KDOQI-Hemodialysis Dose

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Hemodialysis Adequacy

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R.O System-Flow Configuration

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Dialysis Delivery System(HD machine)

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✅ Dialysis Delivery System (Hemodialysis Machine) – MCQ Set 1

1. The primary function of the hemodialysis delivery system is to:
A. Regulate blood pressure
B. Remove blood from the patient and deliver dialysate
C. Generate bicarbonate
D. Monitor hemoglobin levels
✅ Correct answer: B

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2. What is the role of the dialysate proportioning system in the dialysis machine?
A. Removes waste from the dialysate
B. Warms the blood before return
C. Mixes acid, bicarbonate, and water in the correct ratio
D. Adds anticoagulants to blood
✅ Correct answer: C

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3. The blood pump on a hemodialysis machine:
A. Adds dialysate into the blood line
B. Controls ultrafiltration
C. Moves blood through the extracorporeal circuit
D. Monitors conductivity
✅ Correct answer: C

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4. Which part of the HD machine monitors for air in the bloodline?
A. Pressure sensor
B. Venous clamp
C. Conductivity meter
D. Air detector
✅ Correct answer: D

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5. A key component that removes excess fluid during dialysis is:
A. Ultrafiltration pump
B. Blood leak detector
C. Conductivity sensor
D. Arterial pressure monitor
✅ Correct answer: A

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6. The dialysate used in the HD machine typically contains:
A. High potassium and no sodium
B. No electrolytes
C. Electrolytes matched to patient needs
D. Sterile water only
✅ Correct answer: C

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7. The arterial pressure monitor in the machine is positioned:
A. After the dialyzer
B. Before the blood pump
C. In the air trap
D. Near the saline bag
✅ Correct answer: B

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8. The venous pressure monitor helps to:
A. Prevent backflow of blood
B. Detect clotting or kinks after dialyzer
C. Regulate dialysate temperature
D. Control heparin dosing
✅ Correct answer: B

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9. What happens when the conductivity of dialysate is out of range?
A. Blood flow increases
B. Dialysis stops and alarm sounds
C. UF rate is increased
D. Bloodline disconnects
✅ Correct answer: B

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10. The transmembrane pressure (TMP) reflects the pressure:
A. Across the blood and dialysate compartments of the dialyzer
B. Between arterial and venous chambers
C. Between patient and machine
D. In the ultrafiltration pump
✅ Correct answer: A

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11. The hemodialysis machine automatically shuts down dialysate flow when:
A. Blood pressure drops
B. Conductivity or temperature is out of range
C. Patient is late for session
D. Blood flow rate is high
✅ Correct answer: B

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12. What is the normal range for dialysate temperature during treatment?
A. 35–37°C
B. 33–35°C
C. 38–40°C
D. 28–30°C
✅ Correct answer: A

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13. The function of the blood leak detector is to:
A. Detect clotting in the venous chamber
B. Check pressure in the extracorporeal circuit
C. Detect red blood cells crossing the dialyzer membrane
D. Monitor oxygen levels in blood
✅ Correct answer: C

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14. If the heparin pump malfunctions during dialysis, the immediate action is to:
A. Stop dialysis
B. Give more saline
C. Manually inject heparin per protocol
D. Increase blood flow rate
✅ Correct answer: C

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15. Which of the following components directly controls ultrafiltration (UF) in modern dialysis machines?
A. Blood pump
B. Ultrafiltration control pump
C. Air trap
D. TMP alarm
✅ Correct answer: B

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16. A high venous pressure alarm is usually caused by:
A. Arterial line disconnection
B. Patient movement
C. Clotting or kink after the dialyzer
D. Dialysate temperature drop
✅ Correct answer: C

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17. What component of the machine warms the dialysate before it enters the dialyzer?
A. Pressure chamber
B. Heat exchanger
C. Blood pump
D. Ultrafiltration controller
✅ Correct answer: B

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18. What should be checked first if a “conductivity low” alarm occurs?
A. Blood pump speed
B. Temperature sensor
C. Dialysate mixing (acid/base ratios and RO water supply)
D. Venous pressure
✅ Correct answer: C

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19. Disinfection of the dialysis machine should be performed:
A. Weekly only
B. Only when alarms occur
C. Daily or after every treatment per unit protocol
D. Monthly
✅ Correct answer: C

