Hemodialysis Machine - Common Alarm Signals & Its Management

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Hemodialysis Machine – Common Alarm Signals & Their Management (Set 1)

1. The most common reason for a venous pressure high alarm is:
A. Kinked blood tubing after the dialyzer
B. Arterial needle dislodgement
C. Low blood flow rate
D. Air detected in venous chamber
✅ Correct answer: A

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2. What is the appropriate first step when the arterial pressure alarm is low?
A. Flush the dialyzer
B. Check for needle dislodgement or loose connections
C. Increase the blood flow rate
D. Call the nephrologist immediately
✅ Correct answer: B

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3. An air bubble detector alarm activates. What is your immediate action?
A. Clamp the arterial line
B. Clamp the venous line and stop the blood pump
C. Increase the heparin dose
D. Adjust the dialysate temperature
✅ Correct answer: B

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4. High transmembrane pressure (TMP) alarm may be caused by:
A. Blood leak
B. Dialysate pump failure
C. Clotted dialyzer
D. Air in arterial chamber
✅ Correct answer: C

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5. The machine alarm sounds for 'Conductivity Out of Range'. What should you check first?
A. Blood flow rate
B. Dialyzer temperature
C. Dialysate mixing system
D. Heparin line
✅ Correct answer: C

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6. A blood leak alarm indicates:
A. Patient has internal bleeding
B. Blood is leaking from the venous chamber
C. Dialyzer membrane is compromised
D. There is air in the arterial line
✅ Correct answer: C

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7. If the venous pressure drops suddenly, what should you suspect?
A. Kinked line
B. Needle infiltration or disconnection
C. Clotting in dialyzer
D. Low blood flow rate
✅ Correct answer: B

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8. When a 'Temperature Out of Range' alarm occurs, your action should be to:
A. Check and adjust the dialysate heater
B. Increase dialysate flow
C. Lower the blood pump speed
D. Change the dialyzer
✅ Correct answer: A

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9. If the UF (ultrafiltration) control alarm is triggered, what is a likely cause?
A. Blood flow is too fast
B. Target UF goal has been exceeded
C. Arterial pressure is too high
D. Patient is hypotensive
✅ Correct answer: B

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10. A ‘No Flow Detected’ alarm on the blood pump could be due to:
A. Low dialysate conductivity
B. Blood line disconnection or occlusion
C. Incorrect dialyzer priming
D. Clotted venous chamber
✅ Correct answer: B

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11. What does a sudden increase in arterial pressure alarm likely indicate?
A. Venous needle dislodgement
B. Kinked arterial bloodline or needle occlusion
C. Excessive fluid removal
D. Dialysate temperature too high
✅ Correct answer: B

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12. A patient moves and the machine suddenly alarms for “venous pressure low.” What should you check first?
A. Dialysate pH
B. Blood leak detector
C. Disconnection or dislodgement of venous needle
D. Dialyzer clotting
✅ Correct answer: C

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13. A dialysate flow alarm usually indicates a malfunction in which part of the system?
A. Blood pump
B. Arterial line
C. Dialysate pump or delivery system
D. Air detector
✅ Correct answer: C

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14. What action is most appropriate when a 'blood leak' alarm is triggered during treatment?
A. Stop the blood pump and return blood
B. Ignore if patient is stable
C. Flush the dialyzer
D. Increase ultrafiltration
✅ Correct answer: A

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15. Which alarm is triggered by increased resistance across the dialyzer membrane?
A. Blood leak
B. Venous pressure high
C. TMP (Transmembrane Pressure) high
D. Air detector
✅ Correct answer: C

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16. What is the next step after confirming an actual blood leak?
A. Continue dialysis but slow blood flow
B. Stop dialysis, discard circuit, report incident
C. Recalibrate the blood leak sensor
D. Administer heparin
✅ Correct answer: B

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17. The conductivity reading is out of range. What could happen to the patient if dialysis continues?
A. Hyperkalemia
B. Hyponatremia or hypernatremia
C. Hypoglycemia
D. Hyperphosphatemia
✅ Correct answer: B

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18. An alarm shows “air detected in venous line.” What is the first thing you must do?
A. Increase blood flow
B. Clamp venous line and stop pump immediately
C. Reset the machine
D. Silence the alarm and observe
✅ Correct answer: B

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19. High venous pressure during dialysis could be caused by all EXCEPT:
A. Poor vascular access
B. Clotted dialyzer
C. Air in bloodline
D. Kinked tubing post-dialyzer
✅ Correct answer: C

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20. A blood pump stops and displays a “door open” alarm. What should you check?
A. Clamp all lines
B. Check arterial pressure
C. Close and lock the blood pump door properly
D. Re-prime the dialyzer
✅ Correct answer: C

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21. What is the primary cause of an arterial pressure too low alarm?
A. Dislodged venous needle
B. Patient hypotension
C. Inadequate blood flow or poor arterial access
D. Dialyzer clotting
✅ Correct answer: C

