✅ MCQs – Complications During Hemodialysis (Set 1)
1. The most common acute complication during hemodialysis is:
A. Seizures
B. Hypotension
C. Hemolysis
D. Fever
➡️ Answer: B. Hypotension
2. Which of the following symptoms suggests a dialyzer reaction?
A. Cough, chest pain, hypotension shortly after initiation
B. Fever 4 hours post-dialysis
C. Severe muscle cramp
D. Numbness in legs
➡️ Answer: A. Cough, chest pain, hypotension shortly after initiation
3. Muscle cramps during dialysis are often associated with:
A. Rapid ultrafiltration
B. High dialysate calcium
C. Hyperkalemia
D. High hemoglobin
➡️ Answer: A. Rapid ultrafiltration
4. Which of the following is not a cause of intradialytic hypotension?
A. High ultrafiltration rate
B. Eating during dialysis
C. Excessive dialysate sodium
D. Poor cardiac function
➡️ Answer: C. Excessive dialysate sodium
(Low sodium would cause hypotension; high may cause thirst/hypertension.)
5. The initial step in managing hypotension during dialysis includes:
A. Giving IV iron
B. Lowering the dialysate temperature
C. Trendelenburg position and stop ultrafiltration
D. Continue UF and give oral fluids
➡️ Answer: C. Trendelenburg position and stop ultrafiltration
6. Dialysis disequilibrium syndrome is typically caused by:
A. High calcium in dialysate
B. Rapid urea removal in first dialysis
C. Dehydration before dialysis
D. High potassium level
➡️ Answer: B. Rapid urea removal in first dialysis
(Leads to cerebral edema and neurological symptoms.)
7. Signs of dialysis disequilibrium syndrome include all except:
A. Headache
B. Nausea
C. Seizures
D. Hypertension
➡️ Answer: D. Hypertension
(Hypertension is not typical; hypotension may occur.)
8. Air embolism during hemodialysis is most likely to occur due to:
A. Disconnected arterial needle
B. Venous line not clamped during disconnection
C. High heparin dose
D. Potassium overload
➡️ Answer: B. Venous line not clamped during disconnection
9. A patient develops chest tightness and back pain during dialysis. You suspect:
A. Hyperkalemia
B. Myocardial infarction
C. Hemolysis
D. Hypoglycemia
➡️ Answer: C. Hemolysis
(Also watch for cherry-red blood, hypotension, and nausea.)
10. What is the first action if blood leak is detected during dialysis?
A. Continue dialysis and notify doctor
B. Clamp bloodlines and stop the machine
C. Increase heparin
D. Ignore unless patient is unstable
➡️ Answer: B. Clamp bloodlines and stop the machine
11. Which of the following is a common cause of fever during or after hemodialysis?
A. Dialyzer reaction
B. Volume overload
C. Bacterial contamination of dialysate or access infection
D. Hypoglycemia
➡️ Answer: C. Bacterial contamination of dialysate or access infection
12. An ESRD patient on dialysis presents with arrhythmia during treatment. Which electrolyte is most likely involved?
A. Calcium
B. Potassium
C. Phosphate
D. Magnesium
➡️ Answer: B. Potassium
(Both hyperkalemia and hypokalemia can cause arrhythmias.)
13. If a patient becomes restless, confused, and has a headache during dialysis, you should suspect:
A. Hypernatremia
B. Air embolism
C. Dialysis disequilibrium syndrome
D. Vascular access clotting
➡️ Answer: C. Dialysis disequilibrium syndrome
14. Chest pain during dialysis could be due to all EXCEPT:
A. Angina
B. Dialyzer incompatibility
C. Hypokalemia
D. Hemodialysis disequilibrium
➡️ Answer: D. Hemodialysis disequilibrium
(This mainly causes neurological symptoms.)
