Certified Hemodialysis Technologist/Technician Exam Dialysis Complications and Emergency Management 2 — Questions and Answers
Question 1: A patient receiving hemodialysis begins experiencing chest pain, back pain, and the dialysate appears pink-tinged. The most likely cause is:
- Angina from fluid overload
- Dialyzer membrane rupture causing a blood leak (Correct answer)
- Air embolism
- Hypoglycemia
Correct answer: Dialyzer membrane rupture causing a blood leak
Pink-tinged dialysate with chest/back pain is a classic presentation of dialyzer membrane rupture, where blood leaks across the membrane into the dialysate.
Question 2: When a blood leak detector alarm activates on the dialysis machine, the correct action is to:
- Reset the alarm and continue dialysis
- Visually inspect the dialysate line and dialyzer; if confirmed, return blood only if safe or discard and use new dialyzer (Correct answer)
- Increase dialysate flow rate
- Immediately disconnect the patient
Correct answer: Visually inspect the dialysate line and dialyzer; if confirmed, return blood only if safe or discard and use new dialyzer
A blood leak alarm requires visual confirmation; if confirmed, facility policy typically requires discarding the dialyzer to prevent blood-borne pathogen exposure through the dialysate.
Question 3: Which electrolyte imbalance is most likely to cause cardiac arrhythmias during hemodialysis?
- Hyponatremia
- Hyperkalemia (Correct answer)
- Hypophosphatemia
- Hypomagnesemia
Correct answer: Hyperkalemia
Hyperkalemia is the most common life-threatening electrolyte disorder in ESRD patients and can cause fatal cardiac arrhythmias if not corrected with dialysis.
Question 4: A patient on hemodialysis develops sudden shortness of breath, chest tightness, and hives during treatment. This presentation most suggests:
- Pulmonary edema from fluid overload
- Anaphylactic reaction to dialyzer or blood tubing (Correct answer)
- Dialysis disequilibrium
- Normal first-use reaction — continue dialysis
Correct answer: Anaphylactic reaction to dialyzer or blood tubing
Sudden dyspnea, chest tightness, and urticaria are classic signs of anaphylaxis requiring immediate treatment cessation and emergency intervention.
Question 5: The correct dialysate sodium concentration to help prevent intradialytic hypotension in a hemodynamically unstable patient is typically:
- 125-130 mEq/L (hyponatremic)
- 135-145 mEq/L (isotonic to slightly higher) (Correct answer)
- 155-160 mEq/L (hypernatremic for all patients)
- Sodium is irrelevant to hemodynamic stability
Correct answer: 135-145 mEq/L (isotonic to slightly higher)
Isotonic to slightly higher dialysate sodium (135-145 mEq/L) supports osmotic stability and helps maintain hemodynamic stability during dialysis.
Question 6: Hemolysis during hemodialysis can be recognized by which characteristic change in the blood tubing?
- Blood becomes darker and more viscous
- Blood appears cherry-red or pink (translucent) rather than its normal dark red color (Correct answer)
- Blood clots visible in the arterial chamber
- No visible changes occur
Correct answer: Blood appears cherry-red or pink (translucent) rather than its normal dark red color
Hemolyzed blood releases hemoglobin into plasma, turning the blood a characteristic translucent cherry-red or pink color that is visually distinct from normal dark venous blood.
Certified Hemodialysis Technologist/Technician Exam Dialysis Complications and Emergency Management 2
A patient receiving hemodialysis begins experiencing chest pain, back pain, and the dialysate appears pink-tinged.
The most likely cause is: