FLORIDA BOARD OF NURSING CERTIFIED
HEMODIALYSIS NURSE EXAM WITH
ACTUAL QUESTIONS AND VERIFIED
ANSWERS, PLUS EXPLAINED
RATIONALES/EXPERT VERIFIED FOR
GUARANTEED 100% PASS 2026/LATEST
UPDATE/INSTANT DOWNLOAD PDF
1. A patient receiving maintenance hemodialysis develops sudden
dyspnea, chest discomfort, and a blood pressure of 82/48 mmHg
20 minutes after dialysis begins. The ultrafiltration rate is 1.5 L/hr.
Which intervention should the nurse perform first?
A. Administer the prescribed antihypertensive medication
B. Increase the ultrafiltration rate to remove additional fluid
C. Stop ultrafiltration and place the patient in a supine position with legs
elevated as appropriate
D. Administer a high-potassium dietary supplement
Answer: C. Stop ultrafiltration and place the patient in a supine
position with legs elevated as appropriate
Rationale: Intradialytic hypotension is commonly associated with
excessive or rapid fluid removal, impaired vascular refilling,
autonomic dysfunction, cardiac disease, and antihypertensive therapy.
The immediate priority is to restore circulating volume and perfusion
by stopping ultrafiltration and positioning the patient appropriately.
The nurse should reassess blood pressure, symptoms, oxygenation,
and cardiac status and follow the dialysis-unit protocol for saline
administration if indicated. Increasing ultrafiltration would worsen
the problem.
1
, 2. A hemodialysis patient has a functioning arteriovenous fistula in
the left forearm. Which finding requires the nurse's immediate
attention?
A. A palpable thrill over the fistula
B. A soft bruit heard with auscultation
C. Absence of the usual thrill and bruit
D. Mild bruising at an old needle site
Answer: C. Absence of the usual thrill and bruit
Rationale: A functioning AV fistula should have a palpable thrill and
an audible bruit produced by blood flow through the access. Their
sudden absence may indicate thrombosis or severe obstruction and
requires immediate assessment and notification of the appropriate
provider/dialysis team. Patients should also be taught to avoid blood
pressure measurements, venipuncture, and constrictive clothing on the
access arm.
3. During hemodialysis, a patient reports severe headache, nausea,
restlessness, and blurred vision. The patient is receiving dialysis
for severe azotemia and is undergoing an initial treatment. Which
complication should the nurse suspect?
A. Disequilibrium syndrome
B. Air embolism
C. Hemolysis
D. Hyperglycemia
Answer: A. Disequilibrium syndrome
Rationale: Dialysis disequilibrium syndrome can occur when rapid
removal of urea from the blood produces an osmotic gradient that
promotes cerebral edema. Early manifestations include headache,
2
,nausea, restlessness, confusion, and visual disturbances; severe cases
can progress to seizures, decreased consciousness, or coma. It is
particularly associated with initial dialysis treatments or very high pre-
dialysis BUN levels.
4. A dialysis patient develops chest pain, dyspnea, cyanosis, and a
sudden change in mental status shortly after the dialysis circuit is
manipulated. The nurse suspects an air embolism. Which action is
most appropriate?
A. Immediately increase the blood flow rate
B. Stop the blood pump and prevent additional air from entering the
circulation
C. Return all blood rapidly to the patient
D. Place the patient in a sitting position and encourage deep breathing
Answer: B. Stop the blood pump and prevent additional air from
entering the circulation
Rationale: An air embolism is a potentially life-threatening
emergency. The blood pump should be stopped immediately, the source
of air should be clamped or eliminated, and the patient should receive
urgent assessment and emergency management according to facility
protocol. The nurse should not return potentially air-contaminated
blood to the patient. Oxygen and emergency medical support may be
required.
5. A patient with an AV fistula asks why blood pressure should not
be measured on the access arm. Which explanation is most
accurate?
A. The cuff increases the patient's risk of hypoglycemia
B. Compression can impair blood flow and contribute to access injury or
3
, thrombosis
C. The cuff permanently increases serum creatinine
D. Blood pressure measurements cause the fistula to produce excess
erythropoietin
Answer: B. Compression can impair blood flow and contribute to
access injury or thrombosis
Rationale: The dialysis access depends on adequate blood flow.
Repeated or prolonged compression from blood pressure cuffs can
compromise perfusion and potentially contribute to access damage,
thrombosis, or loss of function. The access arm should also generally
be protected from routine venipuncture and restrictive clothing.
6. A patient receiving hemodialysis develops muscle cramps in both
legs and becomes hypotensive. The patient has already had
substantial ultrafiltration. Which mechanism best explains the
symptoms?
A. Excessive intravascular volume expansion
B. Excessive removal of fluid causing reduced circulating volume
C. Increased erythropoietin production
D. Acute increase in serum albumin
Answer: B. Excessive removal of fluid causing reduced circulating
volume
Rationale: Rapid or excessive ultrafiltration can remove fluid faster
than the intravascular compartment can refill from the interstitial
space. This reduces circulating volume and may cause hypotension,
muscle cramps, dizziness, nausea, and weakness. Management
includes reducing or stopping ultrafiltration, reassessing the patient,
and administering fluid according to the prescribed protocol when
indicated.
