Dialysis Care Support - NCLEX Pn

1. Which assessment finding most strongly suggests peritonitis in peritoneal dialysis?

   Cloudy dialysate outflow. Cloudiness indicates increased white cells or fibrin from infection in the peritoneal cavity.

2. What is the primary purpose of dialysis in a client with renal failure?

   Remove waste/extra fluid and correct electrolyte and acid–base balance. Dialysis mimics kidney function by filtering blood to eliminate toxins, excess water, and imbalances in clients with renal failure.

3. What is the priority action for bleeding from an AV fistula needle site after dialysis?

   Apply firm direct pressure with sterile gauze; do not occlude flow. Direct pressure controls hemorrhage without compromising fistula patency by avoiding full occlusion.

4. What is dialysis disequilibrium syndrome most associated with?

   Rapid solute shifts causing cerebral edema (headache, confusion, seizures). Quick solute removal creates osmotic gradients, drawing fluid into brain tissue and causing symptoms.

5. What is the expected immediate post-hemodialysis change in blood urea nitrogen (BUN)?

   Decreases. HD filters urea from blood, reducing BUN as a marker of effective waste clearance.

6. What is the correct client position for peritoneal dialysis catheter insertion site care?

   Supine with abdomen exposed; maintain sterile technique. Supine positioning allows optimal access and visualization while sterility prevents peritonitis.

7. Which dialysis type uses the peritoneum as the semipermeable membrane?

   Peritoneal dialysis (PD). PD employs the peritoneal lining as a natural filter for diffusion and osmosis to remove waste and fluid.

8. What is the most important pre-hemodialysis assessment to determine fluid removal goals?

   Daily weight (compare pre- and post-dialysis). Weight gain reflects fluid accumulation, guiding ultrafiltration targets to prevent overload or hypotension.

9. What is the preferred long-term vascular access for hemodialysis?

   Arteriovenous (AV) fistula. AV fistulas provide durable, low-infection-risk access by surgically connecting an artery and vein for high-flow HD.

10. Which symptom cluster most suggests dialysis disequilibrium syndrome?

    Headache, nausea, restlessness, decreased LOC, seizures. These symptoms arise from cerebral edema due to rapid osmotic shifts during initial HD sessions.

11. Which phosphate-binding medication teaching is correct for dialysis clients?

    Take phosphate binders with meals. Binders complex with dietary phosphorus in the gut, reducing absorption and preventing hyperphosphatemia.

12. What is the priority nursing action for symptomatic hypotension during hemodialysis?

    Stop or slow ultrafiltration and place client supine. Reducing ultrafiltration minimizes further volume loss, while supine position enhances venous return.

13. Which dialysis type requires vascular access and an extracorporeal circuit?

    Hemodialysis (HD). HD circulates blood externally through a dialyzer via vascular access to filter waste and restore balance.

14. Identify the most common acute complication during hemodialysis.

    Hypotension. Rapid fluid removal during HD reduces intravascular volume, leading to decreased blood pressure.

15. Which medication category is commonly held before hemodialysis to prevent hypotension?

    Antihypertensives. Holding these prevents additive hypotensive effects from fluid removal during dialysis.

16. Which action is contraindicated in the arm with an AV fistula or graft?

    No blood pressure measurement on that arm. BP cuffs can compress or damage the vascular access, risking thrombosis or reduced patency.

17. Which complication is more specific to peritoneal dialysis than hemodialysis?

    Hyperglycemia from glucose-based dialysate. Glucose in PD solution is absorbed systemically, elevating blood sugar especially in diabetics.

18. What is the priority nursing action when peritoneal dialysis outflow is poor or absent?

    Reposition the client and check for kinks or clamps. Repositioning or checking equipment resolves common mechanical obstructions to restore flow.

19. Which lab abnormality places a dialysis client at highest risk for dysrhythmias?

    Hyperkalemia. Elevated potassium disrupts cardiac conduction, increasing arrhythmia risk in renal failure clients.

20. What key vital sign should be obtained immediately before and after hemodialysis?

    Blood pressure. BP monitoring detects hypotension from fluid shifts, a common HD complication requiring intervention.

21. What is the priority diet modification commonly reinforced for hemodialysis clients?

    Restrict sodium, potassium, phosphorus, and fluids. These restrictions prevent fluid overload, hyperkalemia, and hyperphosphatemia in clients with impaired excretion.

22. What assessment finding confirms AV fistula patency at the bedside?

    Palpable thrill (and audible bruit). A thrill indicates turbulent blood flow confirming patency, while a bruit is the associated sound via auscultation.

23. Which additional action is contraindicated in the arm with an AV fistula or graft?

    No venipuncture or IV access in that arm. Needle insertions risk infection, bleeding, or damage to the access site's integrity and flow.

24. What is the primary infection-prevention priority for a hemodialysis central venous catheter?

    Use strict aseptic technique and keep dressing clean, dry, intact. Asepsis and proper dressing minimize bacterial entry, reducing catheter-related bloodstream infection risk.

25. What is the priority nursing action if a hemodialysis client develops chest pain or dysrhythmia?

    Stop dialysis and notify the provider immediately. These signs may indicate air embolism or electrolyte imbalance, requiring immediate cessation and medical evaluation.

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