Kidney Diseases, Hemodialysis, and Peritoneal Dialysis (33 Questions)

1. You are caring for Mr. René Lafleur, a 69-year-old patient with chronic kidney disease (CKD) who receives hemodialysis three times per week. Today, during your assessment, he reports:

“I’ve been feeling more short of breath than usual, especially when lying down. My ankles seem more swollen too.”

You note bilateral pedal edema, crackles at the lung bases, and his weight is 2.4 kg higher than it was after his last dialysis session.

Question:
Based on this assessment, what do you suspect? *
2. You are discharging Mr. Michel Fortin, a 62-year-old client newly started on continuous ambulatory peritoneal dialysis (CAPD). His wife expresses concern about doing the procedure at home and asks what signs they should watch for to know if something is wrong.

Question:
What will you teach Mr. Fortin and his wife to monitor as a sign of a complication that requires prompt medical consultation? *
3.1 Mr. Tremblay, a 65-year-old male, has been living with chronic kidney disease (CKD) and is being treated with hemodialysis via an arteriovenous fistula in his left forearm. His medical history includes hypertension (HTN), which is managed with medications. During your assessment, Mr. Tremblay reports feeling more breathless than usual. His vital signs are stable, but he mentions that his breathing difficulty has gradually increased over the past few days.

Question:
What symptom would justify an additional dialysis session? *
3.2 He is scheduled for hemodialysis this morning, and his daily dose of enalapril is due.

Question:
When should you administer the enalapril? *
3.3 Mr. Tremblay, a 65-year-old client undergoing chronic hemodialysis via a left AV fistula, has just returned from his morning dialysis session. As you perform your post-dialysis assessment, you obtain the following vital signs:
*BP: 118/72 mmHg
*HR: 80 bpm, regular
*RR: 18/min
*SpO₂: 97% on room air
*Temperature: 37.8°C

Mr. Tremblay reports feeling fine and is sitting comfortably in bed, reading the newspaper.

Question:
What is your appropriate nursing action? *
3.4 He is now ready to order breakfast. You are reviewing his diet options with him.

His prescribed renal diet is low in potassium, phosphorus, and sodium, with moderate protein and fluid restriction.

His most recent labs show:
*K⁺: 5.2 mmol/L (high-normal)
*Phosphorus: Elevated
*Creatinine and BUN: Consistent with CKD

He mentions he's feeling better after dialysis and is ready to eat.

Question:
Which of the following diet choices is best for this patient? *
4.1 Mr. Sylvain Gagnon, a 63-year-old client with end-stage renal disease, is undergoing continuous ambulatory peritoneal dialysis (CAPD) at home. He arrives at the outpatient dialysis clinic for his regular assessment.

During your evaluation, he shows you the most recent dialysate drainage bag, which appears cloudy, although he has no fever or abdominal pain at the moment.

Question:
Which of the following is the best initial nursing action? *
5.1 Mr. Michel Fortin, a 67-year-old client with chronic renal failure, receives hemodialysis treatments three times per week through an arteriovenous (AV) fistula in his left arm. You are preparing to complete your initial assessment during your shift.

Question:
Which intervention should you include? *
5.2 As he prepares for discharge, you are providing him with teaching on how to protect the AV graft and avoid complications such as clotting or damage to the site.

Question:
Which action(s) will you include in your teaching to Mr. Fortin to avoid? Choose TWO (2) answers *
6. Mr. Gagnon, 73, has stage 4 chronic kidney disease (CKD) secondary to long-standing diabetes and hypertension. He presents to the clinic with increasing fatigue and shortness of breath over 5 days. He reports sleeping on 3 pillows and waking at night “gasping.” His daughter notes his shoes no longer fit by evening. Vitals: BP 168/94, HR 96, RR 24, SpO₂ 92% on room air. On assessment, you hear bilateral crackles at the bases and note 2+ pitting edema to mid-shin.

Question: Which finding requires the most immediate intervention? *
7. Ms. Roberts, 61, receives hemodialysis Mon/Wed/Fri. Today she arrives for dialysis and reports dizziness when standing. Her pre-dialysis vitals: BP 96/58, HR 88. Her medication list includes amlodipine and metoprolol taken every morning. She states she took both medications one hour ago because “I never skip my pills.” The dialysis nurse is preparing to initiate treatment.

Question:
What is the most appropriate nursing action? *
8. Mr. Chen, 54, has a new left forearm AV fistula created 6 weeks ago. He is admitted for pneumonia. During morning rounds, a nurse prepares to take his blood pressure and notices the cuff is closest to the left arm. The patient says, “Use whichever arm is easiest.”

Question:
What is the best action? *
9. Ms. Alvarez, 49, arrives for scheduled hemodialysis. She has a right upper arm AV fistula. On assessment, you cannot palpate a thrill and cannot hear a bruit. The patient states, “It felt fine last night.”

Question:
What is the priority nursing action? *
10. Mr. Ibrahim, 67, is new to hemodialysis for end-stage kidney disease (ESKD). Midway through his first treatment, he develops headache, nausea, restlessness, and mild confusion. Vitals are stable. The machine settings show a relatively rapid fluid and solute removal.

Question:
What complication do these findings most suggest? *
11.1 Ms. Dubois, 58, performs peritoneal dialysis (PD) at home. She presents to the ED with abdominal discomfort and low-grade fever. She brings her drained dialysate bag, which appears cloudy. She reports the catheter exit site looks “a bit red.”

Question:
What is the most likely concern? *
11.2 The physician asks the nurse to initiate the peritonitis protocol.

Question: What is the best initial nursing action? *
12. Mr. Taylor, 62, on Peritoneal Dialysis reports his drain is “barely flowing” during an exchange. He denies fever, severe pain, or shortness of breath. The catheter exit site is clean/dry. He says he has been constipated for 3 days.

Question:
What is the best first intervention? *
13. Mr. Nguyen, 70, with ESKD missed his last dialysis session. He presents with weakness. Labs: K⁺ 6.8 mmol/L (3.5–5.0 mmol/L). ECG shows peaked T waves. Vitals: BP 148/86, HR 58.

Question:
What is the priority nursing action? *
14. Ms. Wallace, 63, has CKD stage 5 and reports itching and “bone aching.” Labs show elevated phosphate. She says she drinks cola daily and eats processed foods because they are easy.

Question:
Which teaching is most appropriate? *
15. A patient prescribed calcium carbonate (phosphate binder) says: “I take it at bedtime so I don’t forget.”

Question:
What instruction is best? *
16. Mr. Patel, 59, with CKD reports fatigue and decreased exercise tolerance. Labs show low hemoglobin with low reticulocyte response. The physician discusses treatment.

Question:
Which therapy is most commonly used for CKD-related anemia? *
17. Ms. Kaur, 72, with advanced CKD reports nausea, metallic taste, severe pruritus, and increasing confusion. Family notes she is “not herself.” Vitals are stable.

Question:
What is the priority action? *
18. A patient with CKD stage 3 asks what to take for chronic knee pain. He reports taking ibuprofen daily.

Question:
Best nursing teaching? *
19. Mr. Martin, 68, with CKD stage 3 is scheduled for a contrast-enhanced CT. He is mildly dehydrated from gastroenteritis. Creatinine is above baseline.

Question:
Which intervention best reduces the risk of contrast-associated kidney injury? *
20. Ms. Simoneau, 77, is admitted from a long-term care facility with vomiting and poor oral intake for 3 days. She is lethargic and thirsty. Vitals: BP 92/54, HR 112. Labs show rising creatinine and BUN.

Question: The most likely type/cause of AKI is: *
21. Mr. O’Connor, 75, presents with lower abdominal discomfort and minimal urine output since yesterday. He has BPH. Palpation reveals suprapubic fullness.

Question: What is the priority nursing action? *
22. Ms. Lee, 64, just returned from hemodialysis. The dressing over her AV fistula site becomes saturated with blood while she is in bed. She looks anxious but is alert.

Question:
What is the priority intervention? *
23. Mr. Hernandez, 45, is discharged after kidney transplant. He is prescribed tacrolimus and mycophenolate. He asks whether he can attend a crowded indoor family event this weekend. He feels well and wants to “celebrate properly.”

Question:
What teaching is most appropriate? *
24.1 Mr. Hamidi, 63, is receiving intermittent hemodialysis via a central venous catheter. Thirty minutes into treatment, he suddenly becomes anxious and says, “I can’t breathe.” He develops a persistent cough and reports sharp chest pain. You note acute dyspnea, tachypnea, and a drop in SpO₂ from 97% to 88% on room air. The venous line tubing appears to have visible air and the machine alarm indicates possible air in the circuit. His BP is trending down and he looks pale.

Question:
What do you suspect is happening? *
24.2 Same patient as above. The patient is worsening and the dialysis machine continues to alarm.

Question: What is your initial nursing intervention? *
25.1 Ms. Fournier, 71, with ESKD on hemodialysis via a tunneled catheter, presents to the dialysis unit appearing unwell. She reports chills since last night and feels “very weak.” On assessment, she is drowsy but arousable. Vitals: T 39.1°C, HR 118, RR 26, BP 88/54 (normally 140s/80s), SpO₂ 94% RA. Her catheter exit site looks mildly erythematous and tender. She is cool and clammy with delayed capillary refill.

Question: What do you suspect is happening? *
25.2 Question: What is your initial nursing intervention? *