✅ Management of Dialysis Complications – MCQs
1. What is the first step in managing intradialytic hypotension?
A. Increase ultrafiltration rate
B. Stop ultrafiltration and lay patient flat with legs elevated
C. Increase dialysate temperature
D. Administer intravenous calcium
➡️ Answer: B. Stop ultrafiltration and lay patient flat with legs elevated
2. Which medication is commonly used to treat muscle cramps during haemodialysis?
A. Intravenous calcium gluconate
B. Oral potassium
C. Intravenous magnesium sulfate
D. Intravenous sodium bicarbonate
➡️ Answer: A. Intravenous calcium gluconate
3. What is the appropriate action if a patient develops chest pain during dialysis?
A. Continue dialysis as usual
B. Stop dialysis immediately and assess for cardiac causes
C. Increase ultrafiltration rate
D. Ignore if mild pain
➡️ Answer: B. Stop dialysis immediately and assess for cardiac causes
4. What is the most common cause of dialysis-related fever?
A. Dialysis membrane reaction
B. Infection, such as catheter-related bloodstream infection
C. Fluid overload
D. Electrolyte imbalance
➡️ Answer: B. Infection, such as catheter-related bloodstream infection
5. How should dialysis disequilibrium syndrome be managed?
A. Increase dialysis duration and ultrafiltration rate
B. Slow dialysis rate and manage symptoms conservatively
C. Administer high doses of diuretics
D. Ignore symptoms and continue usual dialysis
➡️ Answer: B. Slow dialysis rate and manage symptoms conservatively
6. What is the first line treatment for hyperkalemia in a haemodialysis patient?
A. Immediate dialysis
B. Oral potassium supplements
C. Intravenous calcium gluconate and insulin with glucose
D. No treatment required
➡️ Answer: C. Intravenous calcium gluconate and insulin with glucose
7. How is an air embolism during haemodialysis best managed?
A. Place patient in Trendelenburg and left lateral decubitus position
B. Increase blood flow rate
C. Administer intravenous fluids rapidly
D. Ignore if no symptoms
➡️ Answer: A. Place patient in Trendelenburg and left lateral decubitus position
8. What is the management for severe hypotension unresponsive to initial treatment during dialysis?
A. Continue dialysis without changes
B. Discontinue dialysis and provide intravenous fluids and vasopressors if needed
C. Increase ultrafiltration rate
D. Administer oral antihypertensives
➡️ Answer: B. Discontinue dialysis and provide intravenous fluids and vasopressors if needed
9. What should be done if a patient develops signs of anaphylaxis during dialysis?
A. Continue dialysis and monitor closely
B. Stop dialysis immediately and administer intramuscular epinephrine
C. Increase dialysate sodium concentration
D. Administer oral antihistamines only
➡️ Answer: B. Stop dialysis immediately and administer intramuscular epinephrine
10. How is clotting in the dialysis circuit usually managed?
A. Increase blood flow rate
B. Administer anticoagulants such as heparin
C. Decrease ultrafiltration rate
D. Ignore if mild
➡️ Answer: B. Administer anticoagulants such as heparin
11. What is the recommended treatment for Dialysis Disequilibrium Syndrome (DDS)?
A. Increase blood flow rate rapidly
B. Shorten dialysis sessions
C. Slow or shorten dialysis and manage symptoms with anticonvulsants if needed
D. Ignore symptoms and continue as usual
➡️ Answer: C. Slow or shorten dialysis and manage symptoms with anticonvulsants if needed