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22. What can cause a high dialysate temperature alarm?
A. UF goal exceeded
B. Malfunctioning heating element
C. Clotted blood tubing
D. High arterial pressure
✅ Correct answer: B

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23. If an air detector alarm is activated but no visible air is found, what could be the cause?
A. Loose venous connection
B. Faulty air sensor or damp chamber
C. Low TMP
D. Excessive heparin
✅ Correct answer: B

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24. In the event of multiple alarms during dialysis, which principle applies best?
A. Silence all alarms to avoid distraction
B. Stop the machine immediately
C. Prioritize alarms affecting blood circuit safety (air, pressure, blood leak)
D. Call the nephrologist immediately
✅ Correct answer: C

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25. A “TMP too low” alarm might indicate:
A. Clotted dialyzer
B. No dialysate flow or disconnected dialysate line
C. Excessive ultrafiltration
D. Venous needle dislodgement
✅ Correct answer: B

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26. Which patient condition may falsely trigger high venous pressure alarms?
A. Fever
B. Talking during dialysis
C. Fistula stenosis or obstruction
D. High sodium level
✅ Correct answer: C

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27. If the machine displays “heparin pump failure,” what should you do first?
A. Increase blood flow
B. Manually administer heparin after consulting doctor
C. Stop dialysis immediately
D. Restart machine
✅ Correct answer: B

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28. Why is it critical to not ignore conductivity or pH alarms?
A. They cause machine damage
B. They can lead to electrolyte imbalances and patient harm
C. They increase UF rate
D. They reduce blood flow
✅ Correct answer: B

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29. After resolving an alarm, what is best practice before resuming dialysis?
A. Flush the dialyzer
B. Document alarm only if patient complains
C. Confirm alarm source is resolved and monitor patient
D. Reinsert needles
✅ Correct answer: C

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30. What is the safest response to a false air detector alarm that recurs during treatment?
A. Bypass the sensor
B. Manually inspect and clean the air chamber, notify supervisor
C. Deactivate all safety alarms
D. Ignore if blood flow is stable
✅ Correct answer: B

31. During treatment, the “blood pump stopped” alarm is triggered. What should be checked first?
A. Blood leak sensor
B. Heparin pump settings
C. Blood pump door closure and tubing position
D. Dialysate pressure
✅ Correct answer: C

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32. What is the risk of overriding or ignoring a “dialysate flow error” alarm?
A. Reduced dialyzer lifespan
B. Inaccurate ultrafiltration rate
C. Inadequate waste removal leading to underdialysis
D. Minor patient discomfort only
✅ Correct answer: C

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33. The machine is alarming for “UF control error.” What is the safest immediate action?
A. Restart UF system
B. Stop ultrafiltration and notify biomedical/physician
C. Decrease blood flow rate
D. Reprime the blood circuit
✅ Correct answer: B

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34. A recurrent “high TMP” alarm likely indicates:
A. Blood leak detector failure
B. Clotting within the dialyzer membrane
C. Arterial needle dislodgement
D. Venous needle is loose
✅ Correct answer: B

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35. If conductivity is too low, the dialysate may cause:
A. Hypernatremia and hypertension
B. Hemolysis and hypotension
C. Fever
D. Hyperkalemia
✅ Correct answer: B

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36. Which of the following is not a cause of a “venous pressure high” alarm?
A. Clot in venous line
B. Kinked tubing after dialyzer
C. Disconnected arterial line
D. Poor venous access
✅ Correct answer: C

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37. What is the most appropriate response if the “arterial pressure low” alarm occurs and the patient is experiencing signs of shock?
A. Change dialyzer
B. Increase blood pump speed
C. Lower the arterial needle
D. Stop dialysis and initiate emergency response
✅ Correct answer: D

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38. During priming, the “air in line” alarm repeatedly triggers. What is the likely cause?
A. Clotted dialyzer
B. Tubing not completely filled
C. Conductivity sensor error
D. UF volume too low
✅ Correct answer: B

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39. What is the danger of continuing dialysis after overriding a “temperature too high” alarm?
A. Dialysis is more effective
B. Risk of patient hypothermia
C. Increased clotting in circuit
D. Risk of patient hyperthermia or hemolysis
✅ Correct answer: D

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40. If the machine alarms for “blood leak small,” and no blood is visible in the dialysate effluent, what is the best course of action?
A. Continue treatment and monitor
B. Stop treatment and test dialysate for occult blood
C. Ignore the alarm if patient feels well
D. Reduce blood flow to stop leak
✅ Correct answer: B

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41. A “blood pump error” message persists even after restarting. What should be your next step?
A. Silence the alarm and continue dialysis
B. Change the entire machine immediately
C. Inspect and re-seat tubing or notify biomedical technician
D. Clamp the venous line and restart heparin pump
✅ Correct answer: C

