NNCC Dialysis Nurse Question of the Month Survey

Question Title

* The nurse finds that a patient arriving for a hemodialysis treatment is confused. Which of the following laboratory findings could explain the patient's confusion?

a. Phosphorus 8.2 mg/dL.

b. Potassium 6.1 mEq/L.

c. Calcium 11.9 mg/dL.

d. Sodium 140 mEq/L.

The correct answer is c. Calcium 11.9 mg/dL.

References: Bodin, S.M. (Ed). (2022). Contemporary Nephrology Nursing, 4th ed., page 596; Gilbert, S.J. & Weiner, D.E. (Eds). (2023). NKF Primer on Kidney Diseases, 8th ed., page 114.

Rationale: Hypercalcemia occurs when the serum calcium rises above 10.5 mg/dL. Signs and symptoms of hypercalcemia can include fatigue, neuromuscular weakness, lethargy, cardiac arrhythmias, altered mentation, confusion, and even delirium.

Question Title

* A nurse being oriented to peritoneal dialysis (PD) asks the preceptor, “When is it important to determine peritoneal membrane characteristics?” Which of these responses by the preceptor would be correct?

a. When a patient is being considered as a candidate to start PD.

b. Within two weeks of a patient initiating PD treatments.

c. After a patient is diagnosed with a PD exit-site infection.

d. If a patient receiving PD has a loss of ultrafiltration.

The correct answer is d. If a patient receiving PD has a loss of ultrafiltration.

Rationale: Peritoneal membrane characteristics cannot be determined prior to initiating PD, since performing the test requires a PD catheter. The test should be done 4-6 weeks after PD is initiated. An exit-site infection is not likely to change membrane characteristics. Changes in membrane permeability can change ultrafiltration capacity, so the test should be done if there is loss of ultrafiltration

Reference: Counts, C. (Ed.). ANNA Core Curriculum for Nephrology Nursing, 7th ed., pages 635 & 1142

Question Title

* 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?

a. Polyps.

b. Giardiasis

c. Paralytic ileus.

d. Bleeding ulcers.

The correct answer is d. bleeding ulcers.

Rationale: Uremia results in retention of urea that breaks down in the gastrointestinal (GI) tract and releases ammonia, causing irritation of the GI mucosa. Altered capillary permeability and platelet dysfunction in uremia also contribute to GI bleeding.

References: : Counts, C.R. Core Curriculum for Nephrology Nursing, 7th ed., page 1265; Kallenbach, J.Z., Review of Hemodialysis for Nurses and Dialysis Personnel, 10th ed., page 36.

Question Title

* Taking which of the following over-the-counter medications could result in a loss of residual kidney function?

a. Docusate (Colace).

b. Naproxen (Aleve).

c. Loratadine (Claritin).

d. Guaifenesin (Mucinex).

The correct answer is b. naproxen (Aleve).

Rationale: NSAIDS, such as naproxen, inhibit vasodilatory prostaglandins, resulting in decreased blood flow to the kidneys. This can decrease the glomerular filtration rate and lead to a loss of residual kidney function.

Reference: Counts, C. (Ed.). ANNA Core Curriculum for Nephrology Nursing, 7th ed., page 1155; Bodin, S.M. (Ed). Contemporary Nephrology Nursing, 3rd ed., pages 696-697.

Question Title

* A patient who is receiving chronic hemodialysis treatments is on the transplant waitlist. He asks the nurse, “What happens if I get a call for a transplant when I have an infection?” Which of these responses by the nurse would be accurate?

a. “You can get the transplant anyway. They will just continue antibiotics simultaneously.”

b. “You can get the transplant anyway. They will hold the organ for you.”

c. “You cannot get the transplant until the infection is cleared, but you can go back on the active waitlist once that happens.”

d. “You cannot get the transplant until the infection is cleared, and you will need to repeat a transplant evaluation prior to being returned to the waitlist.”

The correct answer is c. “You cannot get the transplant until the infection is cleared, but you can go back on the active waitlist once that happens.”

Rationale: An active infection is a contraindication to transplant, and the patient is listed as temporarily inactive. Persons in this category have already been evaluated and accepted but cannot receive an organ while listed as inactive. However, after the infection is cleared, the transplant center can reactivate the patient’s status without the loss of priority on the waitlist.

Reference: Counts, C. (Ed.) ANNA Core Curriculum for Nephrology Nursing, 7th ed., page 886

Question Title

* While orienting a nurse to the dialysis unit, the preceptor discusses indications for using blood volume monitors (e.g., Crit-Line). The preceptor explains that blood volume monitoring has which of these purposes?

a. To make patients feel they are being closely watched.

b. To minimize hypotensive episodes.

c. To comply with KDOQI recommendations.

d. To observe for adequate real-time clearance.

The correct answer is b. To minimize hypotensive episodes.

Rationale: If fluid removal from the vascular space via ultrafiltration exceeds the fluid refill from the interstitial space, blood pressure may drop. Blood volume monitoring is used to detect intravascular volume contraction before blood pressure drops with a goal of avoiding hypotensive episodes.

