Basic Clinical Dialysis

Self-Study Examination

Instructions: After studying the text answer the following true/false or multiple choice questions.  Remember, there's only one answer to each question.

1. CKD may be staged based on:

a) urine output
b) electrolyte levels
c) BUN and creatinine
d) the level of the GFR

2. Urinary sediment contains red or white cell casts. This suggests:

a) an inflammatory process, usually acute
b) advanced renal disease

3. The major cause of apparent failure of dialysis is suboptimal patient compliance with:
  1. fluid intake
  2. diet
  3. exercise
  4. medications
  5. lifestyle habits such as not smoking

a) 1 and 5
b) 1, 2, and 4
c) 2, 3, and 5
d) 2 and 4
e) 5 only

4. One of the aims of predialysis education is to promote home dialysis as the first option.

a) true
b) false

5. Which of the following are contraindications to home dialysis:
  1. chronic constipation or colostomy
  2. visual impairment
  3. needle phobia and poor water supply
  4. abdominal obesity

a) 1 and 4
b) 2 and 4
c) 2 and 3
d) 1 and 3

6. Dialysis should be started:

a) when the GFR is between 30-59
b) if the urine output is less than 30 ml hour
c) when there are broad casts in the urine
d) before the patient is symptomatic

7. The usual reasons for opting for conservative advanced CKD treatment are:

a) advanced age and comorbidity
b) financial obligations and lifestyle risks
c) lack of family and financial support
d) less travel to dialysis and poor prognosis

8. Nearly half of the deaths in dialysis and post-transplantation are due to:

a) advanced age
b) cardiac causes
c) respiratory ailments
d) diabetes
e) infections

9. Iron deficiency, the most common cause of hematinic deficiency, can be corrected with oral iron therapy.

a) true
b) false

10. Even with treatment for heparin-induced thrombocytopenia, there is a mortality of ______ percent.

a) 2
b) 5
c) 10
d) 20

11. For patients on warfarin therapy with serious acute bleeding, fresh frozen plasma is ordered in addition to:

a) Vitamin K
b) protamine
c) DDAVP
d) platelets

12. The reason lepirudin should not be used to reverse the effects of heparin is:

a) it accumulates in patients with renal impairment
b) it is toxic to the liver
c) research has not approved it
d) it decreases urine output

13. Parathyroid hormone stimulates:
  1. the absorption of vitamin D
  2. osteoblast and osteoclast activity
  3. bone turnover
  4. release of calcium and phosphate from the bone
  5. an increased cardiovascular risk

a) 1, 3, and 5
b) 2, 3, and 4
c) 2 and 4
d) 1 and 5

14. One method of diagnosing osteomalacia is by:

a) a bone scan
b) a bone biopsy
c) blood tests

15. Osteoporosis is more common in the elderly,

a) and those with a family history
b) men, and those with type 2 diabetes
c) women, and those with type 1 diabetes
d) and women after menopause

16. A bone biopsy is performed if the DFO challenge is positive. The bone biopsy is positive for aluminum when aluminum covers ______ - ______ percent of the bone surface.

a) 2, 5
b) 5, 10
c) 15, 25
d) 30, 50

17. One benefit of a parathroidectomy is it may improve pruritis.

a) true
b) false

18. This vaccine is recommended every five years for patients on dialysis:

a) hepatitis B
b) influenza
c) pneumococcal polysaccharide vaccine
d) tetanus
e) diphtheria

19. In order to avoid fetal iron toxicity, iron should be given:

a) IV daily in small doses
b) orally twice a day
c) IV with dialysis
d) IV weekly

20. ___________ is superior to other anticonvulsants for seizures in women with pre-eclampsia but it must be used with extreme caution in dialysis patients.

a) Dilantin
b) Magnesium
c) Phenobarbitol
d) Depakote

21. Cadaveric donation can follow brain death, where the donor is classified as a:

a) “beating heart donor”
b) “non-beating heart donor”

