1. A patient with end-stage renal disease (ESRD) is scheduled for hemodialysis three

times a week. The nurse knows that the main purpose of hemodialysis is to:

a) remove excess fluid and electrolytes from the blood.

b) correct metabolic acidosis and restore pH balance.

c) filter out waste products and toxins from the blood.

d) stimulate erythropoiesis and increase hemoglobin levels.

*Answer: c) filter out waste products and toxins from the blood.*

Rationale: Hemodialysis is a process that uses an artificial membrane (dialyzer) to

remove waste products and toxins from the blood, as well as to maintain fluid and

electrolyte balance. Hemodialysis does not correct metabolic acidosis, as this is done by

the administration of bicarbonate. Hemodialysis does not stimulate erythropoiesis, as this

is done by the administration of erythropoietin.

2. A patient with ESRD is receiving peritoneal dialysis (PD). The nurse observes that the

dialysate drainage is cloudy and has a foul odor. The nurse suspects that the patient has

developed:

a) peritonitis.

b) infection of the catheter site.

c) leakage of dialysate into the abdominal cavity.

d) hyperglycemia due to glucose absorption from the dialysate.

*Answer: a) peritonitis.*

Rationale: Peritonitis is an inflammation of the peritoneum, which is the lining of the

abdominal cavity. Peritonitis is a serious complication of PD that can result from

contamination of the dialysate or the catheter. Peritonitis causes cloudy and foul-smelling

dialysate drainage, as well as abdominal pain, fever, nausea, vomiting, and malaise.

Infection of the catheter site would cause redness, swelling, drainage, and tenderness at

the insertion site. Leakage of dialysate into the abdominal cavity would cause abdominal

distension, weight gain, and decreased urine output. Hyperglycemia due to glucose

absorption from the dialysate would cause increased thirst, hunger, urination, and blood

glucose levels.

3. A patient with ESRD is undergoing continuous renal replacement therapy (CRRT). The

nurse knows that CRRT differs from intermittent hemodialysis in that CRRT:

a) uses lower blood flow rates and longer treatment times.

b) uses higher blood flow rates and shorter treatment times.

c) requires anticoagulation therapy to prevent clotting of the circuit.

d) requires frequent monitoring of fluid balance and electrolyte levels.

*Answer: a) uses lower blood flow rates and longer treatment times.*

Rationale: CRRT is a form of hemodialysis that uses lower blood flow rates (usually less

than 200 mL/min) and longer treatment times (usually 24 hours or more). CRRT is

indicated for patients who are hemodynamically unstable or have multiple organ failure,

as it provides more gentle and continuous removal of fluid and solutes. CRRT also