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20. What is the purpose of the UF (ultrafiltration) profile function in some dialysis machines?
A. Randomize fluid removal
B. Maintain high TMP
C. Vary fluid removal rate to reduce hypotension
D. Adjust dialysate sodium
✅ Correct answer: C

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21. What should be done before starting each dialysis treatment?
A. Only check the UF settings
B. Calibrate the blood pump
C. Complete machine self-test and safety checks
D. Increase dialysate flow
✅ Correct answer: C

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22. What is the function of the venous clamp in the dialysis machine?
A. Controls arterial blood return
B. Clamps the venous line when an air bubble is detected
C. Prevents clotting in the dialyzer
D. Measures TMP
✅ Correct answer: B

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23. An arterial pressure alarm reading of -250 mmHg suggests:
A. A normal functioning system
B. Hypotension
C. Kinked tubing or poor access flow before the blood pump
D. Air in the bloodline
✅ Correct answer: C

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24. The dialysate conductivity is most closely related to:
A. Blood pH
B. Sodium concentration
C. Ultrafiltration rate
D. Potassium level
✅ Correct answer: B

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25. Why is the dialysis machine grounded electrically?
A. For temperature control
B. To prevent static pressure
C. For safety from electrical shocks
D. To improve water conductivity
✅ Correct answer: C

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26. The TMP (transmembrane pressure) alarm helps detect:
A. Bacterial contamination
B. Arterial pressure drops
C. Excessive filtration or clotting in the dialyzer
D. Heparin overdose
✅ Correct answer: C

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27. What is the purpose of the flow pump in a dialysis machine?
A. Increase blood speed
B. Adjust dialysate flow rate
C. Push air into dialysate
D. Recycle bicarbonate
✅ Correct answer: B

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28. Which alarm condition requires immediate termination of dialysis?
A. Low blood flow
B. Blood leak detected
C. Low conductivity
D. High venous pressure
✅ Correct answer: B

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29. If a “dialysate temperature high” alarm occurs, the machine will typically:
A. Switch to bypass mode
B. Continue dialysis with cooling
C. Lower blood flow
D. Stop ultrafiltration
✅ Correct answer: A

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30. During disinfection, the machine should be connected to:
A. The patient
B. Dialysate acid concentrate
C. RO water supply and drain
D. Backup battery
✅ Correct answer: C

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31. A “no flow” alarm on the dialysate side usually means:
A. Blood leak in dialyzer
B. Low blood pressure
C. Blocked dialysate path or pump malfunction
D. Excess heparin
✅ Correct answer: C

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32. A properly functioning air detector will activate an alarm when:
A. TMP rises
B. Heparin is administered
C. Air is present in the venous line
D. Bicarbonate level drops
✅ Correct answer: C

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33. What is the primary cause of a positive blood leak alarm?
A. Kinked tubing
B. Dialysate over-temperature
C. Membrane rupture in the dialyzer
D. Ultrafiltration too low
✅ Correct answer: C

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34. When is the dialyzer priming usually done?
A. After inserting needles
B. Before patient connection
C. During dialysis
D. After treatment ends
✅ Correct answer: B

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35. What should you check if you receive a "low-level bicarbonate" alarm?
A. Dialysate flow
B. Acid concentrate level
C. Bicarbonate jug/container
D. Arterial pressure
✅ Correct answer: C

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36. The main purpose of the conductivity test on the HD machine is to:
A. Measure blood glucose
B. Monitor protein levels
C. Ensure correct electrolyte mix in dialysate
D. Detect bacteria
✅ Correct answer: C

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37. Which of the following ensures no backflow of dialysate into the blood?
A. TMP alarm
B. Ultrafilter
C. Check valves in dialyzer
D. Conductivity sensor
✅ Correct answer: C

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38. “Bypass mode” in the dialysis machine is activated to:
A. Increase blood flow
B. Allow dialysate flow during alarms
C. Stop dialysate from entering the dialyzer during unsafe conditions
D. Flush bloodlines
✅ Correct answer: C

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39. What might cause a sudden drop in arterial pressure during dialysis?
A. Disconnection or needle dislodgement
B. High TMP
C. Blood pump malfunction
D. Heparin overdose
✅ Correct answer: A

