Ultrapure Dialysate

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Dialysis Fluid Quality: An Important Part Of The Dialysis Prescription

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Dialysis Fluid Quality – MCQs

1. What is the primary purpose of maintaining high-quality dialysis fluid?
A. To increase ultrafiltration rate
B. To prevent hypotension
C. To reduce the risk of inflammation and infection
D. To enhance blood clotting

✅ Answer: C. To reduce the risk of inflammation and infection

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2. Which of the following terms refers to dialysis fluid that meets the highest standard of purity?
A. Hypertonic dialysate
B. Acidic dialysate
C. Ultrapure dialysate
D. Alkaline dialysate

✅ Answer: C. Ultrapure dialysate

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3. What is the maximum allowable bacterial count in standard dialysis fluid, according to international guidelines?
A. 100 CFU/mL
B. 200 CFU/mL
C. 50 CFU/mL
D. 500 CFU/mL

✅ Answer: D. 500 CFU/mL

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4. Endotoxins in dialysis fluid can cause which of the following complications in patients?
A. Hypoglycemia
B. Pyrogenic reactions
C. Hypernatremia
D. Anemia

✅ Answer: B. Pyrogenic reactions

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5. What is the typical method used to monitor the quality of dialysis fluid?
A. Urine dipstick
B. Spectrophotometry
C. Bacterial culture and endotoxin assay
D. Hemoglobin A1c test

✅ Answer: C. Bacterial culture and endotoxin assay

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6. Ultrapure dialysate typically has an endotoxin level of:
A. >1 EU/mL
B. <0.25 EU/mL
C. 0.5 EU/mL
D. 2 EU/mL

✅ Answer: B. <0.25 EU/mL

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7. What is the role of reverse osmosis (RO) in dialysis fluid preparation?
A. To concentrate electrolytes
B. To sterilize the blood lines
C. To remove contaminants from water
D. To increase sodium content

✅ Answer: C. To remove contaminants from water

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8. Why is bicarbonate dialysate a potential source of microbial contamination?
A. It is acidic
B. It is stored in hot water
C. It is nutrient-rich and supports bacterial growth
D. It is exposed to UV light

✅ Answer: C. It is nutrient-rich and supports bacterial growth

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9. What is the recommended frequency of dialysis water quality testing in most HD centers?
A. Every session
B. Monthly
C. Weekly for endotoxin, monthly for bacteria
D. Annually

✅ Answer: C. Weekly for endotoxin, monthly for bacteria

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10. Which of the following is NOT a benefit of using ultrapure dialysis fluid?
A. Reduced inflammatory markers
B. Increased erythropoietin resistance
C. Improved nutritional status
D. Decreased hospitalization rate

✅ Answer: B. Increased erythropoietin resistance

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11. Which component in dialysis fluid primarily helps buffer the patient’s blood pH?
A. Sodium
B. Potassium
C. Bicarbonate
D. Glucose

✅ Answer: C. Bicarbonate

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12. What is the function of the acid concentrate in a dialysis solution?
A. To neutralize toxins
B. To provide calcium and magnesium
C. To stabilize bicarbonate
D. To prevent microbial growth in the system

✅ Answer: B. To provide calcium and magnesium

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13. The term "online hemodiafiltration" (HDF) emphasizes the need for which dialysate standard?
A. Sterile dialysate
B. Hypotonic dialysate
C. Ultrapure dialysate
D. Hyperosmolar dialysate

✅ Answer: C. Ultrapure dialysate

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14. Which regulatory body sets standards for dialysis water and dialysate in the United States?
A. WHO
B. CDC
C. AAMI (Association for the Advancement of Medical Instrumentation)
D. ISO

✅ Answer: C. AAMI

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15. What is the ideal conductivity range for standard dialysate?
A. 5–7 mS/cm
B. 12–14 mS/cm
C. 10–12 mS/cm
D. 13–15 mS/cm

✅ Answer: C. 10–12 mS/cm

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16. Which of the following dialysate additives may be adjusted to help control a patient’s potassium level?
A. Bicarbonate
B. Glucose
C. Potassium
D. Sodium

