Certified Peritoneal Dialysis Nurse Practice Test

BONENT-CPDN test Format | Course Contents | Course Outline | test Syllabus | test Objectives

Exam Code: CPDN
Exam Name: BONENT Certified Peritoneal Dialysis Nurse
Questions asked: 150 multiple-choice questions
Passing Marks: 70%
Time Allotted: 3 Hours
Exam Type: Computer-Based Testing (CBT)

DOMAIN I: Nursing Process (60%)
Collect- document and analyze patient information before- during- and after dialysis in order to maintain and/or Excellerate the quality of patient care through continuous evaluation and ongoing revision of interventions.
- Interviewing Techniques
- Physical Assessment
- Normal and abnormal patient signs and symptoms
- Nursing Assessment
- Patient- family- and significant others’ knowledge- skills- and self-care abilities
- Gross and fine motor coordination
- Hand strength
- Vision
- Human Anatomy and Physiology
- Anatomy and physiology of the kidney and urinary system
- Anatomy and physiology of the peritoneum
- Fluid balance
- Acid base balance
- Electrolyte balance
- Erythropoiesis
- Pathophysiology of the Kidney and Urinary System
- Etiologies of End Stage Renal Disease
- Laboratory Testing
- Patient preparation
- Nursing responsibilities
- Interpretation of results
- Diagnostic Testing
- Patient preparation
- Nursing responsibilities
- Interpretation of results
- Pharmacology
- General
- Alterations in drug excretion and metabolism in end stage renal disease
- Drugs used frequently in ESRD patients
- Alterations in drug metabolism and excretion in peritoneal dialysis
- Kinetics of intraperitoneally administered medications
- Antibiotics used in peritonitis
- Methods of administration
- Medical and Surgical Asepsis
- Clinical Manifestations of End Stage Renal Disease
- Dietary Prescriptions for End Stage Renal Disease Patients
- Predialysis
- Peritoneal dialysis
- Hemodialysis
- Transplantation
- General Principles of Dialysis
- Osmosis
- Diffusion
- Ultrafiltration
- Blood flow
- Membrane area
- Dialysis solution
- Kinetics of Peritoneal Dialysis
- Dialysate to plasma equilibration
- Ultrafiltration patterns
- Absorption of calcium- dextrose
- Obligatory losses of protein- water soluble vitamins- hormones
- Factors that influence ultrafiltration
- Factors that influence solute transport
- Drug transport
- Kt/V measurement
- Peritonal Membrane Characteristics
- Measurement of peritoneal membrane characteristics (PET)
- Types of Peritoneal Dialysis
- CAPD
- CCPD
- IPD or NPD
- Peritoneal Dialysis Systems
- (i.e.- Cyclers; CAPD systems – bag-spike- bag-spike with assist device; disconnect systems; sterile connections device)
- Dialysis Solutions
- Composition
- Dextrose concentrations
- Volumes
- Containers
- Access
- Types
- acute
- chronic
- Preoperative nursing management
- Insertion techniques
- Postoperative management
- Peritoneal Dialysis Prescription
- Type of dialysis (i.e.- IPD- CAPD- CCPD)
- Frequency of dialysis
- Exchange volume
- Number exchanges
- Type(s) solution
- System of equipment to be used
- Time (total exchange- fill time- dwell time- drain time- etc.)
