EDPNA EXAM 200 ACTUAL QUESTIONS AND
CORRECT ANSWERS WITH RATIONALE LATEST
UPDATE ALREADY GRADED A+ ASSURED PASS
This comprehensive examination bank features 200 unique, single-best-
answer multiple-choice questions specifically designed for nephrology and
dialysis nursing certification. Each question presents a realistic clinical
scenario involving hemodialysis, peritoneal dialysis, vascular access,
electrolyte imbalances, phosphate binders, anemia management, peritonitis,
catheter complications, fluid management, and transplant pharmacology.
Every question includes a correct answer and a detailed, evidence-based
rationale that explains the underlying pathophysiology and clinical reasoning.
No questions are repeated, and all text is plain for easy study. This bank
strengthens clinical judgment, reinforces renal pharmacotherapeutics, and
prepares candidates for high-stakes dialysis certification examinations.
Question 1
A patient on hemodialysis presents with a temperature of 38.5°C during the
dialysis session. The nurse notes that the dialysis lines are intact and the access site
appears clean. What is the most appropriate initial nursing action?
A) Continue dialysis and administer antipyretics
B) Stop dialysis, return blood, and notify the provider
C) Decrease the dialysate temperature to 35°C
D) Increase the blood flow rate to clear the infection
Answer: B
Rationale: Fever during dialysis can indicate a pyrogenic reaction or bacteremia.
The safest action is to stop the dialysis, return the blood to the patient, and notify
the provider for further evaluation. Continuing dialysis or increasing blood flow
does not address the potential infection.
Question 2
A patient with end-stage renal disease has a serum potassium of 6.8 mEq/L. Which
electrocardiogram change is most concerning?
A) Prolonged PR interval
B) Peaked T waves
,C) Widened QRS complex
D) ST-segment depression
Answer: C
Rationale: Peaked T waves are an early sign of hyperkalemia. A widened QRS
complex indicates more severe hyperkalemia and is associated with a higher risk of
ventricular arrhythmias and cardiac arrest. Prolonged PR and ST depression also
occur but are less immediately life-threatening.
Question 3
A patient is starting peritoneal dialysis. The nurse teaches the patient about the
most common complication associated with this modality. Which complication is
most common?
A) Peritonitis
B) Hemorrhage
C) Hernia
D) Hyperglycemia
Answer: A
Rationale: Peritonitis is the most common and serious complication of peritoneal
dialysis, caused by contamination of the catheter or dialysate. Hemorrhage, hernia,
and hyperglycemia can occur but are less frequent.
Question 4
A patient on hemodialysis has an arteriovenous fistula in the left arm. Which
finding indicates that the fistula is mature and ready for use?
A) Absence of a bruit
B) Palpable thrill and audible bruit
C) Coolness and pallor of the extremity
D) Edema and redness around the site
Answer: B
Rationale: A mature AV fistula has a palpable thrill (vibration) and an audible bruit
(whooshing sound) on auscultation. Absence of these indicates stenosis or
thrombosis. Coolness, pallor, edema, and redness are signs of complications.
Question 5
A patient on hemodialysis develops hypotension during the treatment. The nurse
should place the patient in which position?
A) Supine with legs flat
B) Trendelenburg position
C) High Fowler position
D) Left lateral decubitus position
,Answer: B
Rationale: The Trendelenburg position (head down, feet elevated) promotes
venous return and improves blood pressure during dialysis-induced hypotension.
Supine with legs flat is less effective. High Fowler and left lateral decubitus are not
appropriate.
Question 6
A patient receiving continuous ambulatory peritoneal dialysis reports that the
effluent is cloudy. What is the priority nursing action?
A) Reassure the patient and continue the exchange
B) Send a sample of the effluent for culture and cell count
C) Increase the dwell time
D) Add heparin to the dialysate
Answer: B
Rationale: Cloudy effluent is the hallmark of peritonitis. The nurse should send a
sample for culture, Gram stain, and white blood cell count. Antibiotics are started
after cultures are obtained. Increasing dwell time or adding heparin does not treat
infection.
Question 7
A patient with chronic kidney disease has a serum phosphate of 7.5 mg/dL. Which
medication should the nurse anticipate administering?
