1. What is the best definition of "dry weight" in a hemodialysis patient?
A. The weight after a meal
B. The weight with maximum fluid overload
C. The weight at which the patient is normotensive without signs of fluid overload or depletion
D. The patient’s weight during hospitalization
Answer: C. The weight at which the patient is normotensive without signs of fluid overload or depletion
2. Which of the following is a clinical sign that a patient's post-dialysis weight is above dry weight?
A. Hypotension
B. Muscle cramps
C. Edema
D. Dizziness
Answer: C. Edema
3. What is a common symptom if a patient is dialyzed below their dry weight?
A. Hypertension
B. Dyspnea
C. Post-dialysis hypotension
D. Peripheral edema
Answer: C. Post-dialysis hypotension
4. Which of the following tools can help in assessing a patient's dry weight more accurately?
A. MRI
B. Bioimpedance spectroscopy
C. CT scan
D. ECG
Answer: B. Bioimpedance spectroscopy
5. Which of the following is NOT a reliable indicator to adjust dry weight?
A. Blood pressure trends
B. Presence of lung crepitations
C. Patient’s appetite
D. Post-dialysis symptoms
Answer: C. Patient’s appetite
6. Which of the following statements is TRUE regarding dry weight?
A. It should remain fixed over time
B. It usually increases in elderly patients
C. It may need to be adjusted based on patient’s clinical status
D. It is measured before dialysis starts
Answer: C. It may need to be adjusted based on patient’s clinical status
7. A dialysis patient complains of cramps and lightheadedness after dialysis. What is the likely cause?
A. Inadequate ultrafiltration
B. Fluid overload
C. Dry weight set too low
D. Dry weight set too high
Answer: C. Dry weight set too low
8. A key goal of determining dry weight in hemodialysis is to:
A. Maximize urine output
B. Prevent catheter infection
C. Avoid intradialytic hypotension and fluid overload
D. Ensure anticoagulation is effective
Answer: C. Avoid intradialytic hypotension and fluid overload
9. When is the ideal time to reassess a patient’s dry weight?
A. After every dialysis session
B. Every 3 months
C. When there are changes in blood pressure or signs of volume overload/depletion
D. Only during hospitalization
Answer: C. When there are changes in blood pressure or signs of volume overload/depletion
10. Which of the following would suggest a patient is not yet at dry weight after dialysis?
A. Normal heart rate
B. No edema or shortness of breath
C. Crackles in lungs and elevated blood pressure
D. Slight fatigue
Answer: C. Crackles in lungs and elevated blood pressure
11. Which of the following factors can make dry weight estimation more challenging?
A. Good appetite
B. Stable hemoglobin
C. Congestive heart failure (CHF)
D. Stable blood pressure
Answer: C. Congestive heart failure (CHF)
12. What is the most appropriate action if a patient experiences intradialytic hypotension frequently?
A. Increase ultrafiltration rate
B. Lower the dry weight
C. Reassess and possibly increase the dry weight
D. Skip next dialysis session
Answer: C. Reassess and possibly increase the dry weight
13. Overestimating dry weight in a hemodialysis patient can lead to:
A. Muscle cramps
B. Postural hypotension
C. Hypertension and left ventricular hypertrophy
D. Syncope
Answer: C. Hypertension and left ventricular hypertrophy
14. Which tool is NOT typically used to help assess dry weight?
A. Clinical assessment
B. Chest X-ray
C. ECG
D. Lung ultrasound
Answer: C. ECG
15. Which statement is TRUE regarding the relationship between residual urine output and dry weight?
A. Residual urine output does not affect dry weight
B. Patients with residual diuresis may have lower dry weight
C. All anuric patients have the same dry weight
D. Dry weight is fixed if urine is present
Answer: B. Patients with residual diuresis may have lower dry weight
16. A patient continues to have shortness of breath post-dialysis. What does this suggest?
A. Weight below dry weight
B. Reaching ideal weight
C. Overestimation of dry weight
D. Normal dialysis response
Answer: C. Overestimation of dry weight
17. Which of the following is a consequence of repeatedly removing too much fluid (below dry weight)?
A. Fluid retention
B. Intradialytic hypertension
C. Recurrent hypotension and organ ischemia
D. Increased dry weight
Answer: C. Recurrent hypotension and organ ischemia
18. Adjusting dry weight downward is appropriate in which scenario?
A. Edema increases
B. Patient gains muscle mass
C. Appetite improves
D. Weight loss from catabolism or chronic illness
Answer: D. Weight loss from catabolism or chronic illness
19. The "target weight" in dialysis treatment refers to:
A. Weight before dialysis
B. Estimated dry weight post-dialysis
C. The ideal BMI
D. Random fluid goal
Answer: B. Estimated dry weight post-dialysis
20. Which method provides the most objective estimate of volume status to assist with dry weight adjustment?
A. Asking the patient
B. Measuring interdialytic weight gain
C. Bioimpedance spectroscopy
D. Using dialysis machine alarms
Answer: C. Bioimpedance spectroscopy
21. A patient complains of headache and high BP pre-dialysis, and still has mild edema post-dialysis. What does this likely indicate?
A. Reached dry weight
B. Below dry weight
C. Above dry weight
D. Normal post-dialysis state
Answer: C. Above dry weight
22. A consistent interdialytic weight gain of >5% of dry weight suggests:
A. Patient has reached target weight
B. Good fluid management
C. Poor fluid restriction or inaccurate dry weight
D. Overuse of diuretics
Answer: C. Poor fluid restriction or inaccurate dry weight
23. In which condition should dry weight not be aggressively reduced, even if the patient appears overloaded?
A. Well-nourished patient
B. Chronic liver disease with ascites
C. Mild hypertension
D. Peripheral edema only
Answer: B. Chronic liver disease with ascites
24. A newly dialyzed patient experiences lightheadedness, yawning, and cramps during the last hour. What's the best next step?
A. Increase ultrafiltration
B. Reassess and possibly increase dry weight
C. Increase blood flow rate
D. Continue dialysis as usual
Answer: B. Reassess and possibly increase dry weight
25. Which statement about dry weight is FALSE?
A. It can change over time
B. It can be used to control blood pressure
C. It is the lowest tolerated post-dialysis weight
D. It is based solely on pre-dialysis weight
Answer: D. It is based solely on pre-dialysis weight
26. When assessing dry weight in a patient with amputation, which factor should be most carefully monitored?
A. Post-dialysis fatigue
B. Blood pressure trends
C. Changes in limb circumference
D. Appetite
Answer: B. Blood pressure trends
27. Which organ system is most vulnerable to repeated dialysis below dry weight?
A. Lungs
B. Liver
C. Heart
D. GI tract
Answer: C. Heart
28. Overestimating dry weight increases the risk of:
A. Infections
B. Hyperkalemia
C. Left ventricular hypertrophy and uncontrolled hypertension
D. Dialyzer clotting
Answer: C. Left ventricular hypertrophy and uncontrolled hypertension
29. Why might a dialysis nurse track “post-dialysis blood pressure trends” over several sessions?
A. To decide if the dialyzer is adequate
B. To assess vascular access function
C. To help determine correct dry weight
D. To track medication effects
Answer: C. To help determine correct dry weight
30. Which professional should be involved when significant changes to dry weight are needed?
A. Only the dialysis technician
B. Pharmacist
C. Nephrologist and dialysis nurse
D. Surgeon
Answer: C. Nephrologist and dialysis nurse
31. A patient feels well after dialysis but has elevated BP and mild ankle edema. What is the likely implication?
A. Patient is below dry weight
B. Dry weight is appropriate
C. Patient is above dry weight
D. Dialysis was excessive
Answer: C. Patient is above dry weight
32. Which patient symptom suggests underestimation of dry weight (i.e., too much fluid removed)?
A. Hypertension
B. Edema
C. Shortness of breath
D. Dizziness and fatigue post-dialysis
Answer: D. Dizziness and fatigue post-dialysis
33. What is a common consequence of removing too little fluid during hemodialysis (above dry weight)?
A. Cramps
B. Hypotension
C. Volume overload and hypertension
D. Nausea
Answer: C. Volume overload and hypertension
34. Bioimpedance spectroscopy helps assess dry weight by measuring:
A. Protein levels
B. Electrolyte imbalance
C. Body fluid composition
D. Hemoglobin
Answer: C. Body fluid composition
35. Which of the following would require a reduction in dry weight over time?
A. Congestive heart failure
B. Muscle gain from rehabilitation
C. Progressive malnutrition and muscle wasting
D. Dialysis vintage < 6 months
Answer: C. Progressive malnutrition and muscle wasting
36. Which of the following is a risk of chronically maintaining a patient above their true dry weight?
A. Orthostatic hypotension
B. Tachycardia
C. Left ventricular hypertrophy
D. Muscle cramps
Answer: C. Left ventricular hypertrophy
37. A post-dialysis BP is 80/60 mmHg, and the patient reports weakness. What does this suggest?
A. Excess fluid remains
B. Dry weight too high
C. Dry weight may be too low
D. Patient needs more ultrafiltration
Answer: C. Dry weight may be too low
38. Which action is appropriate when dry weight is suspected to be inaccurate?
A. Increase dialysate temperature
B. Increase ultrafiltration rate without discussion
C. Collaborate with the nephrologist to reassess
D. Ignore unless patient complains
Answer: C. Collaborate with the nephrologist to reassess
39. What is the best way to confirm that a patient has reached their true dry weight over time?
A. They feel tired after every session
B. Their weight is consistent with pre-dialysis weight
C. They remain normotensive post-dialysis without fluid-related symptoms
D. They lose >3 kg per week
Answer: C. They remain normotensive post-dialysis without fluid-related symptoms
40. Which of the following conditions may mask true fluid overload and delay dry weight reduction?
A. Anemia
B. Diarrhea
C. Chronic hypotension
D. Malnutrition with low albumin
Answer: D. Malnutrition with low albumin
41. Which physical assessment is most helpful in evaluating fluid status during dry weight determination?
A. Visual inspection of AV fistula
B. Palpation of liver
C. Jugular venous pressure (JVP) assessment
D. Skin turgor
Answer: C. Jugular venous pressure (JVP) assessment
42. A patient’s BP is consistently low post-dialysis and they feel dizzy. What might this indicate?
A. Too little fluid was removed
B. Dialysis was insufficient
C. Dry weight is set too low
D. Patient is overhydrated
Answer: C. Dry weight is set too low
43. The purpose of determining and adjusting dry weight is to:
A. Prevent infection
B. Avoid medication use
C. Maintain fluid balance and prevent cardiovascular complications
D. Increase protein intake
Answer: C. Maintain fluid balance and prevent cardiovascular complications
44. A rapid drop in weight after initiating dialysis in a new patient typically indicates:
A. An error in dry weight estimation
B. Clearance of excess fluid (fluid overload)
C. Muscle loss
D. Hemoglobin drop
Answer: B. Clearance of excess fluid (fluid overload)
45. A sudden drop in post-dialysis BP, cramps, and fainting are signs of:
A. Good dialysis tolerance
B. Excessive ultrafiltration—overshooting dry weight
C. Dialysis adequacy
D. Appropriate dry weight
Answer: B. Excessive ultrafiltration—overshooting dry weight
46. What would support the need to increase a patient’s dry weight?
A. Decreased appetite and weight loss
B. Frequent post-dialysis hypotension
C. Persistent hypertension
D. Increased interdialytic weight gain
Answer: B. Frequent post-dialysis hypotension
47. Which lab value might indirectly support the need to reassess dry weight?
A. Elevated serum sodium
B. Hemoglobin > 12 g/dL
C. Persistently low serum albumin
D. Normal potassium
Answer: C. Persistently low serum albumin
(Note: Low albumin may mask signs of fluid overload)
48. What is the best time to evaluate a patient's true dry weight?
A. Immediately after dialysis
B. Before dialysis
C. During a hypertensive crisis
D. 24 hours post-dialysis
Answer: A. Immediately after dialysis
49. In elderly dialysis patients, dry weight management is more complicated due to:
A. Increased appetite
B. High urine output
C. Poor skin turgor and cardiovascular fragility
D. High muscle mass
Answer: C. Poor skin turgor and cardiovascular fragility
50. One of the long-term effects of maintaining weight consistently above dry weight is:
A. Dehydration
B. Hypotension
C. Pulmonary edema and LVH (left ventricular hypertrophy)
D. Anemia
Answer: C. Pulmonary edema and LVH (left ventricular hypertrophy)
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