✅ Answer: C. Potassium

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17. Which symptom may indicate exposure to contaminated dialysate?
A. Muscle cramp
B. Fever and chills during dialysis
C. Low hemoglobin
D. Hyperkalemia

✅ Answer: B. Fever and chills during dialysis

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18. What role does the ultrafilter in the dialysis delivery system play?
A. Enhances ultrafiltration rate
B. Sterilizes the dialysate
C. Removes bacteria and endotoxins from the fluid
D. Increases dialysate flow

✅ Answer: C. Removes bacteria and endotoxins from the fluid

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19. Glucose is added to dialysate primarily to:
A. Improve bicarbonate buffering
B. Prevent hypoglycemia during dialysis
C. Promote ultrafiltration
D. Sterilize the dialysate

✅ Answer: B. Prevent hypoglycemia during dialysis

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20. Dialysate prepared incorrectly (wrong proportions or settings) may result in:
A. Hypertension
B. Dialyzer clotting
C. Hemolysis, cramps, or patient death
D. Increased urine output

✅ Answer: C. Hemolysis, cramps, or patient death

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21. Which parameter of dialysate is most critical in preventing patient hemolysis?
A. High glucose level
B. Conductivity and temperature
C. High magnesium level
D. Dialysate color

✅ Answer: B. Conductivity and temperature

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22. A sudden drop in dialysate conductivity may indicate:
A. Endotoxin contamination
B. Incorrect acid concentrate mix
C. Bacterial growth
D. Proper functioning of the RO unit

✅ Answer: B. Incorrect acid concentrate mix

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23. An advantage of bicarbonate over acetate in dialysis fluid is:
A. More stable in storage
B. Less microbial growth
C. Better cardiovascular tolerance
D. Causes metabolic acidosis

✅ Answer: C. Better cardiovascular tolerance

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24. Dialysate with incorrect calcium concentration may lead to:
A. Hyponatremia
B. Cardiac arrhythmias
C. Hypoglycemia
D. Anemia

✅ Answer: B. Cardiac arrhythmias

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25. What can cause pyrogenic reactions during hemodialysis?
A. Low sodium dialysate
B. Endotoxin contamination in dialysate
C. High blood pressure
D. Lack of anticoagulation

✅ Answer: B. Endotoxin contamination in dialysate

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26. Which dialysate temperature is commonly used to reduce hypotension during dialysis?
A. 39°C
B. 36.5°C
C. 34–35.5°C
D. 33°C

✅ Answer: C. 34–35.5°C

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27. What component in dialysis machines continuously monitors dialysate conductivity?
A. Flow meter
B. Pressure sensor
C. Conductivity cell
D. Ultrafiltration pump

✅ Answer: C. Conductivity cell

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28. What action should be taken if dialysate conductivity alarm is triggered?
A. Increase dialysate flow
B. Continue treatment as usual
C. Stop dialysis and investigate immediately
D. Flush dialyzer with saline

✅ Answer: C. Stop dialysis and investigate immediately

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29. What is the ideal range of dialysate pH for patient safety?
A. 6.0–6.5
B. 6.5–7.5
C. 5.5–6.0
D. 7.8–8.5

✅ Answer: B. 6.5–7.5

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30. Why should bicarbonate concentrate be prepared fresh daily?
A. It loses its flavor
B. It supports rapid microbial growth
C. It reacts with acid concentrate
D. It evaporates in air

✅ Answer: B. It supports rapid microbial growth

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31. Which part of the dialysis system is primarily responsible for removing chemical contaminants from water?
A. Carbon filter
B. Dialyzer
C. Blood pump
D. Conductivity meter

✅ Answer: A. Carbon filter

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32. What is the most common reason for microbial contamination of dialysis fluid?
A. Use of chlorinated water
B. Daily replacement of bicarbonate
C. Infrequent disinfection of the water system
D. Low sodium in dialysate

✅ Answer: C. Infrequent disinfection of the water system

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33. Dialysis fluid should be tested for bacterial contamination using which method?
A. Gram staining
B. Culture method with incubation
C. Spectrophotometer reading
D. Saline dilution method

