certified dialysis nurse review
and sample questions and
answers updated 2026
Section 1: Hemodialysis Principles & Safety
Question 1
A patient receiving hemodialysis complains of new post-dialysis cramping and lightheadedness.
Pre-dialysis weight is stable; ultrafiltration was increased by 0.7 L today. Which immediate
nursing action is best?
A. Increase dialysate sodium concentration
B. Slow ultrafiltration and administer small boluses of isotonic saline
C. Stop dialysis and call the nephrologist to admit the patient
D. Give oral salt tablets at the station
Correct ✔✔✔ANSW✔✔: B
Rationale: Acute intradialytic hypotension and cramps commonly result from excessive or too-
rapid ultrafiltration. The immediate nursing intervention is to slow or stop ultrafiltration and
administer small boluses of isotonic saline (100–200 mL IV), reposition the patient supine with
legs elevated, and reassess hemodynamics. Increasing dialysate sodium can help prevent
intradialytic hypotension over time but is not the first acute action. Oral salt tablets act too slowly
in this emergency .
,Question 2
Which laboratory value is most critical to report immediately in a patient undergoing
hemodialysis?
A. Serum potassium 6.2 mEq/L
B. Hemoglobin 10.5 g/dL
C. Blood urea nitrogen 58 mg/dL
D. Serum phosphorus 5.8 mg/dL
Correct ✔✔✔ANSW✔✔: A
Rationale: Hyperkalemia (potassium >5.5 mEq/L) is life-threatening and can cause cardiac
dysrhythmias. This finding requires immediate intervention. The other values are elevated but not
immediately critical .
Question 3
A patient with acute kidney injury (AKI) was oliguric for 48 hours and now begins producing large
amounts of urine. How should the nurse interpret this?
A. Acute worsening of kidney function
B. Expected recovery (diuretic) phase
C. Fluid overload requiring fluid restriction
D. Onset of chronic kidney disease
Correct ✔✔✔ANSW✔✔: B
Rationale: The diuretic phase of AKI follows the oliguric phase and is characterized by increased
urine output. While this indicates recovery of kidney function, the nurse must monitor for
dehydration and electrolyte losses during this phase .
, Question 4
A patient with chronic kidney disease (CKD) reports muscle weakness and palpitations. Which
laboratory abnormality does the nurse anticipate?
A. Sodium 150 mEq/L
B. Potassium 6.1 mEq/L
C. Calcium 11.2 mg/dL
D. Hemoglobin 16 g/dL
Correct ✔✔✔ANSW✔✔: B
Rationale: Muscle weakness and palpitations are classic symptoms of hyperkalemia. Potassium
>5.5 mEq/L requires immediate intervention to prevent cardiac dysrhythmias .
Section 2: Water Treatment & Dialysate Safety
Question 5
During routine water testing, the chlorine level reads 0.10 ppm. What is the appropriate nursing
action?
A. Continue treatment; this is within normal limits
B. Notify the Medical Director immediately and stop treatment
C. Increase water flow rate to dilute chlorine
D. Document findings and continue monitoring
Correct ✔✔✔ANSW✔✔: B
and sample questions and
answers updated 2026
Section 1: Hemodialysis Principles & Safety
Question 1
A patient receiving hemodialysis complains of new post-dialysis cramping and lightheadedness.
Pre-dialysis weight is stable; ultrafiltration was increased by 0.7 L today. Which immediate
nursing action is best?
A. Increase dialysate sodium concentration
B. Slow ultrafiltration and administer small boluses of isotonic saline
C. Stop dialysis and call the nephrologist to admit the patient
D. Give oral salt tablets at the station
Correct ✔✔✔ANSW✔✔: B
Rationale: Acute intradialytic hypotension and cramps commonly result from excessive or too-
rapid ultrafiltration. The immediate nursing intervention is to slow or stop ultrafiltration and
administer small boluses of isotonic saline (100–200 mL IV), reposition the patient supine with
legs elevated, and reassess hemodynamics. Increasing dialysate sodium can help prevent
intradialytic hypotension over time but is not the first acute action. Oral salt tablets act too slowly
in this emergency .
,Question 2
Which laboratory value is most critical to report immediately in a patient undergoing
hemodialysis?
A. Serum potassium 6.2 mEq/L
B. Hemoglobin 10.5 g/dL
C. Blood urea nitrogen 58 mg/dL
D. Serum phosphorus 5.8 mg/dL
Correct ✔✔✔ANSW✔✔: A
Rationale: Hyperkalemia (potassium >5.5 mEq/L) is life-threatening and can cause cardiac
dysrhythmias. This finding requires immediate intervention. The other values are elevated but not
immediately critical .
Question 3
A patient with acute kidney injury (AKI) was oliguric for 48 hours and now begins producing large
amounts of urine. How should the nurse interpret this?
A. Acute worsening of kidney function
B. Expected recovery (diuretic) phase
C. Fluid overload requiring fluid restriction
D. Onset of chronic kidney disease
Correct ✔✔✔ANSW✔✔: B
Rationale: The diuretic phase of AKI follows the oliguric phase and is characterized by increased
urine output. While this indicates recovery of kidney function, the nurse must monitor for
dehydration and electrolyte losses during this phase .
, Question 4
A patient with chronic kidney disease (CKD) reports muscle weakness and palpitations. Which
laboratory abnormality does the nurse anticipate?
A. Sodium 150 mEq/L
B. Potassium 6.1 mEq/L
C. Calcium 11.2 mg/dL
D. Hemoglobin 16 g/dL
Correct ✔✔✔ANSW✔✔: B
Rationale: Muscle weakness and palpitations are classic symptoms of hyperkalemia. Potassium
>5.5 mEq/L requires immediate intervention to prevent cardiac dysrhythmias .
Section 2: Water Treatment & Dialysate Safety
Question 5
During routine water testing, the chlorine level reads 0.10 ppm. What is the appropriate nursing
action?
A. Continue treatment; this is within normal limits
B. Notify the Medical Director immediately and stop treatment
C. Increase water flow rate to dilute chlorine
D. Document findings and continue monitoring
Correct ✔✔✔ANSW✔✔: B
