Set 1 Nnrt (3032 ) 5.

The dialysis staff is required to assess Mr X for first time dialysis

procedure. The initial evaluatition to determine the maturity of the fistula
1. The following is acorrect statement regarding pre- treatment during is
purifying water phase for heamodialysis . A. Depth of 7mm from skin
A. Blend hot and cold water to higher temperature B. Blood flow 500mls / minute
B. Correction of pH is not done at this phase to correct alkalinity C. Less than 6cm segment for needing
C. Remove up to 95% of ionic contaminated and non-contaminants D. Diameter measurement of more than 6mm
D. Prepare the water for optimal operation of primary purification process

6. During the dialysis procedure, the purpose of priming the extracorporeal

2. Sampling location for daily test for hardness in water treatment system circuit with saline is to
is A. Expose to chemical
A. Last distribution point B. Tighten all connectors
B. In between the 2 carbon filters C. Be certain fibres are throughly filled with germicide
C. Immediate post reverse osmosis( RO ) D. Remove air and germicide before initiating treatment
D. In between the softener column and reverse osmosis ( RO ) membrane

7. During the intradialytic phase of dialysis , the etiology of cramps is deu

3. In heamodialysis treatment , the contaminat is untreated water yhat to
causes osteomalacia is A. Hyperosmolar dialysate
A. Zinc B. Decrease muscle perfusion
B. Copper C. Preexist neurological disoder
C. Fluoride D. Side effect of desferrioxamine (DFO) treatment
D. Chloramide

8. Mr Q experienced persistent hypotension during heamodilalysis and the

4. The following is not a preferred site for planning permanent vascular doctor ordered to increase sodium profilling . the side effect of this action
access in heamodialysis will be
A. Radiocephalic vein A. Enhanced sweating
B. Brachialbasillic vein B. Decreased blood sugar
C. Brachialcephalic vein C. Patient experienced fatique
D. Sephenofemoral vein D. Increased intradialytic thrist
9. The hemodialysis patients suddenly developed shortness of breath , 13. Mr J undergoing heamodialysis for past years and has been using the
chest pain and coughing during dialysis. The patients also had tachycardia, machine during the third shift. The dialysis nurse decided to desinfect his
central cyanosis and anxious. The priority action for the nurse is to machine. Thw common methods to disinfect and decalcify the machine are
A. Continue dialysis and monitor vital sign every 15 minutes as below , except
B. Continue dialysis at s dlower rate after checking the lines for air leaking A. Heat
C. Place patiennt on left trendelenburg position and discontinue diallysis B. Chemical
D. Give 500mls of intravenous 0.9% normal saline to break the air C. Sodium bicarbonate
embolus. D. Combined citric thermal

10. A patient with chronic kidney disease is receiving erythropoitein agent 14. The nursing care plan for Mr X who is critically ill , suffering cathether
(ESA) to support erythropoiesis. the medication that supports red blood - related bloodstream infection ( CRBSI ) with cuffed tunnel catheter is
cell production is A. Treat with local antibiotic application for 72hours
A. Iron supplement B. Remove the catheter and an alternative access placed if posibble
B. Zinc supplement C. Antibiotic lock solution be used to reduce catheter related bactereamia
C. Calcium supplement D. Convert the modality of replacement theraphy to intermitent peritoneal
D. Magnesium supplement dialysis (IPD) stat

