Hemodialysis & Peritoneal Dialysis
A nurse is caring for a 60-year-old client with end-stage renal disease who has chosen continuous ambulatory peritoneal dialysis (CAPD) as their method of treatment. The nurse is providing education on home care, potential complications, and signs to report to the provider.
Question:Which findings or actions should the nurse include when teaching the client about peritoneal dialysis? (Select all that apply.)
A. Report cloudy or foul-smelling dialysis outflow to the healthcare provider.
B. Maintain sterile technique when connecting and disconnecting dialysis tubing.
C. Expect abdominal pain during every dwell time as a normal finding.
D. Ensure the catheter exit site is dry and free from redness or drainage.
E. Keep the dialysis fluid at room temperature or warm before infusing.
F. Clamp the peritoneal catheter between exchanges to prevent leakage.
G. Add heparin or antibiotics to the dialysate routinely at home without provider instruction.
✅ A. Report cloudy or foul-smelling dialysis outflow to the healthcare provider.
✅ B. Maintain sterile technique when connecting and disconnecting dialysis tubing.
❌ C. Expect abdominal pain during every dwell time as a normal finding. (Mild discomfort may occur initially, but persistent pain is abnormal.)
✅ D. Ensure the catheter exit site is dry and free from redness or drainage.
✅ E. Keep the dialysis fluid at room temperature or warm before infusing.
❌ F. Clamp the peritoneal catheter between exchanges to prevent leakage. (This is generally not needed unless specifically instructed.)
❌ G. Add heparin or antibiotics to the dialysate routinely at home without provider instruction. (Medications must be prescribed and instructed by the healthcare provider.)
What is the normal range for sodium?
135-145
A nurse is caring for a client who has a chest tube placed to drain abnormal fluid or air from the pleural space.
Which of the following conditions are possible reasons for chest tube placement?
(Select all that apply.)
A. Pneumothorax
B. Hemothorax
C. Pleural Effusion
D. Empyema
E. Chylothorax
F. Pericarditis
G. Post-thoracic surgery
✅ A. Pneumothorax (Air in the pleural space — chest tube helps re-expand the lung)
✅ B. Hemothorax (Blood in the pleural space — chest tube drains the blood)
✅ C. Pleural Effusion (Excess fluid — often drained to improve breathing)
✅ D. Empyema (Pus from infection — chest tube helps drain infected fluid)
✅ E. Chylothorax (Lymphatic fluid accumulation — requires drainage)
F. Pericarditis (Inflammation of the pericardium — not treated with chest tube)
✅ G. Post-thoracic surgery (Common indication to remove air or fluid post-operatively)
On the ECG, there are [_______] visible P waves due to chaotic atrial activity.
Distinct
No distinct
Extra
Normal
No distinct
Which of the following is the primary purpose of a tracheostomy?
A. To improve swallowing ability
B. To maintain a patent airway
C. To prevent pneumonia
D. To allow oral suctioning
B. To maintain a patent airway
“Hemodialysis is a procedure that cleans your blood by removing [_____] through a machine that acts as an artificial kidney.”
A. Proteins and immune cells
B. Excess fluids and waste products
C. Red blood cells and plasma
D. Digestive enzymes and vitamins
B. Excess fluids and waste products
Patients with _________ imbalance should be on continuous heart monitoring
Potassium
A client presents with sudden onset dyspnea, unilateral chest pain, hyperresonance on percussion, and absent breath sounds on one side.
→ [_______]
Pleural Effusion
Pneumothorax
Hemothorax
Empyema
Pneumothorax
The ventricular heart rate during A-Fib typically fluctuates between [_______] beats per minute but can be higher.
60–80
100–175
40–60
180–220
100-175
A nurse is caring for a patient with a tracheostomy and observes that the tracheostomy tube has become dislodged. What is the priority action?
A. Call the provider
B. Attempt to reinsert the tracheostomy tube using a new sterile tube
C. Ventilate the patient with a bag-valve mask over the stoma
D. Cover the stoma with sterile gauze and monitor oxygen saturation
C. Ventilate the patient with a bag-valve mask over the stoma
(Immediate oxygenation is the priority—call for help, then reinsert or escalate care.)
A nurse is providing care and education to a client undergoing hemodialysis for end-stage renal disease.
Which of the following nursing actions are appropriate?
(Select all that apply.)
A. Check the client's blood pressure, pulse, weight, and temperature before and after dialysis.
B. Use the dialysis access site for routine blood draws and IV infusions.
C. Keep the dialysis access site clean, dry, and monitor for signs of infection.
D. Encourage the client to increase fluid intake between dialysis sessions.
E. Educate the client to avoid foods high in potassium such as bananas and oranges.
F. Wash hands before handling the client's access site.
G. Apply a tight bandage over the fistula site to protect it after dialysis.
✅ A. Check the client's blood pressure, pulse, weight, and temperature before and after dialysis.
❌ B. Use the dialysis access site for routine blood draws and IV infusions. (This is not appropriate; it can damage the access.)
✅ C. Keep the dialysis access site clean, dry, and monitor for signs of infection.
❌ D. Encourage the client to increase fluid intake between dialysis sessions. (Clients on dialysis often have strict fluid restrictions.)
✅ E. Educate the client to avoid foods high in potassium such as bananas and oranges.
✅ F. Wash hands before handling the client's access site.
❌ G. Apply a tight bandage over the fistula site to protect it after dialysis. (This can compromise circulation.)
Chvostek's and Trousseau's signs are indications for what imbalance?
Hypocalcemia
A client has milky fluid in the chest tube, shortness of breath, and high triglyceride levels in the fluid.
→ [_______]
Chylothorax
Hemothorax
Empyema
Pleural Effusion
Chylothorax
A client in V-Tach may [_______] a pulse, requiring rapid assessment and intervention.
Always have
May have or may be pulseless
Never have
Always be pulseless
May have a pulse or may be pulseless
What is the recommended frequency for routine tracheostomy care (cleaning and dressing change) in a stable patient with an established tracheostomy?
A. Every 2 hours
B. Once every shift
C. Every 24 hours and as needed
D. Only when secretions are visible
Correct Answer:
C. Every 24 hours and as needed
“It’s important to learn how to care for your dialysis access, follow your meal plan, and [_______] your medications correctly at home.”
A. Skip
B. Flush
C. Store
D. Take
D. Take
A nurse is caring for a patient with serum sodium of 122 mEq/L. Which of these findings should the nurse expect?
A. confusion
B. dry mucous membranes
C. seizures
D. muscle weakness
E. increased deep tendon reflexes
F. nausea
A. confusion
C. seizures
D. muscle weakness
F. nausea
Dry mucous membranes and increased deep tendon reflexes are common in HYPERnatremia rather than HYPOnatremia
A chest tube is placed after cardiac surgery to manage expected fluid or air.
→ [_______]
Post-Surgical Chest Tube Use
Empyema
Hemothorax
Pneumothorax
Post-Surgical Chest Tube Use
The client in V-Fib is typically [_______] and without a pulse, indicating cardiac arrest.
Alert and stable
Responsive with weak pulse
Unresponsive and pulseless
Mildly symptomatic
Unresponsive and pulseless
The nurse is preparing to perform tracheostomy care. Which of the following actions are appropriate? Select all that apply.
A. Use sterile technique when cleaning the inner cannula of a new tracheostomy
B. Secure the tracheostomy ties so that no fingers can fit underneath
C. Suction the tracheostomy before removing the old dressing
D. Remove the entire tracheostomy tube to clean it thoroughly
E. Place a new sterile dressing under the tracheostomy plate after cleaning
✅ A. Use sterile technique when cleaning the inner cannula of a new tracheostomy
❌ B. Secure the tracheostomy ties so that no fingers can fit underneath (Should allow 1 finger)
✅ C. Suction the tracheostomy before removing the old dressing
❌ D. Remove the entire tracheostomy tube to clean it thoroughly (Only the inner cannula is removed; never the full tube unless ordered)
✅ E. Place a new sterile dressing under the tracheostomy plate after cleaning
“Let your healthcare team know right away if you experience dizziness, cramps, nausea, or [_______] during or after dialysis.”
A. Bleeding C.Fever
B. Hunger D. Weight Loss
A. Bleeding
Does hypernatremia cause increased or decreased thirst?
Increased thirst
A common risk factor for pneumothorax includes [_______], such as a car accident or stab wound to the chest.
COPD
Blunt force trauma/penetrating trauma to the chest
Advanced age
Occluded chest tube
Blunt force trauma/ penetrating trauma to the chest
The priority intervention for V-Fib is [_______] and emergency treatment to restore circulation.
Immediate defibrillation
Administer oral medications
Provide oxygen only
Initiate IV fluids slowly
Immediate Defibrillation
The nurse is teaching a patient and family how to care for a long-term tracheostomy at home. Which statements indicate understanding of the instructions?
Select all that apply.
A. “We will clean the inner cannula daily using sterile water and pipe cleaners.”
B. “We should call the provider if we see increased mucus or difficulty breathing.”
C. “We will change the tracheostomy tube by ourselves every 2 days.”
D. “We’ll keep an emergency tracheostomy tube of the same size and one size smaller at home.”
E. “We can cover the tracheostomy with a scarf when outside in cold weather.
✅ A. “We will clean the inner cannula daily using sterile water and pipe cleaners.”
✅ B. “We should call the provider if we see increased mucus or difficulty breathing.”
❌ C. “We will change the tracheostomy tube by ourselves every 2 days.” (Tube changes should be done by trained personnel and not that frequently)
✅ D. “We’ll keep an emergency tracheostomy tube of the same size and one size smaller at home.”
✅ E. “We can cover the tracheostomy with a scarf when outside in cold weather.” (Helps humidify and warm air)