✅ Answer: B. Culture method with incubation

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34. In online hemodiafiltration (HDF), substitution fluid must be:
A. Hypotonic
B. Heated to 60°C
C. Ultrapure and sterile
D. Acidic in nature

✅ Answer: C. Ultrapure and sterile

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35. Which is not typically included in the standard dialysate composition?
A. Sodium
B. Potassium
C. Calcium
D. Hemoglobin

✅ Answer: D. Hemoglobin

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36. What is the purpose of dialysate conductivity monitoring?
A. Detect blood leaks
B. Prevent air embolism
C. Ensure correct electrolyte concentration
D. Monitor blood pressure

✅ Answer: C. Ensure correct electrolyte concentration

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37. What is the normal sodium concentration range in dialysate?
A. 80–100 mmol/L
B. 135–145 mmol/L
C. 155–160 mmol/L
D. 90–110 mmol/L

✅ Answer: B. 135–145 mmol/L

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38. What type of water is required for the final dialysate mix?
A. Sterile water
B. Boiled tap water
C. Reverse osmosis (RO) water
D. Bottled mineral water

✅ Answer: C. Reverse osmosis (RO) water

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39. Which dialysate issue may cause hemolysis during treatment?
A. Hypocalcemia
B. Hypotonicity
C. Overheating
D. Acid-base imbalance

✅ Answer: C. Overheating

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40. The use of ultrapure dialysate is especially important in patients with:
A. Acute kidney injury
B. Short daily dialysis
C. Chronic inflammation or immunosuppression
D. Polycystic kidney disease

✅ Answer: C. Chronic inflammation or immunosuppression

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41. Which of the following can be a result of using dialysate with high calcium concentration?
A. Hypocalcemia
B. Muscle cramping
C. Vascular calcification
D. Respiratory depression

✅ Answer: C. Vascular calcification

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42. The temperature of dialysate is generally maintained around:
A. 34°C
B. 35.5°C
C. 36.5–37°C
D. 38.5°C

✅ Answer: C. 36.5–37°C

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43. In dialysis systems, how often should the bicarbonate mixing system be disinfected?
A. Once a week
B. After every shift
C. Daily
D. Monthly

✅ Answer: C. Daily

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44. The endotoxin assay for dialysis fluid is commonly performed using:
A. ELISA
B. LAL (Limulus Amebocyte Lysate) test
C. Western blot
D. pH strip

✅ Answer: B. LAL (Limulus Amebocyte Lysate) test

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45. Which of the following statements about dialysate is false?
A. It must be sterile before contacting blood
B. It should match body fluid osmolality
C. It contains electrolytes at physiologic levels
D. It is produced by mixing acid, bicarbonate, and RO water

✅ Answer: A. It must be sterile before contacting blood
(Correct: Dialysate does not need to be sterile, but must be ultrapure to avoid contamination.)

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46. The primary function of sodium profiling in dialysate is to:
A. Increase blood glucose
B. Reduce risk of cramps and hypotension
C. Lower blood pressure
D. Prevent anemia

✅ Answer: B. Reduce risk of cramps and hypotension

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47. What is the consequence of dialysate with very low potassium concentration?
A. Hypertension
B. Hyperkalemia
C. Life-threatening arrhythmias
D. Oliguria

✅ Answer: C. Life-threatening arrhythmias

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48. AAMI recommends a maximum endotoxin level in dialysis fluid of:
A. 2.0 EU/mL
B. 1.0 EU/mL
C. 0.5 EU/mL
D. 0.25 EU/mL

✅ Answer: D. 0.25 EU/mL

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49. Which of the following methods improves dialysate purity at the point of use?
A. UV radiation
B. Ultrafiltration
C. Sodium variation
D. Ion exchange

✅ Answer: B. Ultrafiltration

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50. Which component is most critical to monitor in dialysate to prevent acid-base imbalance?
A. Potassium
B. Calcium
C. Bicarbonate
D. Glucose

✅ Answer: C. Bicarbonate

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