22 Intradialytic Complications Practice Questions & Answers

1. 1. Twenty minutes into treatment a patient begins yawning repeatedly and sighing, and says she feels restless and a little queasy. Her blood pressure is only slightly below her starting value. What do these findings most likely represent?

   • A.An expected response to cool dialysate, which often makes patients restless early in the run
   • B.Early features of a pyrogenic reaction, which typically starts with yawning and queasiness
   • C.A normal reaction to the anticoagulant, which often causes sighing and nausea after the bolus
   • D.Early warning signs of intradialytic hypotension, which appear before the pressure collapses✓ Answer

   Yawning, sighing, restlessness, nausea, and cramping form the classic prodrome of intradialytic hypotension: cardiac output and cerebral perfusion are already falling while the cuff pressure still looks acceptable. Recognizing the cluster is what lets the technician reduce ultrafiltration and reposition the patient before an abrupt collapse.

   Source: Core Curriculum for the Dialysis Technician, recognition of intradialytic hypotensionReport a problem with this question

2. 2. A patient's blood pressure falls from 146/84 to 82/46 and she becomes dizzy and diaphoretic. Following the facility's hypotension protocol, what should the technician do FIRST?

   • A.Stop the blood pump and clamp both bloodlines, then wait for the nurse to assess her
   • B.Sit the patient upright to relieve the dizziness and offer a cold drink during the run
   • C.Increase the blood flow rate to improve her perfusion, then recheck the pressure shortly
   • D.Turn the ultrafiltration off and lay the patient flat with her legs elevated, then recheck✓ Answer

   Uncomplicated symptomatic hypotension is treated by removing the cause, which is fluid removal: ultrafiltration goes off and the patient is placed head-down with the legs raised so blood returns to the central circulation, followed by saline and notification of the nurse per protocol. The blood pump keeps running, because stationary blood clots in the circuit.

   Source: Core Curriculum for the Dialysis Technician, intradialytic hypotension protocolReport a problem with this question

3. 3. A patient arrives having gained a large amount of fluid since her last treatment, and her treatment time is not changed. Why does this raise her risk of hypotension during the run?

   • A.The extra fluid dilutes her blood, so the dialyzer clears less and pressure falls as urea leaves
   • B.Fluid must be pulled faster, so removal outpaces the refill of water from tissue into vessels✓ Answer
   • C.The added weight raises transmembrane pressure, and high pressure in the fibers causes shock
   • D.A heavier patient needs a faster dialysate flow, and the faster dialysate itself lowers pressure

   Ultrafiltration removes water from the plasma, and plasma volume is restored only as water moves out of the interstitium at a limited rate. A large interdialytic gain divided by an unchanged treatment time forces an ultrafiltration rate that exceeds vascular refill, so plasma volume falls and the pressure drops.

   Source: Kallenbach, Review of Hemodialysis for Nurses and Dialysis Personnel, ultrafiltration and vascular refillReport a problem with this question

4. 4. A technician responds to simple symptomatic hypotension by stopping the blood pump while waiting for the nurse. Why is stopping the pump the wrong response in this situation?

   • A.Standing blood warms above body temperature, and the returned blood then causes rigors
   • B.Stopping the pump sets off the venous alarm, and repeated alarms desensitize nearby staff
   • C.Blood standing in the circuit clots quickly, and the patient loses that volume and the run✓ Answer
   • D.Dialysate keeps flowing across the membrane and pulls more fluid, deepening the hypotension

   Blood clots when it is not moving, so a stopped pump risks losing the extracorporeal blood volume and the treatment. The pump is stopped only for events in which continued circulation would injure the patient, such as air embolism, hemolysis, a confirmed blood leak, needle dislodgement, or cardiac arrest.

   Source: Kallenbach, Review of Hemodialysis for Nurses and Dialysis Personnel, management of intradialytic hypotensionReport a problem with this question

5. 5. At the end of treatment a patient stands to walk to the scale, tells the technician she feels lightheaded, and insists she is fine. What is the technician's INITIAL action?

   • A.Give her a cup of juice to raise her sugar and record the symptom on the treatment flow sheet
   • B.Walk beside her to the scale so that she can be weighed, then report the symptom to the nurse
   • C.Have her sit back down before doing anything else, then take her pressure and tell the nurse✓ Answer
   • D.Ask her to stand still for a few minutes until the feeling passes, then let her walk unassisted

   Fluid removal leaves patients prone to orthostatic hypotension, and a symptomatic patient who keeps walking can faint and fall. The technician protects the patient first by seating her, then measures sitting and standing pressures and reports the finding, because assessment and any change in plan belong to the nurse.

   Source: ANNA Core Curriculum for Nephrology Nursing, orthostatic hypotension and post-dialysis safetyReport a problem with this question

6. 6. A patient with diabetes who skipped breakfast becomes anxious, confused, and sweaty midway through treatment. His blood pressure is unchanged from the start of the run. What should the technician do?

   • A.Check the blood glucose as well as the pressure and tell the nurse, since the pressure is steady✓ Answer
   • B.Record the behavior as anxiety about the needles and keep observing him until the run finishes
   • C.Assume a dialyzer reaction is starting, end the treatment, and avoid returning any blood to him
   • D.Treat this as hypotension, stop the ultrafiltration, and lay him flat with his legs on a pillow

   Anxiety, confusion, tremor, and diaphoresis occur in both hypotension and hypoglycemia, so the finding that separates them is the blood pressure, which here has not moved. A fasting patient with diabetes needs a glucose check and prompt notification of the nurse, who directs treatment under the facility's protocol.

   Source: Core Curriculum for the Dialysis Technician, hypoglycemia in the patient with diabetesReport a problem with this question

7. 7. A patient develops severe calf cramping in the last hour of a treatment in which a large volume of fluid has been removed. Following protocol, what should the technician do?

   • A.Offer coffee for the caffeine and continue, since cramps come from potassium being removed
   • B.Lower the ultrafiltration rate, check the pressure, stretch the foot, and tell the nurse✓ Answer
   • C.Raise the ultrafiltration rate so the goal is met sooner and the cramping ends with the run
   • D.Massage the limb hard and put an ice pack on the muscle, then continue at the same settings

   Cramps arise from plasma volume contraction and sodium shifts caused by rapid or excessive fluid removal, so the protocol response is to slow or stop ultrafiltration, give normal saline if ordered, support gentle stretching, and report to the nurse. Cramping often accompanies falling pressure, which is why the blood pressure is checked at the same time.

   Source: Core Curriculum for the Dialysis Technician, muscle cramp protocolReport a problem with this question

8. 8. Halfway through a treatment a patient says he feels sick to his stomach and then vomits. What should the technician check FIRST?

   • A.The patient's temperature, because vomiting during a run points first to a pyrogenic reaction
   • B.The venous chamber for clots, because a clotting circuit makes patients nauseated as it worsens
   • C.The patient's blood pressure, because nausea and vomiting most often signal a falling pressure✓ Answer
   • D.The conductivity reading, because a wrong dialysate bath is the usual cause of mid-run nausea

   Nausea and vomiting during dialysis are most commonly a manifestation of hypotension, so the pressure is measured before anything else and the ultrafiltration is adjusted per protocol. Other causes such as disequilibrium, a dialyzer reaction, or eating during treatment are considered after hypotension has been ruled out, and the nurse is notified.

   Source: Kallenbach, Review of Hemodialysis for Nurses and Dialysis Personnel, nausea and vomiting during dialysisReport a problem with this question

9. 9. Which patient is at greatest risk of dialysis disequilibrium syndrome?

   • A.A long-term patient who missed one treatment and arrived with several kilograms of extra fluid
   • B.A patient with a tunneled catheter whose blood flow has been poor for several treatments
   • C.A stable patient whose dialyzer was changed to a different model of the same surface area
   • D.A newly diagnosed patient with a very high urea level receiving one of his first treatments✓ Answer

   Disequilibrium is driven by the size of the solute gradient created during the run, so the highest risk is a new patient with severe uremia whose urea falls steeply for the first time. Long-standing patients with fluid gains, dialyzer changes, or catheter flow problems face other complications, not this one.