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42. If an air detector alarm is triggered during return of blood, what should you do?
A. Pause and inspect for air, do not resume until line is cleared
B. Ignore if air is not visible
C. Flush air through saline line
D. Continue at a slower pump speed
✅ Correct answer: A

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43. The “venous pressure too low” alarm can be triggered if:
A. Arterial needle is dislodged
B. Venous needle is dislodged or disconnected
C. UF goal is too high
D. Heparin dose is too low
✅ Correct answer: B

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44. When a “TMP high” alarm is triggered repeatedly despite rinsing and repositioning, what should be done?
A. Increase dialysate flow
B. Replace the dialyzer (possible clotting)
C. Turn off TMP sensor
D. Give more heparin
✅ Correct answer: B

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45. What is a major danger if a “blood leak alarm” is ignored?
A. Thrombocytopenia
B. Hemolysis
C. Cross-contamination between blood and dialysate
D. Hypocalcemia
✅ Correct answer: C

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46. Which of the following alarms directly indicates a life-threatening risk to the patient?
A. Dialysate flow alarm
B. UF goal alarm
C. Air detector alarm
D. TMP low alarm
✅ Correct answer: C

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47. A conductivity too high alarm could result in:
A. Dialysis not removing phosphate
B. Hypertension or fluid overload
C. Hypernatremia, cramping, and headache
D. Dialyzer clotting
✅ Correct answer: C

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48. A “heparin pump air bubble” alarm occurs. Your next step is to:
A. Flush the heparin line with saline
B. Restart the blood pump
C. Ignore the alarm
D. Pause dialysis
✅ Correct answer: A

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49. Why is it important not to silence alarms without resolving the root cause?
A. Alarms are too sensitive
B. It shortens machine life
C. It violates patient safety protocols and risks patient harm
D. It delays the end of dialysis
✅ Correct answer: C

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50. The machine signals “End of Treatment,” but UF goal has not been reached. What action should you take?
A. Restart the entire treatment
B. Recalculate dry weight
C. Check time settings and consult physician if extended time is needed
D. Immediately disconnect patient
✅ Correct answer: C

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51. What condition may falsely trigger a “blood leak” alarm even when no leak exists?
A. Bloodline kink
B. UV light sensor error
C. Residual disinfectant or medications (e.g., methylene blue) in blood
D. Low blood flow rate
✅ Correct answer: C

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52. What’s the most appropriate initial step when you receive a “machine power failure” alert during treatment?
A. Stop blood pump and wait
B. Immediately clamp bloodlines and prepare for manual blood return
C. Disconnect patient
D. Restart the machine
✅ Correct answer: B

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53. What alarm may occur if the dialysate supply is accidentally disconnected during dialysis?
A. UF goal reached
B. Blood pump error
C. Conductivity or flow alarm
D. Venous pressure high
✅ Correct answer: C

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54. A persistent “arterial pressure high” alarm can indicate:
A. Kinked tubing before the pump
B. Venous needle infiltration
C. Fistula stenosis or poor blood flow from access
D. Patient hypotension
✅ Correct answer: C

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55. During self-care dialysis, the patient reports frequent air alarms. What is a likely cause?
A. Improper priming
B. Low dialysate flow
C. Conductivity mismatch
D. Over-anticoagulation
✅ Correct answer: A

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56. Which of the following will NOT cause a “TMP high” alarm?
A. Blood clotting in the dialyzer
B. High ultrafiltration setting
C. Normal saline priming
D. Slow dialysate flow
✅ Correct answer: C

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57. What is the most appropriate nursing response to a conductivity alarm that does not resolve after checking connections and restarting dialysate?
A. Continue treatment with lower UF
B. Ignore the alarm if patient is stable
C. Stop dialysis and replace dialysate or machine
D. Increase blood flow to compensate
✅ Correct answer: C

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58. “Heparin pump occlusion” alarms may be caused by:
A. Overheating of dialysate
B. Clamped or kinked heparin line
C. Low blood volume
D. Incorrect arterial pressure
✅ Correct answer: B

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59. When should the air detector alarm be tested manually?
A. Once every 6 months
B. At the end of each treatment
C. Before every treatment during machine setup
D. After each disinfection cycle
✅ Correct answer: C

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60. What is the correct step if multiple alarms (pressure, air, blood leak) occur together and machine cannot be reset?
A. Switch off all alarms
B. Reprogram machine
C. Clamp lines, return blood manually, and change machine
D. Ignore and let alarms settle
✅ Correct answer: C

Chronic Renal Failure

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Best Access Procedures from the Dialysis Units’ Viewpoint

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Assessment of the New AVF for Maturity.