12. During dialysis, a patient develops sudden shortness of breath and hypotension. What is the likely complication?
A. Dialysis disequilibrium syndrome
B. Air embolism
C. Muscle cramps
D. Fever
➡️ Answer: B. Air embolism
13. Which of the following is a common cause of intradialytic muscle cramps?
A. Hypokalemia
B. Excessive ultrafiltration leading to hypovolemia
C. Hypernatremia
D. Hypercalcemia
➡️ Answer: B. Excessive ultrafiltration leading to hypovolemia
14. What immediate action should be taken if a patient develops a seizure during dialysis?
A. Increase dialysate flow rate
B. Stop dialysis, protect airway, and manage seizure
C. Continue dialysis with slower blood flow
D. Administer oral sedatives and continue
➡️ Answer: B. Stop dialysis, protect airway, and manage seizure
15. How should hypotension during dialysis be prevented?
A. Rapid ultrafiltration rate
B. Monitor dry weight and adjust ultrafiltration accordingly
C. Use cold dialysate always
D. Increase dialysate sodium concentration drastically
➡️ Answer: B. Monitor dry weight and adjust ultrafiltration accordingly
16. What is the most effective way to manage access site bleeding during dialysis?
A. Apply firm pressure over the site
B. Increase blood flow rate
C. Use anticoagulants immediately
D. Ignore if minor bleeding
➡️ Answer: A. Apply firm pressure over the site
17. If a patient experiences a dialysis reaction with fever and chills, what should be the initial step?
A. Stop dialysis and assess for infection or reaction
B. Continue dialysis and give antipyretics
C. Increase ultrafiltration rate
D. Administer antihypertensives
➡️ Answer: A. Stop dialysis and assess for infection or reaction
18. What electrolyte abnormality is commonly corrected by haemodialysis?
A. Hyperkalemia
B. Hypernatremia
C. Hypocalcemia
D. Hyponatremia
➡️ Answer: A. Hyperkalemia
19. What is the best approach to managing dialysis-associated hypotension refractory to fluids?
A. Use vasopressor support and review dialysis prescription
B. Increase ultrafiltration rate
C. Discontinue dialysis permanently
D. No intervention required
➡️ Answer: A. Use vasopressor support and review dialysis prescription
20. How should dialyzer clotting during dialysis be prevented?
A. Maintain adequate anticoagulation with heparin or alternatives
B. Reduce blood flow rate only
C. Increase ultrafiltration rate
D. No prevention needed
➡️ Answer: A. Maintain adequate anticoagulation with heparin or alternatives
21. What is the first step when a patient experiences severe hypotension during dialysis?
A. Increase ultrafiltration rate
B. Stop ultrafiltration and lay patient flat with legs elevated
C. Administer intravenous antibiotics
D. Increase dialysate temperature
➡️ Answer: B. Stop ultrafiltration and lay patient flat with legs elevated
22. Which of the following is a common cause of fever during dialysis?
A. Dialysis membrane reaction
B. Catheter-related bloodstream infection
C. Electrolyte imbalance
D. Dialysis disequilibrium syndrome
➡️ Answer: B. Catheter-related bloodstream infection
23. How is dialysis-related muscle cramping best managed?
A. Decrease ultrafiltration rate and provide supportive care
B. Increase ultrafiltration rate
C. Administer intravenous potassium
D. Increase dialysate sodium
➡️ Answer: A. Decrease ultrafiltration rate and provide supportive care
24. What is the immediate management of suspected air embolism during dialysis?
A. Place patient in Trendelenburg and left lateral decubitus position
B. Increase blood flow rate
C. Increase ultrafiltration
D. Administer intravenous calcium
