CERTIFIED DIALYSIS NURSE (CDN) EXAM
QUESTIONS AND VERIFIED ANSWERS
Question 1
A patient who has long-standing, untreated chronic kidney disease is admitted via the
emergency department with uremia. Acute dialysis is initiated. Because of the history
of untreated kidney disease, the patient is at risk for which of these gastrointestinal
conditions?
-polyps
-giardiasis
-paralytic ileus
-bleeding ulcers
Correct Answer
-bleeding ulcers
High levels of urea break down in the gastrointestinal (GI) tract and release
ammonia, causing irritation of the GI mucosa. Altered capillary permeability and
platelet dysfunction in uremia also contribute to GI bleeding.
Question 2
Why is monitoring a dialysis patient's albumin level so important?
Correct Answer
It is a powerful predictor of morbidity and mortality in patients with CKD
Question 3
The target hemoglobin range for CKD patients on an ESA is approximately how much
Correct Answer
10 to 12 g/dL
Page 1 of 123
,Question 4
The most common cause of bacterial bloodstream infections in dialysis patients is:
Correct Answer
The use of central venous catheters (CVC) for hemodialysis
Question 5
Which of the following classifications of drugs is nephrotoxic and should be used with
caution to preserve residual kidney function?
1. Aminoglycosides.
2. Fluoroquinolones.
3. Neuromuscular blockers.
4. Calcium channel blockers.
Correct Answer
Aminoglycosides can cause acute kidney injury through direct tubular injury
Page 2 of 123
,Question 6
A dialysis patient has been told she has osteoporosis. What information should the
nurse discuss with this patient during an educational session?
Correct Answer
There is a deficiency of both the bone matrix and calcification of the bones.
Question 1: A patient with end-stage renal disease is beginning hemodialysis.
Which of the following best describes the primary principle by which
hemodialysis removes uremic toxins from the blood?
A. Active transport across a semipermeable membrane
B. Diffusion and ultrafiltration across a semipermeable membrane
C. Osmosis driven solely by hydrostatic pressure
D. Filtration through a high-flux membrane without diffusion
CORRECT ANSWER: B. Diffusion and ultrafiltration across a semipermeable
membrane
Rationale: Hemodialysis relies primarily on diffusion for solute removal and
ultrafiltration for fluid removal across a semipermeable dialyzer membrane.
Concentration gradients drive diffusion of toxins into the dialysate, while
transmembrane pressure drives ultrafiltration of excess fluid.
Question 2: During a hemodialysis treatment, a patient develops sudden chest
pain, dyspnea, and a sense of impending doom. The nurse notes foam in the
venous bloodline. Which complication is most likely occurring?
A. Dialyzer reaction
B. Air embolism
C. Hemolysis
D. Disequilibrium syndrome
CORRECT ANSWER: B. Air embolism
Rationale: Foam in the venous bloodline combined with acute respiratory and
cardiac symptoms is classic for air embolism. Immediate interventions include
clamping the venous line, placing the patient in Trendelenburg on the left side, and
administering oxygen.
Question 3: Which laboratory value is most useful in assessing the adequacy of
a hemodialysis treatment in terms of small-solute clearance?
A. Serum albumin
B. Kt/V or urea reduction ratio (URR)
Page 3 of 123
, C. Hemoglobin
D. Serum calcium
CORRECT ANSWER: B. Kt/V or urea reduction ratio (URR)
Rationale: Kt/V and urea reduction ratio are the standard measures of dialysis
adequacy for small-solute (urea) clearance. Current guidelines recommend a single-
pool Kt/V of at least 1.2 or a URR of at least 65% for thrice-weekly hemodialysis.
Question 4: A patient with a newly placed arteriovenous fistula is scheduled to
begin hemodialysis. What is the minimum recommended maturation time
before the fistula should be routinely cannulated?
A. 1 week
B. 2–3 weeks
C. 4–6 weeks or longer
D. 3 months
CORRECT ANSWER: C. 4–6 weeks or longer
Rationale: An arteriovenous fistula typically requires at least 4–6 weeks (often
longer) to mature sufficiently for safe, repeated cannulation. Premature use
increases the risk of infiltration, thrombosis, and permanent damage to the access.
Question 5: Which of the following is the most appropriate initial nursing
action when a patient develops muscle cramps during hemodialysis?
A. Administer a bolus of normal saline
B. Increase the ultrafiltration rate
C. Decrease the dialysate sodium concentration
D. Administer intravenous potassium
CORRECT ANSWER: A. Administer a bolus of normal saline
Rationale: Intradialytic muscle cramps are frequently related to rapid fluid removal
or shifts in osmolarity. A small normal-saline bolus expands intravascular volume
and often relieves the cramps. Ultrafiltration rate may also need to be reduced.
Question 6: A dialysis nurse is preparing to initiate treatment for a patient with
a central venous catheter. Which action is essential to minimize the risk of
catheter-related bloodstream infection?