   Source: ANNA Core Curriculum for Nephrology Nursing, dialysis disequilibrium syndromeReport a problem with this question

10. 10. A patient on his second treatment develops a headache, nausea, restlessness, and a rising blood pressure. What explains these findings?

    • A.Urea leaves the blood faster than the brain, and water then shifts into the brain tissue✓ Answer
    • B.Cool dialysate constricts the vessels of the scalp and drives the pressure in the skull up
    • C.Heparin thins the blood enough to raise the pressure inside the vessels of the head
    • D.Sodium is removed faster than water is, so the blood grows dilute and the brain shrinks

    Dialysis pulls urea out of the blood faster than it can leave the brain, so the brain is briefly hyperosmolar relative to plasma and water moves into brain cells, producing cerebral edema. The early picture is headache, nausea, restlessness, and hypertension, which can progress to twitching, seizures, and coma if it is not reported.

    Source: ANNA Core Curriculum for Nephrology Nursing, dialysis disequilibrium syndromeReport a problem with this question

11. 11. A patient who has been alert all treatment becomes confused and begins slurring his words. His blood pressure and pulse are within his usual range. What should the technician do?

    • A.Offer him a snack and recheck him in half an hour to see whether he has cleared up
    • B.Wait until the end of the run and then record the change on the treatment flow sheet
    • C.Assume he is sleepy from the long treatment and dim the light so that he can rest
    • D.Report the change in mental status to the nurse at once and stay with the patient✓ Answer

    A new change in level of consciousness during dialysis can signal disequilibrium, hypoglycemia, air embolism, stroke, or an electrolyte shift, and several of those worsen within minutes. The technician's role is to report the change immediately and remain with the patient, because assessment and any change in the prescription belong to the nurse.

    Source: Core Curriculum for the Dialysis Technician, reporting changes in cognitive and mental statusReport a problem with this question

12. 12. A technician sees churning foam in the venous drip chamber, and the patient, who is sitting up, suddenly becomes short of breath, coughs, and looks frightened. What is happening?

    • A.The venous needle has infiltrated and blood is collecting under his skin
    • B.Air is entering the bloodstream through the circuit and reaching the patient✓ Answer
    • C.The circuit is clotting and dark blood is backing up into the chamber
    • D.The dialyzer membrane has ruptured and blood is crossing into the dialysate

    Foaming or churning blood in the venous chamber with sudden respiratory distress is the classic picture of air entering the circuit. In a seated patient the air travels toward the head and may cause visual change, confusion, seizure, or loss of consciousness, while a recumbent patient shows chest pain, cough, cyanosis, and cardiovascular collapse.

    Source: Kallenbach, Review of Hemodialysis for Nurses and Dialysis Personnel, air embolismReport a problem with this question

13. 13. Air has entered a patient's bloodline. After clamping the venous line and stopping the blood pump, how should the technician position the patient?

    • A.On the left side with the head lowered, so air is held away from the outflow of the heart✓ Answer
    • B.Flat on the back with the legs raised, the same position used for a low blood pressure
    • C.On the right side with the head raised, so the air floats upward and away from the lungs
    • D.Sitting fully upright, so that the air rises and can be coughed out through the airway

    Left lateral position with the head down traps air at the apex of the right ventricle, away from the pulmonary outflow tract, so it cannot be pumped into the lungs as a bolus. Oxygen is given per protocol, the nurse and emergency response are called, and the blood in the circuit is never returned.

    Source: Kallenbach, Review of Hemodialysis for Nurses and Dialysis Personnel, air embolism managementReport a problem with this question

14. 14. Two patients on adjacent machines report back pain and shortness of breath, and the blood in both venous lines looks bright cherry-red and translucent. What should the technician suspect?