➡️ Answer: A. Place patient in Trendelenburg and left lateral decubitus position
25. What complication should be suspected if a patient develops chills and fever midway during dialysis?
A. Hypotension
B. Dialysis reaction or infection
C. Muscle cramps
D. Air embolism
➡️ Answer: B. Dialysis reaction or infection
26. Which intervention is critical when managing severe bleeding from the vascular access site?
A. Apply direct pressure immediately
B. Increase blood flow rate
C. Remove vascular access
D. Administer anticoagulants
➡️ Answer: A. Apply direct pressure immediately
27. How can dialysis disequilibrium syndrome be prevented?
A. Use high-efficiency dialysis from the start
B. Initiate dialysis slowly with shorter and lower blood flow sessions
C. Increase ultrafiltration rate quickly
D. Ignore and continue dialysis as usual
➡️ Answer: B. Initiate dialysis slowly with shorter and lower blood flow sessions
28. What is the typical cause of hypotension during dialysis?
A. Fluid overload
B. Excessive ultrafiltration causing hypovolemia
C. Hyperkalemia
D. Infection
➡️ Answer: B. Excessive ultrafiltration causing hypovolemia
29. What is the best way to manage dialyzer clotting?
A. Ensure adequate anticoagulation during dialysis
B. Increase ultrafiltration rate
C. Reduce blood flow rate
D. Stop dialysis immediately
➡️ Answer: A. Ensure adequate anticoagulation during dialysis
30. What should be done if a patient develops chest pain and shortness of breath during dialysis?
A. Continue dialysis and observe
B. Stop dialysis and evaluate for cardiac or pulmonary complications
C. Increase dialysate sodium concentration
D. Administer oral analgesics and continue
➡️ Answer: B. Stop dialysis and evaluate for cardiac or pulmonary complications
31. Which electrolyte imbalance is a common cause of cardiac arrhythmias during dialysis?
A. Hypokalemia
B. Hyperkalemia
C. Hypocalcemia
D. Hypernatremia
➡️ Answer: B. Hyperkalemia
32. What is the recommended action if a patient develops dialysis access thrombosis?
A. Increase ultrafiltration rate
B. Immediate referral for vascular surgery or interventional radiology
C. Stop dialysis permanently
D. Continue dialysis without intervention
➡️ Answer: B. Immediate referral for vascular surgery or interventional radiology
33. Which complication is characterized by sudden hypotension, chest pain, and respiratory distress during dialysis?
A. Dialysis disequilibrium syndrome
B. Air embolism
C. Muscle cramps
D. Infection
➡️ Answer: B. Air embolism
34. How should intradialytic hypertension be managed?
A. Decrease ultrafiltration rate
B. Review dry weight and adjust antihypertensive medications
C. Ignore if asymptomatic
D. Increase dialysate sodium concentration
➡️ Answer: B. Review dry weight and adjust antihypertensive medications
35. What is a common cause of dialysis-related fever without chills?
A. Dialysis membrane reaction
B. Bacterial infection
C. Hypotension
D. Air embolism
➡️ Answer: A. Dialysis membrane reaction
36. How can dialysis access infection be prevented?
A. Proper aseptic technique during cannulation
B. Reuse of catheters without sterilization
C. Ignoring skin disinfection
D. Sharing dialysis machines between patients
➡️ Answer: A. Proper aseptic technique during cannulation
37. What is the appropriate management of hypotension due to excessive ultrafiltration?
A. Increase fluid removal
B. Stop or reduce ultrafiltration and provide fluid replacement if necessary
C. Ignore and continue dialysis
D. Increase blood flow rate
➡️ Answer: B. Stop or reduce ultrafiltration and provide fluid replacement if necessary