A) Calcitriol
B) Calcium acetate
C) Ferrous sulfate
D) Erythropoietin
Answer: B
Rationale: Calcium acetate is a phosphate binder that binds dietary phosphate in
the gastrointestinal tract, reducing serum phosphate levels. Calcitriol is active
vitamin D. Ferrous sulfate is for anemia. Erythropoietin stimulates red blood cell
production.
Question 8
A patient on hemodialysis is receiving heparin during the treatment. The nurse
understands that heparin is given to prevent:
A) Infection
B) Clotting in the extracorporeal circuit
C) Hypotension
D) Electrolyte imbalances
Answer: B
, Rationale: Heparin is an anticoagulant given during hemodialysis to prevent blood
from clotting in the dialysis circuit and the dialyzer. It does not prevent infection,
hypotension, or electrolyte imbalances.
Question 9
A patient with end-stage renal disease is on a fluid restriction of 1000 mL per day.
Which beverage should the nurse instruct the patient to avoid?
A) Water
B) Coffee
C) Orange juice
D) Cranberry juice
Answer: C
Rationale: Orange juice has a high fluid content and is also high in potassium. All
fluids must be counted, but orange juice is particularly problematic due to
potassium. Water, coffee, and cranberry juice are lower in potassium but still
counted in the fluid restriction.
Question 10
A patient on peritoneal dialysis complains of severe abdominal pain and nausea.
The effluent is cloudy with a white blood cell count of 1500 cells/mm3. The nurse
suspects peritonitis and prepares to:
A) Administer intraperitoneal antibiotics
B) Remove the peritoneal catheter
C) Switch to hemodialysis
D) Increase the dextrose concentration
Answer: A
Rationale: Peritonitis is treated with intraperitoneal antibiotics, often with added
heparin to prevent fibrin clots. Catheter removal is reserved for refractory or fungal
peritonitis. Switching to hemodialysis is not the first step. Increasing dextrose does
not treat infection.
Question 11
A patient on hemodialysis has a central venous catheter in the right internal jugular
vein. Which nursing intervention is essential to prevent catheter-related
bloodstream infection?
A) Changing the catheter site daily
B) Using chlorhexidine for site care
C) Flushing the catheter with heparin twice daily
D) Changing the dressing every 7 days
Answer: B
CORRECT ANSWERS WITH RATIONALE LATEST
UPDATE ALREADY GRADED A+ ASSURED PASS
This comprehensive examination bank features 200 unique, single-best-
answer multiple-choice questions specifically designed for nephrology and
dialysis nursing certification. Each question presents a realistic clinical
scenario involving hemodialysis, peritoneal dialysis, vascular access,
electrolyte imbalances, phosphate binders, anemia management, peritonitis,
catheter complications, fluid management, and transplant pharmacology.
Every question includes a correct answer and a detailed, evidence-based
rationale that explains the underlying pathophysiology and clinical reasoning.
No questions are repeated, and all text is plain for easy study. This bank
strengthens clinical judgment, reinforces renal pharmacotherapeutics, and
prepares candidates for high-stakes dialysis certification examinations.
Question 1
A patient on hemodialysis presents with a temperature of 38.5°C during the
dialysis session. The nurse notes that the dialysis lines are intact and the access site
appears clean. What is the most appropriate initial nursing action?
A) Continue dialysis and administer antipyretics
B) Stop dialysis, return blood, and notify the provider
C) Decrease the dialysate temperature to 35°C
D) Increase the blood flow rate to clear the infection
Answer: B
Rationale: Fever during dialysis can indicate a pyrogenic reaction or bacteremia.
The safest action is to stop the dialysis, return the blood to the patient, and notify
the provider for further evaluation. Continuing dialysis or increasing blood flow
does not address the potential infection.
Question 2
A patient with end-stage renal disease has a serum potassium of 6.8 mEq/L. Which
electrocardiogram change is most concerning?
A) Prolonged PR interval
B) Peaked T waves
,C) Widened QRS complex
D) ST-segment depression
Answer: C
Rationale: Peaked T waves are an early sign of hyperkalemia. A widened QRS
complex indicates more severe hyperkalemia and is associated with a higher risk of
ventricular arrhythmias and cardiac arrest. Prolonged PR and ST depression also
occur but are less immediately life-threatening.
Question 3
A patient is starting peritoneal dialysis. The nurse teaches the patient about the
most common complication associated with this modality. Which complication is
most common?