- Additives
- Acute Peritoneal Dialysis (hospitalized- ill patients)
- Indications
- Predialysis patient assessment and education
- Initiating and terminating dialysis
- Monitoring
- Patient education- psychosocial support during treatment
- Procedures
- Chronic automated dialysis (IPD- CCPD)
- predialysis patient assessment
- machine set up
- initiation of dialysis
- technical problem solving- troubleshooting
- diagnosis and management of patient problems/complicaitons
- discontinuing dialysis
- post dialysis assessment
- documentation
- Chronic manual dialysis (CAPD)
- procedure for initiation of dialysis
- exchange procedure
- daily patient assessment- documentation
- diagnosis and management of patient problems/complications
- technical problems
- procedure to discontinue or interrupt dialysis
- Other procedures
- warming dialysis solutions
- adding medications for IP administration
- catheter fluoroscopy
- CT scan for diagnosis of internal leaks
- splicing damaged catheter
- changing catheter adapter
- transfer set change
- Complications
- Infectious: Etiology- signs and symptoms- diagnostic evaluation- nursing- medical and surgical intervention- sequelae of:
- peritonitis
- exit site infection
- subcutaneous tunnel infection
- intraperitoneal abscess
- systemic infection (septicemia)
- recurrent infections
- Noninfectious: Etiology- signs and symptoms- diagnostic evaluation- nursing- medical and surgical intervention- sequelae of:
- catheter related problems
- malfunction (i.e.- malposition- obstruction- air lock- other)
- pain
- cuff erosion
- cuff extrusion
- damage to catheter
- surgical complications
- bladder perforation
- bowel perforation
- incisional pain
- external leak
- subcutaneous leak
- hemorrhage
- ileus
- complications resulting from increased intraabdominal pressure
- hernia
- hemorrhage
- dialysate leaks
- problems related to peritoneal dialysis (inherent and due to less than optimal management)
- pain
- abdominal pain
- low pH
- solution infusion
- empty abdomen
- low back pain
- shoulder pain
- pneumoperitoneum
- fibrin production
- blood in dialysate
- pleural leak
- changes in pulmonary function
- changes in cardiovascular function
- inherent glucose load
- changes in glucose metabolism
- fluid overload
- hyperkalemia
- hypokalemia
- hypernatremia
- hyponatremia
- hyperphosphatemia
- hypertension
- hypotension
- hyperglycemia
- protein losses
- other losses
- peritoneal eosinophilia
- significant changes in membrane permeability
- Contraindications to Peritoneal Dialysis
- Hypercatabolism
- Pleural-peritoneal communication
- Inadequate membrane permeability
- Relative contraindications
- Outpatient Nursing Management of the Chronic Peritoneal Dialysis Patient
- Ongoing assessment- nursing diagnosis and intervention
- Anemia
- etiology
- management
- erythropoietin
- administration
- Diabetes mellitus
- pathophysiology
- glucose control
- insulin pharmacokinetics
- blood glucose monitoring
- urine testing
- systemic complications
- intraperitoneal and subcutaneous insulin administration
- Gerontology
- physiologic changes associated with aging
- interventions to facilitate vision
- interventions to facilitate hearing
- Other Treatment Modalities
- Principles of transplantation
- candidate selection criteria
- pre-transplant evaluation
- surgical proedure
- immunosuppressive therapy
- complications
- success/failure rates
- Principles of hemodialysis
- indications
- access
- components of the extracorporeal system
- solute and fluid removal
- treatment parameters
- complications

DOMAIN II: Administration (10%)
- Management
- Establish and implement policies/procedures/standards relating to personnel management of patient care staff in order to deliver
- Patient needs and staffing patterns
- Staff abilities and limitations
- Standards of dialysis care
- Unit policies and procedures relating to personnel management
- Medical-ethical issues involved with patient care
- Staff Training and Development
- Environmental Control
- Biological agents
- potential hazards
- effects of biological agents
- routes of transmission
- Infection control
- CDC recommendations
- OSHA Standards
- Hazards Prevention and Control
- i.e.- fire- bomb threats- power failures- etc.
- EPA requirements
- Equipment and Supplies
Develop and implement policies and procedures for evaluation- use and maintenance of equipment and supplies in order to deliver safe- effective- and economical care.
- status of dialysis technology
- Critical elements for evaluation of dialysis equipment and supplies
- Budgeting/Financial Planning
Determine short and long term operational and financial goals and strategies in order to achieve efficient management of the peritoneal dialysis program.
- Budget/financial/operational planning
- Reimbursement structure
- Regulations/options
- Institution’s financial strategies and billing system
- Quality Assurance
Establish and implement a quality assurance program that ensures compliance with established standards in order to provide optimal patient care.
- Continuous quality improvement


DOMAIN III: Education (20%)
Instruction and guidance for the patient and/or family
and significant others in peritoneal dialysis theory and procedures based on the principles of adult learning- to achieve optimal health status.
- Principles of Learning
- Learning styles
- Teaching methods
- Learning domains
- i.e.- cognitive- psychomotor- affective
- Activities and Teaching
- Comparison to nursing process
- Assessment/diagnosis phase
- assessment of learning needs
- assessment of readiness and ability to learn
- Planning phase
- teaching activities
- purpose
- developing the teaching plan
- behavioral objectives
- content and outline
- learning activities
- alternative teaching strategies
- evaluation
- Implementation phase
- Evaluation phase


DOMAIN IV: Professional Development (10%)
- Information Sharing
Share information with colleagues to stimulate professional growth by participating in and/or organizing formal inservice programs- disseminating professional literature and attending professional meetings.
- Professional literature
- Professional organizations
- Research
Participate in and/or conduct research designed to analyze and validate current practice and procedures and generate new knowledge. Communicate the information obtained to clarify- revise- and strengthen nursing practice.
- Scientific method and its application
- Research design and implementation
- Ethics
Adhere to the professional code of ethics (e.g.- patient confidentiality- patient’s rights- informed consent- allocation of resources) and intervene- if necessary- when violations of practice standards- institutional policies- codes of ethics- or legal standards have been identified in order to protect the peritoneal dialysis patient and the public.
- Nursing Code of Ethics
- State Nurse Practice Act
- Patient’s Bill of Rights
- Nursing Practice Standards
- Patient Care Standards
- Legislative process
- legal standards
- legal ramifications

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Question: 1089
A PD unit manager is addressing a fire hazard after a small electrical fire in the storage room. The unit�s
fire safety protocol requires annual drills and compliance with NFPA 101 Life Safety Code. A patient on
APD with a cycler reports smoke exposure, with a SpO2 of 92% and respiratory rate of 24 breaths/min.
What should the manager include in the revised protocol to prevent future incidents?
A. Train staff to evacuate patients immediately upon any smoke detection
B. Limit cycler use to battery-powered models to reduce electrical risks
C. Require staff to store all electrical equipment in fireproof cabinets
D. Conduct fire drills biannually and install additional smoke detectors
Answer: D
Explanation: Conducting fire drills biannually and installing additional smoke detectors enhances fire
safety per NFPA 101 while addressing the patient�s smoke exposure risk (SpO2 92%). Limiting cycler
use to battery-powered models is impractical and not standard. Storing equipment in fireproof cabinets is
insufficient to address broader fire risks. Immediate evacuation may be unsafe without assessing the
situation, especially for PD patients mid-treatment.
Question: 1090
A 55-year-old patient on CAPD develops severe abdominal pain and pneumoperitoneum on CT scan
after a accurate exchange. The patient is afebrile, and dialysate analysis shows no infection. The dialysate
flow rate is 200 mL/min, and the patient uses 2.5% dextrose solution. What is the most likely cause of
pneumoperitoneum, and how should it be managed?
A. Catheter introduction of air; reduce fill volume
B. Bowel perforation; urgent surgical consultation
C. Peritonitis; initiate intraperitoneal antibiotics
D. Visceral irritation; switch to 1.5% dextrose solution
Answer: A
Explanation: Pneumoperitoneum in peritoneal dialysis patients is often due to air introduced via the
catheter during exchanges, especially in the absence of fever or infection. Reducing fill volume can
minimize air entry and intra-abdominal pressure. Bowel perforation is unlikely without systemic signs or
abnormal dialysate analysis. Peritonitis is ruled out by negative dialysate cultures. Switching to 1.5%
dextrose solution addresses visceral irritation but not pneumoperitoneum.
Question: 1091
During transfer set change, which step is critical to reduce the risk of bacterial contamination?
A. Following sterile technique and disinfecting catheter hub with antimicrobial solution before and after
change
B. Disconnecting old transfer set and immediately applying the new set without disinfection
C. Flushing the peritoneal cavity with saline before changing the transfer set
D. Changing the transfer set only when visible contamination is present
Answer: A
Explanation: Disinfecting the catheter hub with antimicrobial solution before and after transfer set change
and strict sterile technique are essential to minimize peritonitis risk. Immediate connection without
disinfection and waiting for visible contamination are unsafe.
Question: 1092
What is the rationale for using 2.5% dextrose peritoneal dialysate solution compared to 1.5% in chronic
PD patients?
A. To promote greater ultrafiltration in patients with fluid overload
B. To reduce glucose absorption and hyperglycemia risk
C. To decrease protein loss during dialysis
D. To enhance clearance of middle molecules
Answer: A
Explanation: Higher glucose concentration solutions like 2.5% provide greater osmotic gradient leading
to increased ultrafiltration, useful in fluid overloaded patients. Higher glucose increases glucose
absorption and hyperglycemia risk. Protein loss and middle molecule clearance are not significantly
affected.
Question: 1093
A peritoneal dialysis patient develops acute dyspnea and decreased ultrafiltration volume. Imaging
reveals a pleural effusion on the right side. What parameter in the dialysate fluid is most consistent with
a pleural leak?
A. Presence of pleural fibrin strands
B. Decreased dialysate sodium concentration
C. Elevated dialysate potassium concentration
D. Increased dialysate glucose concentration in pleural fluid
Answer: D
Explanation: A pleural leak in peritoneal dialysis is usually due to diaphragmatic defects permitting
dialysate to migrate from the peritoneal cavity into the pleural space, commonly on the right side. The
hallmark diagnostic finding is a pleural effusion with a high glucose concentration, similar to dialysate
fluid glucose (which is higher than serum).
Question: 1094
What is the most common route of transmission for biological agents causing peritoneal dialysis
infections?
A. Vector-borne transmission via insects
B. Airborne particles in the dialysis unit
C. Touch contamination of catheter exit sites or connection systems
D. Waterborne transmission through dialysate solution
Answer: C
Explanation: Touch contamination during exchanges or poor exit site care mainly leads to infections.
Airborne, vector, or waterborne routes are less common if proper procedures and solution manufacturing
standards are followed.
Question: 1095
A 57-year-old patient on APD reports weight gain and shortness of breath. The nurse notes 1 L of
ultrafiltration with 2.5% dextrose and a dwell time of 2 hours. What factor is most likely limiting
ultrafiltration?
A. High peritoneal membrane permeability
B. Inadequate dwell time
C. Low dextrose concentration
D. Reduced membrane surface area
Answer: B
Explanation: Inadequate dwell time (2 hours) limits ultrafiltration in APD, as the osmotic gradient
dissipates before optimal fluid removal (Inadequate dwell time). High permeability (High peritoneal
membrane permeability) enhances, not limits, ultrafiltration. Low dextrose (Low dextrose concentration)
is less likely with 2.5% dextrose. Reduced membrane area (Reduced membrane surface area) is
uncommon without surgical history.
Question: 1096
A patient on peritoneal dialysis has a low serum albumin of 2.8 g/dL and is noted to have protein losses
in dialysate of 7 g/day. Which nutritional intervention is most appropriate?
A. Restrict protein intake to reduce losses
B. Limit fluid intake to prevent dilution
C. Supplement dialysate with albumin
D. Increase dietary protein intake to 1.2-1.3 g/kg/day
Answer: D
Explanation: PD patients lose protein daily via dialysate, requiring increased dietary protein intake (1.2�
1.3 g/kg/day) to maintain adequate nutrition and prevent malnutrition. Restriction worsens catabolism.
Albumin supplementation in dialysate is ineffective. Fluid restriction does not address protein loss.
Question: 1097
A transplant candidate with a BMI of 34 kg/m� is undergoing evaluation. Which criterion is most likely
to exclude them from transplantation?