38. What complication might arise from rapid changes in plasma osmolality during dialysis?
A. Dialysis disequilibrium syndrome
B. Hypotension
C. Muscle cramps
D. Access infection
➡️ Answer: A. Dialysis disequilibrium syndrome
39. What is the treatment for suspected anaphylactic reaction during dialysis?
A. Administer epinephrine immediately and stop dialysis
B. Continue dialysis and observe
C. Administer antihypertensives
D. Increase ultrafiltration rate
➡️ Answer: A. Administer epinephrine immediately and stop dialysis
40. What is the best preventive measure against clotting in the dialysis circuit?
A. Regular anticoagulation with heparin or alternatives
B. Increase dialysate temperature
C. Decrease blood flow rate
D. Ignore minor clotting
➡️ Answer: A. Regular anticoagulation with heparin or alternatives
41. What is the initial management step for a patient who develops severe chest pain and hypotension during dialysis?
A. Continue dialysis and monitor
B. Stop dialysis, assess airway and circulation, and prepare for emergency treatment
C. Increase ultrafiltration rate
D. Administer oral painkillers and continue
➡️ Answer: B. Stop dialysis, assess airway and circulation, and prepare for emergency treatment
42. Which complication is suggested by the presence of blood leaking from the dialysis machine circuit?
A. Dialyzer clotting
B. Circuit disconnection or rupture
C. Access infection
D. Dialysis disequilibrium syndrome
➡️ Answer: B. Circuit disconnection or rupture
43. How should hypotension unresponsive to fluids be managed during dialysis?
A. Increase ultrafiltration
B. Use vasopressors and reassess dialysis prescription
C. Ignore and continue dialysis
D. Decrease blood flow rate only
➡️ Answer: B. Use vasopressors and reassess dialysis prescription
44. What is the recommended treatment if a patient has severe allergic reaction to the dialyzer?
A. Continue dialysis with same dialyzer
B. Stop dialysis immediately and provide supportive treatment including antihistamines and steroids
C. Increase dialysate sodium
D. Ignore and continue
➡️ Answer: B. Stop dialysis immediately and provide supportive treatment including antihistamines and steroids
45. What is a common cause of muscle cramps during haemodialysis?
A. Hypovolemia due to excessive ultrafiltration
B. Hyperkalemia
C. Hypercalcemia
D. Infection
➡️ Answer: A. Hypovolemia due to excessive ultrafiltration
46. What is the MOH recommended action if total chlorine levels in dialysis water exceed limits?
A. Continue dialysis with caution
B. Stop dialysis until water treatment is corrected
C. Dilute water with untreated water
D. Ignore if patient is asymptomatic
➡️ Answer: B. Stop dialysis until water treatment is corrected
47. How should bleeding from a vascular access site be managed during dialysis?
A. Apply direct pressure and consult vascular team if needed
B. Increase anticoagulation
C. Continue dialysis as usual
D. Remove vascular access immediately
➡️ Answer: A. Apply direct pressure and consult vascular team if needed
48. What is the main treatment for hyperkalemia in an acute dialysis setting?
A. Immediate dialysis combined with medical treatment like calcium gluconate and insulin/glucose
B. Increase potassium intake
C. Decrease dialysis duration
D. Ignore if asymptomatic
➡️ Answer: A. Immediate dialysis combined with medical treatment like calcium gluconate and insulin/glucose
49. What is the primary cause of dialysis disequilibrium syndrome?
A. Rapid removal of urea and solutes causing cerebral edema
B. Infection
C. Excessive ultrafiltration
D. Electrolyte imbalance
➡️ Answer: A. Rapid removal of urea and solutes causing cerebral edema
50. Which of the following is a key preventive measure for infection in haemodialysis patients?
A. Routine hand hygiene and aseptic technique during access manipulation
B. Sharing equipment between patients without cleaning
C. Avoiding vaccination
D. Ignoring early signs of infection
➡️ Answer: A. Routine hand hygiene and aseptic technique during access manipulation
