DIALYSIS Flashcards
Which hemodialysis access option has the highest long-term patency rate?
A. Arteriovenous grafts
B. Tunneled hemodialysis catheters
C. Arteriovenous fistulas
D. Peritoneal dialysis catheters
C. Arteriovenous fistulas
Rationale: Arteriovenous fistulas (AVFs) have the highest long-term patency rate among all hemodialysis access options, making them the preferred choice.
What is the principal reason for using an arteriovenous graft instead of an arteriovenous fistula?
A. Higher long-term patency rate
B. Improved blood flow
C. Failure of fistula maturation or inadequate vasculature
D. Lower risk of thrombosis
C. Failure of fistula maturation or inadequate vasculature
Rationale: Arteriovenous grafts are used in patients where fistulas fail to mature or when the vasculature is inadequate for successful fistula creation.
What is the primary complication associated with arteriovenous grafts?
A. Infection at the graft site
B. Thrombosis due to intimal hyperplasia
C. Stenosis of the arterial inflow
D. Graft migration
B. Thrombosis due to intimal hyperplasia
Rationale: The most important complication of arteriovenous grafts is thrombosis caused by intimal hyperplasia at the anastomosis between the graft and the recipient vein.
What is the most common acute complication of hemodialysis?
A. Muscle cramps
B. Hypotension
C. Anaphylactoid reactions
D. Hyperkalemia
B. Hypotension
Rationale: Hypotension is the most common acute complication of hemodialysis, particularly in patients with diabetes mellitus, due to factors such as excessive ultrafiltration and impaired autonomic responses.
Which of the following is NOT a risk factor for hypotension during dialysis?
A. Impaired autonomic responses
B. High-output cardiac failure
C. Excessive ultrafiltration
D. Cooling of the dialysate
D. Cooling of the dialysate
Rationale: Cooling of the dialysate is a preventive measure for intradialytic hypotension, not a risk factor.
Which strategy is recommended to manage hypotension during dialysis?
A. Rapid fluid removal
B. Administration of isotonic saline
C. Increasing ultrafiltration
D. Performing dialysis without fluid removal
B. Administration of isotonic saline
Rationale: Management of hypotension during dialysis includes discontinuing ultrafiltration and administering isotonic saline (100–250 mL).
What type of reaction to the dialyzer is IgE-mediated and can result in full-blown anaphylaxis if untreated?
A. Type A reaction
B. Type B reaction
C. Complement-mediated reaction
D. Cytokine release reaction
A. Type A reaction
Rationale: Type A dialyzer reactions are IgE-mediated hypersensitivity reactions to ethylene oxide used in dialyzer sterilization and can lead to anaphylaxis if untreated.
Which of the following interventions can help prevent dialysis-associated muscle cramps?
A. Rapid fluid removal
B. Avoiding ultrafiltration modeling
C. Reducing volume removal during dialysis
D. Using cellulosic-containing membranes
C. Reducing volume removal during dialysis
Rationale: Reducing volume removal, ultrafiltration profiling, and sodium modeling are strategies to prevent dialysis-associated muscle cramps.
What is the most common cause of peritonitis in peritoneal dialysis patients?
A. Fungal infections
B. Gram-negative rods
C. Gram-positive cocci (e.g., Staphylococcus)
D. Mycobacterial infections
C. Gram-positive cocci (e.g., Staphylococcus)
Rationale: Peritonitis in peritoneal dialysis patients is most often caused by gram-positive cocci, such as Staphylococcus, due to contamination from the skin during exchange procedures.
Which of the following laboratory findings supports a diagnosis of peritonitis in a peritoneal dialysis patient?
A. Peritoneal fluid leukocyte count >100/mm³ with >50% lymphocytes
B. Peritoneal fluid leukocyte count >100/mm³ with >50% polymorphonuclear neutrophils
C. Peritoneal fluid leukocyte count >250/mm³ with >50% lymphocytes
D. Peritoneal fluid leukocyte count >250/mm³ with >50% eosinophils
B. Peritoneal fluid leukocyte count >100/mm³ with >50% polymorphonuclear neutrophils
Rationale: Peritonitis is typically defined by an elevated peritoneal fluid leukocyte count (>100/mm³) with at least 50% polymorphonuclear neutrophils.
Which complication of peritoneal dialysis typically requires catheter removal for effective management?
A. Peritonitis caused by gram-positive cocci
B. Peritonitis caused by Pseudomonas or yeast
C. Tunnel infections responsive to local antibiotics
D. Hyperglycemia
B. Peritonitis caused by Pseudomonas or yeast
Rationale: Peritonitis caused by hydrophilic gram-negative rods (e.g., Pseudomonas) or yeast often requires catheter removal to ensure complete eradication of the infection.
Which metabolic disturbance is commonly associated with peritoneal dialysis?
A. Hypoglycemia
B. Hyperglycemia and hypertriglyceridemia
C. Hypoproteinemia and hypokalemia
D. Hyperphosphatemia
B. Hyperglycemia and hypertriglyceridemia
Rationale: Peritoneal dialysis patients often develop hyperglycemia due to the absorption of dextrose from dialysis solutions and may also develop hypertriglyceridemia, especially in those with insulin resistance.
What is one dietary advantage for patients undergoing peritoneal dialysis compared to hemodialysis?
A. Reduced potassium and phosphorus removal
B. Continuous removal of potassium and phosphorus
C. Need for low dietary protein intake
D. Restricted caloric intake
B. Continuous removal of potassium and phosphorus
Rationale: The continuous nature of peritoneal dialysis allows for more liberal dietary intake of potassium and phosphorus due to their continuous removal.
Which of the following is a common complication of peritoneal dialysis requiring higher dietary protein intake?
A. Hyperglycemia
B. Hypertriglyceridemia
C. Hypoproteinemia
D. Metabolic alkalosis
C. Hypoproteinemia
Rationale: Hypoproteinemia occurs due to the loss of albumin and other proteins across the peritoneal membrane, necessitating a higher dietary protein intake to maintain nitrogen balance.
What is the leading cause of death in patients with end-stage kidney disease (ESKD)?
A. Infection
B. Cardiovascular disease
C. Malignancy
D. Electrolyte imbalance
B. Cardiovascular disease
Rationale: Cardiovascular disease is the major cause of death in patients with ESKD, both in those on dialysis and posttransplantation.