A. accurate myocardial infarction within 3 months
B. History of non-compliance with dialysis
C. BMI alone if controlled with diet
D. Type 2 diabetes with HbA1c of 7.5%
Answer: A
Explanation: A accurate myocardial infarction (within 3�6 months) is a contraindication to transplantation
due to high perioperative cardiac risk. BMI of 34 may require optimization but is not an absolute
exclusion. Non-compliance is a concern but not an automatic exclusion. Controlled diabetes is not a
contraindication.
Question: 1098
Which lab value is most critical for evaluating peritoneal dialysis adequacy and should be monitored
regularly?
A. Serum potassium level
B. Hemoglobin A1c
C. Serum albumin
D. Blood urea nitrogen (BUN) and creatinine clearance
Answer: D
Explanation: BUN and creatinine clearance are indicators of solute removal efficacy, vital for dialysis
adequacy.
Question: 1099
A patient with ESRD from polycystic kidney disease is on PD. Which systemic complication is most
frequently associated with this condition?
A. Intracranial aneurysms
B. Hyperkalemia
C. Pulmonary hypertension
D. Bone fractures
Answer: A
Explanation: Polycystic kidney disease is associated with increased risk of intracranial aneurysms due to
vascular abnormalities.
Question: 1100
A chronic PD patient demonstrates inadequate dialysis clearance with a D/P creatinine ratio of 0.45 on
the peritoneal equilibration test. What does this indicate?
A. Low transporter status with slow solute equilibration
B. High transporter status with rapid solute equilibration
C. Normal peritoneal membrane permeability
D. Dialysis catheter malfunction
Answer: A
Explanation: A D/P creatinine ratio below 0.5 indicates low transporter status, meaning slow
equilibration of solutes and possibly reduced dialysis adequacy. High transporter status usually shows
D/P >0.8.
Question: 1101
A 54-year-old patient on CAPD has a dialysate effluent with a WBC count of 200/mm� and reports
abdominal pain. The nurse is teaching the patient to recognize peritonitis. Which teaching activity should
the nurse prioritize?
A. Demonstrate catheter site cleaning
B. Explain the significance of WBC counts >100/mm�
C. Provide a written guide on antibiotic therapy
D. Review the patient�s exchange schedule
Answer: B
Explanation: Explaining the significance of WBC counts >100/mm� directly addresses the cognitive need
to recognize peritonitis, as the patient�s effluent (200/mm�) indicates infection. Demonstrating cleaning is
psychomotor, providing a guide is cognitive but less urgent, and reviewing the schedule is unrelated.
Question: 1102
A 60-year-old patient on automated peritoneal dialysis (APD) reports difficulty performing exchanges
due to accurate hand tremors. During the nursing assessment, the patient struggles to manipulate a syringe,
dropping it twice. Which assessment tool should the nurse use to quantify the patient�s fine motor
coordination?
A. Visual Acuity Chart
B. Tinetti Balance Assessment
C. Nine-Hole Peg Test
D. Wong-Baker Pain Scale
Answer: C
Explanation: The Nine-Hole Peg Test is a standardized tool to assess fine motor coordination and
dexterity, ideal for evaluating the patient�s ability to handle dialysis equipment. The Tinetti Balance
Assessment evaluates gait and balance, not fine motor skills. The Visual Acuity Chart tests vision, and
the Wong-Baker Pain Scale assesses pain, neither of which address motor coordination.
Question: 1103
A patient on CAPD with a known catheter fracture undergoes splicing of the damaged catheter. Which is
the most important step to prevent infection during this procedure?
A. Use of local anesthesia at the splice site
B. Flushing catheter with heparinized saline post-splice
C. Clamping of catheter proximal and distal before splicing
D. Strict sterile technique with prophylactic antibiotics administration
Answer: D
Explanation: Strict sterile technique and prophylactic antibiotics are crucial to prevent peritonitis during
catheter splicing because this procedure exposes the sterile catheter lumen and peritoneal cavity to
infection risks.
