✅ MCQs – Complications of Hemodialysis
1. Which of the following is a common acute complication during a hemodialysis session?
A. Hepatitis B infection
B. Left ventricular hypertrophy
C. Intradialytic hypotension
D. Renal osteodystrophy
Answer: C. Intradialytic hypotension
2. What is the most common cause of cramps during dialysis?
A. Hyperkalemia
B. Rapid fluid removal
C. Infection
D. Low calcium levels
Answer: B. Rapid fluid removal
3. Dialysis Disequilibrium Syndrome (DDS) occurs most commonly in:
A. Long-term dialysis patients
B. Patients with high hemoglobin
C. New patients with severe uremia
D. Patients on peritoneal dialysis
Answer: C. New patients with severe uremia
4. A sudden drop in blood pressure during dialysis may be caused by all EXCEPT:
A. High ultrafiltration rate
B. Vasodilation from warm dialysate
C. Excessive sodium in dialysate
D. Blood loss
Answer: C. Excessive sodium in dialysate
(Note: Excessive sodium usually leads to fluid retention and high BP)
5. Which chronic complication is associated with aluminum-based phosphate binders in dialysis patients?
A. Encephalopathy
B. Hypercalcemia
C. Anemia
D. Hyperphosphatemia
Answer: A. Encephalopathy
6. A patient complains of chest pain during dialysis. You should first suspect:
A. Myocardial infarction
B. Pericarditis
C. Air embolism
D. All of the above
Answer: D. All of the above
7. Which of the following is a vascular access-related complication?
A. Hypokalemia
B. Steal syndrome
C. Bone pain
D. Hypernatremia
Answer: B. Steal syndrome
8. What infection risk is most commonly associated with reuse of dialyzers and poor hygiene practices?
A. Tuberculosis
B. HIV
C. Hepatitis C
D. Influenza
Answer: C. Hepatitis C
9. What is the common cause of air embolism during hemodialysis?
A. Inadequate water treatment
B. Dialysate temperature too high
C. Disconnected bloodline or poor air detector function
D. Low calcium levels
Answer: C. Disconnected bloodline or poor air detector function
10. Long-term dialysis can lead to bone disorders due to:
A. Vitamin C deficiency
B. Calcium-phosphorus imbalance and secondary hyperparathyroidism
C. High urea clearance
D. Protein restriction
Answer: B. Calcium-phosphorus imbalance and secondary hyperparathyroidism
11. Dialysis Disequilibrium Syndrome is best prevented by:
A. Giving IV calcium before dialysis
B. Using high sodium dialysate
C. Starting with short and gentle dialysis sessions
D. Administering erythropoietin pre-dialysis
Answer: C. Starting with short and gentle dialysis sessions
12. A major cause of anemia in dialysis patients is:
A. Blood loss during dialysis
B. High hemoglobin breakdown
C. Excess protein intake
D. High iron levels
Answer: A. Blood loss during dialysis
13. Which of the following is a symptom of aluminum toxicity in dialysis patients?
A. Muscle cramps
B. Anemia
C. Memory loss and confusion
D. Constipation
Answer: C. Memory loss and confusion
14. A patient on dialysis suddenly experiences coughing, dyspnea, and chest pain. You suspect:
A. Air embolism
B. Hypokalemia
C. Dialyzer clotting
D. Hypertension
Answer: A. Air embolism
15. What lab result would indicate a possible chronic dialysis complication?
A. High serum phosphorus
B. Low white blood cell count
C. Low albumin
D. High LDL
Answer: A. High serum phosphorus
(Suggests secondary hyperparathyroidism and bone mineral disorder)
16. Which of the following is a sign of volume overload in a dialysis patient?
A. Hypotension
B. Edema and shortness of breath
C. Muscle twitching
D. Nausea and vomiting
Answer: B. Edema and shortness of breath
17. Infections related to hemodialysis most commonly occur due to:
A. Contaminated dialysate
B. Poor vascular access care
C. Food intake before dialysis
D. High ultrafiltration
Answer: B. Poor vascular access care
18. Which of the following is a long-term cardiovascular complication in hemodialysis patients?
A. Bradycardia
B. Hypotension
C. Left ventricular hypertrophy
D. Aortic aneurysm rupture
Answer: C. Left ventricular hypertrophy
19. A patient becomes restless, nauseated, and has a headache during the first 30 minutes of dialysis. This suggests:
A. Hyperglycemia
B. Dialysis Disequilibrium Syndrome
C. Stroke
D. Volume depletion
Answer: B. Dialysis Disequilibrium Syndrome
20. A rare but serious allergic reaction at the start of dialysis is most commonly due to:
A. Excessive potassium
B. Ethylene oxide sterilization of the dialyzer
C. High glucose in dialysate
D. Iron injection
Answer: B. Ethylene oxide sterilization of the dialyzer
21. Hyperkalemia in dialysis patients is most commonly due to:
A. High protein intake
B. Missed dialysis sessions
C. Excessive water intake
D. Low calcium levels
Answer: B. Missed dialysis sessions
22. Which of the following is a symptom of hypokalemia during dialysis?
A. Muscle weakness
B. Hypertension
C. Seizures
D. Facial twitching
Answer: A. Muscle weakness
23. The presence of a painful, cold, and pale hand distal to an AV fistula suggests:
A. Thrombosis
B. Steal syndrome
C. Infection
D. High-output heart failure
Answer: B. Steal syndrome
24. One of the early signs of vascular access infection is:
A. Thrill is stronger
B. Pain, redness, and swelling around access site
C. Access appears more prominent
D. Lowered blood pressure
Answer: B. Pain, redness, and swelling around access site
25. A patient experiences nausea, dizziness, and yawning during dialysis. The likely cause is:
A. Hypertension
B. Hypoglycemia
C. Hypotension
D. Hypernatremia
Answer: C. Hypotension
26. Muscle cramps during dialysis are typically related to:
A. Hyperkalemia
B. Low phosphorus
C. Rapid volume removal
D. High dialysate bicarbonate
Answer: C. Rapid volume removal
27. Which of the following is considered a chronic complication of repeated dialysis sessions?
A. Dialyzer reaction
B. Sepsis
C. Amyloidosis
D. Intradialytic nausea
Answer: C. Amyloidosis
(Due to β2-microglobulin buildup over time)
28. Which laboratory finding may indicate dialysis-related bone disease?
A. High sodium
B. Low potassium
C. High phosphorus and PTH
D. Low albumin
Answer: C. High phosphorus and PTH
29. During dialysis, a patient suddenly develops chest pain and hypotension. This may indicate:
A. Pericardial tamponade
B. Anxiety attack
C. AVF stenosis
D. Anemia
Answer: A. Pericardial tamponade
30. Bloodline disconnection during dialysis may lead to:
A. Sepsis
B. Air embolism
C. Dialysis disequilibrium
D. Muscle cramps
Answer: B. Air embolism
31. A serious emergency complication during dialysis due to air entering the bloodstream is called:
A. Myocardial infarction
B. Hemolysis
C. Air embolism
D. Dialysis disequilibrium syndrome
Answer: C. Air embolism
32. Long-term hemodialysis patients are at increased risk of which type of bone disorder?
A. Osteoarthritis
B. Osteomalacia
C. Renal osteodystrophy
D. Gout
Answer: C. Renal osteodystrophy
33. What is the most common cause of access failure in an AV fistula?
A. Infection
B. Thrombosis
C. Steal syndrome
D. Hematoma
Answer: B. Thrombosis
34. Which of the following symptoms may suggest hemolysis during dialysis?
A. Hypertension
B. Red-colored blood in tubing and chest tightness
C. Fever
D. Muscle cramps
Answer: B. Red-colored blood in tubing and chest tightness
35. What is the recommended action if a patient complains of chest pain during dialysis?
A. Increase ultrafiltration
B. Stop dialysis and assess the patient
C. Administer food
D. Increase blood flow rate
Answer: B. Stop dialysis and assess the patient
36. What electrolyte abnormality is associated with muscle twitching, paresthesia, and tetany in dialysis patients?
A. Hyperkalemia
B. Hypocalcemia
C. Hypernatremia
D. Hyperphosphatemia
Answer: B. Hypocalcemia
37. Which of the following signs suggest fluid overload in a dialysis patient?
A. Dry mucous membranes
B. Bounding pulse and shortness of breath
C. Weight loss
D. Bradycardia
Answer: B. Bounding pulse and shortness of breath
38. One method to prevent infection in vascular access is:
A. Changing the needle every hour
B. Use of alcohol swab and aseptic technique
C. Applying heat packs
D. Using low sodium dialysate
Answer: B. Use of alcohol swab and aseptic technique
39. The presence of bubbles in the venous bloodline during dialysis is a potential sign of:
A. Electrolyte imbalance
B. Clotting
C. Air embolism risk
D. Fluid overload
Answer: C. Air embolism risk
40. A patient with chronic hemodialysis develops carpal tunnel syndrome. This is most likely due to:
A. High calcium
B. Accumulation of β2-microglobulin (dialysis-related amyloidosis)
C. Low potassium
D. Poor diet
Answer: B. Accumulation of β2-microglobulin (dialysis-related amyloidosis)
41. Which of the following is a possible cause of chest tightness and back pain during dialysis due to overheating of the dialysate?
A. Dialysis disequilibrium
B. Hemolysis
C. Air embolism
D. Myocardial infarction
Answer: B. Hemolysis
42. Dialysis patients with prolonged high phosphorus levels are at risk of:
A. Liver cirrhosis
B. Anemia
C. Vascular calcification
D. Hypoglycemia
Answer: C. Vascular calcification
43. The most common symptom of intradialytic hypotension is:
A. Chest pain
B. Muscle cramps
C. Dizziness and light-headedness
D. Facial swelling
Answer: C. Dizziness and light-headedness
44. Which complication is most likely if a patient presents with fever, chills, and rigors during dialysis?
A. Air embolism
B. Access infection or bacteremia
C. Dialysis disequilibrium syndrome
D. Hyperkalemia
Answer: B. Access infection or bacteremia
45. One preventive measure against dialysis hypotension is:
A. Increasing blood flow rate
B. Using cold dialysate
C. Rapid ultrafiltration
D. Reducing dialyzer size
Answer: B. Using cold dialysate
46. A patient becomes restless, has shortness of breath, and sudden hypotension. You suspect:
A. Fluid overload
B. Anaphylactic reaction
C. Hypoglycemia
D. Uremia
Answer: B. Anaphylactic reaction
47. Recurrent intradialytic hypotension may lead to which long-term consequence?
A. Hyperkalemia
B. Silent myocardial ischemia
C. Anemia
D. Uremic frost
Answer: B. Silent myocardial ischemia
48. A rise in serum aluminum in dialysis patients can cause:
A. Hypertension
B. Diabetes
C. Bone disease and encephalopathy
D. Hyperkalemia
Answer: C. Bone disease and encephalopathy
49. What is the term for the painful complication due to nerve compression by amyloid deposits in dialysis patients?
A. Neuropathy
B. Carpal tunnel syndrome
C. Dialysis disequilibrium
D. Encephalopathy
Answer: B. Carpal tunnel syndrome
50. In patients with inadequate dialysis, which symptom is likely to persist?
A. Hypotension
B. Uremic symptoms like pruritus and fatigue
C. Hypernatremia
D. Proteinuria
Answer: B. Uremic symptoms like pruritus and fatigue
51. Which of the following conditions is associated with Dialysis Disequilibrium Syndrome?
A. Rapid removal of urea
B. Hypernatremia
C. Overhydration
D. High phosphorus
Answer: A. Rapid removal of urea
52. Which patient group is at the highest risk for dialysis disequilibrium?
A. Long-term dialysis patients
B. Diabetic patients
C. First-time dialysis patients with very high BUN
D. Elderly patients
Answer: C. First-time dialysis patients with very high BUN
53. A patient develops chest tightness, dyspnea, and cyanosis during dialysis. What is the most likely emergency?
A. Hypoglycemia
B. Air embolism
C. Stroke
D. Hypertension
Answer: B. Air embolism
54. Aluminum toxicity in dialysis patients is associated with:
A. Nausea
B. Anemia and bone pain
C. Hyperkalemia
D. Increased urine output
Answer: B. Anemia and bone pain
55. Dialysis-related amyloidosis is most often seen after how many years on dialysis?
A. 1–2 years
B. 2–4 years
C. 5–7 years
D. >10 years
Answer: D. >10 years
56. The use of outdated or poorly rinsed dialyzers may result in:
A. Seizures
B. Pyrogenic reaction or fever
C. Anemia
D. Cramps
Answer: B. Pyrogenic reaction or fever
57. A common metabolic complication of frequent hemodialysis is:
A. Hyperphosphatemia
B. Metabolic alkalosis
C. Hypocalcemia
D. Hyperglycemia
Answer: C. Hypocalcemia
58. Which of the following symptoms is NOT typical of an AV fistula infection?
A. Warmth
B. Redness
C. Pulsatile thrill
D. Purulent discharge
Answer: C. Pulsatile thrill
(A thrill indicates patency, not infection)
59. A cause of persistent hypotension during dialysis despite interventions could be:
A. Eating a large meal before dialysis
B. Low albumin levels (malnutrition)
C. High potassium
D. Hypervolemia
Answer: B. Low albumin levels (malnutrition)
60. Which of the following lab values should be closely monitored to prevent bone complications in dialysis patients?
A. ALT and AST
B. Calcium, phosphate, and PTH
C. Hemoglobin and hematocrit
D. BUN and creatinine
Answer: B. Calcium, phosphate, and PTH
61. One of the major risk factors for developing access-related infections in hemodialysis patients is:
A. Using a buttonhole technique
B. Poor glycemic control
C. Access in the lower limb
D. Use of fistula instead of catheter
Answer: B. Poor glycemic control
62. Which of the following is most likely to occur if ultrafiltration is too aggressive during dialysis?
A. Hypervolemia
B. Hypotension
C. Hypernatremia
D. Fistula infection
Answer: B. Hypotension
63. Seizures occurring during or immediately after dialysis are often due to:
A. Stroke
B. Dialyzer reaction
C. Electrolyte shifts (especially sodium or calcium)
D. High hemoglobin
Answer: C. Electrolyte shifts (especially sodium or calcium)
64. Which symptom most strongly suggests Dialysis Disequilibrium Syndrome?
A. Nausea and vomiting
B. Muscle cramps
C. Confusion and restlessness during or after first dialysis
D. Hypoglycemia
Answer: C. Confusion and restlessness during or after first dialysis
65. What is the primary treatment for Dialysis Disequilibrium Syndrome?
A. Continue dialysis quickly to clear toxins
B. Stop dialysis and provide supportive care (oxygen, IV fluids)
C. Administer potassium
D. Increase dialysate sodium
Answer: B. Stop dialysis and provide supportive care (oxygen, IV fluids)
66. Which access type is most associated with bloodstream infections?
A. AV fistula
B. AV graft
C. Tunneled central venous catheter
D. Buttonhole technique
Answer: C. Tunneled central venous catheter
67. Which complication is most likely with long-term catheter use in dialysis patients?
A. Steal syndrome
B. Central vein stenosis
C. Air embolism
D. Dry weight fluctuation
Answer: B. Central vein stenosis
68. A sign of clotting in the AV fistula includes:
A. Loud bruit
B. Bounding pulse
C. Absence of bruit or thrill
D. Redness around cannulation site
Answer: C. Absence of bruit or thrill
69. What is the best way to detect early access dysfunction?
A. Waiting for machine alarms
B. Regular physical assessment (thrill, bruit, swelling)
C. Only monitoring blood pressure
D. Asking patient about pain
Answer: B. Regular physical assessment (thrill, bruit, swelling)
70. Which of the following strategies can help reduce dialysis-related cramps?
A. Ice packs on limbs
B. High sodium dialysate
C. Avoid excessive fluid removal and warm dialysate
D. Decrease dialyzer surface area
Answer: C. Avoid excessive fluid removal and warm dialysate
71. What electrolyte disturbance can lead to cardiac arrhythmias in dialysis patients?
A. Hypernatremia
B. Hyperkalemia
C. Hypophosphatemia
D. Hypermagnesemia
Answer: B. Hyperkalemia
72. Which condition may result from repeated blood exposure to dialyzer membranes?
A. Hepatitis C
B. Iron overload
C. Dialyzer-related allergy (hypersensitivity reaction)
D. Renal osteodystrophy
Answer: C. Dialyzer-related allergy (hypersensitivity reaction)
73. Which of the following symptoms is least likely in a patient with chronic underdialysis?
A. Pruritus
B. Fatigue
C. Sleep disturbances
D. Bradycardia
Answer: D. Bradycardia
74. A dialysis patient has bone pain, muscle weakness, and itching. Lab tests show high phosphate. What is the likely diagnosis?