4
HEMODIALYSIS NURSE EXAM WITH
ACTUAL QUESTIONS AND VERIFIED
ANSWERS, PLUS EXPLAINED
RATIONALES/EXPERT VERIFIED FOR
GUARANTEED 100% PASS 2026/LATEST
UPDATE/INSTANT DOWNLOAD PDF
1. A patient receiving maintenance hemodialysis develops sudden
dyspnea, chest discomfort, and a blood pressure of 82/48 mmHg
20 minutes after dialysis begins. The ultrafiltration rate is 1.5 L/hr.
Which intervention should the nurse perform first?
A. Administer the prescribed antihypertensive medication
B. Increase the ultrafiltration rate to remove additional fluid
C. Stop ultrafiltration and place the patient in a supine position with legs
elevated as appropriate
D. Administer a high-potassium dietary supplement
Answer: C. Stop ultrafiltration and place the patient in a supine
position with legs elevated as appropriate
Rationale: Intradialytic hypotension is commonly associated with
excessive or rapid fluid removal, impaired vascular refilling,
autonomic dysfunction, cardiac disease, and antihypertensive therapy.
The immediate priority is to restore circulating volume and perfusion
by stopping ultrafiltration and positioning the patient appropriately.
The nurse should reassess blood pressure, symptoms, oxygenation,
and cardiac status and follow the dialysis-unit protocol for saline
administration if indicated. Increasing ultrafiltration would worsen
the problem.
1
, 2. A hemodialysis patient has a functioning arteriovenous fistula in
the left forearm. Which finding requires the nurse's immediate
attention?
A. A palpable thrill over the fistula
B. A soft bruit heard with auscultation
C. Absence of the usual thrill and bruit
D. Mild bruising at an old needle site
Answer: C. Absence of the usual thrill and bruit
Rationale: A functioning AV fistula should have a palpable thrill and
an audible bruit produced by blood flow through the access. Their
sudden absence may indicate thrombosis or severe obstruction and
requires immediate assessment and notification of the appropriate
provider/dialysis team. Patients should also be taught to avoid blood
pressure measurements, venipuncture, and constrictive clothing on the
access arm.
3. During hemodialysis, a patient reports severe headache, nausea,
restlessness, and blurred vision. The patient is receiving dialysis
for severe azotemia and is undergoing an initial treatment. Which
complication should the nurse suspect?
A. Disequilibrium syndrome
B. Air embolism
C. Hemolysis
D. Hyperglycemia
Answer: A. Disequilibrium syndrome
Rationale: Dialysis disequilibrium syndrome can occur when rapid
removal of urea from the blood produces an osmotic gradient that
promotes cerebral edema. Early manifestations include headache,
2
,nausea, restlessness, confusion, and visual disturbances; severe cases
can progress to seizures, decreased consciousness, or coma. It is
particularly associated with initial dialysis treatments or very high pre-
dialysis BUN levels.
4. A dialysis patient develops chest pain, dyspnea, cyanosis, and a
sudden change in mental status shortly after the dialysis circuit is
manipulated. The nurse suspects an air embolism. Which action is
most appropriate?
A. Immediately increase the blood flow rate
B. Stop the blood pump and prevent additional air from entering the
circulation
C. Return all blood rapidly to the patient
D. Place the patient in a sitting position and encourage deep breathing
Answer: B. Stop the blood pump and prevent additional air from
entering the circulation
Rationale: An air embolism is a potentially life-threatening
emergency. The blood pump should be stopped immediately, the source
of air should be clamped or eliminated, and the patient should receive
urgent assessment and emergency management according to facility
protocol. The nurse should not return potentially air-contaminated
blood to the patient. Oxygen and emergency medical support may be
required.
5. A patient with an AV fistula asks why blood pressure should not
be measured on the access arm. Which explanation is most
accurate?
A. The cuff increases the patient's risk of hypoglycemia
B. Compression can impair blood flow and contribute to access injury or
3
, thrombosis
C. The cuff permanently increases serum creatinine
D. Blood pressure measurements cause the fistula to produce excess
erythropoietin
Answer: B. Compression can impair blood flow and contribute to
access injury or thrombosis
Rationale: The dialysis access depends on adequate blood flow.
Repeated or prolonged compression from blood pressure cuffs can
compromise perfusion and potentially contribute to access damage,
thrombosis, or loss of function. The access arm should also generally
be protected from routine venipuncture and restrictive clothing.
6. A patient receiving hemodialysis develops muscle cramps in both
legs and becomes hypotensive. The patient has already had
substantial ultrafiltration. Which mechanism best explains the
symptoms?
A. Excessive intravascular volume expansion
B. Excessive removal of fluid causing reduced circulating volume
C. Increased erythropoietin production
D. Acute increase in serum albumin
Answer: B. Excessive removal of fluid causing reduced circulating
volume
Rationale: Rapid or excessive ultrafiltration can remove fluid faster
than the intravascular compartment can refill from the interstitial
space. This reduces circulating volume and may cause hypotension,
muscle cramps, dizziness, nausea, and weakness. Management
includes reducing or stopping ultrafiltration, reassessing the patient,
and administering fluid according to the prescribed protocol when
indicated.
4