51. What is the recommended initial management for a patient experiencing severe muscle cramps during dialysis?
A. Increase ultrafiltration rate
B. Decrease or stop ultrafiltration and stretch the affected muscles
C. Administer intravenous potassium
D. Increase dialysate sodium
➡️ Answer: B. Decrease or stop ultrafiltration and stretch the affected muscles
52. Which of the following is an indication of air embolism during dialysis?
A. Sudden hypotension, dyspnea, and chest pain
B. Gradual onset fever
C. Muscle cramps
D. Gradual rise in blood pressure
➡️ Answer: A. Sudden hypotension, dyspnea, and chest pain
53. How should an anaphylactic reaction to dialysis membrane be treated?
A. Administer intramuscular epinephrine and stop dialysis
B. Continue dialysis and monitor
C. Administer oral antihistamines only
D. Increase dialysate temperature
➡️ Answer: A. Administer intramuscular epinephrine and stop dialysis
54. What is the first action if a dialysis patient develops sudden hypotension and loss of consciousness?
A. Continue dialysis
B. Stop dialysis, secure airway, and initiate resuscitation
C. Increase ultrafiltration
D. Administer oral fluids
➡️ Answer: B. Stop dialysis, secure airway, and initiate resuscitation
55. Which of the following can cause dialysis-related fever?
A. Bloodstream infection
B. Allergic reaction to dialyzer membrane
C. Both A and B
D. None of the above
➡️ Answer: C. Both A and B
56. What is the best way to prevent vascular access infections?
A. Routine hand hygiene and aseptic cannulation technique
B. Use same needle for multiple patients
C. Ignore skin antisepsis
D. Delay catheter replacement indefinitely
➡️ Answer: A. Routine hand hygiene and aseptic cannulation technique
57. How should hypotension during dialysis be prevented?
A. Avoid excessive ultrafiltration and monitor patient’s dry weight closely
B. Use rapid fluid removal
C. Increase dialysate sodium concentration indiscriminately
D. Ignore symptoms and continue dialysis
➡️ Answer: A. Avoid excessive ultrafiltration and monitor patient’s dry weight closely