A. Uremic encephalopathy
B. Dialysis-related amyloidosis
C. Secondary hyperparathyroidism
D. Hepatitis B
Answer: C. Secondary hyperparathyroidism
75. Which complication can be minimized by using ultrapure dialysate?
A. Hypoglycemia
B. Dialysis-related amyloidosis
C. Fluid overload
D. Hypernatremia
Answer: B. Dialysis-related amyloidosis
76. Muscle cramps during dialysis are typically associated with:
A. Infection
B. Blood loss
C. Fluid volume depletion and sodium loss
D. Hyperkalemia
Answer: C. Fluid volume depletion and sodium loss
77. Which of the following can cause hemolysis during dialysis?
A. Hypokalemia
B. Overheated dialysate or hypotonic dialysate
C. High calcium dialysate
D. Low ultrafiltration
Answer: B. Overheated dialysate or hypotonic dialysate
78. Hepatitis B and C transmission during dialysis can be prevented by:
A. Isolating affected patients and dedicated machines
B. Using cold dialysate
C. Increasing dialyzer size
D. Changing vascular access
Answer: A. Isolating affected patients and dedicated machines
79. Which condition is strongly linked to β2-microglobulin buildup in long-term dialysis patients?
A. Hyperparathyroidism
B. Encephalopathy
C. Amyloidosis
D. Hypertension
Answer: C. Amyloidosis
80. What is the most effective strategy to manage pruritus in dialysis patients?
A. Avoiding all protein
B. Managing phosphorus and calcium levels
C. Increasing dialysate temperature
D. Restricting potassium
Answer: B. Managing phosphorus and calcium levels
81. Which of the following is a late complication of long-term hemodialysis?
A. Hyperacute rejection
B. Dialysis-related amyloidosis
C. Diabetic ketoacidosis
D. Portal hypertension
Answer: B. Dialysis-related amyloidosis
82. Which of the following clinical signs is most consistent with air embolism during hemodialysis?
A. Gradual weight gain
B. Chest tightness, dyspnea, and sudden hypotension
C. Muscle cramps
D. Bradycardia only
Answer: B. Chest tightness, dyspnea, and sudden hypotension
83. Which of the following laboratory findings supports hemolysis as a complication of dialysis?
A. Decreased reticulocyte count
B. Elevated potassium and low haptoglobin
C. Increased serum calcium
D. Low BUN
Answer: B. Elevated potassium and low haptoglobin
84. Hypoxia during dialysis may be due to:
A. Hypernatremia
B. Improper dialysate calcium
C. Disequilibrium syndrome
D. Hypoventilation or fluid overload
Answer: D. Hypoventilation or fluid overload
85. The most likely cause of chest pain during dialysis in a patient with left ventricular hypertrophy is:
A. Anxiety
B. Coronary ischemia due to intradialytic hypotension
C. Uremic gastritis
D. Hyperkalemia
Answer: B. Coronary ischemia due to intradialytic hypotension
86. Dialysis disequilibrium syndrome is primarily caused by:
A. Rapid reduction of urea from the blood
B. Infection
C. Overhydration
D. Calcium overload
Answer: A. Rapid reduction of urea from the blood
87. The following is a clinical feature of uremic encephalopathy EXCEPT:
A. Asterixis
B. Confusion
C. Coma
D. Hypertension
Answer: D. Hypertension
88. Which of the following best describes "Steal Syndrome"?
A. Arterial steal of blood from the heart
B. Venous occlusion causing arm swelling
C. Reduced blood flow distal to AVF, causing ischemia
D. Infection of the fistula site
Answer: C. Reduced blood flow distal to AVF, causing ischemia
89. What is the first step when a patient develops anaphylactic shock during dialysis?
A. Flush with saline
B. Discontinue dialysis and administer epinephrine
C. Increase blood flow rate
D. Lower dialysate temperature
Answer: B. Discontinue dialysis and administer epinephrine
90. A major risk of repeated blood transfusions in dialysis patients is:
A. Hyperglycemia
B. Iron deficiency
C. Alloimmunization and iron overload
D. Leukopenia
Answer: C. Alloimmunization and iron overload
91. Which of the following is most effective in reducing intradialytic hypotension?
A. Increasing dialysate potassium
B. Using cool dialysate
C. Reducing calcium in dialysate
D. Increasing ultrafiltration rate
Answer: B. Using cool dialysate
92. What is the most common cause of death in hemodialysis patients?
A. Sepsis
B. Electrolyte imbalance
C. Cardiovascular disease
D. Hypoglycemia
Answer: C. Cardiovascular disease
93. The most appropriate action when a patient becomes unconscious during dialysis is:
A. Increase the ultrafiltration rate
B. Check airway, breathing, and circulation immediately
C. Administer 50% dextrose
D. Give antihypertensive medication
Answer: B. Check airway, breathing, and circulation immediately
94. A patient develops a fever and chills 30 minutes after dialysis starts. The most likely cause is:
A. Hypotension
B. Dialyzer reaction or line infection
C. Low calcium
D. Disequilibrium syndrome
Answer: B. Dialyzer reaction or line infection
95. Chronic anemia in hemodialysis patients is usually due to:
A. Low potassium
B. Erythropoietin deficiency
C. High urea
D. Excess heparin use
Answer: B. Erythropoietin deficiency
96. Which of the following helps prevent clotting in the extracorporeal circuit during dialysis?
A. Calcium
B. Saline flush
C. Heparin
D. Sodium bicarbonate
Answer: C. Heparin
97. What is the most common cause of vascular access failure?
A. Steal syndrome
B. Infection
C. Thrombosis
D. Aneurysm
Answer: C. Thrombosis
98. Which vitamin is typically supplemented in long-term hemodialysis patients?
A. Vitamin A
B. Vitamin C
C. Vitamin B complex including folate
D. Vitamin K
Answer: C. Vitamin B complex including folate
99. Sudden vision changes during dialysis could indicate:
A. Hypoglycemia
B. Retinal detachment
C. Hypotension and decreased cerebral perfusion
D. Iron overload
Answer: C. Hypotension and decreased cerebral perfusion
100. Which of the following is a preventive strategy for dialysis disequilibrium syndrome?
A. High ultrafiltration rate in first session
B. Starting with short and low-efficiency dialysis
C. Increasing blood flow rate
D. Using a high-flux dialyzer
Answer: B. Starting with short and low-efficiency dialysis
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