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Assessment of New AVF for Maturity – MCQ

1. What is the recommended minimum duration before a new AVF should be assessed for maturity?
A. 1 week
B. 2 weeks
C. 4-6 weeks
D. 10-12 weeks
Answer: C. 4-6 weeks

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2. Which of the following is not part of the 'rule of 6's' for AVF maturity?
A. Depth less than 6 mm
B. Diameter more than 6 mm
C. Flow rate more than 600 mL/min
D. Bruit audible for 6 seconds
Answer: D. Bruit audible for 6 seconds

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3. A mature AVF should have a blood flow rate of at least:
A. 200 mL/min
B. 400 mL/min
C. 600 mL/min
D. 1000 mL/min
Answer: C. 600 mL/min

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4. Which physical finding suggests an immature AVF?
A. Easily compressible vein
B. Continuous thrill during palpation
C. Collapsed vein on arm elevation
D. Shallow vein less than 6 mm deep
Answer: C. Collapsed vein on arm elevation

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5. What diagnostic tool is most commonly used to assess AVF maturity?
A. Chest X-ray
B. Doppler ultrasound
C. CT angiogram
D. Venogram
Answer: B. Doppler ultrasound

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6. The presence of a strong continuous thrill upon palpation indicates:
A. Thrombosis
B. Infection
C. Adequate AVF flow
D. Low blood pressure
Answer: C. Adequate AVF flow

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7. According to the KDOQI guidelines, how long after AVF creation should it ideally be used for dialysis if mature?
A. Immediately
B. Within 1 week
C. After 2 weeks
D. After 6 weeks
Answer: D. After 6 weeks

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8. What is the purpose of the “rule of 6’s” in AVF assessment?
A. To diagnose AVF thrombosis
B. To monitor infection
C. To evaluate AVF maturity
D. To plan surgical intervention
Answer: C. To evaluate AVF maturity

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9. Which of the following is a sign of AVF maturity suitable for cannulation?
A. No palpable thrill
B. Vein depth of 1.5 cm
C. Vein diameter of 7 mm
D. Pulsatile mass over the site
Answer: C. Vein diameter of 7 mm

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10. Which clinical sign during auscultation indicates an AVF with sufficient flow?
A. Continuous machinery murmur
B. No sound heard
C. Soft bruit only on compression
D. Bruit during both systole and diastole
Answer: D. Bruit during both systole and diastole

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11. Which of the following is a false statement regarding AVF maturation?
A. Maturation is influenced by the size of the vein and artery
B. Handgrip exercises can promote maturation
C. AVF should ideally be used within 3 days of creation
D. AVF may fail to mature due to venous stenosis
Answer: C. AVF should ideally be used within 3 days of creation

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12. The rule of 6’s includes all the following EXCEPT:
A. Minimum blood flow of 600 mL/min
B. Vein diameter of at least 6 mm
C. Vein depth of more than 6 cm
D. Length of usable vein > 6 cm
Answer: C. Vein depth of more than 6 cm
(Correct depth is less than 6 mm, not more than 6 cm)

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13. Which imaging study helps confirm stenosis if an AVF fails to mature?
A. Abdominal ultrasound
B. MRI scan
C. Fistulogram
D. Echocardiogram
Answer: C. Fistulogram

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14. Which of the following may delay AVF maturation?
A. Handgrip exercises
B. Arterial calcification
C. Normal venous anatomy
D. Daily vein palpation
Answer: B. Arterial calcification

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15. What is a key reason for routine physical examination of a new AVF?
A. Check blood sugar
B. Detect infection only
C. Evaluate thrill, bruit, and vein characteristics
D. Confirm anticoagulation dose
Answer: C. Evaluate thrill, bruit, and vein characteristics

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16. What is the typical frequency for monitoring a new AVF during its maturation period?
A. Daily
B. Weekly
C. Every 3 months
D. Only on the first day
Answer: B. Weekly

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17. A newly created AVF is assessed at 6 weeks and has no thrill or bruit. What is the most likely issue?
A. Hyperkalemia
B. Venous hypertension
C. Thrombosis or occlusion
D. Arterial steal syndrome
Answer: C. Thrombosis or occlusion

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18. The presence of a continuous thrill upon palpation and a bruit during both systole and diastole is associated with:
A. Infection
B. Adequate AVF flow
C. Inflow stenosis
D. Hematoma
Answer: B. Adequate AVF flow

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19. What vein depth is generally considered acceptable for successful AVF cannulation?
A. <3 mm
B. <6 mm
C. >10 mm
D. >12 mm
Answer: B. <6 mm

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20. In a maturing AVF, which of the following helps predict successful use for dialysis?
A. No palpable vein
B. Pulsatile mass
C. Straight segment of vein at least 6 cm
D. Redness and warmth at site
Answer: C. Straight segment of vein at least 6 cm

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21. A new AVF shows high-pitched bruit with weak thrill. What is the most probable cause?
A. Normal maturation
B. Venous outflow stenosis
C. Hypotension
D. Fistula rupture
Answer: B. Venous outflow stenosis