11. Hepatitis B virus is the major cause of viral hepatitis in end stage renal 15. Patient with hemodialysis treatment is given antocoagulant theraphy in
failure to the natuure of hemodialysis treatment. Patient with Hepatitis B oder to
positive should be routinely tested A. Lyse existing clot
A. Annualy B. Prevent coagulopathy
B. 3 monthly C. Axtivates the coagulant cascade
C. 6 monthly D. Prevent cooagulation of extracorporeal circuit
D. During active infection
16. The nurse prepared the normal heparin regime for patient with body
12. Following the Association for Advancement of medical instrument weight 60kg . the dose of preparation will be
(AAMI) standard for heamodialysis water quality , microbiological A. 2500 unit/kg/hour
monitoring should be performen at least monthly and total viable microbial B. 3000 unit/kg/hour
counts shall not exceed C. 3200 unit/kg/hour
A. 100cfu/ml D. 4300 unit/kg/hour
B. 150 cfu/ml
C. 200cfu/ml
D. 250cfu/ml
17. A patients with chronic kidney disease has completed the hemodialysis 20. During hemodialysis , the factor that influences good clearence is
treatment . the following standard indicator to evaluate the patients status A. Reuse dialyser
after dialysis is B. High heamatocrit
A. Vital signs and BUN C. Access recirculation
B. Vital signs and weight D. High dialysate flow rate
C. BUN and creatinine leve;
D. Potassium level and weight 21. Based on the kidney disease improving global outcome ( KDIGO),
urea reduction rate ( URR ) for hemodialysis patient is 65%. the nurse
should focus on patient education contributing factor on achieving URR ,
18. The aim of 1st time hemodialysis of CKD stage 5 patient is to ensure except
patient receives a safe hemodialysis and reduce intradialytic complication. A. Increase in protein consumption
Therefore the first time hemodialysis should be B. Increase the dialysis prescription
A. 1hour, high efficiency dialyser,Qb 200ml/min, possibly heparin free, C. Time of dialysis calculated correctly
dialysate flow rate <500ml/min D. Patient compliences to hemodialysis treatment.
B. 2 hour , low efficiency dialyser, Qb 200ml/min, posibbly heparin free,
dialysate flow rate <500mls/min
C. 3 hour , low efficiency dialyser, Qb 200ml/min, possibly heparin free, 22. The hemodialysis patient with a left arm fistula is at risk to steal
dialysate flow rate<500ml/min syndrome. The clinical manifestation include
D. 4 hour, low efficiency dialyser, Qb 200ml/min, possibly heparin free, A. Warmth, redness and pain in the left hand
dialysate flow rate <500ml/min B. Aching pain , pallor and edema on the left arm
C. Pallor , dimnish pulse and pain in the left hand
D. Edema anf reddish discolouration of the left arm
19. health education on life modification will be changed after initiating
hemodialysiss include
A. High intake protein should be allowed to increase muscle bulk of the 23. The management of hypertewnsion in dialysis is essential in reducing
patients the mortality rate due to cardiovascular disease. This include
B. Sexual impotence can be eleminated by reducing antihypertensive drugs A. Interdialytic weight gain should be ≥ 4% of the set dry weight
on the patients B. Achieve target dry weight over 4-6 weeks after commencing dialysis
C. Limited fluid is allowed and interdialytic weight gain cannot exceed 4% C. Pre and post dialysis blood pressure goals should be systolic Bp >150
of total dry weight mmhg diastolic Bp > 90mmhg
D. Daily two hours cardiovascular exercise should be advised on daily D. Temporary cessation of Angiotensin-converting enzyme (ACE)
basis to improve energy level inhibitors drugs are most preffered
24. the primary cause of anemia in chronic kidney disease is erythropoietin B. Chills and rigor
deficiency . in oder to maintain heamoglobin level >11gm in dialysis C. Hemolytic anemia
patient , the most important patient education is D. Ventricular fibrillation
A. Maintain iron in daily diet
B. Ensure adequate dialysis 3. In preventing risk of air embolism on removal of dialysis catheters
C. Monitoring hemoglobin monthly from the neck of dialysis patient
D. Monitoring blood pressure and blood glucose A. Patient head upwards position during catheter removal
B. Heparin should be given an hour before planned removak
C. Occlusive dressing with antibiotic ointment should be done
25. Rehabilitation is a restoration process of an individual foe maximum D. The dressing should be compressed with ice for period of 24
possible level of function and achievement , the goals of rehabilitation in hours
hemodialysis patients includes
i. Developing a positive outlook 4. To deliver safe haemodialysis treatment, the procedure of
ii. Feeling useful to family and community cannulation work process includes
iii. Achieving dry weight at the end of hemodialysis treatment A. Apply pressure with tourniquet to stop the bleeding
iv. Achieving target of hemoglobin rate to 11g/l B. Check patency of blood flow using saline and clamp fistula
A. i&ii needle
B. ii&iii C. Retrograde needling (direction of needling is away from the
C. iii&iv anastomosis site)
D. iv&i D. Cannulation site should be at least 5cm away from the
anastomosis site.
SET 2 5. The below is the management of catheter related bloodstream
1. In dialysis treatment ultrapure dialysis solution infection (CRBSI) in the haemodialysis
A. Reduces in flammatory stimulus A. It should be removed and replace immediately via guidewire
B. Has bacterial level <0.2CFU/ml and endotocin level B. The patient should receive at least 24 hours of antibiotic
<o.04EU/ml therapy
C. Causes less frequent occurrence of gout arthritis and renal C. Convert the mode of replacement therapy to intermittent
bone disease peritoneal dialysis (IPD) stat
D. Together with low complement activating membranes D. Vancomycin is usually recommended for methilisin resistant
minimizes the biocompatibility of dialysis treatment staphylococci (MRSA)