Question: 1104
In the peritoneum, which layer acts as the primary barrier to solute and fluid transport in PD?
A. Visceral peritoneum
B. Parietal peritoneum
C. Endothelium of peritoneal capillaries
D. Submesothelial interstitium
Answer: C
Explanation: The endothelium of peritoneal capillaries is the primary barrier regulating solute and fluid
transport during PD. Both visceral and parietal peritoneum contribute, but the capillary endothelium is
key in the transport process.
Question: 1105
Which of the following changes in pulmonary function are typically seen in patients undergoing chronic
peritoneal dialysis with large dialysate volumes?
A. Elevated diffusion capacity for carbon monoxide
B. Increased forced expiratory volume in 1 second (FEV1)
C. Decreased total lung capacity and reduced functional residual capacity
D. Bronchodilation due to metabolic alkalosis
Answer: C
Explanation: Large volumes of dialysate increase intra-abdominal pressure, impeding diaphragmatic
excursion, resulting in decreased total lung capacity (TLC) and functional residual capacity (FRC). FEV1
usually does not increase. Diffusion capacity is not typically elevated. Bronchodilation due to metabolic
alkalosis is not a known feature in PD patients.
Question: 1106
A PD nurse manager is revising staff training to address OSHA standards for biological hazard exposure.
A patient�s dialysate bag leaks during an exchange, and the fluid tests positive for Staphylococcus
epidermidis. What should the training emphasize for handling this incident?
A. Use PPE and dispose of contaminated materials in a biohazard container
B. Clean the spill with an alcohol-based disinfectant
C. Neutralize the spill with a 1:100 bleach solution
D. Restrict the area and call an environmental safety team
Answer: A
Explanation: Using PPE and disposing of contaminated materials in a biohazard container aligns with
OSHA standards for handling infectious fluids like dialysate with Staphylococcus epidermidis. Alcohol-
based disinfectants are ineffective against certain pathogens. A 1:100 bleach solution is too dilute for
biohazards. Calling a safety team is unnecessary for a routine spill.
Question: 1107
During a PD exchange, a 47-year-old patient reports poor dialysate outflow. The nurse confirms
constipation via patient history and notes a dwell time of 4 hours with 1.5% dextrose. What is the most
likely cause of poor outflow, and what should the nurse do next?
A. Catheter kinking; reposition the patient
B. Peritonitis; obtain effluent culture
C. Fibrin buildup; add heparin to dialysate
D. Constipation; administer a laxative
Answer: D
Explanation: Constipation is a common cause of poor dialysate outflow in PD, as fecal mass can obstruct
catheter flow (Constipation; administer a laxative). Administering a laxative addresses this issue. Catheter
kinking (Catheter kinking; reposition the patient) is less likely without positional changes. Fibrin buildup
(Fibrin buildup; add heparin to dialysate) typically causes cloudy effluent, not mentioned here. Peritonitis
(Peritonitis; obtain effluent culture) is unlikely without cloudy effluent or fever.
Question: 1108
A patient on CAPD presents with fatigue and muscle weakness. Laboratory results show a serum
potassium of 3.2 mEq/L. What should the nurse suspect?
A. Hyperkalemia from inadequate dialysis
B. Metabolic acidosis from dialysate pH
C. Hypokalemia from excessive potassium removal
D. Uremic neuropathy
Answer: C
Explanation: A serum potassium of 3.2 mEq/L indicates hypokalemia, likely due to excessive potassium
removal during CAPD exchanges. Fatigue and muscle weakness are classic symptoms. Hyperkalemia is
incorrect, as the potassium level is low. Metabolic acidosis is unrelated to these symptoms or potassium
levels. Uremic neuropathy causes sensory changes, not primarily muscle weakness.
Question: 1109
A nurse presents a study at a CNNT meeting on the effect of patient education on ultrafiltration failure.
The study reports a relative risk of 0.75 for educated versus non-educated patients. What does this
relative risk indicate?