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22. Hand exercises post-AVF creation are encouraged to:
A. Prevent infection
B. Reduce swelling
C. Promote venous dilation and maturation
D. Lower blood pressure
Answer: C. Promote venous dilation and maturation

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23. What should be the ideal time gap between AVF creation and first cannulation attempt?
A. 1-2 days
B. 1 week
C. 4-6 weeks
D. 3 months
Answer: C. 4-6 weeks

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24. A 6-week-old AVF has good thrill and bruit but a narrow segment of vein. What’s the next best step?
A. Start using for dialysis immediately
B. Apply cold compress
C. Refer for ultrasound mapping
D. Clamp the AVF
Answer: C. Refer for ultrasound mapping

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25. A mature AVF should have how many cm of accessible straight vein for successful cannulation?
A. 1 cm
B. 3 cm
C. 6 cm
D. 10 cm
Answer: C. 6 cm

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26. During AVF assessment, which of the following indicates inadequate inflow?
A. Strong continuous thrill
B. High-pitched bruit
C. Weak or absent thrill
D. Soft compressible vein
Answer: C. Weak or absent thrill

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27. The term “non-maturing fistula” is typically applied when the AVF fails to mature after:
A. 1 week
B. 2 weeks
C. 4 weeks
D. 6 weeks
Answer: D. 6 weeks

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28. The most common cause of primary AVF failure is:
A. Infection
B. Hematoma
C. Central venous stenosis
D. Juxta-anastomotic stenosis
Answer: D. Juxta-anastomotic stenosis

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29. Which of the following is NOT part of a physical examination of AVF maturity?
A. Palpation of thrill
B. Auscultation of bruit
C. Monitoring blood pressure
D. Assessment of vein diameter and depth
Answer: C. Monitoring blood pressure

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30. A newly formed AVF with swelling, redness, and tenderness at the site may indicate:
A. Normal postoperative change
B. Infection or hematoma
C. Proper AVF dilation
D. High fistula flow
Answer: B. Infection or hematoma

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31. Doppler ultrasound shows AVF flow at 350 mL/min, vein diameter 4 mm, and depth 10 mm. What does this indicate?
A. Fistula ready for use
B. Fistula is mature
C. Fistula is immature
D. Normal result
Answer: C. Fistula is immature

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32. During assessment, a long segment of the vein collapses with arm elevation. This suggests:
A. Normal AVF
B. Venous stenosis
C. Patent outflow
D. Arterial steal
Answer: B. Venous stenosis

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33. In clinical practice, how often should physical exams of a new AVF be conducted before first use?
A. Only on day 1
B. Weekly until use
C. Monthly
D. Only when symptoms arise
Answer: B. Weekly until use

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34. Which of the following is LEAST useful in evaluating AVF maturity?
A. Vein compressibility
B. Doppler flow measurement
C. Skin pigmentation over site
D. Palpation of thrill
Answer: C. Skin pigmentation over site

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35. What is the key factor in determining whether a new AVF can be successfully used for two-needle cannulation?
A. Flow rate only
B. Bruit alone
C. Vein size, depth, and accessible length
D. Patient’s age
Answer: C. Vein size, depth, and accessible length

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36. A new AVF is difficult to visualize and cannulate due to depth. What is the most appropriate management?
A. Apply cold packs
B. Immediate use for dialysis
C. Surgical superficialization
D. Start heparin infusion
Answer: C. Surgical superficialization

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37. The term "primary failure" of AVF refers to:
A. Fistula infection
B. Thrombosis after 6 months
C. Failure to mature adequately for use
D. Stenosis due to repeated cannulation
Answer: C. Failure to mature adequately for use

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38. What is the minimum vein diameter required for an AVF to be considered mature?
A. 2 mm
B. 4 mm
C. 6 mm
D. 10 mm
Answer: C. 6 mm

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39. Which intervention is often performed when an AVF fails to mature due to a stenotic segment?
A. Antibiotic infusion
B. Balloon angioplasty
C. Vein ligation
D. Compression therapy
Answer: B. Balloon angioplasty

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40. The absence of bruit and thrill on physical examination of a new AVF most likely indicates:
A. High flow AVF
B. Hyperfunctioning AVF
C. AVF occlusion or thrombosis
D. Venous spasm
Answer: C. AVF occlusion or thrombosis

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41. Which of the following is the most sensitive imaging method for evaluating AVF blood flow and vessel size?
A. CT angiogram
B. Chest X-ray
C. Doppler ultrasound
D. MRI
Answer: C. Doppler ultrasound

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42. Why is it important to assess the straight segment length of the vein in AVF evaluation?
A. Prevent thrombosis
B. Determine needle placement zone
C. Avoid infection
D. Reduce blood pressure
Answer: B. Determine needle placement zone

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43. What is the ideal depth from the skin surface for a mature AVF vein to allow successful cannulation?
A. Less than 6 mm
B. More than 8 mm
C. 1–2 cm
D. 3–4 cm
Answer: A. Less than 6 mm