2. The presence of copper and zinc from metal pipes and fittings in
dialysis water can cause
A. Bone disese
6. Transmembrane pressure during haemodialysis is refer to 10. The ultrafiltration coefficient (Kuf) is a measure of the
A. Dialysate flow rate of 300-400ml/min A. Parameter of dialysis adequacy
B. The hydrostatic pressure gradient across the membrane B. Water permeability of a membrane in dialyser
C. Association with a significant increase in dialysis adequacy C. Blood volume cleared of a given solute per unit time
D. The dialysis to pull toxins from the blood into the dialysate D. Efficacy of removal of middle – to large molecular weght
solutes
7. The internal jugular vein catheter heparin lock refers to
A. Filling of dead space with 1000-5000 unit of heparin 11. During the haemodialysis if the patient’s blood pressure is
B. The volume is the same in the both side of the catheter 180/110mmHg
C. During the dressing the heparin must be flushed in into the A. Give IV Erythropoitin slow bolus over 15 minutes
blood stream B. Terminate the dialysis and admit the patient to the ward
D. Injection of heparin volume larger than stated in the lumen C. Increase the extraction and give subcutaneous Erythropoietin
was found prevent clotting of the lumen D. Continue the dialysis, give oral Nifidipine 5mg and increase
the dialysis hours
8. Mr. F with native fistula, plan for haemodialisis with aminimal
heparin (tight heparin). The care plan for the patient during 12. A 10 years old boy with acute kidney injury needs an urgent
haemodialisis include hemodialysis. The following is the guidline for peadiatrics
A. Termination time should be between 20 – 40 minutes before hemodialysis.
the time off. A. Blood flow rate up to 30ml/min
B. It is not necessary to monitor during dialysis for any visual B. The volume capcity of blood lines range from 10ml to 130ml
signs of clotting C. Short dialysis daily 5 – 6 sessions per week with each session
C. In the event of an accidental overdose of any anticoagulant the 2 – 3 hours
antidote is warfarin therapy. D. Total extracorporeal circuit volume should be <20% of child
D. Observe bleeding time post fistula needle removal, if extended estimated blood volume
(>120sec) to monitor possible bleeding tendency.
13. During blood sampling technique for access re-circulation
9. During haemodialisis the use of low molecular weight haparins measurement, the dialysis nurse should
(LMVHs) on a patient possible, immediate consequence that must A. Obtain arterial and venous blood sample simultaneously (post
be observed by the dialysis nurse is dialyser only)
A. Muscle cramps B. Obyain arterial andvenous blood sample simultaneously (pre
B. Cardiac arrhythmia & post dialyser)
C. Seizure and vomiting C. Ensure both arterial and venous blood sample is obtained 1
D. Anaphylactic reactions hour after haemodialisis
D. Despacth blood samples to laboratory the next day of
hemodialisis treatment
14. A regular hemodialisis patient experienced giddiness, sweating 18. A 55 years old man had a history of hyperphosphatemia. Recently
and palpitation. You suspected recurrent hypotension,. Below are he was diagnosed with chronic kidney disease (CKD-MBD). The
the conservative steps to treat recurrent a, except appropriate recommendation for CKD_MBD assessment is
A. Adjustment of sodium profiling monitoring of
B. Limiting intradialytic weight gain A. Bone mineral density
C. Reassess reduce dry weight B. Vascular calcification
D. No food intake during hemodialisis C. Transferrin saturation
D. Alpha-fetoprotein annually
15. A hemodialisis patient presented with sign of syncope, palpitation
and persistence hypotension during hemodialisis. The staff should 19. Mr. M initiated with oral calcitriol 0.25ug per day. The following
manage the patient for complication of test should be done within the next 3 month is serum
A. Air embolism A. Potassium
B. Dialyser reaction B. Magnesium
C. Cardic arrhythmias C. Calcium and phosphate
D. Disequilibrium syndrome D. Alkaline phosphate (ALP)

