DAVITA RN FINAL EXAM 2026/2027 | 120
VERIFIED QUESTIONS & ANSWERS |
HEMODIALYSIS NURSING
COMPETENCY | INSTANT DOWNLOAD
Hemodialysis Nursing Competency — Practice Questions, Answers & Rationales
Section 1: Hemodialysis Fundamentals (Questions 1–25)
1. What is the primary purpose of hemodialysis in patients with end-stage kidney disease?
A. To restore normal kidney function permanently
B. To remove waste products and excess fluid from the blood
C. To increase red blood cell production immediately
D. To eliminate the need for dietary restrictions
Answer: B. To remove waste products and excess fluid from the blood.
Rationale: Hemodialysis removes metabolic waste, excess electrolytes, and fluid when the kidneys cannot
adequately perform these functions.
2. Which principle allows small waste molecules to move across a dialysis membrane?
A. Osmosis only
B. Active transport
C. Diffusion
D. Phagocytosis
Answer: C. Diffusion.
Rationale: Diffusion moves solutes from an area of higher concentration to an area of lower concentration
across a semipermeable membrane.
3. What is the primary purpose of ultrafiltration during hemodialysis?
A. To remove excess fluid from the patient
B. To increase blood glucose
C. To produce red blood cells
D. To increase serum albumin
Answer: A. To remove excess fluid from the patient.
Rationale: Ultrafiltration uses a pressure gradient across the dialyzer membrane to remove excess water
from the bloodstream.
4. Which vascular access is generally preferred for long-term hemodialysis when suitable?
A. Peripheral IV catheter
B. Arteriovenous fistula
C. Temporary peripheral cannula
D. Intramuscular injection site
Answer: B. Arteriovenous fistula.
,Rationale: An arteriovenous fistula is generally preferred because it offers good blood flow and lower
infection and thrombosis risks than many alternative access types.
5. Which finding may indicate an arteriovenous fistula is functioning?
A. Absence of a pulse and thrill
B. Redness extending along the entire arm
C. A palpable thrill over the access
D. Severe pain with cool fingers
Answer: C. A palpable thrill over the access.
Rationale: A thrill is a vibration caused by blood flowing through the fistula. The nurse should also assess
the bruit and investigate any change or absence of these findings.
6. Which action should a nurse avoid on the arm containing an AV fistula whenever possible?
A. Assessing the access for a thrill
B. Inspecting for signs of infection
C. Measuring blood pressure
D. Checking the skin for bleeding
Answer: C. Measuring blood pressure.
Rationale: Blood pressure cuffs can compress the access and interfere with blood flow. Avoid blood draws,
IV placement, and unnecessary compression on the access arm as well.
7. Which electrolyte abnormality is particularly dangerous in a patient with kidney failure?
A. Hyperkalemia
B. Mildly decreased chloride
C. Low-normal sodium
D. Slightly decreased phosphate
Answer: A. Hyperkalemia.
Rationale: Elevated potassium can cause life-threatening cardiac conduction abnormalities and
dysrhythmias.
8. What is the purpose of dialysate in hemodialysis?
A. To replace all circulating blood
B. To provide a solution that facilitates waste and electrolyte exchange
C. To prevent every possible infection
D. To increase blood viscosity
Answer: B. To provide a solution that facilitates waste and electrolyte exchange.
Rationale: Dialysate has a controlled composition that allows selected solutes to move across the dialyzer
membrane according to concentration gradients.
9. Which assessment should be completed before initiating a routine hemodialysis treatment?
A. Obtain baseline vital signs and assess the patient and vascular access
B. Give every patient a fluid bolus
C. Disconnect the water treatment system
D. Ignore the prescribed target weight
Answer: A. Obtain baseline vital signs and assess the patient and vascular access.
Rationale: Baseline assessment helps identify instability, access problems, fluid overload, and other risks
before treatment begins.
, 10. What does a patient's prescribed dry weight generally represent?
A. The patient's weight immediately after eating
B. A target postdialysis weight reflecting an appropriate fluid balance
C. The patient's highest recorded weight
D. A weight that never changes over time
Answer: B. A target postdialysis weight reflecting an appropriate fluid balance.
