CDN Exam Test Bank 2026: 200 Questions
with Detailed Verified Explanations (NNCC
Blueprint)
Question 1
, A patient undergoing hemodialysis suddenly develops acute hypotension
halfway through their treatment session. After placing the patient in the
Trendelenburg position, which of the following actions is the most appropriate
next step for the dialysis nurse?
A. Increase the ultrafiltration rate to clear fluid quickly
B. Administer a 100–200 mL bolus of 0.9% Normal Saline
C. Turn off the blood pump immediately
D. Infuse 500 mL of sterile water
Answer: B. Administer a 100–200 mL bolus of 0.9% Normal Saline
Explanation: Hypotension is the most frequent intradialytic complication,
typically caused by rapid fluid removal exceeding the vascular refilling rate.
Administering a targeted bolus of isotonic normal saline expands
intravascular volume rapidly to restore blood pressure without halting the
therapy.
Question 2
According to AAMI and CMS standards, what is the maximum allowable level
of aluminum in water used for hemodialysis dialysate?
A. 0.1 mg/L
B. 0.01 mg/L
C. 0.005 mg/L
D. 0.0001 mg/L
Answer: B. 0.01 mg/L
Explanation: Aluminum accumulation in dialysis patients leads to severe
neurotoxicity (dialysis dementia) and metabolic bone disease. The Association
for the Advancement of Medical Instrumentation (AAMI) sets the maximum
safe limit strictly at 0.01 mg/L.
Question 3
, A home peritoneal dialysis patient contacts the clinic reporting that their
effluent fluid bag looks cloudy. They deny having any abdominal pain or fever.
What is the most critical initial intervention?
A. Instruct the patient to take oral acetaminophen and monitor for 24 hours
B. Have the patient come to the clinic or ER immediately for an effluent cell
count and culture
C. Tell the patient to skip their next two exchanges to rest the peritoneum
D. Advise the patient to add heparin directly to their next dialysate bag
Answer: B. Have the patient come to the clinic or ER immediately for an
effluent cell count and culture
Explanation: Cloudy peritoneal fluid is considered a primary sign of
peritonitis until proven otherwise, even if a fever or pain has not yet
manifested. A fluid sample must be gathered immediately for a cell count with
differential, Gram stain, and culture to guide antibiotic selection.
Question 4
Which of the following laboratory profiles matches the typical presentation of
secondary hyperparathyroidism in a client with long-standing End-Stage Renal
Disease (ESRD)?
A. Elevated intact PTH, elevated phosphorus, and low-to-normal calcium
B. Low intact PTH, low phosphorus, and elevated calcium
C. Elevated intact PTH, low phosphorus, and elevated calcium
D. Low intact PTH, elevated phosphorus, and low calcium
Answer: A. Elevated intact PTH, elevated phosphorus, and low-to-normal
calcium
Explanation: Failing kidneys cannot properly excrete phosphorus or
synthesize active Vitamin D (calcitriol). The resulting hyperphosphatemia and
, hypocalcemia chronically trigger the parathyroid glands to oversecrete
parathyroid hormone (PTH) to leach calcium from bones.
Question 5
During a routine assessment of a patient’s mature arteriovenous fistula (AVF),
the nurse notes a sudden high-pitched, whistling bruit and a localized, weak
thrill concentrated at the arterial anastomosis. This clinical finding most likely
indicates:
A. Excellent, unhindered vascular blood flow
B. Inflow or outflow stenosis of the access
C. Complete thrombosis and occlusion of the fistula
D. An active systemic infection at the cannulation site
Answer: B. Inflow or outflow stenosis of the access
Explanation: A healthy AV fistula displays a low-pitched, continuous
machinery-like bruit and a soft, humming thrill throughout the access. When
the sound shifts to a high-pitched whistle or the thrill weakens significantly, it
signifies narrowing (stenosis) of the vessel, creating high turbulence.
Question 6
A patient undergoing their very first hemodialysis treatment has an initial Blood
Urea Nitrogen (BUN) level of 142 mg/dL. During the final hour of the session,
the patient reports a severe headache, nausea, and becomes progressively
confused. The nurse recognizes these signs as:
A. An anaphylactic reaction to the synthetic dialyzer membrane
B. Dialysis Disequilibrium Syndrome (DDS)
C. Accelerated pyrogenic shock from contaminated water
D. Acute myocardial infarction
Answer: B. Dialysis Disequilibrium Syndrome (DDS)
Explanation: DDS is caused by the rapid clearance of urea from the vascular
with Detailed Verified Explanations (NNCC
Blueprint)
Question 1
, A patient undergoing hemodialysis suddenly develops acute hypotension
halfway through their treatment session. After placing the patient in the
Trendelenburg position, which of the following actions is the most appropriate
next step for the dialysis nurse?
