Hemodialysis & Peritoneal Dialysis Practice Exam
with Questions and Rationalized Answers
1. The nurse instructs a client with renal failure who is receiving hemodialysis about dietary
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modifications. The nurse determines that the client understands these dietary modificatio
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ns if the client selects which items from the menu?
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a. Cream of wheat, blueberries, coffee d d d d
b. Sausage and eggs, banana, orange juice. d d d d d
c. Bacon, cantaloupe melon, tomato juice. d d d d
d. Cured pork, grits, strawberries, orange juice.: Ad d d d d d
The diet for a client with renal failure who is receiving hemodialysis should include controlled
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amounts of sodium, phosphorus, calcium, potassium, and fluids. Options 2, 3, and 4 are high i
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n sodium, phosphorus and potassium.
d d d d
2. The client with chronic renal failure is scheduled for hemodialysis this morning is due t
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o receive a daily dose of enalapril (Vasotec).The nurse should plan to administer this medi
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cation:
a. During dialysis. d
b. Just before dialysis. d d
c. The day after dialysis. d d d
d. On return from dialysis.: D d d d d
Antihypertensive medications such as enalapril are given to the client following hemodialysis d d d d d d d d d d d
. This prevents the client from becoming hypotensive during dialysis and also from having the
d d d d d d d d d d d d d d d
medication removed from the bloodstream by dialysis. No rationale exists for waiting an entire
d d d d d d d d d d d d d
dday to resume the medication. This would lead to ineffective control of the blood pressure.
d d d d d d d d d d d d d d
3. The client being hemodialyzed suddenly becomes short of breath and complains of che
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st pain.The client is tachycardic, pale, and anxious.The nurse suspects air embolism. The pr
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iority action for the nurse is to:
d d d d d d
a. Discontinue dialysis and notify the physician. d d d d d
b. Monitor vital signs every 15 minutes for the next hour. d d d d d d d d d
1d/d30
,c. Continue dialysis at a slower rate after checking the lines for air.
d d d d d d d d d d d
d. Bolus the client with 500 mL of normal saline to break up the embolus.: A If the client e
d d d d d d d d d d d d d d d d d d
xperiences air embolus during hemodialysis, the nurse should termi-
d d d d d d d d
dnate dialysis immediately, notify the physician, and administer oxygen as needed. Options 2
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, 3, and 4 are incorrect.
d d d d d
4. The nurse has completed client teaching with the hemodialysis client about self-
d d d d d d d d d d d
monitoring between hemodialysis treatments. The nurse determines that the client best u
d d d d d d d d d d d
nderstands the information if the client states to record daily the:
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a. Amount of activity. d d
b. Pulse and respiratory rate.
d d d
c. Intake and output and weight.
d d d d
2d/d30
, d. Blood urea nitrogen and creatinine levels.: C d d d d d d
The client on hemodialysis should monitor fluid status between hemodialysis treat-
d d d d d d d d d d
dments by recording intake and output and measuring weight daily. Ideally, the hemodialysis c
d d d d d d d d d d d d d
lient should not gain more than 0.5 kg of weight/day.
d d d d d d d d d
5. The client with an external arteriovenous shunt in place for hemodialysis is at risk for bl
d d d d d d d d d d d d d d d
eeding. The priority nurse action would be to: d d d d d d d
a. Check the shunt for the presence of bruit and thrill. d d d d d d d d d
b. Observe the site once as time permits during the shift. d d d d d d d d d
c. Check the results of the prothrombin times as they are determined.