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44. Which patient factor may delay or impair AVF maturation?
A. Young age
B. Diabetes mellitus
C. Handgrip exercises
D. High protein diet
Answer: B. Diabetes mellitus

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45. A bruit that disappears suddenly from a previously mature AVF suggests:
A. Normal function
B. Venous hypertension
C. Acute thrombosis
D. Low flow AVF
Answer: C. Acute thrombosis

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46. What is the most common reason for an AVF to fail to mature within the expected time frame?
A. Patient non-compliance
B. Early cannulation
C. Venous stenosis near the anastomosis
D. High calcium levels
Answer: C. Venous stenosis near the anastomosis

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47. A mature AVF should support a dialysis blood flow rate of at least:
A. 200 mL/min
B. 400 mL/min
C. 500 mL/min
D. 600 mL/min
Answer: D. 600 mL/min

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48. A weak, discontinuous thrill in a new AVF may be a sign of:
A. Proper function
B. Outflow obstruction
C. Hypotension
D. Normal adaptation
Answer: B. Outflow obstruction

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49. Why should tourniquet use be minimized during AVF maturation?
A. It causes infection
B. It impairs arterial inflow and causes vein trauma
C. It dilates the fistula too much
D. It falsely increases bruit sounds
Answer: B. It impairs arterial inflow and causes vein trauma

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50. A well-functioning AVF should exhibit which characteristic on auscultation?
A. No sound
B. Bruit only during systole
C. Bruit during both systole and diastole
D. Bruit only when compressed
Answer: C. Bruit during both systole and diastole

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51. Before using a new AVF for dialysis, the vein should ideally be:
A. Sclerosed and deep
B. Soft, compressible, and superficial
C. Narrow and non-pulsatile
D. Indurated and firm
Answer: B. Soft, compressible, and superficial

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52. A bruit that is high-pitched and localized near the anastomosis likely indicates:
A. Hyperfunctioning AVF
B. Normal maturity
C. Stenosis at the anastomotic site
D. Low blood flow
Answer: C. Stenosis at the anastomotic site

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53. What is the primary goal of pre-cannulation assessment of AVF?
A. Prevent bleeding
B. Assess infection
C. Confirm functional maturity for successful dialysis
D. Evaluate for AV graft need
Answer: C. Confirm functional maturity for successful dialysis

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54. Which of the following may enhance AVF maturation post-surgery?
A. Arm immobilization
B. Isometric handgrip exercises
C. High-protein diet
D. Smoking
Answer: B. Isometric handgrip exercises

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55. When assessing an AVF for the first time after surgery, what is the most important early sign of patency?
A. Audible bruit only
B. Palpable thrill immediately post-op
C. High blood pressure
D. Skin color changes
Answer: B. Palpable thrill immediately post-op

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56. Which of the following findings during AVF assessment would most likely require surgical or interventional correction?
A. Soft thrill and continuous bruit
B. Vein diameter of 7 mm
C. Flow rate of 300 mL/min at 6 weeks
D. Palpable, superficial vein
Answer: C. Flow rate of 300 mL/min at 6 weeks

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57. A newly created AVF is not maturing and the patient has central venous stenosis. What is a common clinical finding?
A. Warmth over the site
B. Enlarged collateral veins in the upper chest
C. Bounding pulse in the radial artery
D. Pale hand on AVF side
Answer: B. Enlarged collateral veins in the upper chest

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58. What is the recommended follow-up action if an AVF fails to mature by 6 weeks?
A. Continue monitoring until 3 months
B. Begin dialysis through the AVF
C. Refer for imaging (e.g., Doppler) and possible angioplasty
D. Apply hot packs daily
Answer: C. Refer for imaging (e.g., Doppler) and possible angioplasty

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59. An AVF with no thrill but an audible bruit most likely indicates:
A. High flow AVF
B. Maturation complete
C. Thrombosed fistula
D. Partial outflow obstruction
Answer: D. Partial outflow obstruction

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60. When planning for dialysis initiation, what is the primary criterion to determine if the AVF is ready for use?
A. Time since creation
B. Size of the incision scar
C. Palpable thrill and adequate vein length
D. Bruit during systole only
Answer: C. Palpable thrill and adequate vein length

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61. Why is it important to assess both bruit and thrill in AVF evaluation?
A. To monitor infection
B. They confirm the presence and adequacy of blood flow
C. They help reduce blood pressure
D. They assess the patient’s pain level
Answer: B. They confirm the presence and adequacy of blood flow

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62. In clinical practice, what does a “short segment” AVF refer to?
A. A fistula that is less than 1 week old
B. Vein segment < 6 cm suitable for cannulation
C. Narrow artery
D. AVF with two anastomoses
Answer: B. Vein segment < 6 cm suitable for cannulation

