Dialysis Modalities Practice Questions
20 free Dialysis Modalities practice questions for the NCLEX Exam. Tap an option to answer — you get instant feedback, the correct answer, and a detailed explanation for every question.
What is a primary reason for using a fistula rather than a temporary catheter?
- A Fistulas lower infection risk and provide better blood flow.
- B Fistulas allow noticeably shorter dialysis session times.
- C Fistulas eliminate the need for any anticoagulation therapy.
- D Fistulas prevent all episodes of hypotension during dialysis.
Correct answer: Fistulas lower infection risk and provide better blood flow.
A surgically created arteriovenous fistula offers reliable blood flow and lower infection/morbidity risk compared to temporary catheters. It’s the preferred long‐term access.
Which statement accurately distinguishes Peritoneal Dialysis (PD) from hemodialysis?
- A PD uses an artificial blood‐filtering machine in a dialysis center.
- B PD uses the peritoneal membrane in the abdomen to clear wastes.
- C PD always requires hospital admission for each treatment.
- D PD does not require a catheter.
Correct answer: PD uses the peritoneal membrane in the abdomen to clear wastes.
PD uses the patient’s peritoneum as the semi‐permeable membrane, with dialysate infused into the abdomen to remove wastes and fluids.
A nurse is preparing a patient for HD. Which complication is most important to monitor during the treatment?
- A Bradycardia from slow ultrafiltration
- B Hypotension from rapid fluid removal
- C Hypertension due to dialysate sodium overload
- D Hyperglycemia due to high glucose dialysate
Correct answer: Hypotension from rapid fluid removal
Rapid ultrafiltration during HD can lead to intradialytic hypotension, which may cause dizziness, cramps, nausea or cardiac issues.
A patient on PD presents with cloudy dialysate effluent. What is the priority nursing action?
- A Increase the dialysate glucose concentration for this exchange.
- B Send the effluent for culture and start empiric peritonitis therapy.
- C Temporarily switch the patient to in-center hemodialysis instead.
- D Administer a diuretic to clear the cloudy peritoneal effluent.
Correct answer: Send the effluent for culture and start empiric peritonitis therapy.
Cloudy effluent in PD is a strong sign of peritonitis (infection of the peritoneal cavity) and requires immediate evaluation and treatment.
Which patient scenario is more suitable for PD than in‐center HD?
- A A patient with extensive abdominal adhesions from prior surgery.
- B A highly active working adult who desires home dialysis flexibility.
- C A patient with major aortic vascular disease impairing fistula creation.
- D A patient with repeated peritoneal dialysis catheter infections.
Correct answer: A highly active working adult who desires home dialysis flexibility.
PD offers more home‐based flexibility and lifestyle freedom, making it a good choice for active patients who can manage the therapy themselves.
In HD, what is the principal mechanism for removing solutes such as urea from the blood?
- A Osmotic filtration across the peritoneal membrane in the abdomen
- B Diffusion across a semipermeable dialyzer membrane
- C Active transport into dialysate driven by special pumps
- D Metabolic conversion of urea into a harmless excreted gas
Correct answer: Diffusion across a semipermeable dialyzer membrane
In HD, blood is pumped through a dialyzer where solutes diffuse across a semipermeable membrane into dialysate to remove wastes.
Which dietary implication is true of PD compared to HD?
- A PD requires far stricter daily fluid restriction than HD does.
- B HD permits a markedly more liberal sodium and potassium diet than PD.
- C PD tends to allow somewhat more liberal fluid and diet limits.
- D HD patients, unlike PD patients, never need to restrict potassium.
Correct answer: PD tends to allow somewhat more liberal fluid and diet limits.
PD, being more continuous, can allow somewhat more liberal diet/fluid tolerances compared with intermittent HD.
What is a recognized disadvantage of PD compared to HD?
- A Requires frequent large-needle access in the arm.
- B Higher risk of systemic hypotension during treatment.
- C Daily exchanges add burden and peritonitis risk.
- D It is only ever available in hospital settings.
Correct answer: Daily exchanges add burden and peritonitis risk.
PD requires daily exchanges which can be burdensome and has inherent risk of peritonitis.
A patient on HD complains of persistent leg cramps during sessions. What is likely the contributing factor?
- A Ultrafiltration rate set too slow during the session.
- B Rapid fluid removal causing volume depletion and muscle hypoperfusion.
- C Elevated potassium concentration in the dialysate bath.
- D Excessive calcium concentration in the dialysate bath.
Correct answer: Rapid fluid removal causing volume depletion and muscle hypoperfusion.
Rapid fluid removal can lead to volume depletion and muscle hypoperfusion causing cramps during HD.
Which access type is considered the gold standard for HD?
- A Temporary tunneled catheter in jugular vein.
- B Arteriovenous fistula (AVF) in the arm.
- C Peritoneal catheter in the abdomen.
- D Peripherally inserted central catheter (PICC).
Correct answer: Arteriovenous fistula (AVF) in the arm.
An AV fistula provides durable high‐flow access with fewer complications and is considered the best long‐term access for HD.
What is the key reason HD is often performed thrice weekly?
- A To completely replace natural kidney function each time.
- B Because intermittent sessions suffice when residual function remains.
- C Because wastes and fluid accumulate between sessions.
- D To allow enough time for home therapy training.
Correct answer: Because wastes and fluid accumulate between sessions.
Regular HD is scheduled to clear wastes and control fluid and electrolytes before accumulation becomes too high.
A patient on PD asks why they have fewer hemodynamic shifts than HD. The best response is:
- A Because peritoneal dialysis uses no dialysate at all.
- B Because PD removes fluid and solutes continuously, not in large boluses.
- C Because PD sessions are much shorter than HD sessions.
- D Because PD uses higher ultrafiltration rates than HD.
Correct answer: Because PD removes fluid and solutes continuously, not in large boluses.
PD provides more gradual and continuous removal of wastes and fluid, reducing rapid volume shifts.
In which situation would HD be preferred over PD?
- A Encourage an aggressive fluid bolus to replace removed fluid.
- B Monitor for disequilibrium syndrome: headache, nausea, seizure.
- C Immediately administer a high-dose potassium supplement.
- D Allow the patient an unrestricted diet afterward.
Correct answer: Monitor for disequilibrium syndrome: headache, nausea, seizure.
If the peritoneum is compromised then PD may not be feasible and HD is preferred.
What is one nursing priority when caring for a patient after HD session?
- A Encourage aggressive fluid bolus to replace removed fluid.
- B Monitor for signs of disequilibrium syndrome: headache, nausea, seizure.
- C Immediately administer high‐dose potassium.
- D Allow unrestricted diet.
Correct answer: Monitor for signs of disequilibrium syndrome: headache, nausea, seizure.
Rapid removal during HD may lead to dialysis disequilibrium, so monitoring for signs is crucial.
For PD, what is the meaning of the 'dwell time' in an exchange?
- A The time dialysate is draining out of the abdomen.
- B The time spent priming the fresh dialysate bag.
- C The time dialysate stays in the peritoneum absorbing wastes.
- D The time the patient spends in the dialysis center.
Correct answer: The time dialysate stays in the peritoneum absorbing wastes.
In PD, an exchange includes fill time, dwell time, and drain time.
What is a common complication associated with HD vascular access?
- A Peritonitis from the abdominal catheter.
- B Hernia formation at the catheter site.
- C Steal syndrome—hand ischemia from the AVF shunt.
- D Glucose load absorbed from the dialysate.
Correct answer: Steal syndrome—hand ischemia from the AVF shunt.
AV fistula for HD can cause 'steal' phenomenon leading to distal ischemia, coldness, or pain in the limb.
Which statement regarding PD dialysate composition is correct?
- A It carries high potassium to drive potassium into the abdomen.
- B It uses glucose or other osmotic agents to draw off fluid.
- C It excludes sodium entirely to promote sodium loss.
- D It always contains a very high bicarbonate concentration.
Correct answer: It uses glucose or other osmotic agents to draw off fluid.
PD dialysate often contains glucose or osmotic agents to draw excess fluid into the abdomen for removal.
A patient on PD reports rapid weight gain and increasing edema overnight. What may be the cause?
- A The dwell time set for exchanges was too short.
- B Peritoneal membrane failure causing inadequate fluid removal.
- C An unexpected recovery of residual kidney function.
- D An excessively high ultrafiltration rate overnight.
Correct answer: Peritoneal membrane failure causing inadequate fluid removal.
In PD, membrane failure can lead to inadequate fluid removal causing weight gain and edema.
Which measurement is used to assess dialysis adequacy for both HD and PD?
- A Glomerular filtration rate (GFR) measured alone.
- B Hemoglobin A1C blood glucose level.
- C Kt/V, the urea clearance index.
- D Serum creatinine measured alone.
Correct answer: Kt/V, the urea clearance index.
Kt/V is used to quantify the adequacy of dialysis treatments in removing urea and small solutes.
A patient on HD complains of itchy skin and restless legs at night. What might this indicate?
- A Excessive dialysis frequency irritating the skin.
- B Under-dialysis with accumulating uremic toxins; consider a higher dose.
- C Normal electrolytes unrelated to the symptoms.
- D Symptoms have no connection to dialysis adequacy.
Correct answer: Under-dialysis with accumulating uremic toxins; consider a higher dose.
Persistent symptoms may indicate under-dialysis, suggesting the need to assess and possibly adjust treatment.