81. Which of the following is an important factor for successful buttonhole cannulation?
A. Consistent needle size, angle, and depth at each session
B. Changing the needle insertion site daily
C. Using sharp needles throughout the process
D. Avoiding scab removal at all costs
➡️ Answer: A. Consistent needle size, angle, and depth at each session
82. Which of the following best describes “tunnel tract infection” in buttonhole cannulation?
A. Infection along the needle tract beneath the skin at the buttonhole site
B. Infection in the central venous catheter
C. Urinary tract infection associated with dialysis
D. Infection limited to the bloodstream only
➡️ Answer: A. Infection along the needle tract beneath the skin at the buttonhole site
83. In comparison to conventional cannulation, buttonhole cannulation has been shown to:
A. Increase pain and discomfort
B. Decrease the number of needle infiltrations
C. Have no effect on bruising incidence
D. Increase vascular trauma
➡️ Answer: B. Decrease the number of needle infiltrations
84. Which is a recommended disinfectant for cleaning the buttonhole site before cannulation?
A. Plain water
B. Chlorhexidine gluconate
C. Isopropyl alcohol without antiseptic properties
D. Saline solution
➡️ Answer: B. Chlorhexidine gluconate
85. What is a primary reason for higher infection risk with buttonhole cannulation?
A. Multiple puncture sites
B. Repeated use of the same tract allowing bacterial colonization
C. Use of blunt needles causing trauma
D. Use of smaller needles
➡️ Answer: B. Repeated use of the same tract allowing bacterial colonization
86. Which is true about needle gauge used in buttonhole cannulation?
A. Larger gauge needles are used initially for tract formation, then smaller blunt needles are used
B. Only small gauge needles are ever used
C. Needle size changes every session
D. Needle gauge has no impact on cannulation success
➡️ Answer: A. Larger gauge needles are used initially for tract formation, then smaller blunt needles are used
87. A patient has repeated infections at the buttonhole site. What is the best next step?
A. Continue buttonhole cannulation with antibiotics
B. Switch to conventional cannulation technique
C. Ignore infections if mild
D. Use larger needles
➡️ Answer: B. Switch to conventional cannulation technique
88. Which is a potential advantage of buttonhole cannulation for patient independence?
A. It allows easier self-cannulation with less pain and anxiety
B. It requires more frequent clinical intervention
C. It limits patient involvement in care
D. It always requires a nurse to perform cannulation
➡️ Answer: A. It allows easier self-cannulation with less pain and anxiety
89. Which of the following statements about fistula longevity is correct?
A. Buttonhole cannulation is proven to shorten fistula life
B. Conventional cannulation always results in longer fistula survival
C. Buttonhole cannulation may preserve fistula by reducing repeated trauma
D. Cannulation technique does not affect fistula longevity
➡️ Answer: C. Buttonhole cannulation may preserve fistula by reducing repeated trauma
90. Which is a common reason for buttonhole cannulation failure?
A. Poor tract formation due to inconsistent needle placement
B. Use of blunt needles too early
C. Early removal of scabs
D. Excessive rotation of cannulation sites
➡️ Answer: A. Poor tract formation due to inconsistent needle placement
91. What is the recommended frequency for needle site rotation in conventional cannulation?
A. Every session
B. Weekly
C. Monthly
D. Never rotate
➡️ Answer: A. Every session
92. Which of the following is a hallmark of buttonhole cannulation technique?
A. Rotating needle sites regularly to avoid trauma
B. Creating a permanent scarred tunnel by cannulating the exact same spot and angle
C. Use of sharp needles every session
D. Avoiding scab removal at the site
➡️ Answer: B. Creating a permanent scarred tunnel by cannulating the exact same spot and angle
93. Which statement about infection prevention in buttonhole cannulation is true?
A. Scab removal before needle insertion is unnecessary
B. Proper hand hygiene and site disinfection are critical
C. Antibiotic ointments should never be used
D. Infection risk is negligible without antiseptic use
➡️ Answer: B. Proper hand hygiene and site disinfection are critical
94. How does buttonhole cannulation impact the patient’s experience during dialysis?
A. It generally causes more pain and anxiety
B. It tends to reduce pain and anxiety related to needle insertion
C. It has no impact on patient comfort
D. It requires longer cannulation time leading to discomfort
➡️ Answer: B. It tends to reduce pain and anxiety related to needle insertion
95. What is a common complication unique to buttonhole cannulation?
A. Tunnel tract infection
B. Hematoma formation due to site rotation
C. Central venous stenosis
D. Peritonitis
➡️ Answer: A. Tunnel tract infection
96. Which of the following best practices improves buttonhole cannulation outcomes?
A. Using blunt needles after the tract is formed
B. Using sharp needles every session
C. Avoiding scab removal before needle insertion
D. Frequently changing needle insertion sites
➡️ Answer: A. Using blunt needles after the tract is formed
97. What patient characteristic might influence the choice of buttonhole cannulation?
A. Immature AV fistula (<3 months old)
B. Patient needle phobia and difficult veins
C. Patients with peritoneal dialysis
D. Patients with central venous catheters
➡️ Answer: B. Patient needle phobia and difficult veins
98. Which of the following is NOT a benefit of buttonhole cannulation?
A. Less needle-related pain
B. Reduced hematoma incidence
C. Higher infection risk if aseptic technique lapses
D. Increased frequency of aneurysm formation
➡️ Answer: D. Increased frequency of aneurysm formation
99. What should be done if a buttonhole site shows signs of infection?
A. Continue cannulation with antibiotics
B. Immediately stop buttonhole cannulation and treat infection
C. Ignore minor symptoms
D. Increase needle size
➡️ Answer: B. Immediately stop buttonhole cannulation and treat infection
100. What is a critical step in the initial creation of a buttonhole tract?
A. Using blunt needles for the first cannulation
B. Consistent use of the same needle insertion site, angle, and depth with sharp needles
C. Avoiding antiseptic cleaning before needle insertion
D. Rotating needle sites frequently
➡️ Answer: B. Consistent use of the same needle insertion site, angle, and depth with sharp needles
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