58. What complication is associated with rapid reduction in serum osmolality during dialysis?
A. Dialysis disequilibrium syndrome
B. Muscle cramps
C. Access thrombosis
D. Infection
➡️ Answer: A. Dialysis disequilibrium syndrome
59. Which intervention is appropriate for management of clotting in the dialysis circuit?
A. Increase anticoagulation dosing
B. Reduce blood flow rate only
C. Stop dialysis permanently
D. Ignore minor clotting
➡️ Answer: A. Increase anticoagulation dosing
60. What is the appropriate treatment for access site bleeding during dialysis?
A. Apply direct pressure and hold until bleeding stops
B. Increase anticoagulation
C. Continue dialysis without intervention
D. Remove access immediately
➡️ Answer: A. Apply direct pressure and hold until bleeding stops
61. What is the common cause of chest pain during haemodialysis?
A. Myocardial ischemia due to hypotension
B. Muscle cramps
C. Electrolyte imbalance only
D. Air embolism only
➡️ Answer: A. Myocardial ischemia due to hypotension
62. What is the main cause of intradialytic hypotension?
A. Excessive ultrafiltration causing hypovolemia
B. Hyperkalemia
C. Hypercalcemia
D. Infection
➡️ Answer: A. Excessive ultrafiltration causing hypovolemia
63. How is dialysis-related muscle cramps best prevented?
A. Avoid rapid fluid removal and maintain adequate hydration
B. Increase dialysate potassium
C. Decrease dialysate sodium
D. Increase ultrafiltration rate
➡️ Answer: A. Avoid rapid fluid removal and maintain adequate hydration
64. What is the immediate treatment for anaphylactic reaction during dialysis?
A. Stop dialysis and administer intramuscular epinephrine
B. Continue dialysis with antihistamines
C. Increase dialysate sodium concentration
D. Administer oral corticosteroids only
➡️ Answer: A. Stop dialysis and administer intramuscular epinephrine
65. Which complication can be caused by rapid removal of urea during dialysis?
A. Dialysis disequilibrium syndrome
B. Infection
C. Access thrombosis
D. Muscle cramps
➡️ Answer: A. Dialysis disequilibrium syndrome
66. What is the appropriate response to access site bleeding during dialysis?
A. Apply firm pressure and monitor
B. Increase anticoagulation
C. Continue dialysis without intervention
D. Remove the access immediately
➡️ Answer: A. Apply firm pressure and monitor
67. What is a typical sign of dialysis-associated infection?
A. Fever and chills during or after dialysis
B. Hypotension only
C. Muscle cramps
D. Hypertension
➡️ Answer: A. Fever and chills during or after dialysis
68. What is the recommended management of air embolism during haemodialysis?
A. Place patient in Trendelenburg and left lateral decubitus position
B. Increase ultrafiltration
C. Continue dialysis as usual
D. Administer oral fluids
➡️ Answer: A. Place patient in Trendelenburg and left lateral decubitus position
69. What is a preventive strategy for dialysis disequilibrium syndrome?
A. Initiate dialysis with low blood and dialysate flow rates
B. Use high-efficiency dialysis immediately
C. Increase ultrafiltration rate
D. Ignore symptoms
➡️ Answer: A. Initiate dialysis with low blood and dialysate flow rates
70. Which of the following is the most effective way to prevent infection in dialysis patients?
A. Proper hand hygiene and aseptic technique
B. Reuse needles between patients
C. Avoid vaccination
D. Ignore early signs of infection
➡️ Answer: A. Proper hand hygiene and aseptic technique
71. Which electrolyte disturbance is most commonly corrected by dialysis?
A. Hyperkalemia
B. Hyponatremia
C. Hypocalcemia
D. Hypermagnesemia
➡️ Answer: A. Hyperkalemia
72. What is the first step when a patient develops sudden shortness of breath and chest pain during dialysis?
A. Stop dialysis and assess for complications such as air embolism or myocardial ischemia
B. Continue dialysis and monitor
C. Increase dialysate temperature
D. Administer intravenous calcium
➡️ Answer: A. Stop dialysis and assess for complications such as air embolism or myocardial ischemia
73. Which condition is characterized by rapid onset of fever, chills, and hypotension during dialysis?
A. Dialysis reaction (pyrogenic reaction)
B. Muscle cramps
C. Hypotension due to ultrafiltration
D. Dialysis disequilibrium syndrome
➡️ Answer: A. Dialysis reaction (pyrogenic reaction)
74. What is the most effective way to prevent vascular access thrombosis?
A. Regular monitoring and anticoagulation as appropriate
B. Avoid dialysis altogether
C. Increase ultrafiltration rate
D. Use high dialysate sodium concentration
➡️ Answer: A. Regular monitoring and anticoagulation as appropriate
75. Which complication is best managed by slowing dialysis blood flow rate and duration?
A. Dialysis disequilibrium syndrome
B. Access thrombosis
C. Infection
D. Muscle cramps
➡️ Answer: A. Dialysis disequilibrium syndrome
76. What is the best initial treatment for muscle cramps during dialysis?
A. Decrease ultrafiltration rate and stretch muscles
B. Increase blood flow rate
C. Increase dialysate potassium
D. Administer oral potassium supplements
➡️ Answer: A. Decrease ultrafiltration rate and stretch muscles
77. What should be done if the dialysis circuit becomes clotted?
A. Administer anticoagulants and assess dialysis prescription
B. Ignore and continue dialysis
C. Increase ultrafiltration rate
D. Stop dialysis permanently
➡️ Answer: A. Administer anticoagulants and assess dialysis prescription
78. Which of the following is the initial treatment of anaphylaxis during dialysis?
A. Administer intramuscular epinephrine and stop dialysis
B. Continue dialysis and monitor symptoms
C. Administer oral antihistamines only
D. Increase dialysate sodium concentration
➡️ Answer: A. Administer intramuscular epinephrine and stop dialysis
79. What is the cause of dialysis disequilibrium syndrome?
A. Rapid removal of urea causing cerebral edema
B. Infection
C. Excessive ultrafiltration
D. Air embolism
➡️ Answer: A. Rapid removal of urea causing cerebral edema
80. How can infection risk be minimized in dialysis patients?
A. Strict hand hygiene, aseptic technique, and vaccination
B. Sharing dialysis equipment between patients
C. Avoiding vaccinations
D. Ignoring minor infections
➡️ Answer: A. Strict hand hygiene, aseptic technique, and vaccination