A) Peritonitis
B) Hemorrhage
C) Hernia
D) Hyperglycemia
Answer: A
Rationale: Peritonitis is the most common and serious complication of peritoneal
dialysis, caused by contamination of the catheter or dialysate. Hemorrhage, hernia,
and hyperglycemia can occur but are less frequent.
Question 4
A patient on hemodialysis has an arteriovenous fistula in the left arm. Which
finding indicates that the fistula is mature and ready for use?
A) Absence of a bruit
B) Palpable thrill and audible bruit
C) Coolness and pallor of the extremity
D) Edema and redness around the site
Answer: B
Rationale: A mature AV fistula has a palpable thrill (vibration) and an audible bruit
(whooshing sound) on auscultation. Absence of these indicates stenosis or
thrombosis. Coolness, pallor, edema, and redness are signs of complications.
Question 5
A patient on hemodialysis develops hypotension during the treatment. The nurse
should place the patient in which position?
A) Supine with legs flat
B) Trendelenburg position
C) High Fowler position
D) Left lateral decubitus position
,Answer: B
Rationale: The Trendelenburg position (head down, feet elevated) promotes
venous return and improves blood pressure during dialysis-induced hypotension.
Supine with legs flat is less effective. High Fowler and left lateral decubitus are not
appropriate.
Question 6
A patient receiving continuous ambulatory peritoneal dialysis reports that the
effluent is cloudy. What is the priority nursing action?
A) Reassure the patient and continue the exchange
B) Send a sample of the effluent for culture and cell count
C) Increase the dwell time
D) Add heparin to the dialysate
Answer: B
Rationale: Cloudy effluent is the hallmark of peritonitis. The nurse should send a
sample for culture, Gram stain, and white blood cell count. Antibiotics are started
after cultures are obtained. Increasing dwell time or adding heparin does not treat
infection.
Question 7
A patient with chronic kidney disease has a serum phosphate of 7.5 mg/dL. Which
medication should the nurse anticipate administering?
A) Calcitriol
B) Calcium acetate
C) Ferrous sulfate
D) Erythropoietin
Answer: B
Rationale: Calcium acetate is a phosphate binder that binds dietary phosphate in
the gastrointestinal tract, reducing serum phosphate levels. Calcitriol is active
vitamin D. Ferrous sulfate is for anemia. Erythropoietin stimulates red blood cell
production.
Question 8
A patient on hemodialysis is receiving heparin during the treatment. The nurse
understands that heparin is given to prevent:
A) Infection
B) Clotting in the extracorporeal circuit
C) Hypotension
D) Electrolyte imbalances
Answer: B
, Rationale: Heparin is an anticoagulant given during hemodialysis to prevent blood
from clotting in the dialysis circuit and the dialyzer. It does not prevent infection,
hypotension, or electrolyte imbalances.
Question 9
A patient with end-stage renal disease is on a fluid restriction of 1000 mL per day.
Which beverage should the nurse instruct the patient to avoid?
A) Water
B) Coffee
C) Orange juice
D) Cranberry juice
Answer: C
Rationale: Orange juice has a high fluid content and is also high in potassium. All
fluids must be counted, but orange juice is particularly problematic due to
potassium. Water, coffee, and cranberry juice are lower in potassium but still
counted in the fluid restriction.
Question 10
A patient on peritoneal dialysis complains of severe abdominal pain and nausea.
The effluent is cloudy with a white blood cell count of 1500 cells/mm3. The nurse
suspects peritonitis and prepares to:
A) Administer intraperitoneal antibiotics
B) Remove the peritoneal catheter
C) Switch to hemodialysis
D) Increase the dextrose concentration
Answer: A
Rationale: Peritonitis is treated with intraperitoneal antibiotics, often with added
heparin to prevent fibrin clots. Catheter removal is reserved for refractory or fungal
peritonitis. Switching to hemodialysis is not the first step. Increasing dextrose does
not treat infection.
Question 11
A patient on hemodialysis has a central venous catheter in the right internal jugular
vein. Which nursing intervention is essential to prevent catheter-related
bloodstream infection?
A) Changing the catheter site daily
B) Using chlorhexidine for site care
C) Flushing the catheter with heparin twice daily
D) Changing the dressing every 7 days
Answer: B
