Chronic Kidney Disease and Dialysis Practice Questions

25 multiple-choice questions on Chronic kidney disease and dialysis for paramedic and EMT students, from Chapter 22 (Genitourinary and Renal Emergencies). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

25 practice questions

1. The two most common causes of chronic kidney disease are:

   1. A. Kidney stones and repeat UTIs
   2. B. Smoking and asthma
   3. C. Trauma and burns
   4. D. Diabetes and hypertension
   Show answer

   Answer: D. Diabetes and hypertension

   Long-term high glucose and high blood pressure damage the small vessels of the glomeruli. Together they cause most cases of end-stage renal disease.

2. End-stage renal disease (ESRD) means the patient:

   1. A. Has a temporary kidney injury
   2. B. Needs dialysis or transplant
   3. C. Has only one kidney left
   4. D. Has a bladder infection
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   Answer: B. Needs dialysis or transplant

   ESRD is the final stage of CKD, when kidney function is too low to sustain life without dialysis or transplant.

3. Hemodialysis works by:

   1. A. Placing fluid into the abdomen
   2. B. Inserting a catheter into the bladder
   3. C. Filtering blood through a machine
   4. D. Giving IV antibiotics
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   Answer: C. Filtering blood through a machine

   Blood passes through a dialyzer, which removes waste, potassium, and fluid, then returns it to the patient. It is usually done 3 times a week.

4. Peritoneal dialysis uses the:

   1. A. Peritoneal membrane as filter
   2. B. Bowel lining to absorb waste
   3. C. Remaining filters in the kidneys
   4. D. Liver to clear the toxins
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   Answer: A. Peritoneal membrane as filter

   Dialysate is placed into the abdomen through a catheter. Wastes and fluid move across the peritoneum into the fluid, which is then drained. The bowel lining, the liver, and the failing kidneys are not the filter in this method.

5. An arteriovenous (AV) fistula is:

   1. A. A catheter placed in the bladder
   2. B. A feeding tube into the stomach
   3. C. A deep vein clot in the forearm
   4. D. A surgical artery-vein link
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   Answer: D. A surgical artery-vein link

   A fistula, usually in the forearm or upper arm, creates a strong vessel for dialysis needles. A thrill should be felt over it.

6. When you palpate a working AV fistula, you should feel:

   1. A. No pulse at all
   2. B. A thrill (vibration)
   3. C. A cold, hard, cordlike vein
   4. D. A soft, empty vein
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   Answer: B. A thrill (vibration)

   A thrill and an audible bruit indicate blood is flowing. A missing thrill suggests clotting and needs prompt evaluation.

7. Minutes after a hemodialysis session starts, a patient develops hives, wheezing, and low blood pressure. You should suspect:

   1. A. A reaction to the dialyzer or drugs
   2. B. Normal fluid shifts of dialysis
   3. C. A clotted fistula in the arm
   4. D. Low potassium from the dialysis session
   Show answer

   Answer: A. A reaction to the dialyzer or drugs

   Dialyzer reactions and reactions to drugs given during dialysis (such as heparin or iron) can cause anaphylaxis early in a session. Stop the treatment without returning blood per unit protocol, and treat as anaphylaxis with epinephrine.

8. A dialysis patient's fistula is bleeding heavily after treatment. The first action is:

   1. A. A tourniquet placed below the fistula
   2. B. Ice and elevation alone
   3. C. Firm direct pressure on the site
   4. D. Remove the bandage to inspect
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   Answer: C. Firm direct pressure on the site

   Firm, direct pressure usually controls fistula bleeding. A tourniquet above the site may be needed if pressure fails, per protocol.

9. A dialysis fistula has an enlarging bulge with thin, shiny skin and a scab on top. This finding means:

   1. A. The fistula is healing well
   2. B. High risk of sudden rupture
   3. C. The fistula is clotted off
   4. D. A normal sign of good flow
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   Answer: B. High risk of sudden rupture

   Thin, shiny skin, ulceration, or scabs over an aneurysmal access are warning signs of impending rupture and massive bleeding. The patient needs prompt surgical evaluation.

10. Chronic kidney disease is defined as reduced function or kidney damage that lasts for at least:

    1. A. 3 months
    2. B. 3 days
    3. C. 1 week
    4. D. 5 years or more
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    Answer: A. 3 months

    KDIGO defines CKD as abnormalities of kidney structure or function, such as a GFR below 60 mL/min/1.73 m2, present for more than 3 months. Shorter episodes are classified as AKI or acute kidney disease.

11. Which treatment is most useful for pulmonary edema in a dialysis patient?

    1. A. Large fluid boluses
    2. B. Placing the patient flat
    3. C. Oral fluids only
    4. D. CPAP, upright position
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    Answer: D. CPAP, upright position

    Positive pressure ventilation helps push fluid out of the alveoli. Diuretics have little effect in patients who make little or no urine.

12. Why might a dialysis patient's blood pressure drop during or after dialysis?

    1. A. Weight gain during dialysis
    2. B. Too much potassium removed
    3. C. Rapid fluid removal
    4. D. The fistula clotting
    Show answer

    Answer: C. Rapid fluid removal

    Removing fluid quickly can cause hypotension. Lay the patient flat and give small boluses per protocol.