A. Educated patients have a 25% lower risk of ultrafiltration failure
B. Educated patients have a 25% higher risk of ultrafiltration failure
C. Non-educated patients have a 75% lower risk of ultrafiltration failure
D. No significant difference in ultrafiltration failure risk
Answer: A
Explanation: A relative risk of 0.75 indicates that educated patients have a 25% lower risk of
ultrafiltration failure (1 - 0.75 = 0.25) compared to non-educated patients. A higher risk would have a
relative risk >1. Non-educated patients are the reference group, so the reduction applies to educated
patients. No difference would have a relative risk near 1 with a non-significant p-value.
Question: 1110
A PD nurse is evaluating a 56-year-old patient�s understanding of fluid balance after a teaching session.
The patient calculates an ultrafiltration volume of 300 mL from a 2000 mL inflow and 2300 mL outflow.
Which evaluation method should the nurse use to confirm cognitive learning?
A. Review the patient�s fluid intake records
B. Observe the patient measuring outflow
C. Provide a quiz on fluid balance principles
D. Ask the patient to repeat the calculation
Answer: D
Explanation: Asking the patient to repeat the calculation confirms cognitive learning by verifying the
understanding of ultrafiltration (2300 mL - 2000 mL = 300 mL). Observing measurement is
psychomotor, a quiz is broader, and reviewing records is unrelated to cognitive confirmation.
Question: 1111
A 60-year-old patient on CCPD using a cycler with a 2 L fill volume, 2.5% dextrose, and 5 cycles/night
has a Kt/V of 1.4 and ultrafiltration (UF) of 600 mL/day. The PET shows a low transporter (D/P
creatinine 0.48). Lab results indicate serum albumin of 3.0 g/dL and effluent protein loss of 8 g/day.
Which prescription adjustment would best Excellerate Kt/V and UF?
A. Use icodextrin for a long daytime dwell
B. Increase fill volume to 2.5 L, maintaining 2.5% dextrose and 5 cycles
C. Switch to CAPD with 2 L, 4.25% dextrose, 4 exchanges/day
D. Add a daytime exchange with 2 L, 1.5% dextrose
Answer: A
Explanation: A low transporter (D/P creatinine 0.48) benefits from longer dwell times for optimal solute
clearance and UF. Icodextrin, a glucose polymer, provides sustained ultrafiltration over long dwells (e.g.,
8�12 hours), improving UF and Kt/V (target =1.7). Low UF (600 mL/day) and hypoalbuminemia (3.0
g/dL) suggest protein loss contributes to reduced oncotic pressure, making icodextrin�s sustained UF
effective. Adding a 1.5% dextrose daytime exchange may not sufficiently Excellerate UF for a low
transporter. Increasing fill volume without changing dwell time may not optimize clearance. Switching to
CAPD with 4.25% dextrose is less effective due to shorter dwells unsuitable for low transporters.
Question: 1112
During ongoing assessment, a nurse notices a PD patient with unexplained weight loss, muscle wasting,
and serum albumin 2.7 g/dL. What is the most likely contributing factor?
A. Iron deficiency anemia
B. Excessive fluid removal by dialysis
C. Protein-energy wasting from hypercatabolism
D. Peritoneal membrane infection
Answer: C
Explanation: Weight loss, muscle wasting, and low serum albumin suggest protein-energy wasting, a
catabolic state common in dialysis patients due to inflammation and metabolic imbalance. Excessive fluid
removal causes dehydration but not muscle wasting. Iron deficiency impacts anemia, and infection would
cause systemic signs.
Question: 1113
A patient's dialysate analysis shows significant protein loss. What is the expected impact and nursing
consideration?
A. Decrease dialysis solution volume
B. Monitor nutritional status and consider dietary protein supplementation
C. Increase dwell time to Excellerate protein retention
D. Limit oral protein intake to reduce losses
Answer: B
Explanation: Protein loss through peritoneal dialysis can lead to malnutrition; monitoring and dietary
adjustments are critical. Reducing solution volume or increasing dwell time does not affect protein losses.
Limiting protein intake worsens nutritional status.
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