CertifiedDialysisNurse(CDN)PracticeQuestions

1.SomeconditionsthatcontributetothedevelopmentofCKDmayincludethefollowing
diseaseprocesses.WhichofthefollowingisleastlikelytobeadirectcauseofCKD?

a. Chronicobstructivepulmonarydisease(COPD)
b. Diabetesmellitus(type1and2)
c. Systemiclupus
d. Hypertension

2.Oneofthenegativesassociatedwithperitonealdialysisincludesproteinmalnutrition.
Whatarethecausesofproteinmalnutrition?

a. Lossofaminoacidsandproteininthedialysate
b. Decreasedappetiteduetoglucoseloadfromdialysate
c. Lackofproteinintakeduetohighcarbohydratediet
d. aandb

3.Mostaluminumisproteinboundsothekidneysmaynotbeabletofilteritoutofthe
blood.Itisthenstoredinvarioustissuesinthebody,includingthebrainandbone.What
arethesymptomsofaluminumtoxicity?

a. Nausea,vomiting,diarrhea,fever,chills,upperrespiratorytractinfection,elevatedwhite
bloodcount,headache
b. Behavioralchanges,memoryloss,slurredspeech,lackofenergy,lossofappetitebone
disease,dementia,anemia,constipation
c. Jointpainandredness,gangreneoffingersandtoes,backpain,fractures,itching
d. Nausea,vomiting,poorappetite,metallictaste,fetidbreath,GIbleeding,diarrhea,
functionalconstipation

4.Manyfactorsaffectthesuccessfulremovaloftoxinsduringdialysis.Whichofthe
followingiscorrect?

a. Lowertemperatureofdialysate=higheramountofsolutesremoved
b. Slowerflowofdialysate=greaterremovalofsolutes
c. Lowermolecularweightofsolutes=moresolutesremoved
d. Greaterbloodflowrate=lesserremovalofsolutes

5.Whichofthefollowingbestdefinesconcentrationgradient?

a. Thedifferenceinhydrostaticpressurebetweenthebloodandthedialysatesolution
 b. Themovementofsoluteparticlesfromthesideofhigherconcentrationtothesideof
lowerconcentrationthroughthedialysismembrane
c. Therateofmovementthroughamembrane
d. Theconcentrationofacertaintypeofparticleishigherononesideofamembranethan
ontheotherside

CertifiedDialysisNurse(CDN)AnswerKey
1.Answer:A

Althoughmanyelderlypatientsmayalsosufferfromchronicobstructivepulmonarydiseaseitis
notconsideredadirectcauseofCKD.Diabetesmellitus(bothtype1andtype2),systemiclupus,
andhypertensionarealldiseasesthatcontributetothedevelopmentofCKD.

2.Answer:D

Someofthenegativesassociatedwithperitonealdialysis(PD)includeproteinmalnutritionand
inadequatedialysis.Theproteinmalnutritionresultsfromthelossofaminoacidsandproteinin
thedialysate.Theappetiteisdecreasedbecauseoftheglucoseloadabsorbedfromthedialysis.
Thisfrequentlyresultsinhypertriglyceridemia,whichcausesweightgainfromthecaloric
increase(notfromahighcarbohydratediet).

3.Answer:B

Sincealuminumisusuallystoredinthebrainorthebones,behavioralchanges,memoryloss,
slurredspeech,lackofenergy,dementia,andbonediseasearesymptomsofaluminumtoxicity.
Anemia,constipation,andlossofappetitearealsorelatedtoanexcessiveamountofaluminum
inthebody.Nausea,vomiting,diarrhea,fever,chills,upperrespiratorytractinfection,elevated
WBC,andheadachecouldbesymptomsofinfluenzaormultipleotherinfectiousprocesses.Joint
painandredness,gangrene,backpain,fractures,anditchingareclassicsymptomsof
osteodystrophy.Nausea,vomiting,metallictaste,fetidbreath,GIbleeding,diarrhea,and
functionalconstipationaretheGIeffectsofuremia.

4.Answer:C

Thelowerthemolecularweightofthesolutes,thegreatertheamountofsolutesthatwillbe
removed.Thehigherthetemperature,thegreatertheamountofsolutesremoved,thefasterthe
flowrateofthedialysate,thegreatertheremovalofsolutes,andthefasterthebloodflow,the
greatertheamountofsolutesremoved.

5.Answer:D

Concentrationgradientisthetermusedwhentheconcentrationofacertainparticleishigheron
onesideofamembranethanontheotherside.Transmembranepressure(TMP)referstothe
differenceinhydrostaticpressurebetweenthebloodandthedialysatesolution.Diffusive,or
conductivetransport,referstothemovementofsoluteparticlesfromthesideofhigher
concentrationtothesideoflowerconcentrationthroughthedialysismembrane.Masstransfer
rate,orsoluteflux,referstotherateofmovementthroughamembrane.