Hemodialysis & Peritoneal Dialysis
Exam-Graded A
The nurse instructs a client with renal failure who is receiving hemodialysis about
dietary modifications. The nurse determines that the client understands these dietary
modifications if the client selects which items from the menu?
a. Cream of wheat, blueberries, coffee
b. Sausage and eggs, banana, orange juice.
c. Bacon, cantaloupe melon, tomato juice.
d. Cured pork, grits, strawberries, orange juice. - ANSWER-A
The diet for a client with renal failure who is receiving hemodialysis should include
controlled amounts of sodium, phosphorus, calcium, potassium, and fluids. Options 2, 3,
and 4 are high in sodium, phosphorus and potassium.
The client with chronic renal failure is scheduled for hemodialysis this morning is due to
receive a daily dose of enalapril (Vasotec). The nurse should plan to administer this
medication:
a. During dialysis.
b. Just before dialysis.
c. The day after dialysis.
d. On return from dialysis. - ANSWER-D
Antihypertensive medications such as enalapril are given to the client following
hemodialysis. This prevents the client from becoming hypotensive during dialysis and
also from having the medication removed from the bloodstream by dialysis. No rationale
exists for waiting an entire day to resume the medication. This would lead to ineffective
control of the blood pressure.
The client being hemodialyzed suddenly becomes short of breath and complains of
chest pain. The client is tachycardic, pale, and anxious. The nurse suspects air
embolism. The priority action for the nurse is to:
a. Discontinue dialysis and notify the physician.
b. Monitor vital signs every 15 minutes for the next hour.
c. Continue dialysis at a slower rate after checking the lines for air.
d. Bolus the client with 500 mL of normal saline to break up the embolus. - ANSWER-A
If the client experiences air embolus during hemodialysis, the nurse should terminate
dialysis immediately, notify the physician, and administer oxygen as needed. Options 2,
3, and 4 are incorrect.
The nurse has completed client teaching with the hemodialysis client about self-
monitoring between hemodialysis treatments. The nurse determines that the client best
understands the information if the client states to record daily the:
, a. Amount of activity.
b. Pulse and respiratory rate.
c. Intake and output and weight.
d. Blood urea nitrogen and creatinine levels. - ANSWER-C
The client on hemodialysis should monitor fluid status between hemodialysis treatments
by recording intake and output and measuring weight daily. Ideally, the hemodialysis
client should not gain more than 0.5 kg of weight/day.
The client with an external arteriovenous shunt in place for hemodialysis is at risk for
bleeding. The priority nurse action would be to:
a. Check the shunt for the presence of bruit and thrill.
b. Observe the site once as time permits during the shift.
c. Check the results of the prothrombin times as they are determined.
d. Ensure that small clamps are attached to the arteriovenous shunt dressing. -
ANSWER-D
An arteriovenous shunt is a less common form of access site but carries a risk for
bleeding when it is used because two ends of an external cannula are tunneled
subcutaneously into an artery and a vein, and the ends of the cannula are joined. If
accidental disconnection occurs, the client could lose blood rapidly. For this reason,
small clamps are attached to the dressing that covers the insertion site for use if
needed. The shunt site also should be assessed at least every 4 hours.
A nurse is assessing the patency of a client's left arm arteriovenous fistula prior to
initiating hemodialysis. Which finding indicates that the fistula is patent?
a. Palpation of a thrill over the fistula.
b. Presence of a radial pulse in the left wrist.
c. Absence of a bruit on auscultation of the fistula.
d. Capillary refill less than 3 seconds in the nail beds of the fingers of the left hand. -
ANSWER-A
The nurse assesses the patency of the fistula by palpating for the presence of a thrill or
auscultating for a bruit. The presence of a thrill and bruit indicate patency of the fistula.
Although the presence of a radial pulse in the left wrist and capillary refill shorter than 3
seconds in the nail beds of the fingers on the left hand are normal findings, they do not
assess fistula patency.
The client newly diagnosed with chronic renal failure recently has begun hemodialysis.
Knowing that the client is at risk for disequilibrium syndrome, the nurse assesses the
client during dialysis for:
a. Hypertension, tachycardia, and fever.
b. Hypotension, bradycardia, and hypothermia.
c. Restlessness, irritability, and generalized weakness.
d. Headache, deteriorating level of consciousness, and twitching. - ANSWER-D
Disequilibrium syndrome is characterized by headache, mental confusion, decreasing
level of consciousness, nausea, vomiting, twitching, and possible seizure activity.
