Comprehensive Competency Examination for Certified Peritoneal Dialysis Nurses: Advanced Concepts in Continuous Cycling Peritoneal Dialysis (CCPD), Automated Peritoneal Dialysis (APD) Therapy Management, Cyclers, Troubleshooting, Prescriptions, Infecti

Comprehensive Competency Examination for Certified Peritoneal Dialysis Nurses:
Concepts in Continuous Cycling Peritoneal Dialysis (CCPD), Automated Peritoneal
Therapy Management, Cyclers, Troubleshooting, Prescriptions, Infectious Complic
Safety Protocols.
Questions 1–150
Domain 1: APD/CCPD Fundamentals & Prescription (Questions 1–25)
1. A patient new to APD is prescribed 5 cycles of 2 liters each, with a final fill of 1.5 liters. Total dialysate volume used
per night is:
A) 9.5 L
B) 10 L
C) 11.5 L
D) 12 L
Correct Answer: C
Rationale: 5 cycles × 2 L = 10 L infused + 1.5 L final fill = 11.5 L total. The final fill remains in the abdomen during the
day.
2. In CCPD, the last fill of the night is typically:
A) Drained immediately after the last cycle
B) Left in for the entire day (dwell)
C) Exchanged for a fresh bag mid-morning
D) Dextrose 4.25% only
Correct Answer: B
Rationale: The last fill (day dwell) remains in the abdomen during the day to maintain continuous clearance.
3. Which cycler feature automatically adjusts fill volume based on patient position or intraperitoneal pressure?
A) Tidal volume
B) Last fill override
C) Dynamic fill sensor
D) Ultrafiltration profiling
Correct Answer: C
Rationale: Dynamic fill sensors reduce fill volume if pressure is high, preventing leaks or pain.
4. A patient on APD has a residual renal function of 3 mL/min. To preserve residual function, you should avoid:
A) Icodextrin for long dwell
B) High dextrose concentrations unnecessarily
C) Using a cycler nightly
D) Adding sodium polystyrene sulfonate
Correct Answer: B
Rationale: High glucose concentrations may accelerate peritoneal membrane failure and loss of residual renal
function.
5. Tidal peritoneal dialysis (TPD) differs from standard APD by:

,A) Keeping a constant volume of dialysate in the abdomen during cycling
B) Using only 0.5 L fills
C) Eliminating the need for a cycler
D) Requiring manual exchanges during the day only
Correct Answer: A
Rationale: TPD maintains a residual volume (e.g., 50–80%) in the peritoneum throughout all cycles, improving
clearance.
6. A CCPD patient with high transport status on PET should have which overnight prescription adjustment to avoid
excessive glucose absorption?
A) Shorter dwell times, more cycles
B) Longer dwell times, fewer cycles
C) Icodextrin for overnight cycles
D) Decrease fill volume to 1 L
Correct Answer: A
Rationale: High transporters benefit from short, frequent cycles overnight to prevent rapid glucose absorption and
loss of UF.
7. The minimum recommended break-in period after PD catheter placement before starting APD is:
A) Immediately after surgery
B) 24 hours
C) 10–14 days
C) 10–14 days
D) 6 weeks
Correct Answer: C
Rationale: 10–14 days allows wound healing and reduces leak risk; some programs individualize.
8. A patient has inadequate UF on APD with 2.5% dextrose. Which change is most appropriate first?
A) Switch to 4.25% dextrose for all cycles
B) Add a midday manual exchange
C) Use icodextrin for the long day dwell
D) Reduce fill volume to decrease intraperitoneal pressure
Correct Answer: C
Rationale: Icodextrin provides sustained UF over long dwells (≥8–12 h) without glucose absorption.
9. In CCPD, the cycler’s “drain alarm” sounds with residual volume >300 mL after drain phase. Likely cause in a
constipated patient:
A) Catheter migration
B) Omental wrap
C) Intra-abdominal pressure from stool
D) Air in the line
Correct Answer: C
Rationale: Constipation elevates intra-abdominal pressure and blocks catheter side holes; treat with laxatives.
10. Which statement about tidal APD is FALSE?
A) It reduces drain pain

, B) It improves small solute clearance in high transporters
C) It is contraindicated in low transporters
D) Tidal volume is typically set at 50–80% of total fill
Correct Answer: C
Rationale: Tidal PD can be used in any transport type, though benefits vary.
11. A patient on APD complains of morning headache and nausea. Blood pressure is 150/95 (previous 120/70). Likely
cause:
A) Hyperglycemia
B) Fluid overload from poor UF
C) Dehydration from excessive UF
D) Hyponatremia
Correct Answer: C
Rationale: Excessive UF causes hypovolemia, headache, and reactive hypertension from RAAS activation.
12. The cycler parameter that controls total nightly treatment time is:
A) Dwell time
B) Fill time
C) Cycle length = fill + dwell + drain
D) Ultrafiltration target
Correct Answer: C
Rationale: Cycle length determines how many cycles fit into the prescribed therapy time.
13. Icodextrin is BEST suited for:
A) Short 1-hour dwells during APD cycles
B) Long dwell (daytime) in CCPD
C) All cycles to reduce glucose load
D) First cycle of the night
Correct Answer: B
Rationale: Icodextrin requires ≥8 hours to achieve sustained UF; perfect for daytime dwell.
14. In APD, “drain pain” is often relieved by:
A) Increasing tidal volume
B) Decreasing fill volume
C) Adding heparin to dialysate
D) Using supine position only
Correct Answer: B
Rationale: Decreasing fill volume reduces tension on catheter tip against peritoneum.
15. A patient’s cycler displays “No drain after 30 minutes.” FIRST action:
A) Increase drain time limit in settings
B) Clamp catheter and call surgeon
C) Check for kinked tubing and patient position
D) Instill 500 mL rapid fill to dislodge fibrin
Correct Answer: C