    • A.A pyrogenic reaction from endotoxin, which turns the returning blood bright red
    • B.Air embolism in both circuits, since trapped air gives blood a translucent look
    • C.Anaphylactic dialyzer reactions, which are typical of a newly opened lot of dialyzers
    • D.Hemolysis caused by a problem with the dialysate or the water feeding both machines✓ Answer

    Cherry-red translucent blood with back pain, chest tightness, and dyspnea is the signature of hemolysis, and more than one patient affected at once points to a shared cause such as overheated, hypotonic, or contaminated dialysate or water. The pump is stopped, lines are clamped, the blood is not returned, and the nurse and the water system are involved immediately.

    Source: Core Curriculum for the Dialysis Technician, hemolysisReport a problem with this question

15. 15. A hemolytic reaction is confirmed during a treatment. Why must the blood remaining in the circuit not be returned to the patient?

    • A.The ruptured cells have lost their clotting factors, and returning them causes bleeding
    • B.The ruptured cells have released potassium, and giving it back can stop the heart✓ Answer
    • C.The blood in the circuit has cooled below body temperature and would trigger rigors
    • D.The blood still holds the germicide that caused the reaction and would repeat the injury

    Hemolyzed red cells spill their intracellular potassium into the plasma of the circuit, so reinfusing that blood delivers a potassium load that can cause life-threatening arrhythmia or cardiac arrest. The circuit and a dialysate sample are saved so the cause, such as dialysate temperature, conductivity, or water contamination, can be investigated.

    Source: American Journal of Kidney Diseases Core Curriculum, hemodialysis emergenciesReport a problem with this question

16. 16. A blood leak alarm sounds and the dialysate outflow line shows a pink tinge. What should the technician do?

    • A.Stop the blood pump, clamp the lines, call the nurse, and do not return the blood✓ Answer
    • B.Lower the blood flow rate and finish the treatment early with the same dialyzer in place
    • C.Silence the alarm and watch the dialysate for a few minutes to see whether it clears
    • D.Rinse the dialyzer with saline and restart the pump once the pink tinge has disappeared

    A blood leak alarm with discolored dialysate means the membrane has ruptured, so blood is in contact with non-sterile dialysate and the patient is exposed to blood loss and contamination. The circulation is stopped and clamped, the blood is not reinfused, and the nurse directs replacement of the dialyzer under facility policy.

    Source: Core Curriculum for the Dialysis Technician, blood leak alarm and dialyzer ruptureReport a problem with this question

17. 17. Venous pressure and transmembrane pressure have both been climbing, and the technician sees dark streaking in the dialyzer fibers. What does this indicate?

    • A.The extracorporeal circuit is clotting and the nurse should be told before it is lost✓ Answer
    • B.The dialysate has become too warm and the returning blood is being damaged by heat
    • C.The heparin dose is too high and the fibers are filling with blood that will not clot
    • D.The vascular access has infiltrated and blood is pooling in the tissue near the needle

    Rising venous and transmembrane pressures together with dark streaks or shadowing in the fiber bundle and clots in the drip chambers are the signs that the circuit is clotting, usually from inadequate anticoagulation or interrupted flow. Reporting early allows the nurse to rinse the circuit or adjust heparin per order before the blood volume is lost.

    Source: Kallenbach, Review of Hemodialysis for Nurses and Dialysis Personnel, extracorporeal circuit clottingReport a problem with this question

18. 18. A patient asks to have a blanket pulled over both arms because the treatment area is cold. Why must the technician keep the access site and the line connections uncovered?

    • A.A needle that pulls out beneath a blanket may go unnoticed until severe blood loss occurs✓ Answer
    • B.A covered arm keeps the venous pressure alarm from sensing pressure changes in the line
    • C.A covered access warms the blood inside the needle and raises the risk of clotting there
    • D.A blanket lying over the arm presses on the fistula and can shut the blood flow down

    Federal requirements for the dialysis physical environment call for each patient, including the vascular access site and the bloodline connections, to remain visible to staff throughout treatment, and video monitoring does not satisfy that requirement. A needle that dislodges under covering can bleed unseen, and exsanguination is possible within minutes.