Disequilibrium syndrome is caused by rapid removal of solutes from the body during
hemodialysis. At the same time, the blood-brain barrier interferes with the efficient
Exam-Graded A
The nurse instructs a client with renal failure who is receiving hemodialysis about
dietary modifications. The nurse determines that the client understands these dietary
modifications if the client selects which items from the menu?
a. Cream of wheat, blueberries, coffee
b. Sausage and eggs, banana, orange juice.
c. Bacon, cantaloupe melon, tomato juice.
d. Cured pork, grits, strawberries, orange juice. - ANSWER-A
The diet for a client with renal failure who is receiving hemodialysis should include
controlled amounts of sodium, phosphorus, calcium, potassium, and fluids. Options 2, 3,
and 4 are high in sodium, phosphorus and potassium.
The client with chronic renal failure is scheduled for hemodialysis this morning is due to
receive a daily dose of enalapril (Vasotec). The nurse should plan to administer this
medication:
a. During dialysis.
b. Just before dialysis.
c. The day after dialysis.
d. On return from dialysis. - ANSWER-D
Antihypertensive medications such as enalapril are given to the client following
hemodialysis. This prevents the client from becoming hypotensive during dialysis and
also from having the medication removed from the bloodstream by dialysis. No rationale
exists for waiting an entire day to resume the medication. This would lead to ineffective
control of the blood pressure.
The client being hemodialyzed suddenly becomes short of breath and complains of
chest pain. The client is tachycardic, pale, and anxious. The nurse suspects air
embolism. The priority action for the nurse is to:
a. Discontinue dialysis and notify the physician.
b. Monitor vital signs every 15 minutes for the next hour.
c. Continue dialysis at a slower rate after checking the lines for air.
d. Bolus the client with 500 mL of normal saline to break up the embolus. - ANSWER-A
If the client experiences air embolus during hemodialysis, the nurse should terminate
dialysis immediately, notify the physician, and administer oxygen as needed. Options 2,
3, and 4 are incorrect.
The nurse has completed client teaching with the hemodialysis client about self-
monitoring between hemodialysis treatments. The nurse determines that the client best
understands the information if the client states to record daily the:
, a. Amount of activity.
b. Pulse and respiratory rate.
c. Intake and output and weight.
d. Blood urea nitrogen and creatinine levels. - ANSWER-C
The client on hemodialysis should monitor fluid status between hemodialysis treatments
by recording intake and output and measuring weight daily. Ideally, the hemodialysis
client should not gain more than 0.5 kg of weight/day.
The client with an external arteriovenous shunt in place for hemodialysis is at risk for
bleeding. The priority nurse action would be to:
a. Check the shunt for the presence of bruit and thrill.
b. Observe the site once as time permits during the shift.
c. Check the results of the prothrombin times as they are determined.
d. Ensure that small clamps are attached to the arteriovenous shunt dressing. -
ANSWER-D
An arteriovenous shunt is a less common form of access site but carries a risk for
bleeding when it is used because two ends of an external cannula are tunneled
subcutaneously into an artery and a vein, and the ends of the cannula are joined. If
accidental disconnection occurs, the client could lose blood rapidly. For this reason,
small clamps are attached to the dressing that covers the insertion site for use if
needed. The shunt site also should be assessed at least every 4 hours.
A nurse is assessing the patency of a client's left arm arteriovenous fistula prior to
initiating hemodialysis. Which finding indicates that the fistula is patent?
a. Palpation of a thrill over the fistula.
b. Presence of a radial pulse in the left wrist.
c. Absence of a bruit on auscultation of the fistula.
d. Capillary refill less than 3 seconds in the nail beds of the fingers of the left hand. -
ANSWER-A
The nurse assesses the patency of the fistula by palpating for the presence of a thrill or
auscultating for a bruit. The presence of a thrill and bruit indicate patency of the fistula.
Although the presence of a radial pulse in the left wrist and capillary refill shorter than 3
seconds in the nail beds of the fingers on the left hand are normal findings, they do not
assess fistula patency.
The client newly diagnosed with chronic renal failure recently has begun hemodialysis.
Knowing that the client is at risk for disequilibrium syndrome, the nurse assesses the
client during dialysis for:
a. Hypertension, tachycardia, and fever.
b. Hypotension, bradycardia, and hypothermia.
c. Restlessness, irritability, and generalized weakness.
d. Headache, deteriorating level of consciousness, and twitching. - ANSWER-D
Disequilibrium syndrome is characterized by headache, mental confusion, decreasing
level of consciousness, nausea, vomiting, twitching, and possible seizure activity.
Disequilibrium syndrome is caused by rapid removal of solutes from the body during
hemodialysis. At the same time, the blood-brain barrier interferes with the efficient