Reference: Kallenbach, J.Z. (2021). Review of Hemodialysis for Nurses and Dialysis Personnel, 10th ed., p. 61, 116

Question Title

* Which of the following patient statements indicates the need for further education regarding the influenza vaccine?

a. “Since I'm on dialysis, I am at higher risk of getting flu from the vaccine.”

b. “Since I'm on dialysis, I am at higher risk of hospitalization from the flu.”

c. “The flu vaccine takes two weeks to become effective.”

d. “The flu vaccine is not 100% effective.”

The correct answer is a. “Since I'm on dialysis, I am at higher risk of getting flu from the vaccine.”

Rationale: The patient who believes dialysis creates a higher risk of getting influenza from the vaccine is incorrect and requires further education. Influenza vaccine cannot cause flu illness. Influenza vaccines are made with either inactivated (killed) viruses or with only a single protein from the flu virus. People who are receiving dialysis should receive the influenza vaccine every year.

Reference: American Nephrology Nurses Association. (2020). Core curriculum for nephrology nursing (7th ed.), page 822.

CDC, Misconceptions about Seasonal Flu and Flu Vaccines, Page last reviewed June 1, 2021. https://www.cdc.gov/flu/prevent/misconceptions.htm

Question Title

* The nurse administering heparin to patients in the hemodialysis unit should be aware that it

a. works by preventing the formation of thrombi.

b. is used to prolong the patient’s prothrombin time.

c. cannot be used for regional anticoagulation.

d. is administered via the venous bloodline post-dialyzer.

The correct answer is a. works by preventing the formation of thrombi.

Rationale: Heparin is an anticoagulant that prevents formation of thrombi (clots) by blocking the conversion of prothrombin to thrombin and fibrinogen to fibrin. It does not lyse already existing thrombi but may prevent their extension. It is administered via the arterial bloodline.

Reference: Counts, C. (Ed.). ANNA Core Curriculum for Nephrology Nursing, 7th ed., Vol. 2, page 1012; Bodin, S.M. (Ed). Contemporary Nephrology Nursing, 3rd ed., pages 180-181.

Question Title

* A patient has an arteriovenous (AV) fistula placed and it is allowed to mature. The “rule of 6s” for AV fistula maturation includes which of the following?

a. The vessel should be less than 6 mm under the skin surface.

b. The vessel should be less than 6 mm in diameter.

c. The vessel has a straight segment less than 6 cm in length.

d. The flow through the vessel should not exceed 600 mL per min.

The correct answer is a. The vessel should be less than 6 mm under the skin surface.

Rationale: Included in the rule of 6s is the recommendation that the vein be no deeper than 6 mm under the skin surface. This facilitates successful cannulation.

Reference: Bodin, S.M. (2017). Contemporary Nephrology Nursing, 3rd ed., p. 322.

Question Title

* A 22-year old college student who has CKD Stage 5 asks the nurse, "Why do I need to be tested for TB?" The nurse should explain that testing for tuberculosis is required for the following reason:

Close living arrangements in university housing can lead to spread of disease.

The skin test will diagnose active disease that requires isolation.

Younger adults have a higher than average risk for developing the disease.

Immunocompromised patients are at risk for developing the disease.

The correct answer is immunocompromised patients are at risk for developing the disease.
reference Bodin, S.M. (2017). Contemporary Nephrology Nursing. 3rd ed., p. 322

Rationale: The CDC recommends screening for TB in CKD patients because they are immunocompromised and, therefore, are at higher risk for infection.

NNCC Dialysis Nurse Question of the Month

January 2024

Question Title

* The nurse finds that a patient arriving for a hemodialysis treatment is confused. Which of the following laboratory findings could explain the patient's confusion?

Question Title

* A nurse being oriented to peritoneal dialysis (PD) asks the preceptor, “When is it important to determine peritoneal membrane characteristics?” Which of these responses by the preceptor would be correct?

Question Title

* 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?

Question Title

* Taking which of the following over-the-counter medications could result in a loss of residual kidney function?

Question Title

* A patient who is receiving chronic hemodialysis treatments is on the transplant waitlist. He asks the nurse, “What happens if I get a call for a transplant when I have an infection?” Which of these responses by the nurse would be accurate?

Question Title

* While orienting a nurse to the dialysis unit, the preceptor discusses indications for using blood volume monitors (e.g., Crit-Line). The preceptor explains that blood volume monitoring has which of these purposes?

Question Title

* Which of the following patient statements indicates the need for further education regarding the influenza vaccine?

Question Title

* The nurse administering heparin to patients in the hemodialysis unit should be aware that it

Question Title

* A patient has an arteriovenous (AV) fistula placed and it is allowed to mature. The “rule of 6s” for AV fistula maturation includes which of the following?

Question Title

* A 22-year old college student who has CKD Stage 5 asks the nurse, "Why do I need to be tested for TB?" The nurse should explain that testing for tuberculosis is required for the following reason: