysis.
13. Which complication of arteriovenous fistula is characterized by dilation
and tortuosity of the venous limb?
A. Steal syndrome
B. Aneurysm formation
C. Venous hypertension
D. Thrombosis
Answer: B
Rationale: Aneurysm formation in an AV fistula appears as localized dilation and
tortuosity of the venous segment, often due to repeated needle cannulation in the
same area.
14. Steal syndrome associated with vascular access is best described as:
A. Excessive blood flow through the access leading to heart failure
B. Ischemia of the hand distal to the access due to blood diversion
C. Infection of the graft material
D. Thrombosis of the fistula
Answer: B
Rationale: Steal syndrome occurs when blood is diverted away from the
hand/distal extremity into the fistula, causing ischemia, pain, numbness, or tissue
loss.
15. Which site is preferred for placement of a tunneled dialysis catheter?
A. Femoral vein
B. Subclavian vein
VERIFIED QUESTIONS & DETAILED ANSWERS | LATEST | NEPHROLOGY
NURSING PREP | TOP RATED
1. Which of the following best describes the principle of diffusion in
hemodialysis?
A. Movement of solutes from low to high concentration
B. Movement of solutes from high to low concentration across a semipermeable
membrane
C. Movement of water across a membrane due to hydrostatic pressure
D. Removal of solutes through convection only
Answer: B
Rationale: Diffusion is the passive movement of solutes from an area of high
concentration to low concentration across a semipermeable membrane — the
primary mechanism of solute clearance in hemodialysis.
2. Which process in hemodialysis is responsible for fluid removal?
A. Diffusion
B. Osmosis
C. Ultrafiltration
D. Active transport
Answer: C
Rationale: Ultrafiltration refers to the removal of excess fluid from the blood using
transmembrane pressure (TMP) across the dialyzer membrane.
3. Kt/V is used in dialysis to measure:
A. Blood pressure control
B. Adequacy of dialysis
C. Rate of fluid removal
D. Membrane permeability
Answer: B
Rationale: Kt/V is a dimensionless number used to quantify the adequacy of
dialysis. K = clearance, t = time, V = volume of distribution of urea.
,4. The minimum recommended Kt/V for a hemodialysis patient receiving
three sessions per week is:
A. 0.8
B. 1.0
C. 1.2
D. 1.4
Answer: C
Rationale: KDOQI guidelines recommend a minimum delivered Kt/V of 1.2 per
session for patients on thrice-weekly hemodialysis.
5. Which of the following is the most commonly used measure of small solute
clearance in peritoneal dialysis?
A. Kt/V urea
B. URR
C. Creatinine clearance
D. Beta-2 microglobulin
Answer: A
Rationale: Kt/V urea is the standard measure for small solute clearance in
peritoneal dialysis, with a weekly target of at least 1.7.
6. The urea reduction ratio (URR) target for hemodialysis patients is at least:
A. 45%
B. 55%
C. 65%
D. 75%
Answer: C
Rationale: A URR of at least 65% is recommended by KDOQI guidelines as an
indicator of adequate dialysis.
7. Which type of dialyzer membrane provides the highest clearance of middle
molecules?
A. Low-flux cellulose
B. High-flux synthetic
C. Low-flux cuprophane
D. Regenerated cellulose
Answer: B
,Rationale: High-flux synthetic membranes have larger pore sizes, enabling better
clearance of middle molecules such as beta-2 microglobulin.
8. Convection in hemodialysis involves:
A. Passive solute movement across a concentration gradient
B. Solute removal via water movement through the membrane
C. Osmotic pressure-driven fluid shifts
D. Active transport of electrolytes
Answer: B
Rationale: Convection (solvent drag) involves the movement of solutes along with
water through the dialyzer membrane, driven by hydrostatic pressure differences.
9. Which of the following is a contraindication to anticoagulation with heparin
during dialysis?
A. Hypertension
B. Active bleeding or recent surgery
C. Peripheral vascular disease
D. Fluid overload
Answer: B
Rationale: Active bleeding or high bleeding risk (e.g., recent surgery, pericarditis)
are contraindications to heparin use during dialysis. Heparin-free or regional
citrate anticoagulation should be considered.
10. Which dialysis modality provides the most continuous solute removal?
A. Intermittent hemodialysis (IHD)
B. Peritoneal dialysis (PD)
C. Continuous renal replacement therapy (CRRT)
D. Sustained low-efficiency dialysis (SLED)
Answer: C
Rationale: CRRT operates 24 hours a day and provides the most continuous and
hemodynamically gentle solute and fluid removal.
11. The preferred permanent vascular access for hemodialysis is:
A. Central venous catheter
B. Arteriovenous graft
C. Arteriovenous fistula
D. Subclavian tunneled catheter
Answer: C
, Rationale: The arteriovenous fistula (AVF) is the preferred access due to lower
infection rates, longer patency, and fewer complications compared to grafts and
catheters.
12. The minimum blood flow rate recommended through an AV fistula during
dialysis is:
A. 100 mL/min
B. 200 mL/min
C. 300 mL/min
D. 400 mL/min
Answer: C
Rationale: A blood flow rate of at least 300 mL/min is typically required through a
functional AV fistula to achieve adequate dialysis.
13. Which complication of arteriovenous fistula is characterized by dilation
and tortuosity of the venous limb?
A. Steal syndrome
B. Aneurysm formation
C. Venous hypertension
D. Thrombosis
Answer: B
Rationale: Aneurysm formation in an AV fistula appears as localized dilation and
tortuosity of the venous segment, often due to repeated needle cannulation in the
same area.
14. Steal syndrome associated with vascular access is best described as:
A. Excessive blood flow through the access leading to heart failure
B. Ischemia of the hand distal to the access due to blood diversion
C. Infection of the graft material
D. Thrombosis of the fistula
Answer: B
Rationale: Steal syndrome occurs when blood is diverted away from the
hand/distal extremity into the fistula, causing ischemia, pain, numbness, or tissue
loss.
15. Which site is preferred for placement of a tunneled dialysis catheter?
A. Femoral vein
B. Subclavian vein