22. Recently there has been a shift from living unrelated organ donation to living related transplants.

a) true
b) false

23. Drugs with a large volume of distribution throughout the body would be:

a) effectively removed by dialysis
b) poorly removed by dialysis

24. An example of a low potassium food for a patient on hemodialysis would be:

a) dried fruit
b) vegetable juice
c) most canned fruit (drained)
d) soybeans

25. Solutes in the blood pushed through a membrane by a pressure gradient is the definition of:

a) convection
b) diffusion

26. When a molecule attaches to the dialysis membrane, it is called:

a) membrane attachment
b) permeability
c) absorption
d) porosity

27. High efficiency membranes are recommended to shorten dialysis treatment time.

a) true
b) false

28. If this impurity is not removed from the water used for dialysis, it may cause “dialysis dementia”, bone disease and anemia:

a) chlorine
b) copper
c) fluoride
d) aluminum

29. Which of the following are most effective methods of delivering a dialysis dose:
  1. increase dialysis time
  2. increase dialysate flow during dialysis
  3. increase the blood flow during dialysis
  4. change the dialysis membrane to a larger

a) 1 and 2
b) 2, 3, and 4
c) 1 and 4
d) 1, 2, and 3

30. This type of hemodialysis catheter is for urgent access:

a) non-tunneled
b) tunneled

31. Catheter fatigue is a specific complication of ________- _______ access.

a) short term
b) long term

32. The radiocephalic fistula is located in the:

a) bend of the arm
b) neck
c) subclavian area
d) wrist

33. The length of maturation time before use for the AV fistula is _____ weeks- ______ months.

a) 2, 2
b) 4, 4
c) 6, 3
d) 6, 6

34. Arterial steal syndrome is:
  1. an occlusion
  2. hand ischemia caused by excessive fistula flow
  3. common in diabetic patients
  4. caused by firm compression when bleeding occurs

a) 1 and 2
b) 2 and 3
c) 1 and 4
d) 2 only

35. The most common problem of hemodialysis is:

a) sepsis
b) hypoxemia
c) air embolus
d) hypotension

36. One advantage of peritoneal dialysis is the training period is 1-2 weeks.

a) true
b) false

37. Peritoneal dialysis requires strict sterile technique and must be performed:

a) every day
b) two times a week
c) three times a week
d) five times a week

38. In normal states, the peritoneal cavity contains _____ ______ or less of fluid; however the normal adult can tolerate 2 liters or more of fluid without pain or alteration to the respiratory function.

a) 240 ml
b) 1 ounce
c) 100 ml
d) 16 ounces

39. Which of the following substances are absorbed into the circulation during peritoneal dialysis:

a) urea and creatinine
b) dextrose and calcium
c) sodium and potassium
d) hormones and drugs

40. The tip of the peritoneal dialysis catheter is placed:

a) in the bladder
b) in the pelvis
c) between the visceral and parietal peritoneum
d) in the inferior vena cava

41. Chronic care of the peritoneal dialysis catheter includes which of the following:
  1. showers are allowed
  2. swimming is permitted if a watertight dressing is used
  3. immobilizing the catheter
  4. baths are permitted

a) 1 and 2
b) 2 and 3
c) 1 and 4
d) 1, 2, and 3

42. Dextrose is used as a(n) ________ agent in the peritoneal dialysis solution.

a) osmotic
b) buffer
c) physiological
d) absorption

43. Each exchange begins with drainage of the peritoneal dialysis solution remaining from a previous cycle.

a) true
b) false

44. The most common form of peritoneal dialysis is:

a) continuous ambulatory peritoneal dialysis
b) automated peritoneal dialysis

45. Absent residual renal function is defined as a urine volume less than 200 ml per _____ _____.

a) 8 hours
b) 12 hours
c) 1 day
d) 2 days

46. This is the most common type of contamination of the peritoneum:

a) endogenous
b) transluminal
c) exogenous
d) MRSA

47. In this medical complication, the patient may experience weakness and arrhythmias. Potassium is increased in the diet or with supplements.

a) metabolic abnormality
b) fluid overload
c) volume depletion

48. Fourth-line therapy for constipation is:

a) stool softeners
b) a glycerin suppository
c) an enema
d) bulk-forming agents

49. Weight loss in children on peritoneal dialysis may occur from:
  1. reduced appetite and dietary restrictions
  2. growth
  3. increased catabolic demands due to renal failure
  4. peritonitis and leakage
  5. pain due to an inguinal or umbi

a) 2 and 5
b) 1, 3, and 4
c) 4 and 5
d) 1, 2, and 3

50. The treatment of this complication is calcium chloride/gluconate if ECG changes and /or rapid rise, to prevent cardiac toxicity:

a) hyperkalemia
b) hypertension
c) fluid overload
d) uremic seizures

51. In this modality, blood circulates through an extracorporeal circuit containing an absorbent column, such as activated charcoal:

a) hemodialysis
b) hemofiltration
c) hemoperfusion

52. In this process, a component of circulating blood is removed using centrifugation, filtration or selective absorption:

a) plasma pheresis
b) aphersis