Rationale: Target weight estimates the weight at which the patient is adequately hydrated without
significant excess fluid. It may need adjustment as the patient's clinical condition changes.
11. Which symptom may indicate fluid overload in a patient receiving hemodialysis?
A. Dry mucous membranes
B. Crackles in the lungs and shortness of breath
C. Decreased peripheral edema
D. Reduced jugular venous pressure
Answer: B. Crackles in the lungs and shortness of breath.
Rationale: Excess fluid can accumulate in the lungs and tissues, causing pulmonary congestion, dyspnea,
edema, and elevated blood pressure.
12. What is the purpose of heparin during hemodialysis when prescribed?
A. To increase serum potassium
B. To prevent clotting in the extracorporeal blood circuit
C. To treat bacterial infections
D. To increase blood glucose
Answer: B. To prevent clotting in the extracorporeal blood circuit.
Rationale: Heparin is an anticoagulant that helps prevent blood from clotting in the dialysis tubing and
dialyzer. Administration must follow the prescription and bleeding-risk assessment.
13. Which finding during dialysis requires immediate nursing assessment?
A. The patient is resting comfortably
B. The patient reports sudden chest pain and difficulty breathing
C. The patient asks for a blanket
D. The patient reports mild thirst
Answer: B. The patient reports sudden chest pain and difficulty breathing.
Rationale: Sudden chest pain and dyspnea may indicate a serious cardiovascular, respiratory, or dialysis-
related complication requiring immediate assessment and emergency intervention as indicated.
14. Why is pre-dialysis weight measured?
A. To determine the patient's blood type
B. To help estimate fluid gain and calculate the prescribed fluid-removal goal
C. To determine the patient's height
D. To establish the patient's medication allergies
Answer: B. To help estimate fluid gain and calculate the prescribed fluid-removal goal.
Rationale: Comparing pre- and postdialysis weights with the target weight helps assess interdialytic fluid
accumulation and guide the prescribed ultrafiltration goal.
15. Which finding may indicate infection at a dialysis catheter exit site?
A. Clean, dry skin
VERIFIED QUESTIONS & ANSWERS |
HEMODIALYSIS NURSING
COMPETENCY | INSTANT DOWNLOAD
Hemodialysis Nursing Competency — Practice Questions, Answers & Rationales
Section 1: Hemodialysis Fundamentals (Questions 1–25)
1. What is the primary purpose of hemodialysis in patients with end-stage kidney disease?
A. To restore normal kidney function permanently
B. To remove waste products and excess fluid from the blood
C. To increase red blood cell production immediately
D. To eliminate the need for dietary restrictions
Answer: B. To remove waste products and excess fluid from the blood.
Rationale: Hemodialysis removes metabolic waste, excess electrolytes, and fluid when the kidneys cannot
adequately perform these functions.
2. Which principle allows small waste molecules to move across a dialysis membrane?
A. Osmosis only
B. Active transport
C. Diffusion
D. Phagocytosis
Answer: C. Diffusion.
Rationale: Diffusion moves solutes from an area of higher concentration to an area of lower concentration
across a semipermeable membrane.
3. What is the primary purpose of ultrafiltration during hemodialysis?
A. To remove excess fluid from the patient
B. To increase blood glucose
C. To produce red blood cells
D. To increase serum albumin
Answer: A. To remove excess fluid from the patient.
Rationale: Ultrafiltration uses a pressure gradient across the dialyzer membrane to remove excess water
from the bloodstream.
4. Which vascular access is generally preferred for long-term hemodialysis when suitable?
A. Peripheral IV catheter
B. Arteriovenous fistula
C. Temporary peripheral cannula
D. Intramuscular injection site
Answer: B. Arteriovenous fistula.
,Rationale: An arteriovenous fistula is generally preferred because it offers good blood flow and lower
infection and thrombosis risks than many alternative access types.
5. Which finding may indicate an arteriovenous fistula is functioning?
A. Absence of a pulse and thrill
B. Redness extending along the entire arm
C. A palpable thrill over the access
D. Severe pain with cool fingers
Answer: C. A palpable thrill over the access.
