Comprehensive Certification Examination for Peritoneal Dialysis Nurses: Advanced Clinical Judgment in
Continuous Cycling Peritoneal Dialysis (CCPD), Automated Peritoneal Dialysis (APD) Prescription
Management, Cycler Technology, Infection Control, and Patient Safety Optimization.
Questions 1–150
Domain 1: APD/CCPD Fundamentals and Prescription Design (1–25)
1. A patient is prescribed CCPD with 5 nocturnal cycles of 2.5 L each, no day dwell. What is the total nightly dialysate
volume?
A) 10 L
B) 12.5 L
C) 15 L
D) 17.5 L
Correct Answer: B
Rationale: 5 cycles × 2.5 L = 12.5 L total.
2. In APD, the term "ultrafiltration" refers to:
A) Movement of solutes from blood to dialysate
B) Movement of water from blood to dialysate across a pressure gradient
C) Heating dialysate to body temperature
D) Draining dialysate from the abdomen
Correct Answer: B
Rationale: UF is water removal driven by osmotic pressure (glucose) or hydrostatic pressure.
3. Which APD modality maintains a constant intraperitoneal volume throughout all cycles?
A) CCPD
B) NIPD
C) Tidal PD
D) IPD
Correct Answer: C
Rationale: Tidal PD leaves a residual volume and replaces only a portion each cycle.
4. A patient with high average transport status on PET is on CCPD but has inadequate small solute clearance. Best
prescription change:
A) Increase dwell time per cycle
B) Decrease fill volume
C) Increase number of cycles
D) Add icodextrin for day dwell
Correct Answer: C
Rationale: More cycles increase total dialysate flow, improving clearance in average transporters.
5. The cycler parameter that determines the total duration of the APD treatment is:
A) Dwell time
B) Fill time
C) Total therapy time
,D) Number of cycles only
Correct Answer: C
Rationale: Total therapy time = (fill + dwell + drain) × number of cycles.
6. A patient on CCPD has a night UF of 600 mL and day dwell UF of 150 mL. What is total 24-hour UF?
A) 450 mL
B) 600 mL
C) 750 mL
D) 900 mL
Correct Answer: C
Rationale: 600 + 150 = 750 mL.
7. Which cycler feature automatically reduces fill volume when intraperitoneal pressure exceeds a preset threshold?
A) Tidal volume override
B) Pressure-limited fill
C) Dynamic fill sensor
D) Last fill reduction
Correct Answer: C
Rationale: Dynamic fill sensors adjust volume to prevent leaks and pain.
8. Icodextrin is indicated for which specific clinical scenario in CCPD?
A) First nocturnal cycle for high transporters
B) Day dwell in patients with poor UF on dextrose
C) All cycles to reduce glucose load
D) Last nocturnal cycle to enhance overnight UF
Correct Answer: B
Rationale: Icodextrin provides sustained UF over long dwells (≥8 hours).
9. A patient on APD complains of morning fatigue, dizziness on standing, supine BP 160/90, standing BP 100/60. Most
likely cause:
A) Hypervolemia
B) Intradialytic hypotension
C) Nocturnal hypovolemia from excessive UF
D) Autonomic neuropathy
Correct Answer: C
Rationale: Excessive overnight UF causes morning hypovolemia and supine hypertension.
10. In NIPD (nocturnal intermittent PD), the absence of a day dwell results in:
A) Higher total weekly Kt/V
B) Lower middle molecule clearance compared to CCPD
C) Better UF
D) Reduced peritonitis risk
Correct Answer: B
Rationale: Without day dwell, continuous clearance of larger molecules is reduced.
11. According to ISPD 2020, the minimum recommended weekly Kt/V for a patient with significant residual renal
, function (RRF >2 mL/min) is:
A) 1.5
B) 1.7
C) 2.0
D) 2.2
Correct Answer: B
Rationale: Target 1.7/week; higher if anuric.
12. A low transporter patient on APD has poor UF. Which prescription change is most effective?
A) Shorten dwell times
B) Use icodextrin for long dwell
C) Increase dextrose concentration and prolong dwell times
D) Add midday manual exchange
Correct Answer: C
Rationale: Low transporters need longer dwells and higher glucose for UF.
13. In tidal PD, the tidal volume is typically set as a percentage of:
A) Total fill volume
B) Residual volume
C) Last fill volume
D) Heater bag volume
Correct Answer: A
Rationale: Tidal volume = 50–80% of total fill volume.
14. A patient's cycler is set for 3 cycles of 2 L each over 6 hours. What is the cycle length?
A) 1 hour
B) 1.5 hours
C) 2 hours
D) 3 hours
Correct Answer: C
Rationale: 6 hours / 3 cycles = 2 hours per cycle.
15. Which PET finding predicts better solute clearance with APD compared to CAPD?
A) Low transporter
B) High transporter
C) Low average transporter
D) All transport types equally benefit
Correct Answer: B
Rationale: High transporters benefit from short, frequent cycles (APD).