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63. Which patient factor has the strongest association with poor AVF maturation?
A. Female gender
B. History of stroke
C. Obesity
D. Diabetes and peripheral vascular disease
Answer: D. Diabetes and peripheral vascular disease

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64. What is the best non-invasive method to evaluate an AVF that fails clinical maturation assessment?
A. MRI
B. Venogram
C. Doppler ultrasound
D. Chest X-ray
Answer: C. Doppler ultrasound

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65. When assessing a mature AVF, which parameter is NOT a part of the standard “rule of 6's”?
A. Vein depth < 6 mm
B. Vein diameter ≥ 6 mm
C. Straight vein segment ≥ 6 cm
D. Access pressure < 60 mmHg
Answer: D. Access pressure < 60 mmHg

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66. What is the most appropriate next step when an AVF has adequate thrill and bruit but insufficient vein dilation?
A. Start using it for dialysis
B. Ligate the AVF
C. Refer for balloon angioplasty
D. Apply ice packs
Answer: C. Refer for balloon angioplasty

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67. Which of the following is considered a functional AVF?
A. One that produces bruit only
B. One that has been surgically created
C. One that can be successfully cannulated with two needles for adequate dialysis
D. One with an incision wound healing well
Answer: C. One that can be successfully cannulated with two needles for adequate dialysis

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68. A thrill is best assessed using which technique?
A. Stethoscope over AVF
B. Gentle palpation with fingers over the vein
C. Applying a BP cuff
D. Using a tourniquet
Answer: B. Gentle palpation with fingers over the vein

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69. The absence of bruit in a previously functioning AVF is most likely due to:
A. Vasodilation
B. Hematoma
C. AVF thrombosis
D. Excessive flow
Answer: C. AVF thrombosis

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70. In physical examination of a new AVF, the term “augmentation test” refers to:
A. Elevating the arm to observe venous collapse
B. Compressing outflow and observing increased thrill
C. Using ultrasound to measure vein size
D. Checking for arm circumference
Answer: B. Compressing outflow and observing increased thrill

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71. What is the significance of a strong pulsatile AVF with no thrill?
A. It is normal
B. Indicates venous hypertension or outflow stenosis
C. Ready for dialysis
D. Suggests high cardiac output
Answer: B. Indicates venous hypertension or outflow stenosis

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72. Which physical finding is most suggestive of early AVF stenosis?
A. Strong continuous thrill
B. High-pitched bruit localized to a single area
C. Deep, compressible vein
D. Soft bruit over full length of vein
Answer: B. High-pitched bruit localized to a single area

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73. In assessing AVF maturity, the straight segment should be free of curves and branches for at least:
A. 3 cm
B. 5 cm
C. 6 cm
D. 10 cm
Answer: C. 6 cm

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74. What is the best indicator that an AVF can consistently provide adequate dialysis?
A. Presence of surgical scar
B. Use of ultrasound alone
C. Successful two-needle cannulation with prescribed blood flow
D. Vein that “pops up” when arm is raised
Answer: C. Successful two-needle cannulation with prescribed blood flow

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75. A non-maturing AVF that shows narrowing at the anastomosis on Doppler should be:
A. Observed for another month
B. Used with a single needle
C. Considered for surgical revision or angioplasty
D. Tied off and removed
Answer: C. Considered for surgical revision or angioplasty

 

76. A patient’s AVF has a vein diameter of 7 mm, depth of 4 mm, and flow of 700 mL/min. What does this indicate?

A. Immature fistula
B. Ready for first cannulation
C. Fistula thrombosis
D. Inflow stenosis
Answer: B. Ready for first cannulation

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77. Which feature would most likely delay cannulation despite acceptable AVF blood flow?
A. Soft thrill
B. Vein depth of 12 mm
C. Bruit on auscultation
D. Straight segment of 7 cm
Answer: B. Vein depth of 12 mm

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78. A 6-week-old AVF has a continuous thrill but no visible vein. What is the most appropriate next step?
A. Use tourniquet and attempt cannulation
B. Proceed to dialysis with single-needle cannulation
C. Refer for ultrasound to assess depth
D. Ligation of fistula
Answer: C. Refer for ultrasound to assess depth

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79. During assessment, you find a mature AVF with 6 mm vein, shallow depth, but only 400 mL/min flow. What is the likely status?
A. Ready for full use
B. Still maturing
C. High-risk of infection
D. Should be abandoned
Answer: B. Still maturing

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80. A dialysis nurse reports difficulty with two-needle cannulation despite AVF thrill and bruit. What is the likely cause?
A. Arterial aneurysm
B. Central venous stenosis
C. Short cannulation zone or deep vein
D. Infection
Answer: C. Short cannulation zone or deep vein

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81. What tool helps best in mapping out a superficial segment for cannulation?
A. Tourniquet
B. Ultrasound
C. Stethoscope
D. BP cuff
Answer: B. Ultrasound