16. Mr X develops persistent hypotension after infused with 200ml of 20. The following protocol is the right way to reduce risk of
normal saline during haemodialisis. The dialysis staff should carry transmission of the virus in a hemodialysis unit except
out the following management A. If anti HBs Ab>100mlU/mlm. A booster dose shall be given
A. Increase dialysate temperature B. In HIV positive patient, single use of dialyser is mandatory
B. Blood transfusion may be necessary C. A separate room for reprocessing dialyser of patient with
C. Blood glucose to exclude hypoglycemia Hepatitis B and Hepatitis C
D. Continue with the same ultrafiltration rate D. Patient shall be tested fo HbsAg after returning from another
haemodialysis
17. A chronic haemodialysis patient present with
i. Swaollen joints 21. A new patient with positive HbsAg planned for hemodialisis. The
ii. Shoulder pad sign appropriate infection protocol should be
iii. Soft-tissue swelling A. Heat or chemical disinfestion should be done at the end of the
iv. Carpak tunnel syndrome days operation
B. Rinse to clean the hydraulic component of hemodialysis
The staff should observe for machines at the end of each session
A. Hypercalcemia C. Bleaching with disinfectant as recommended by the
B. Aluminium overload manufacturer should be done at the end daily
C. β 2 microglobulin amyloidosis D. After initiating the decalcification for 30 minutes, continue
D. secondary hyperparathyroidism with normal rinsing after each session ends.
 C. Advise patient to just accept their fate and reduce their
22. The air detector has detected some bubbles. The management to functional capacity
troubleshoot the problem is by D. Teach the patient the problem solving and effective coping
A. Ensuring the line going into the filter is free from blood clots technique to manage their health.
B. Setting up a new extracorporeal cicuit if the circuit is full of
froth
C. Starting from the machine and work along the cicuit, checking SET 3
for kinks 1. The standard proportioning of dialysis solution is
D. Increasing the blood flow rate or decreasing the dialysate flow a. 1:1.83:34 where one parts of acid concentrate is mixed with
rate 1.83 parts of RO and 34 parts of bicarbonate concentrate
b. 1:1.83:34 where one parts of RO is mixed with 1.83 parts of
23. A dialysis staff is providing information on the need to take blood acid concentrate and 34 parts of bicarbonate concentrate
for Kt/V. during her education she must emphasize that Kt/V is c. 1:1.83:34 where one parts of acid concentrate is mixed with
essential to measure solute removal during dialysisisis that focuses 1.83 parts of bicarbonate concentrate and 34 parts of RO
on d. 1:1.83:34 where one parts of bicarbonate concentrate is mixed
A. Urea clearance with 1.83 parts of acid concentrate, 34 parts of RO and 34
B. B12 biocompatibility parts of bicarbonate concentrate
C. Blood cell dialysis volume
D. Beta 2 microglobulin sustainance 2. The purpose to remove calcium and magnesium in the dialysis
water treatment is to
24. A critically ill patient requires hemodialysis, SLED modality was a. Maintain deionization process
chosen. The underlying principles that influence the use of SLED b. Support regeneration schedule
therapy on this patient is c. Prevent scaling on RO membrane
A. Provide good ultrafiltration d. Confirm conductivity of the membrane
B. Has a good middle molecule clearance
C. Provides high diffusion clearance but low in convection 3. The following are water contaminants and its complication
clearance a. Sodium-anemia
D. It is slightly expensive in cost than Contonuous Renal b. Chlorine-hemolysis
Replacement Therap (CRRT) c. Calcium-inflammation
d. Chloramine-bone disease
25. The appropriate rehabilitation aspect for hemodialisis patients is to
maintain a normal life as possible include 4. AV grafts more often develop low blood flow caused by clotting
A. Advice patient to increase the intake of phosphate binder of the access. The management is
B. Encourage the patient to do a high intense exercise such as a. Thrombectomy
rope jumping b. Ligation of the AV grafts
 c. Treat the steal syndrome 9. The management for client returning from other hemodialysis
d. Checking the thrill in access every day center is to
a. Use reuse dialyzer
5. Mr. M had done laparotomy and need urgent dialysis. The suitable b. Asses for viral status
management during hemodialysis is c. Give stat hepatitis B vaccination
a. Heparin free d. Continue dialysis as normal schedule
b. Tight heparin
c. Routine heparin 10. Mr. M has just been transferred from a private clinic to dialysis in
d. Regional heparin your clinic. The following action should action should be taken by
the dialysis nurse before initiating dialysis on Mr. M
6. The following are true regarding side effect of heparin except a. Dialysis patient in third shift of hepatitis C unit
a. Alopecia b. Provide him with stat dose of hepatitis booster
b. Osteoporosis c. Do rapid test to rule out hepatitis B on the patient
c. Thrombocytopenia d. Dialysis the patient as unknown viral status while waiting for
d. Hemolytic uremic syndrome his viral screening result

7. The following is specific preparation for a hemodialysis patient 11. Mr. J has recently created on AVF on his left arm and ready for
going for surgery. his first dialysis. What is the rule of six that the dialysis nurse
a. Infuse normal saline for hydration should adhere before cannulating vascular access for the first
b. Prepare patient with vitamin K injection time?
c. ‘no bp taking or needling’ label should be placed on the AV a. Look for any discoloration or bruise
fistula arm. b. Palpate for thrill and auscultate for bruit
d. Ultrafiltration during hemodialysis prior to surgery is set to c. Look for signs of redness or inflammation
achieve dry weight d. Ensure the blood flow of the fistula is above 600ml/min