    Source: CMS ESRD Conditions for Coverage, 42 CFR 494.60, physical environment and patient visibility during treatmentReport a problem with this question

19. 19. A venous needle pulls out during treatment and blood is spurting from the site. What should the technician do FIRST?

    • A.Call the nurse and wait beside the chair for direction before touching the bleeding site
    • B.Stop the blood pump and clamp the lines, then press directly on the bleeding site✓ Answer
    • C.Press on the site with gauze while the pump keeps running so no blood volume is lost
    • D.Reinsert the needle immediately so that the circuit and the treatment can be preserved

    With the venous needle out, the pump is still pushing the patient's blood onto the floor, so the bleeding cannot be controlled until the pump is stopped and the lines are clamped, and only then is direct pressure applied. Help is called at the same time, the patient is kept flat, vital signs are monitored, and significant blood loss is treated as an emergency.

    Source: CMS ESRD Conditions for Coverage, 42 CFR 494.60, response to significant blood loss during treatmentReport a problem with this question

20. 20. Within the first few minutes of a treatment a patient develops hives, swollen lips, and wheezing. What should the technician do?

    • A.Change to a different dialyzer and restart the treatment from the beginning again
    • B.Return the blood quickly, take the patient off, and then notify the nurse of the event
    • C.Stop the treatment, clamp the lines without returning blood, and call for the nurse✓ Answer
    • D.Slow the blood flow, give oxygen, and continue the run while watching him closely

    Hives, angioedema, wheezing, and a sense of impending doom in the first minutes describe a type A anaphylactic dialyzer reaction, so the treatment stops at once and the blood, which carries the triggering material, is never returned. The milder type B reaction appears later with chest and back pain and may be continued with oxygen and observation after the nurse assesses the patient.

    Source: Core Curriculum for the Dialysis Technician, dialyzer reactionsReport a problem with this question

21. 21. An hour into treatment a patient who was afebrile at the start develops shaking chills, a fever, and a falling blood pressure. What should the technician do?

    • A.Take a full set of vital signs, keep him warm, and notify the nurse immediately✓ Answer
    • B.Raise the ultrafiltration rate, since a fever means his target weight is set too high
    • C.Warm the dialysate a few degrees and continue, since the chills come from cooling
    • D.Give him a blanket and recheck the temperature at the end of the run as usual

    Chills, new fever, and hypotension appearing well into a run in a patient who started afebrile suggest a pyrogenic reaction from endotoxin crossing from contaminated dialysate or water, or a catheter-related bloodstream infection. The technician documents full vital signs, keeps the patient warm, and reports at once, because cultures, medication, and evaluation of the water system follow from the nurse and the facility.

    Source: CMS ESRD Conditions for Coverage, 42 CFR 494.40, water and dialysate quality and patient reactionsReport a problem with this question

22. 22. A patient begins having a generalized seizure during treatment. What should the technician do?

    • A.Call for help, protect him from injury, guard the needles, and stop the ultrafiltration✓ Answer
    • B.Sit him fully upright so he can breathe and hold his head still until the movement stops
    • C.Restrain his arms so the needles are not pulled out and put a bite block in his mouth
    • D.Return his blood and take him off the machine before calling anyone else for assistance

    Seizure care during dialysis is protective rather than restrictive: summon help, clear the area so the patient is not injured, safeguard the needles and lines from dislodgement, stop ultrafiltration and lower blood flow per protocol, note the time, and give oxygen as ordered. Restraining a seizing patient or forcing anything into the mouth causes injury and is not done.

    Source: ANNA Core Curriculum for Nephrology Nursing, intradialytic seizuresReport a problem with this question

Practice questions based on the NNCC CCHT content outline, CDC recommendations for hemodialysis settings, and the OSHA Bloodborne Pathogens Standard. Not affiliated with or endorsed by NNCC, and not medical advice. Machine settings, dialysate composition, flow rates, alarm thresholds, water-quality limits and laboratory targets are deliberately never the answer to a question here — those are set by your machine's manufacturer, your facility's protocol and the physician's prescription. Always follow your facility's policies and your patient's prescribed treatment. About the CCHT exam (NNCC) →