A. Increase the ultrafiltration rate to clear fluid quickly
B. Administer a 100–200 mL bolus of 0.9% Normal Saline
C. Turn off the blood pump immediately
D. Infuse 500 mL of sterile water
Answer: B. Administer a 100–200 mL bolus of 0.9% Normal Saline
Explanation: Hypotension is the most frequent intradialytic complication,
typically caused by rapid fluid removal exceeding the vascular refilling rate.
Administering a targeted bolus of isotonic normal saline expands
intravascular volume rapidly to restore blood pressure without halting the
therapy.
Question 2
According to AAMI and CMS standards, what is the maximum allowable level
of aluminum in water used for hemodialysis dialysate?
A. 0.1 mg/L
B. 0.01 mg/L
C. 0.005 mg/L
D. 0.0001 mg/L
Answer: B. 0.01 mg/L
Explanation: Aluminum accumulation in dialysis patients leads to severe
neurotoxicity (dialysis dementia) and metabolic bone disease. The Association
for the Advancement of Medical Instrumentation (AAMI) sets the maximum
safe limit strictly at 0.01 mg/L.
Question 3
, A home peritoneal dialysis patient contacts the clinic reporting that their
effluent fluid bag looks cloudy. They deny having any abdominal pain or fever.
What is the most critical initial intervention?
A. Instruct the patient to take oral acetaminophen and monitor for 24 hours
B. Have the patient come to the clinic or ER immediately for an effluent cell
count and culture
C. Tell the patient to skip their next two exchanges to rest the peritoneum
D. Advise the patient to add heparin directly to their next dialysate bag
Answer: B. Have the patient come to the clinic or ER immediately for an
effluent cell count and culture
Explanation: Cloudy peritoneal fluid is considered a primary sign of
peritonitis until proven otherwise, even if a fever or pain has not yet
manifested. A fluid sample must be gathered immediately for a cell count with
differential, Gram stain, and culture to guide antibiotic selection.
Question 4
Which of the following laboratory profiles matches the typical presentation of
secondary hyperparathyroidism in a client with long-standing End-Stage Renal
Disease (ESRD)?
A. Elevated intact PTH, elevated phosphorus, and low-to-normal calcium
B. Low intact PTH, low phosphorus, and elevated calcium
C. Elevated intact PTH, low phosphorus, and elevated calcium
D. Low intact PTH, elevated phosphorus, and low calcium
Answer: A. Elevated intact PTH, elevated phosphorus, and low-to-normal
calcium
Explanation: Failing kidneys cannot properly excrete phosphorus or
synthesize active Vitamin D (calcitriol). The resulting hyperphosphatemia and
, hypocalcemia chronically trigger the parathyroid glands to oversecrete
parathyroid hormone (PTH) to leach calcium from bones.
Question 5
During a routine assessment of a patient’s mature arteriovenous fistula (AVF),
the nurse notes a sudden high-pitched, whistling bruit and a localized, weak
thrill concentrated at the arterial anastomosis. This clinical finding most likely
indicates:
A. Excellent, unhindered vascular blood flow
B. Inflow or outflow stenosis of the access
C. Complete thrombosis and occlusion of the fistula
D. An active systemic infection at the cannulation site
Answer: B. Inflow or outflow stenosis of the access
Explanation: A healthy AV fistula displays a low-pitched, continuous
machinery-like bruit and a soft, humming thrill throughout the access. When
the sound shifts to a high-pitched whistle or the thrill weakens significantly, it
signifies narrowing (stenosis) of the vessel, creating high turbulence.
Question 6
A patient undergoing their very first hemodialysis treatment has an initial Blood
Urea Nitrogen (BUN) level of 142 mg/dL. During the final hour of the session,
the patient reports a severe headache, nausea, and becomes progressively
confused. The nurse recognizes these signs as:
A. An anaphylactic reaction to the synthetic dialyzer membrane
B. Dialysis Disequilibrium Syndrome (DDS)
C. Accelerated pyrogenic shock from contaminated water
D. Acute myocardial infarction
Answer: B. Dialysis Disequilibrium Syndrome (DDS)
Explanation: DDS is caused by the rapid clearance of urea from the vascular