8. When dialysis adequacy is assessed by using pre-dialysis and post- 12. Activated clotting time (ACT) monitoring every 30 minutes for
dialysis blood urea nitrogen (BUN) measurement, blood samples tight heparinization schemes are recommended for patient who are
should be drawn by using certain acceptable procedures. at slight risk for bleeding. What is the desired range ACT value
Procedure to withdraw post-dialysis sample is follows except required for patient in the dialysis unit?
a. Clamp venous pressure line a. 120-150s
b. Stop ultrafiltration and dialysate flow b. 130-160s
c. Withdraw blood from the arterial port c. 170-190s
d. Reduce blood flow rate to 100ml/min and wait 30 seconds. d. 200-250s
13. Miss A is undergoing heparin free hemodialysis. The warning sign 18. Mr. R developed severe anaphylactic reaction after heparin
that the nurse should be alert is injection. The right action for the nurse for the nurse to manage a
a. Effluent change to pink colour patient who is allergic to heparin during hemodialysis is to
b. Venous blood appears to be darker a. Convert o CAPD
c. Turbulence at the tip of the chamber. b. Use tight heparin
d. Blood in the extracorporeal circuit appear transparent c. Reassess heparin dose
d. Infuse protamine sulphate
14. Increase in Trans Membrane Pressure (TMP) during hemodialysis
session may indicates clots in 19. Mr. J has been ordered for first time dialysis in your centre. To
a. Heparin free ensure patients receive safe dialysis for the 1st time undergoing
b. Pump segment hemodialysis procedure, the nurse must ensure the prescription
c. Dialyser connector includes
d. Dialyser membrane a. High flux dislyzer
b. 3 hours per session
15. Dialyzer reprocessing is the process of cleaning and sterilizing a c. Removal of ≤ 1L fluid
dialyzer once used to be used again on that same patient. What is d. Dialysate flow ≥ 500ml/min
the advantage of dialyzer reuse?
a. Increase biomedical waste 20. Mr. X experienced hypotension during hemodialysis and doctor
b. Increase usage of RO water ordered to increase sodium profiling. The nurse must anticipate the
c. First-use syndrome is reduced below side effects during observation
d. Risk of bacterial infection is reduced a. Diffused sweating
b. Decreased blood sugar
16. Reason for under delivery of KT/V include c. Increased intradialytic thirst
a. High blood pump rate d. Patient will experience fatigue
b. Use of polysulphone membrane
c. Recurrent hypotension during dialysis 21. Mr. T prescribed with lanthanum carbonate during his visit to
d. Use of large bore cannulation needle nephrology clinic. The patient education that should be emphasize
is
17. A patient who is on CRRT and having fluid overload while his a. Take the medication after meals
electrolytes is in normal range. Which mode is best for his b. Crush a tablet and take with meals
treatment? c. The medication should be swallowed intact
a. SCUF (Slow continuous ultrafiltration) d. Take the lanthanum together with ferrous fumerate
b. CVVH (Continuous veno-venous hemofiltration)
c. CVVHD (Continuous veno-venous hemodialysis)
d. CVVHDF (Continuous veno-venous hemofiltration)
22. During dialysis Mr. A develop sudden cough, difficulty in
breathing and his extracorporeal line was full with air bubbles.
Immediate intervention that need to be done by dialysis nurse is
a. Return the blood and terminate the dialysis
b. Keep the intravenous line open for rapid infusion of colloids
c. Put the patient on cardiac monitoring and prepare to
defibrillate the patient
d. Put the patient on left lateral Trendelenburg position and give
oxygen via face mask

23. A nurse should be aware that a low alarm in the arterial pressure
monitor maybe the consequence of
a. Decrease in blood pimp speed
b. Hypotension or vasoconstriction
c. Obstruction in the circuit after the dialyzer
d. Line separation between patient and the blood pump

24. Mr. L will be discharged with the IJC in situ. The following is
patient education on care of IJC
a. Put ointment around the exit site
b. Do daily dressing using povidone iodine
c. Change dressing at nearest clinic if it is socked
d. Push the catheter back if it’s dislodged from the site

25. The aim of rehabilitation on hemodialysis patient is to evaluate the

impact on
a. The health status
b. Changes of lifestyle
c. The quality of life of patient
d. Improved in quality of patient’s life partner.