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
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
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
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
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
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
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
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
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
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
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
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)
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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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