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82. If a thrill is only felt during systole, the likely AVF issue is:
A. Complete thrombosis
B. Normal function
C. Inflow stenosis
D. Outflow stenosis
Answer: D. Outflow stenosis

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83. Which of the following would not indicate a mature AVF?
A. 6 cm straight segment
B. 6 mm vein diameter
C. 3 cm depth from skin
D. 700 mL/min flow rate
Answer: C. 3 cm depth from skin

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84. What is the clinical purpose of using the “augmentation test” during AVF assessment?
A. Confirm patency of AV graft
B. Identify arterial steal
C. Detect inflow problems
D. Identify infection
Answer: C. Detect inflow problems

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85. An AVF with a flat bruit and no thrill on palpation is most likely:
A. Mature and functional
B. Ready for cannulation
C. Thrombosed or severely stenosed
D. Hyperfunctioning
Answer: C. Thrombosed or severely stenosed

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86. After 6 weeks, an AVF has excellent thrill and bruit but cannulation repeatedly infiltrates. What is the likely issue?
A. Deep vein
B. High flow
C. Arterial steal
D. Maturation complete
Answer: A. Deep vein

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87. A newly matured AVF shows 6 mm vein diameter, 5 mm depth, and 800 mL/min flow, but bruising after every cannulation. What might be the cause?
A. Early use
B. Incorrect needle angle or technique
C. Low AVF pressure
D. Infection
Answer: B. Incorrect needle angle or technique

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88. A patient with a maturing AVF has difficulty doing handgrip exercises. What is an alternative recommendation?
A. Avoid using the arm
B. Isometric ball squeeze exercises
C. Blood pressure cuff inflation
D. Passive elevation
Answer: B. Isometric ball squeeze exercises

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89. Which of the following signs suggests inflow stenosis rather than outflow stenosis?
A. Thrill present only during diastole
B. High-pitched localized bruit
C. Weak or absent thrill even on augmentation
D. Vein collapses with elevation
Answer: C. Weak or absent thrill even on augmentation

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90. A maturing AVF with strong thrill and bruit but short usable vein (<3 cm) should be:
A. Used immediately
B. Declared mature
C. Evaluated for surgical revision
D. Ignored
Answer: C. Evaluated for surgical revision

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91. What is the importance of mapping veins preoperatively for AVF creation?
A. Predict the duration of dialysis
B. Ensure vein diameter and patency are suitable
C. Identify AVF thrill early
D. Improve infection control
Answer: B. Ensure vein diameter and patency are suitable

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92. A sudden loss of bruit and thrill in a previously functional AVF most likely indicates:
A. Successful maturation
B. Fistula collapse
C. Infection
D. Acute thrombosis
Answer: D. Acute thrombosis

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93. In assessing AVF cannulation readiness, why is depth from the skin important?
A. Deeper veins are stronger
B. Shallow veins resist flow
C. Deeper veins are harder to cannulate and increase infiltration risk
D. It predicts infection risk
Answer: C. Deeper veins are harder to cannulate and increase infiltration risk

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94. What is the recommended action if an AVF flow is <500 mL/min after 6 weeks?
A. Proceed with use
B. Start anticoagulants
C. Refer for ultrasound and consider angioplasty
D. Bandage the arm
Answer: C. Refer for ultrasound and consider angioplasty

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95. Which sign indicates high flow AVF, potentially leading to cardiac strain?
A. Systolic-only bruit
B. Continuous low-pitched bruit
C. Bounding pulse, strong thrill, and venous hypertension
D. Deep narrow vein
Answer: C. Bounding pulse, strong thrill, and venous hypertension

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96. Which of the following findings is least useful when determining AVF readiness for dialysis?
A. Vein diameter
B. Depth from skin
C. Skin color over the AVF
D. Flow rate
Answer: C. Skin color over the AVF

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97. A bruit is heard only during systole. This is a classic sign of:
A. Maturation complete
B. Inflow stenosis
C. Normal variant
D. Arterial aneurysm
Answer: B. Inflow stenosis

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98. An AVF with 6 mm diameter, 4 mm depth, but curved tortuous segments is considered:
A. Ready for two-needle use
B. At risk of infiltration; needs further evaluation
C. Functionally mature
D. A sign of thrombosis
Answer: B. At risk of infiltration; needs further evaluation

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99. You are unable to palpate a thrill during AVF exam, but the patient is hypotensive. What should you do first?
A. Document as thrombosed
B. Wait for the next shift
C. Reassess after stabilizing blood pressure
D. Initiate heparin
Answer: C. Reassess after stabilizing blood pressure

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100. The most reliable combination of signs indicating AVF maturity includes:
A. Bruit and elevated WBC
B. Vein length and edema
C. Vein diameter ≥ 6 mm, depth ≤ 6 mm, flow ≥ 600 mL/min
D. Patient-reported thrill only
Answer: C. Vein diameter ≥ 6 mm, depth ≤ 6 mm, flow ≥ 600 mL/min

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