15. A sudden drop in venous pressure during dialysis may indicate:
A. Hypoglycemia
B. Dislodged venous needle or line leak
C. Kink in arterial line
D. Dialyzer clotting
➡️ Answer: B. Dislodged venous needle or line leak
16. During dialysis, the nurse notices red or pink-colored dialysate. This most likely indicates:
A. Sepsis
B. Hemolysis
C. Blood leak
D. Dislodged arterial needle
➡️ Answer: C. Blood leak
17. Which of the following is not a common cause of hemolysis during dialysis?
A. Hypotonic dialysate
B. Kinked blood tubing
C. Disinfectant in dialysate
D. High dialysate sodium
➡️ Answer: D. High dialysate sodium
18. What immediate action should be taken if an air embolism is suspected during dialysis?
A. Stop dialysis and place the patient in Trendelenburg and left lateral position
B. Give hypertonic saline
C. Raise the patient’s head
D. Flush the line with saline
➡️ Answer: A. Stop dialysis and place the patient in Trendelenburg and left lateral position
(This helps trap the air in the right atrium.)
19. A patient complains of itching and restlessness during dialysis. Which is most likely the cause?
A. Hyperkalemia
B. Uremia or inadequate dialysis
C. Hypoglycemia
D. Vascular access infection
➡️ Answer: B. Uremia or inadequate dialysis
20. Which of the following is NOT typically a cause of hypertension during dialysis?
A. Volume overload
B. Renin-angiotensin activation
C. Pain or anxiety
D. Excessive ultrafiltration
➡️ Answer: D. Excessive ultrafiltration
(Excessive UF usually leads to hypotension.)
21. What is the most appropriate response to a severe muscle cramp during dialysis?
A. Continue dialysis at same rate
B. Give saline bolus and stop ultrafiltration
C. Increase dialysate sodium
D. Administer glucose
➡️ Answer: B. Give saline bolus and stop ultrafiltration
22. A rise in transmembrane pressure (TMP) during dialysis usually indicates:
A. High blood pressure
B. Filter clotting
C. Dialyzer membrane rupture
D. Blood leak
➡️ Answer: B. Filter clotting
23. What is the most frequent cause of seizures during hemodialysis?
A. Hypoglycemia
B. Dialysis disequilibrium syndrome
C. Hypernatremia
D. Infection
➡️ Answer: B. Dialysis disequilibrium syndrome
24. Intradialytic nausea and vomiting are most commonly due to:
A. High ultrafiltration rate and hypotension
B. Low potassium dialysate
C. Excess sodium
D. Slow blood flow
➡️ Answer: A. High ultrafiltration rate and hypotension
25. Which of the following should be monitored closely during dialysis to detect complications early?
A. Blood pressure
B. Venous and arterial pressure
C. Temperature and heart rate
D. All of the above
➡️ Answer: D. All of the above
26. When should a dialysis nurse suspect clotting in the extracorporeal circuit?
A. Rising venous pressure and falling blood flow
B. Low TMP and low venous pressure
C. Patient vomiting
D. Clear dialysate fluid
➡️ Answer: A. Rising venous pressure and falling blood flow
27. What is the best prevention method for intradialytic hypotension?
A. Cold dialysate and slow ultrafiltration rate
B. High UF rate at start
C. High sodium bath
D. Post-dialysis fluid loading
➡️ Answer: A. Cold dialysate and slow ultrafiltration rate
28. What action should be taken if a patient loses consciousness during dialysis?
A. Increase ultrafiltration rate
B. Clamp bloodlines and call emergency team
C. Continue dialysis and monitor
D. Turn off the dialysis machine
➡️ Answer: B. Clamp bloodlines and call emergency team
29. The most likely cause of hypercalcemia during dialysis is:
A. High calcium dialysate
B. Excess fluid removal
C. Uremia
D. Infection
➡️ Answer: A. High calcium dialysate
30. Which of the following is true regarding chest pain during dialysis?
A. It should be ignored unless severe
B. Always indicates heart failure
C. May indicate angina, air embolism, or hemolysis
D. Is a normal finding in some patients
➡️ Answer: C. May indicate angina, air embolism, or hemolysis
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