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40. The component of the dialysis machine responsible for heating the dialysate is called the:
A. Thermostat
B. Heat exchanger or heater plate
C. Warming coil
D. Diathermic probe
✅ Correct answer: B

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41. What happens when the venous pressure exceeds the set high limit?
A. Blood pump increases speed
B. Venous clamp closes, and machine alarms
C. Machine switches to bypass
D. Air detector shuts down
✅ Correct answer: B

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42. Dialysis machines are programmed to automatically stop treatment when:
A. Arterial pressure becomes too low
B. Patient feels dizzy
C. Heparin finishes
D. Ultrafiltration goal is reached
✅ Correct answer: D

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43. A “dialysate flow error” is most commonly due to:
A. Too much bicarbonate
B. Poor water supply or blocked filter
C. Bloodline clot
D. Low blood pressure
✅ Correct answer: B

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44. Why is it important to monitor the heparin pump during treatment?
A. To prevent air entry
B. To ensure accurate anticoagulant delivery
C. To monitor venous pressure
D. To increase UF rate
✅ Correct answer: B

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45. If the conductivity is too high, the dialysate may cause:
A. Hyponatremia
B. Hypokalemia
C. Hypernatremia and fluid retention
D. Hypoglycemia
✅ Correct answer: C

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46. A sudden drop in venous pressure may indicate:
A. Clotting in dialyzer
B. Air in dialysate
C. Dislodged venous needle
D. High TMP
✅ Correct answer: C

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47. When testing the machine before a session, what must be confirmed about the UF pump?
A. It’s full of dialysate
B. It’s not making noise
C. It’s calibrated and functioning properly
D. It’s pumping air
✅ Correct answer: C

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48. During dialysis, the air detector is located:
A. On the arterial bloodline
B. In the dialysate outlet
C. On the venous return line
D. In the bicarbonate line
✅ Correct answer: C

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49. To prevent bacterial contamination, dialysis machines must be disinfected with:
A. Normal saline
B. Cold water
C. Chemical disinfectant or heat disinfection per protocol
D. Bloodline rinsing
✅ Correct answer: C

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50. Dialysis machines are tested for all of the following before use EXCEPT:
A. Conductivity
B. pH of dialysate
C. Blood flow accuracy
D. Temperature
✅ Correct answer: C

Principles of Hemodialysis

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✅ MCQs – Principles of Hemodialysis (Set 3)

21. Which factor does not significantly influence diffusion during hemodialysis?
A. Solute molecular weight
B. Surface area of the membrane
C. Concentration gradient
D. Patient’s blood type
➡️ Answer: D. Patient’s blood type

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22. Which of the following solutes is considered a “middle molecule”?
A. Urea
B. Glucose
C. β2-microglobulin
D. Sodium
➡️ Answer: C. β2-microglobulin

23. What is the main function of the dialyzer membrane?
A. To increase blood pressure
B. To act as a semipermeable barrier for solute and water exchange
C. To filter oxygen into blood
D. To deliver heparin into circulation
➡️ Answer: B. To act as a semipermeable barrier for solute and water exchange

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24. What is the best indicator that a hemodialysis session has effectively removed uremic toxins?
A. Blood pressure increase
B. KT/V > 1.2
C. Pulse rate drops
D. Patient eats a full meal post-dialysis
➡️ Answer: B. KT/V > 1.2

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25. What is the most common reason for inadequate dialysis dose (low KT/V)?
A. Increased potassium levels
B. Dialyzer clotting or poor blood flow
C. Increased TMP
D. Overhydration
➡️ Answer: B. Dialyzer clotting or poor blood flow

26. Which component controls ultrafiltration volume in modern dialysis machines?
A. Arterial pressure monitor
B. Blood leak detector
C. Ultrafiltration pump
D. Air detector
➡️ Answer: C. Ultrafiltration pump

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27. What does the term “high-efficiency dialyzer” refer to?
A. Dialyzer with low clearance rate
B. Dialyzer that uses no dialysate
C. Dialyzer with high urea clearance and large surface area
D. Dialyzer that prevents protein loss
➡️ Answer: C. Dialyzer with high urea clearance and large surface area

28. Dialysis clearance is defined as:
A. The rate at which fluid is lost
B. Volume of plasma completely cleared of a substance per unit time
C. Change in body weight post-dialysis
D. The amount of dialysate used
➡️ Answer: B. Volume of plasma completely cleared of a substance per unit time

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29. Which is a disadvantage of using cellulose-based dialyzer membranes?
A. Poor solute clearance
B. Highly biocompatible
C. Higher incidence of complement activation
D. Can’t be sterilized
➡️ Answer: C. Higher incidence of complement activation

30. The rate of fluid removal (UF rate) is typically expressed as:
A. mL/kg/hr
B. mmHg/hr
C. L/min
D. mmol/L
➡️ Answer: A. mL/kg/hr

31. Which of the following best describes hemodiafiltration (HDF)?
A. A process that uses diffusion only
B. A process combining both diffusion and convection for solute clearance
C. A blood purification method that filters blood through the liver
D. A low-efficiency method for fluid removal
➡️ Answer: B. A process combining both diffusion and convection for solute clearance

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32. Which of the following parameters increases convective clearance?
A. Increasing dialysate sodium
B. Increasing TMP
C. Increasing dialysate flow rate
D. Decreasing blood flow rate
➡️ Answer: B. Increasing TMP

33. The “UFR” (Ultrafiltration Rate) should be limited to prevent intradialytic hypotension. Recommended limit is:
A. < 5 mL/kg/hr
B. < 7 mL/min
C. < 1 L/hr
D. < 2 mL/kg/hr
➡️ Answer: A. < 5 mL/kg/hr

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34. In dialysis, clearance of small solutes is mainly determined by:
A. Membrane thickness
B. Blood flow rate and dialysate flow rate
C. Patient’s urine output
D. Hematocrit
➡️ Answer: B. Blood flow rate and dialysate flow rate

35. A dialyzer is termed “reprocessed” when:
A. The dialyzer membrane is replaced
B. It is reused after cleaning and sterilization
C. It is discarded and replaced
D. Blood lines are flushed only
➡️ Answer: B. It is reused after cleaning and sterilization

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36. Which dialysis machine component measures negative pressure in the arterial line?
A. TMP sensor
B. Arterial pressure monitor
C. Blood leak detector
D. Conductivity sensor
➡️ Answer: B. Arterial pressure monitor

37. KT/V = 1.0 means:
A. No clearance achieved
B. Urea removal equals 50% of total body content
C. Urea clearance volume equals total body water
D. Excessive fluid was removed
➡️ Answer: C. Urea clearance volume equals total body water

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38. Which of the following contributes to increased solute removal in high-efficiency hemodialysis?
A. Decreased dialysate flow rate
B. High membrane surface area and porosity
C. Reduced blood flow
D. Small molecule retention
➡️ Answer: B. High membrane surface area and porosity

39. The purpose of dialysate conductivity monitoring is to:
A. Measure blood pressure
B. Detect ultrafiltration errors
C. Prevent hemolysis or cramps due to incorrect dialysate composition
D. Measure KT/V
➡️ Answer: C. Prevent hemolysis or cramps due to incorrect dialysate composition

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40. A “dry dialyzer” refers to one that:
A. Is used without water
B. Has not yet been primed
C. Has no fibers
D. Is for pediatric use only
➡️ Answer: B. Has not yet been primed

Scientific Principles Related to Dialysis, (Principles of Hemodialysis)

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✅ MCQs – Principles of Hemodialysis (Set 5)

41. The transmembrane pressure (TMP) in hemodialysis represents the pressure gradient across:
A. Dialyzer blood compartment only
B. Arterial and venous bloodlines
C. Dialyzer membrane from blood to dialysate side
D. Arterial access to dialysate flow
➡️ Answer: C. Dialyzer membrane from blood to dialysate side

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42. What is the main purpose of bicarbonate in the dialysate solution?
A. To enhance diffusion
B. To remove potassium
C. To buffer blood pH and correct acidosis
D. To increase osmosis
➡️ Answer: C. To buffer blood pH and correct acidosis

43. Which alarm will trigger if venous pressure rises due to an obstruction in the venous line?
A. Arterial pressure alarm
B. TMP alarm
C. Venous pressure alarm
D. Blood leak alarm
➡️ Answer: C. Venous pressure alarm

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44. What is the main risk if dialysate conductivity is too low?
A. Hyperkalemia
B. Hypotension and hemolysis
C. Hypertension
D. Blood clotting in the dialyzer
➡️ Answer: B. Hypotension and hemolysis

45. Which component ensures no air enters the bloodstream during dialysis?
A. Blood leak detector
B. Ultrafiltration pump
C. Air bubble detector
D. TMP sensor
➡️ Answer: C. Air bubble detector

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46. A dialyzer’s clearance is defined as:
A. Solute concentration in dialysate
B. Dialysate volume per minute
C. The rate at which solute is removed from blood
D. The amount of ultrafiltration
➡️ Answer: C. The rate at which solute is removed from blood

47. High-flux dialyzers are superior in removing:
A. Water only
B. Small molecules like urea
C. Medium to large molecules like β2-microglobulin
D. Only protein-bound toxins
➡️ Answer: C. Medium to large molecules like β2-microglobulin

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48. Which one is not a uremic toxin?
A. Urea
B. Creatinine
C. Sodium
D. β2-microglobulin
➡️ Answer: C. Sodium

49. What happens if the blood flow rate is set too low during dialysis?
A. Enhanced ultrafiltration
B. Inefficient solute clearance
C. High blood pressure
D. Blood leak alarm triggers
➡️ Answer: B. Inefficient solute clearance

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50. What is the key determinant of diffusion efficiency in dialysis?
A. TMP
B. Solute concentration gradient
C. Blood temperature
D. Arterial pressure
➡️ Answer: B. Solute concentration gradient

51. Which of the following best describes the Sieving Coefficient (SC)?
A. The ratio of dialysate to blood flow
B. The ability of a membrane to remove sodium
C. The ease with which a solute passes through a membrane during convection
D. The blood pressure difference across the dialyzer
➡️ Answer: C. The ease with which a solute passes through a membrane during convection

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52. Which of the following factors has the most significant impact on diffusion?
A. TMP
B. Solute size and concentration gradient
C. Arterial pressure
D. Blood temperature
➡️ Answer: B. Solute size and concentration gradient

53. What is the purpose of using a high dialysate flow rate (e.g., 800 mL/min)?
A. Increase convection
B. Maximize ultrafiltration
C. Maximize diffusion gradient
D. Prevent clotting
➡️ Answer: C. Maximize diffusion gradient

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54. What is the function of the ultrafiltration pump in the dialysis machine?
A. Pump dialysate to the dialyzer
B. Control blood temperature
C. Control fluid removal volume
D. Pump heparin
➡️ Answer: C. Control fluid removal volume

55. Which statement is true about dialysate composition?
A. Potassium is always higher than plasma
B. Bicarbonate is used to correct metabolic alkalosis
C. Calcium is present to maintain cardiac function
D. Dialysate contains blood thinners
➡️ Answer: C. Calcium is present to maintain cardiac function

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56. The main function of the blood pump is to:
A. Regulate dialysate conductivity
B. Ensure constant dialysate flow
C. Move blood through the extracorporeal circuit
D. Detect air bubbles
➡️ Answer: C. Move blood through the extracorporeal circuit

57. During dialysis, a sudden drop in venous pressure may indicate:
A. Dialyzer clotting
B. Disconnection or line leakage
C. Air in the bloodline
D. Patient hypertension
➡️ Answer: B. Disconnection or line leakage

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58. Which parameter should be adjusted if a patient cramps during dialysis?
A. Increase dialysate potassium
B. Increase blood flow rate
C. Decrease ultrafiltration rate
D. Increase dialysate bicarbonate
➡️ Answer: C. Decrease ultrafiltration rate

59. What is the likely cause of an arterial pressure alarm showing high negative pressure?
A. Blood clot in dialyzer
B. Kink or clot in arterial line
C. Air detected in venous line
D. High dialysate pressure
➡️ Answer: B. Kink or clot in arterial line

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60. The 'first use syndrome' associated with a new dialyzer is mostly caused by:
A. Inadequate heparinization
B. Dialysate contamination
C. Ethylene oxide sterilization
D. Low dialysate temperature
➡️ Answer: C. Ethylene oxide sterilization