A. Wearing clean gloves during connection
B. Performing thorough hand hygiene and using aseptic technique with sterile
gloves and mask
C. Soaking the catheter hubs in povidone-iodine for 5 seconds
D. Allowing the patient to handle the catheter ends
Page 4 of 123
QUESTIONS AND VERIFIED ANSWERS
Question 1
A patient who has long-standing, untreated chronic kidney disease is admitted via the
emergency department with uremia. Acute dialysis is initiated. Because of the history
of untreated kidney disease, the patient is at risk for which of these gastrointestinal
conditions?
-polyps
-giardiasis
-paralytic ileus
-bleeding ulcers
Correct Answer
-bleeding ulcers
High levels of urea break down in the gastrointestinal (GI) tract and release
ammonia, causing irritation of the GI mucosa. Altered capillary permeability and
platelet dysfunction in uremia also contribute to GI bleeding.
Question 2
Why is monitoring a dialysis patient's albumin level so important?
Correct Answer
It is a powerful predictor of morbidity and mortality in patients with CKD
Question 3
The target hemoglobin range for CKD patients on an ESA is approximately how much
Correct Answer
10 to 12 g/dL
Page 1 of 123
,Question 4
The most common cause of bacterial bloodstream infections in dialysis patients is:
Correct Answer
The use of central venous catheters (CVC) for hemodialysis
Question 5
Which of the following classifications of drugs is nephrotoxic and should be used with
caution to preserve residual kidney function?
1. Aminoglycosides.
2. Fluoroquinolones.
3. Neuromuscular blockers.
4. Calcium channel blockers.
Correct Answer
Aminoglycosides can cause acute kidney injury through direct tubular injury
Page 2 of 123
,Question 6
A dialysis patient has been told she has osteoporosis. What information should the
nurse discuss with this patient during an educational session?
Correct Answer
There is a deficiency of both the bone matrix and calcification of the bones.
Question 1: A patient with end-stage renal disease is beginning hemodialysis.
Which of the following best describes the primary principle by which
hemodialysis removes uremic toxins from the blood?
A. Active transport across a semipermeable membrane
B. Diffusion and ultrafiltration across a semipermeable membrane
C. Osmosis driven solely by hydrostatic pressure
D. Filtration through a high-flux membrane without diffusion
CORRECT ANSWER: B. Diffusion and ultrafiltration across a semipermeable
membrane
Rationale: Hemodialysis relies primarily on diffusion for solute removal and
ultrafiltration for fluid removal across a semipermeable dialyzer membrane.
Concentration gradients drive diffusion of toxins into the dialysate, while
transmembrane pressure drives ultrafiltration of excess fluid.
Question 2: During a hemodialysis treatment, a patient develops sudden chest
pain, dyspnea, and a sense of impending doom. The nurse notes foam in the
venous bloodline. Which complication is most likely occurring?
A. Dialyzer reaction
B. Air embolism
C. Hemolysis
D. Disequilibrium syndrome
CORRECT ANSWER: B. Air embolism
Rationale: Foam in the venous bloodline combined with acute respiratory and
cardiac symptoms is classic for air embolism. Immediate interventions include
clamping the venous line, placing the patient in Trendelenburg on the left side, and
administering oxygen.
Question 3: Which laboratory value is most useful in assessing the adequacy of
a hemodialysis treatment in terms of small-solute clearance?
A. Serum albumin
B. Kt/V or urea reduction ratio (URR)
Page 3 of 123
, C. Hemoglobin
D. Serum calcium
CORRECT ANSWER: B. Kt/V or urea reduction ratio (URR)
Rationale: Kt/V and urea reduction ratio are the standard measures of dialysis
adequacy for small-solute (urea) clearance. Current guidelines recommend a single-
pool Kt/V of at least 1.2 or a URR of at least 65% for thrice-weekly hemodialysis.
Question 4: A patient with a newly placed arteriovenous fistula is scheduled to
begin hemodialysis. What is the minimum recommended maturation time
before the fistula should be routinely cannulated?
A. 1 week
B. 2–3 weeks
C. 4–6 weeks or longer
D. 3 months
CORRECT ANSWER: C. 4–6 weeks or longer
Rationale: An arteriovenous fistula typically requires at least 4–6 weeks (often
longer) to mature sufficiently for safe, repeated cannulation. Premature use
increases the risk of infiltration, thrombosis, and permanent damage to the access.
Question 5: Which of the following is the most appropriate initial nursing
action when a patient develops muscle cramps during hemodialysis?
A. Administer a bolus of normal saline
B. Increase the ultrafiltration rate
C. Decrease the dialysate sodium concentration
D. Administer intravenous potassium
CORRECT ANSWER: A. Administer a bolus of normal saline
Rationale: Intradialytic muscle cramps are frequently related to rapid fluid removal
or shifts in osmolarity. A small normal-saline bolus expands intravascular volume
and often relieves the cramps. Ultrafiltration rate may also need to be reduced.
Question 6: A dialysis nurse is preparing to initiate treatment for a patient with
a central venous catheter. Which action is essential to minimize the risk of
catheter-related bloodstream infection?
A. Wearing clean gloves during connection
B. Performing thorough hand hygiene and using aseptic technique with sterile
gloves and mask
C. Soaking the catheter hubs in povidone-iodine for 5 seconds
D. Allowing the patient to handle the catheter ends
Page 4 of 123
