Certified Hemodialysis Technologist/Technician Exam Dialysis Complications and Emergency Management 1 — Questions and Answers
Question 1: Intradialytic hypotension (IDH) is most commonly defined as a systolic blood pressure drop of more than:
- 5 mmHg from baseline
- 20 mmHg or to below 90 mmHg systolic (Correct answer)
- 50 mmHg from baseline
- 10 mmHg from baseline
Correct answer: 20 mmHg or to below 90 mmHg systolic
IDH is typically defined as a systolic BP drop ≥20 mmHg or a decline to below 90 mmHg, often accompanied by symptoms requiring intervention.
Question 2: The most appropriate immediate response when a patient develops severe muscle cramps during dialysis is:
- Increase the ultrafiltration rate
- Administer hypertonic saline or dextrose, and reduce the ultrafiltration rate (Correct answer)
- Disconnect the patient from the machine
- Increase blood flow rate only
Correct answer: Administer hypertonic saline or dextrose, and reduce the ultrafiltration rate
Muscle cramps during dialysis result from rapid osmotic shifts and volume depletion; treatment includes reducing ultrafiltration rate and administering hypertonic solutions.
Question 3: Air embolism during hemodialysis most commonly enters the extracorporeal circuit through:
- The dialyzer membrane rupture
- Loose connections or tubing cracks on the arterial (pre-pump) side (Correct answer)
- The venous bubble trap
- Backfiltration from dialysate
Correct answer: Loose connections or tubing cracks on the arterial (pre-pump) side
Air most commonly enters the circuit through loose needle connections, cracked tubing, or accessory ports on the arterial (negative pressure) side of the blood pump.
Question 4: The immediate action when air embolism is suspected during hemodialysis is:
- Increase blood flow rate to push air through
- Clamp the venous line, stop the blood pump, and position patient in left lateral Trendelenburg (Correct answer)
- Administer heparin IV
- Flush with normal saline immediately
Correct answer: Clamp the venous line, stop the blood pump, and position patient in left lateral Trendelenburg
Clamping the venous line and stopping the pump prevents more air from entering; left lateral Trendelenburg traps air in the right ventricle apex away from the pulmonary vasculature.
Question 5: Dialysis disequilibrium syndrome is most likely to occur in which patient population?
- Patients on dialysis for more than 10 years
- First-time dialysis patients with very high BUN levels (Correct answer)
- Patients with low blood urea nitrogen (BUN)
- Elderly patients with normal kidney function
Correct answer: First-time dialysis patients with very high BUN levels
Dialysis disequilibrium occurs most often in first-time dialysis patients with severely elevated BUN, as rapid urea removal creates osmotic gradients causing cerebral edema.
Question 6: When a patient experiences nausea, vomiting, and falling blood pressure during dialysis, which intervention should be performed FIRST?
- Stop dialysis and return blood immediately
- Lower the head of the bed, reduce ultrafiltration rate, and assess BP (Correct answer)
- Administer antiemetics only
- Increase dialysate temperature
Correct answer: Lower the head of the bed, reduce ultrafiltration rate, and assess BP
Initial management of intradialytic hypotension with nausea includes Trendelenburg positioning and reducing ultrafiltration while assessing the degree of hemodynamic compromise.
Certified Hemodialysis Technologist/Technician Exam Dialysis Complications and Emergency Management 1
Intradialytic hypotension (IDH) is most commonly defined as a systolic blood pressure drop of more than: