✅ Hemodialysis Access – MCQ Set 1 (Questions 1–10)
1. Which of the following is considered the gold standard vascular access for long-term hemodialysis?
A. Tunneled catheter
B. AV graft
C. AV fistula
D. Peritoneal catheter
✅ Correct answer: C
2. Which artery and vein are commonly used for creating a radiocephalic AV fistula?
A. Radial artery and cephalic vein
B. Brachial artery and basilic vein
C. Femoral artery and vein
D. Subclavian artery and vein
✅ Correct answer: A
3. What is the typical time required for an AV fistula to mature before use?
A. 1 week
B. 2 weeks
C. 4–6 weeks
D. 1 year
✅ Correct answer: C
4. A thrill should be palpable over a mature AV fistula. What does it indicate?
A. Inflammation
B. Clot formation
C. Functioning blood flow
D. Infection
✅ Correct answer: C
5. Which of the following is a major risk of using a central venous catheter (CVC) for dialysis?
A. Hyperkalemia
B. Hypocalcemia
C. Catheter-related bloodstream infection (CRBSI)
D. Hypertension
✅ Correct answer: C
6. Which of the following is not a suitable site for permanent hemodialysis access?
A. Forearm
B. Upper arm
C. Neck vein
D. Femoral vein
✅ Correct answer: D
7. What is the preferred method for evaluating AV fistula maturity and blood flow?
A. Chest X-ray
B. CT scan
C. Duplex ultrasound
D. ECG
✅ Correct answer: C
8. What is a common cause of AV fistula failure?
A. Low hemoglobin
B. Hyperkalemia
C. Stenosis or thrombosis
D. High dialysate flow
✅ Correct answer: C
9. The Buttonhole technique is used with which type of access?
A. AV graft
B. AV fistula
C. Tunneled catheter
D. Temporary catheter
✅ Correct answer: B
10. Which of the following is not a best practice for AV fistula care?
A. Rotating cannulation sites
B. Using a tourniquet when accessing
C. Regular checking for bruit and thrill
D. Drawing blood samples directly from fistula regularly
✅ Correct answer: D
11. The Buttonhole cannulation technique involves:
A. Random needle insertion each time
B. Using dull needles in a developed tunnel tract
C. Immediate catheter insertion
D. Use of ultrasound every session
✅ Correct answer: B
12. Which of the following is the first-line treatment for thrombosed AV fistula?
A. Antibiotics
B. Surgical resection
C. Thrombolysis or angioplasty
D. Antihypertensive therapy
✅ Correct answer: C
13. What is the most common site of central venous stenosis in dialysis patients with CVCs?
A. Subclavian vein
B. Iliac vein
C. Inferior vena cava
D. Femoral vein
✅ Correct answer: A
14. During dialysis, increased venous pressure in the access line may indicate:
A. Air in the dialyzer
B. Arterial inflow problem
C. Venous outflow stenosis
D. Hypotension
✅ Correct answer: C
15. What complication is more frequent with AV grafts compared to fistulas?
A. Infection and thrombosis
B. Longer maturation time
C. Hypotension
D. Hyperkalemia
✅ Correct answer: A
16. How often should AV fistula sites be assessed for bruit and thrill in chronic dialysis patients?
A. Weekly
B. Only during initiation
C. Before every dialysis session
D. Monthly
✅ Correct answer: C
17. Which of the following is not true about tunneled cuffed catheters?
A. Used for long-term access when AVF is not possible
B. Inserted in the internal jugular vein
C. Require minimal aseptic precautions
D. More infection-prone than AVFs
✅ Correct answer: C
18. Which complication is specific to arterial needle dislodgement during dialysis?
A. Dialyzer clotting
B. Hemolysis
C. Severe blood loss
D. Infection
✅ Correct answer: C
19. For the rope-ladder technique in AVF cannulation:
A. The same site is used every time
B. Cannulation is done distally only
C. Needle sites are rotated along the length of the vessel
D. It is only used with catheters
✅ Correct answer: C
20. A patient on dialysis complains of arm swelling and facial puffiness on the same side as the catheter. What is the likely cause?
A. Heart failure
B. Central venous stenosis
C. Hypernatremia
D. Pericardial effusion
✅ Correct answer: B
21. What is the purpose of using ultrasound during AV fistula creation?
A. To monitor blood pressure
B. To guide needle placement
C. To assess vein and artery suitability
D. To check electrolyte levels
✅ Correct answer: C
22. The most common infection in patients with tunneled dialysis catheters is:
A. Fungal infection
B. Viral hepatitis
C. Catheter-related bloodstream infection (CRBSI)
D. Urinary tract infection
✅ Correct answer: C
23. When should a temporary non-tunneled catheter be used?
A. For long-term dialysis (>3 months)
B. For urgent dialysis initiation
C. For peritoneal dialysis only
D. When AV fistula has matured
✅ Correct answer: B
24. AV grafts are made of which of the following materials?
A. Stainless steel
B. Polyvinyl chloride
C. Expanded polytetrafluoroethylene (ePTFE)
D. Silicone
✅ Correct answer: C
25. What is the recommended needle angle for cannulating a new AV fistula (rope ladder technique)?
A. 15–20 degrees
B. 45 degrees
C. 90 degrees
D. 5 degrees
✅ Correct answer: A
26. Which of the following reduces the risk of catheter-related bloodstream infections?
A. Reusing dialysis catheters
B. Avoiding daily dressing change
C. Using strict aseptic technique and antimicrobial locks
D. Daily irrigation with saline only
✅ Correct answer: C
27. Which of the following signs indicates steal syndrome in a patient with AV fistula?
A. Bruit present
B. Edema of the hand
C. Cold, pale fingers and hand ischemia
D. High venous pressure
✅ Correct answer: C
28. Which of the following is not an advantage of AV fistula over AV graft?
A. Lower infection risk
B. Higher long-term patency
C. Lower stenosis risk
D. Shorter maturation time
✅ Correct answer: D
29. When assessing for catheter patency, which of the following is most appropriate?
A. Listening for bruit
B. Palpating the vein
C. Checking for easy blood aspiration and flush
D. Using a tourniquet
✅ Correct answer: C
30. What is the most appropriate action when no thrill or bruit is detected in an AV fistula during pre-dialysis assessment?
A. Proceed with dialysis
B. Call the nephrologist urgently
C. Apply heat to the arm
D. Attempt to flush with heparin
✅ Correct answer: B
31. What is the first sign of infection in an AV fistula or graft?
A. Loss of thrill
B. Bruit disappearance
C. Redness, warmth, and tenderness
D. Bleeding from needle site
✅ Correct answer: C
32. Which of the following cannulation techniques has the lowest risk of aneurysm formation?
A. Buttonhole technique
B. Area cannulation
C. Random rotation
D. Rope-ladder technique
✅ Correct answer: D
33. What is the most reliable indicator of AV access dysfunction?
A. Decreased post-dialysis weight
B. Prolonged bleeding post-needle removal
C. Loss of bruit
D. High blood urea nitrogen (BUN)
✅ Correct answer: C
34. A well-functioning AV graft should have:
A. No palpable thrill
B. A strong bruit only during systole
C. Continuous thrill and bruit
D. Intermittent thrill with high venous pressure
✅ Correct answer: C
35. What is the purpose of measuring dynamic venous pressure during dialysis?
A. To calculate fluid removal rate
B. To estimate dialysate sodium
C. To monitor for stenosis or outflow obstruction
D. To assess hemoglobin
✅ Correct answer: C
36. In AVF monitoring, Kt/V or URR that suddenly drops may indicate:
A. Improved kidney function
B. Hyperkalemia
C. Access dysfunction or underdialysis
D. Patient dehydration
✅ Correct answer: C
37. What should be avoided in the arm with a dialysis fistula?
A. Blood pressure measurement
B. Intravenous cannulation
C. Blood drawing
D. All of the above
✅ Correct answer: D
38. In case of suspected AVF stenosis, which diagnostic test is most appropriate?
A. Chest X-ray
B. Duplex ultrasound or fistulogram
C. Serum potassium
D. ECG
✅ Correct answer: B
39. Which cannulation method may result in the formation of a fibrous tunnel tract?
A. Rope-ladder
B. Buttonhole
C. Area cannulation
D. Single-needle dialysis
✅ Correct answer: B
40. What is the best method to reduce infection risk in hemodialysis vascular access?
A. Use of heparin
B. Antibiotics after each session
C. Proper hand hygiene and aseptic technique
D. Reusing fistula needles
✅ Correct answer: C
41. What is the most common cause of AV fistula failure to mature?
A. Infection
B. Stenosis due to intimal hyperplasia
C. Patient non-compliance
D. High blood pressure
✅ Correct answer: B
42. Which site is preferred for creating an AV fistula?
A. Upper arm brachiocephalic
B. Femoral artery and vein
C. Wrist radiocephalic
D. Subclavian region
✅ Correct answer: C
43. How long does a typical AV fistula require to mature before it can be used for dialysis?
A. 1–2 days
B. 1–2 weeks
C. 4–8 weeks
D. 6–12 months
✅ Correct answer: C
44. What is the recommended frequency of AV access monitoring by clinical staff?
A. Daily
B. Once a week
C. Before each dialysis session
D. Once a month
✅ Correct answer: C
45. Cannulation for hemodialysis should begin on a new AV fistula only when:
A. Thrill is absent
B. Fistula is soft and flat
C. Fistula is mature, palpable with good thrill
D. Veins are not visible
✅ Correct answer: C
46. Which factor increases the risk of catheter-related bloodstream infections?
A. Cannulation by trained staff
B. Use of tunneled catheters
C. Poor hand hygiene and improper dressing
D. Catheter placed in internal jugular vein
✅ Correct answer: C
47. A thrill that is present during systole only suggests:
A. Normal functioning access
B. Arterial stenosis
C. Venous stenosis
D. Aneurysm
✅ Correct answer: C
48. Which condition is a contraindication for using the subclavian vein for CVC placement?
A. Emergency dialysis need
B. History of AV fistula on same side
C. High serum potassium
D. Old age
✅ Correct answer: B
49. What should be done if infiltration occurs during AVF cannulation?
A. Continue dialysis normally
B. Immediately attempt a second needle insertion in the same area
C. Stop cannulation on that site and apply cold compress
D. Use a larger needle next time
✅ Correct answer: C
50. In Buttonhole technique, the following is true:
A. Sharp needles are used permanently
B. It increases aneurysm formation
C. The same angle and site are used every time
D. It requires no training
✅ Correct answer: C
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