d d d d d d d d d d
d. Ensure that small clamps are attached to the arteriovenous shunt dressing.-
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:D d
An arteriovenous shunt is a less common form of access site but carries a risk for bleeding wh
d d d d d d d d d d d d d d d d d
en it is used because two ends of an external cannula are tunneled subcutaneously into an art
d d d d d d d d d d d d d d d d
ery and a vein, and the ends of the cannula are joined. If accidental disconnection occurs, the
d d d d d d d d d d d d d d d d d
client could lose blood rapidly. For this reason, small clamps are attached to the dressing that
d d d d d d d d d d d d d d d d
covers the insertion site for use if needed. The shunt site also should be assessed at least eve
d d d d d d d d d d d d d d d d d
ry 4 hours. d d
6. A nurse is assessing the patency of a client's left arm arteriovenous fistula prior to initia
d d d d d d d d d d d d d d d
ting hemodialysis. Which finding indicates that the fistula is patent?
d d d d d d d d d
a. Palpation of a thrill over the fistula. d d d d d d
b. Presence of a radial pulse in the left wrist. d d d d d d d d
c. Absence of a bruit on auscultation of the fistula. d d d d d d d d
d. Capillary refill less than 3 seconds in the nail beds of the fingers of the left hand.: A
d d d d d d d d d d d d d d d d d
The nurse assesses the patency of the fistula by palpating for the presence of a thrill or ausculta
d d d d d d d d d d d d d d d d d
ting for a bruit. The presence of a thrill and bruit indicate patency of the fistula. Although the pr
d d d d d d d d d d d d d d d d d d
esence of a radial pulse in the left wrist and capillary refill shorter than 3 seconds in the nail b
d d d d d d d d d d d d d d d d d d d
eds of the fingers on the left hand are normal findings, they do not assess fistula patency.
d d d d d d d d d d d d d d d d
7. The client newly diagnosed with chronic renal failure recently has begun hemodialysis
d d d d d d d d d d d
. Knowing that the client is at risk for disequilibrium syndrome, the nurse assesses the cli
d d d d d d d d d d d d d d d
ent during dialysis for:
d d d
a. Hypertension, tachycardia, and fever. d d d
3d/d30
with Questions and Rationalized Answers
1. The nurse instructs a client with renal failure who is receiving hemodialysis about dietary
d d d d d d d d d d d d d
modifications. The nurse determines that the client understands these dietary modificatio
d d d d d d d d d d d
ns if the client selects which items from the menu?
d d d d d d d d d
a. Cream of wheat, blueberries, coffee d d d d
b. Sausage and eggs, banana, orange juice. d d d d d
c. Bacon, cantaloupe melon, tomato juice. d d d d
d. Cured pork, grits, strawberries, orange juice.: Ad d d d d d
The diet for a client with renal failure who is receiving hemodialysis should include controlled
d d d d d d d d d d d d d d d
amounts of sodium, phosphorus, calcium, potassium, and fluids. Options 2, 3, and 4 are high i
d d d d d d d d d d d d d d d
n sodium, phosphorus and potassium.
d d d d
2. The client with chronic renal failure is scheduled for hemodialysis this morning is due t
d d d d d d d d d d d d d d
o receive a daily dose of enalapril (Vasotec).The nurse should plan to administer this medi
d d d d d d d d d d d d d d d
cation:
a. During dialysis. d
b. Just before dialysis. d d
c. The day after dialysis. d d d
d. On return from dialysis.: D d d d d
Antihypertensive medications such as enalapril are given to the client following hemodialysis d d d d d d d d d d d
. This prevents the client from becoming hypotensive during dialysis and also from having the
d d d d d d d d d d d d d d d
medication removed from the bloodstream by dialysis. No rationale exists for waiting an entire
d d d d d d d d d d d d d
dday to resume the medication. This would lead to ineffective control of the blood pressure.
d d d d d d d d d d d d d d
3. The client being hemodialyzed suddenly becomes short of breath and complains of che
d d d d d d d d d d d d
st pain.The client is tachycardic, pale, and anxious.The nurse suspects air embolism. The pr
d d d d d d d d d d d d d d d
iority action for the nurse is to:
d d d d d d
a. Discontinue dialysis and notify the physician. d d d d d
b. Monitor vital signs every 15 minutes for the next hour. d d d d d d d d d
1d/d30
,c. Continue dialysis at a slower rate after checking the lines for air.
d d d d d d d d d d d
d. Bolus the client with 500 mL of normal saline to break up the embolus.: A If the client e
d d d d d d d d d d d d d d d d d d
xperiences air embolus during hemodialysis, the nurse should termi-
d d d d d d d d
dnate dialysis immediately, notify the physician, and administer oxygen as needed. Options 2
d d d d d d d d d d d d
, 3, and 4 are incorrect.
d d d d d
4. The nurse has completed client teaching with the hemodialysis client about self-
d d d d d d d d d d d
monitoring between hemodialysis treatments. The nurse determines that the client best u
d d d d d d d d d d d
nderstands the information if the client states to record daily the:
d d d d d d d d d d
a. Amount of activity. d d
b. Pulse and respiratory rate.
d d d
c. Intake and output and weight.
d d d d
2d/d30
, d. Blood urea nitrogen and creatinine levels.: C d d d d d d
The client on hemodialysis should monitor fluid status between hemodialysis treat-
d d d d d d d d d d
dments by recording intake and output and measuring weight daily. Ideally, the hemodialysis c
d d d d d d d d d d d d d
lient should not gain more than 0.5 kg of weight/day.
d d d d d d d d d
5. The client with an external arteriovenous shunt in place for hemodialysis is at risk for bl
d d d d d d d d d d d d d d d
eeding. The priority nurse action would be to: d d d d d d d
a. Check the shunt for the presence of bruit and thrill. d d d d d d d d d
b. Observe the site once as time permits during the shift. d d d d d d d d d
c. Check the results of the prothrombin times as they are determined.
d d d d d d d d d d
d. Ensure that small clamps are attached to the arteriovenous shunt dressing.-
d d d d d d d d d d
:D d
An arteriovenous shunt is a less common form of access site but carries a risk for bleeding wh
d d d d d d d d d d d d d d d d d
en it is used because two ends of an external cannula are tunneled subcutaneously into an art
d d d d d d d d d d d d d d d d
ery and a vein, and the ends of the cannula are joined. If accidental disconnection occurs, the
d d d d d d d d d d d d d d d d d
client could lose blood rapidly. For this reason, small clamps are attached to the dressing that
d d d d d d d d d d d d d d d d
covers the insertion site for use if needed. The shunt site also should be assessed at least eve
d d d d d d d d d d d d d d d d d
ry 4 hours. d d
6. A nurse is assessing the patency of a client's left arm arteriovenous fistula prior to initia
d d d d d d d d d d d d d d d
ting hemodialysis. Which finding indicates that the fistula is patent?
d d d d d d d d d
a. Palpation of a thrill over the fistula. d d d d d d
b. Presence of a radial pulse in the left wrist. d d d d d d d d
c. Absence of a bruit on auscultation of the fistula. d d d d d d d d
d. Capillary refill less than 3 seconds in the nail beds of the fingers of the left hand.: A
d d d d d d d d d d d d d d d d d
The nurse assesses the patency of the fistula by palpating for the presence of a thrill or ausculta
d d d d d d d d d d d d d d d d d
ting for a bruit. The presence of a thrill and bruit indicate patency of the fistula. Although the pr
d d d d d d d d d d d d d d d d d d
esence of a radial pulse in the left wrist and capillary refill shorter than 3 seconds in the nail b
d d d d d d d d d d d d d d d d d d d
eds of the fingers on the left hand are normal findings, they do not assess fistula patency.
d d d d d d d d d d d d d d d d
7. The client newly diagnosed with chronic renal failure recently has begun hemodialysis
d d d d d d d d d d d
. Knowing that the client is at risk for disequilibrium syndrome, the nurse assesses the cli
d d d d d d d d d d d d d d d
ent during dialysis for:
d d d
a. Hypertension, tachycardia, and fever. d d d
3d/d30