13. Dialysis disequilibrium syndrome may cause:

    1. A. Chest pain and ST elevation
    2. B. Headache, confusion, seizure
    3. C. Fever and rash
    4. D. Diarrhea and cramps
    Show answer

    Answer: B. Headache, confusion, seizure

    Rapid removal of waste causes fluid shifts into brain cells. It is more common in new dialysis patients.

14. The cap comes off a patient's chest dialysis catheter and she suddenly becomes short of breath and hypotensive. You suspect air embolism. After clamping the catheter, position her:

    1. A. Sitting fully upright
    2. B. Prone with the legs raised
    3. C. On her left side, head down
    4. D. Supine with the head raised
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    Answer: C. On her left side, head down

    Air entering a central venous catheter can lodge in the right heart. Clamping the line and placing the patient on the left side with the head down may help trap air in the heart's apex while you give high-flow oxygen and transport.

15. CKD increases the risk of which leading cause of death in dialysis patients?

    1. A. Heart disease
    2. B. Lung cancer
    3. C. Major trauma
    4. D. Skin infections
    Show answer

    Answer: A. Heart disease

    Dialysis patients have very high rates of MI, heart failure, and sudden cardiac death.

16. Why are patients with CKD at higher risk for infection?

    1. A. Dialysis raises white cell counts
    2. B. Their fever response is exaggerated
    3. C. They avoid hospitals and clinics
    4. D. Uremia weakens immunity
    Show answer

    Answer: D. Uremia weakens immunity

    Uremia impairs white cell function, and vascular access sites provide entry for bacteria.

17. A peritoneal dialysis patient is short of breath with a tense abdomen full of dialysate. Draining the fluid can help by:

    1. A. Raising his blood potassium
    2. B. Increasing his blood volume
    3. C. Lowering his blood glucose level
    4. D. Easing pressure on the diaphragm
    Show answer

    Answer: D. Easing pressure on the diaphragm

    Several liters of dialysate in the abdomen raise intra-abdominal pressure and push the diaphragm upward. Draining it (per the patient's routine) can improve breathing. It does not raise potassium or blood volume.

18. A tunneled dialysis catheter in the chest should NOT be used by EMS unless:

    1. A. Arrest with no other access
    2. B. The patient has a minor fever only
    3. C. The patient needs a blood draw
    4. D. You need to give oral medicine
    Show answer

    Answer: A. Arrest with no other access

    These catheters are locked with heparin and are high infection risk. Use only in extreme situations per protocol.

19. A dialysis patient's hand on the fistula side is cold, pale, and painful, worse during dialysis. You should suspect:

    1. A. A normal effect of dialysis
    2. B. Carpal tunnel from typing
    3. C. Steal syndrome from the access
    4. D. Gout flaring in the wrist joint
    Show answer

    Answer: C. Steal syndrome from the access

    Dialysis access steal syndrome occurs when the fistula diverts blood away from the hand, causing ischemic pain, coolness, and numbness. Severe cases risk tissue loss and need prompt surgical review.

20. A patient on hemodialysis three times a week (Monday, Wednesday, Friday) is at highest risk of sudden cardiac death on:

    1. A. Wednesday afternoon
    2. B. Monday, after the long gap
    3. C. Friday after dialysis
    4. D. Any day; the risk is equal
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    Answer: B. Monday, after the long gap

    The 2-day weekend gap lets potassium and fluid accumulate, and studies show higher rates of cardiac death and admission on the day after the long interval. Ask when the last session was.

21. A kidney transplant recipient has fever and decreased urine output. The concern is:

    1. A. Normal postoperative recovery
    2. B. Rejection or infection
    3. C. Too much exercise
    4. D. Kidney stones only
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    Answer: B. Rejection or infection

    Immunosuppressed transplant patients are vulnerable to infection, and rejection may reduce urine output. Transport to the transplant center if possible.

22. Kidney transplant patients take immunosuppressants, which may:

    1. A. Increase their fever response
    2. B. Protect them from all infections
    3. C. Hide signs of infection
    4. D. Make them heal faster
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    Answer: C. Hide signs of infection

    Immunosuppression blunts fever and inflammation, so infections may look mild early.

23. Renal osteodystrophy in CKD refers to:

    1. A. Infection of the renal pelvis wall
    2. B. A stone lodged in the bladder
    3. C. Swelling of both ankles
    4. D. Bone disease from mineral shifts
    Show answer

    Answer: D. Bone disease from mineral shifts

    Low vitamin D and high phosphate weaken bones, raising fracture risk.

24. A dialysis patient tells you they have gained 4 kg since last dialysis. This suggests:

    1. A. Fluid retention
    2. B. Normal weight variation
    3. C. Dehydration
    4. D. Muscle gain
    Show answer

    Answer: A. Fluid retention

    Weight gain between dialysis sessions reflects fluid accumulation. Large gains raise the risk of pulmonary edema.

25. For a headache at home, which pain reliever is usually safest for a patient with advanced CKD?

    1. A. Ibuprofen
    2. B. Acetaminophen
    3. C. Naproxen
    4. D. High-dose aspirin
    Show answer

    Answer: B. Acetaminophen

    NSAIDs such as ibuprofen and naproxen reduce kidney blood flow and raise potassium, and high-dose aspirin also harms the kidneys. Acetaminophen at standard doses is generally preferred in CKD.