Rationale: A thrill is a vibration caused by blood flowing through the fistula. The nurse should also assess
the bruit and investigate any change or absence of these findings.
6. Which action should a nurse avoid on the arm containing an AV fistula whenever possible?
A. Assessing the access for a thrill
B. Inspecting for signs of infection
C. Measuring blood pressure
D. Checking the skin for bleeding
Answer: C. Measuring blood pressure.
Rationale: Blood pressure cuffs can compress the access and interfere with blood flow. Avoid blood draws,
IV placement, and unnecessary compression on the access arm as well.
7. Which electrolyte abnormality is particularly dangerous in a patient with kidney failure?
A. Hyperkalemia
B. Mildly decreased chloride
C. Low-normal sodium
D. Slightly decreased phosphate
Answer: A. Hyperkalemia.
Rationale: Elevated potassium can cause life-threatening cardiac conduction abnormalities and
dysrhythmias.
8. What is the purpose of dialysate in hemodialysis?
A. To replace all circulating blood
B. To provide a solution that facilitates waste and electrolyte exchange
C. To prevent every possible infection
D. To increase blood viscosity
Answer: B. To provide a solution that facilitates waste and electrolyte exchange.
Rationale: Dialysate has a controlled composition that allows selected solutes to move across the dialyzer
membrane according to concentration gradients.
9. Which assessment should be completed before initiating a routine hemodialysis treatment?
A. Obtain baseline vital signs and assess the patient and vascular access
B. Give every patient a fluid bolus
C. Disconnect the water treatment system
D. Ignore the prescribed target weight
Answer: A. Obtain baseline vital signs and assess the patient and vascular access.
Rationale: Baseline assessment helps identify instability, access problems, fluid overload, and other risks
before treatment begins.
, 10. What does a patient's prescribed dry weight generally represent?
A. The patient's weight immediately after eating
B. A target postdialysis weight reflecting an appropriate fluid balance
C. The patient's highest recorded weight
D. A weight that never changes over time
Answer: B. A target postdialysis weight reflecting an appropriate fluid balance.
Rationale: Target weight estimates the weight at which the patient is adequately hydrated without
significant excess fluid. It may need adjustment as the patient's clinical condition changes.
11. Which symptom may indicate fluid overload in a patient receiving hemodialysis?
A. Dry mucous membranes
B. Crackles in the lungs and shortness of breath
C. Decreased peripheral edema
D. Reduced jugular venous pressure
Answer: B. Crackles in the lungs and shortness of breath.
Rationale: Excess fluid can accumulate in the lungs and tissues, causing pulmonary congestion, dyspnea,
edema, and elevated blood pressure.
12. What is the purpose of heparin during hemodialysis when prescribed?
A. To increase serum potassium
B. To prevent clotting in the extracorporeal blood circuit
C. To treat bacterial infections
D. To increase blood glucose
Answer: B. To prevent clotting in the extracorporeal blood circuit.
Rationale: Heparin is an anticoagulant that helps prevent blood from clotting in the dialysis tubing and
dialyzer. Administration must follow the prescription and bleeding-risk assessment.
13. Which finding during dialysis requires immediate nursing assessment?
A. The patient is resting comfortably
B. The patient reports sudden chest pain and difficulty breathing
C. The patient asks for a blanket
D. The patient reports mild thirst
Answer: B. The patient reports sudden chest pain and difficulty breathing.
Rationale: Sudden chest pain and dyspnea may indicate a serious cardiovascular, respiratory, or dialysis-
related complication requiring immediate assessment and emergency intervention as indicated.
14. Why is pre-dialysis weight measured?
A. To determine the patient's blood type
B. To help estimate fluid gain and calculate the prescribed fluid-removal goal
C. To determine the patient's height
D. To establish the patient's medication allergies
Answer: B. To help estimate fluid gain and calculate the prescribed fluid-removal goal.
Rationale: Comparing pre- and postdialysis weights with the target weight helps assess interdialytic fluid
accumulation and guide the prescribed ultrafiltration goal.
15. Which finding may indicate infection at a dialysis catheter exit site?
A. Clean, dry skin