16. A patient reports their cycler alarms "drain incomplete" only on the third cycle of five. Most likely cause:
A) Catheter tip migration
B) Constipation worsening over night
C) Patient rolled onto side
D) Heater bag empty
Correct Answer: B
Continuous Cycling Peritoneal Dialysis (CCPD), Automated Peritoneal Dialysis (APD) Prescription
Management, Cycler Technology, Infection Control, and Patient Safety Optimization.
Questions 1–150
Domain 1: APD/CCPD Fundamentals and Prescription Design (1–25)
1. A patient is prescribed CCPD with 5 nocturnal cycles of 2.5 L each, no day dwell. What is the total nightly dialysate
volume?
A) 10 L
B) 12.5 L
C) 15 L
D) 17.5 L
Correct Answer: B
Rationale: 5 cycles × 2.5 L = 12.5 L total.
2. In APD, the term "ultrafiltration" refers to:
A) Movement of solutes from blood to dialysate
B) Movement of water from blood to dialysate across a pressure gradient
C) Heating dialysate to body temperature
D) Draining dialysate from the abdomen
Correct Answer: B
Rationale: UF is water removal driven by osmotic pressure (glucose) or hydrostatic pressure.
3. Which APD modality maintains a constant intraperitoneal volume throughout all cycles?
A) CCPD
B) NIPD
C) Tidal PD
D) IPD
Correct Answer: C
Rationale: Tidal PD leaves a residual volume and replaces only a portion each cycle.
4. A patient with high average transport status on PET is on CCPD but has inadequate small solute clearance. Best
prescription change:
A) Increase dwell time per cycle
B) Decrease fill volume
C) Increase number of cycles
D) Add icodextrin for day dwell
Correct Answer: C
Rationale: More cycles increase total dialysate flow, improving clearance in average transporters.
5. The cycler parameter that determines the total duration of the APD treatment is:
A) Dwell time
B) Fill time
C) Total therapy time
,D) Number of cycles only
Correct Answer: C
Rationale: Total therapy time = (fill + dwell + drain) × number of cycles.
6. A patient on CCPD has a night UF of 600 mL and day dwell UF of 150 mL. What is total 24-hour UF?
A) 450 mL
B) 600 mL
C) 750 mL
D) 900 mL
Correct Answer: C
Rationale: 600 + 150 = 750 mL.
7. Which cycler feature automatically reduces fill volume when intraperitoneal pressure exceeds a preset threshold?
A) Tidal volume override
B) Pressure-limited fill
C) Dynamic fill sensor
D) Last fill reduction
Correct Answer: C
Rationale: Dynamic fill sensors adjust volume to prevent leaks and pain.
8. Icodextrin is indicated for which specific clinical scenario in CCPD?
A) First nocturnal cycle for high transporters
B) Day dwell in patients with poor UF on dextrose
C) All cycles to reduce glucose load
D) Last nocturnal cycle to enhance overnight UF
Correct Answer: B
Rationale: Icodextrin provides sustained UF over long dwells (≥8 hours).
9. A patient on APD complains of morning fatigue, dizziness on standing, supine BP 160/90, standing BP 100/60. Most
likely cause:
A) Hypervolemia
B) Intradialytic hypotension
C) Nocturnal hypovolemia from excessive UF
D) Autonomic neuropathy
Correct Answer: C
Rationale: Excessive overnight UF causes morning hypovolemia and supine hypertension.
10. In NIPD (nocturnal intermittent PD), the absence of a day dwell results in:
A) Higher total weekly Kt/V
B) Lower middle molecule clearance compared to CCPD
C) Better UF
D) Reduced peritonitis risk
Correct Answer: B
Rationale: Without day dwell, continuous clearance of larger molecules is reduced.
11. According to ISPD 2020, the minimum recommended weekly Kt/V for a patient with significant residual renal
, function (RRF >2 mL/min) is:
A) 1.5
B) 1.7
C) 2.0
D) 2.2
Correct Answer: B
Rationale: Target 1.7/week; higher if anuric.
12. A low transporter patient on APD has poor UF. Which prescription change is most effective?
A) Shorten dwell times
B) Use icodextrin for long dwell
C) Increase dextrose concentration and prolong dwell times
D) Add midday manual exchange
Correct Answer: C
Rationale: Low transporters need longer dwells and higher glucose for UF.
13. In tidal PD, the tidal volume is typically set as a percentage of:
A) Total fill volume
B) Residual volume
C) Last fill volume
D) Heater bag volume
Correct Answer: A
Rationale: Tidal volume = 50–80% of total fill volume.
14. A patient's cycler is set for 3 cycles of 2 L each over 6 hours. What is the cycle length?
A) 1 hour
B) 1.5 hours
C) 2 hours
D) 3 hours
Correct Answer: C
Rationale: 6 hours / 3 cycles = 2 hours per cycle.
15. Which PET finding predicts better solute clearance with APD compared to CAPD?
A) Low transporter
B) High transporter
C) Low average transporter
D) All transport types equally benefit
Correct Answer: B
Rationale: High transporters benefit from short, frequent cycles (APD).
16. A patient reports their cycler alarms "drain incomplete" only on the third cycle of five. Most likely cause:
A) Catheter tip migration
B) Constipation worsening over night
C) Patient rolled onto side
D) Heater bag empty
Correct Answer: B
