22 Intradialytic Complications Practice Questions & Answers
Every Intradialytic Complications practice question from the Dialysis Technician Practice Test, with the correct answer and a short explanation.
Start practice test →1. Three hours into a treatment a patient becomes restless, yawns repeatedly, and says he feels dizzy. His blood pressure is 84/48 mmHg, down from 148/82 mmHg at the start. What should the technician do FIRST?
- A.Reduce or stop ultrafiltration and lay the patient flat with the legs elevated, unless contraindicated✓ Answer
- B.Rinse the blood back and take the patient off the machine immediately
- C.Decrease the blood pump speed so the treatment runs more slowly
- D.Offer the patient something to drink and continue the treatment as prescribed
Intradialytic hypotension occurs because fluid is being pulled out of the blood faster than fluid can refill the vascular space from the tissues, so the first action must remove that cause: stop or reduce ultrafiltration and use gravity to improve venous return. Slowing the blood pump does not restore intravascular volume and is the classic wrong answer. Saline per facility protocol, oxygen per order, notifying the nurse and documenting follow.
Source: NNCC CCHT content outline, Clinical practice area (monitor the patient during treatment; follow protocol for treating hypotension)Report a problem with this question
2. A patient arrives 4.5 kg above his target weight for a scheduled 4-hour treatment and becomes hypotensive in the third hour. Which explanation best accounts for this?
- A.The blood pump creates negative pressure that dilates the patient's arteries
- B.Diffusion of urea across the membrane pulls water out of the arteries into the dialysate
- C.The dialyzer membrane removes plasma protein, which lowers the blood's oncotic pressure
- D.A large interdialytic weight gain forces a high fluid-removal rate, and fluid is pulled from the blood faster than it can move back in from the tissues✓ Answer
The pre-treatment weight compared with the target weight sets the fluid-removal goal, and a large gain in a fixed treatment time forces a removal rate that can exceed the plasma refill rate from the interstitial space. When the vascular space is emptied faster than it refills, blood pressure falls. Dialyzer membranes are not intended to remove albumin, and diffusion of urea does not drive the drop in pressure.
Source: NNCC CCHT content outline, Clinical practice area (relate changes in blood pressure to fluid volume status)Report a problem with this question
3. Which group of findings should a technician recognize as EARLY warning signs of intradialytic hypotension?
- A.Yawning, restlessness, nausea, and sudden sweating✓ Answer
- B.Itching at the access site with hives and wheezing
- C.A slow bounding pulse with warm dry skin and increased urine output
- D.Rising blood pressure with a pounding headache and muscle twitching
Falling intravascular volume triggers a sympathetic response and reduced perfusion, which shows up as yawning, restlessness, nausea, dizziness, blurred vision and diaphoresis before the patient reports feeling faint. Rising blood pressure with neurologic signs points instead to disequilibrium, and itching with hives and wheezing points to a dialyzer reaction. Some patients, especially those with diabetic neuropathy, drop with no symptoms at all, which is why scheduled vital-sign checks matter.
Source: NNCC CCHT content outline, Clinical practice area (identify and report changes in the patient's general physical state)Report a problem with this question
4. At the end of treatment a patient's sitting blood pressure is 118/70 mmHg, but on standing it falls to 92/58 mmHg and the patient feels lightheaded. What is the technician's most appropriate action?
- A.Give an oral fluid bolus and send the patient home
- B.Encourage the patient to walk it off slowly on the way to the exit
- C.Document only the sitting pressure, since it is within the patient's usual range
- D.Have the patient sit back down, do not let him ambulate unassisted, and report the finding to the nurse✓ Answer
A drop of roughly 20 mmHg systolic or 10 mmHg diastolic from sitting to standing, with symptoms, is orthostatic hypotension, and post-dialysis hypotension and fatigue are leading causes of falls in this population. The technician's in-scope response is to keep the patient safe and seated, assist any transfer, and report the finding so the nurse can evaluate before the patient leaves.
Source: NNCC CCHT content outline, Clinical practice area (recognize orthostatic hypotension; identify patients at risk for falls)Report a problem with this question
5. A patient with diabetes who skipped breakfast becomes sweaty, shaky, and confused two hours into treatment. His blood pressure is 138/78 mmHg, essentially unchanged from the start of the run. What should the technician suspect and do?
- A.Hypoglycemia; check the blood glucose and notify the nurse so it can be treated per protocol✓ Answer
- B.A Type A dialyzer reaction; stop treatment and discard the blood
- C.Intradialytic hypotension; give a saline bolus without checking anything else
- D.Disequilibrium syndrome; increase the blood flow rate to finish the treatment sooner
Hypoglycemia and hypotension share the same picture of diaphoresis, tremor, weakness and confusion, so the finding that separates them is the blood pressure, which here is unchanged. When the pressure does not explain the symptoms in a patient with diabetes who has missed a meal or taken insulin, the technician checks the glucose and reports to the nurse rather than assuming volume loss; treatment of the low glucose is given per protocol and physician order.
Source: NNCC CCHT content outline, Clinical practice area (recognize and report changes in cognitive or mental status; report changes in the patient's condition)Report a problem with this question
6. Near the end of treatment a patient develops severe cramping in both calves. The blood pressure has fallen from 140/80 to 96/54 mmHg and the patient is now below his target weight. Which response addresses the cause and stays within the technician's scope?
- A.Independently administer hypertonic saline to relieve the cramp
- B.Raise the dialysate temperature so the muscle relaxes
- C.Stop ultrafiltration, notify the nurse, and give normal saline and support or stretch the limb per facility protocol✓ Answer
- D.Massage the leg and keep removing fluid so the prescribed goal is still met
Cramps late in a run together with a falling blood pressure and a weight below target mean the patient is volume depleted, so the cause is excessive fluid removal, not an isolated muscle problem. Stopping ultrafiltration and replacing volume per protocol treats the mechanism, while stretching and warmth relieve the symptom. Hypertonic saline or dextrose is a medication given only on a nurse's or physician's order, not on the technician's own initiative, and repeated end-of-run cramping should be reported so the target weight and the interdialytic weight gain can be reassessed.
Source: NNCC CCHT content outline, Clinical practice area (follow protocol for treatment of muscle cramps; recognize signs and symptoms of volume depletion)Report a problem with this question
7. A patient reports nausea and then vomits about ninety minutes into treatment. What should the technician do FIRST?
- A.Ask the nurse to obtain an antiemetic
- B.Offer the patient sips of cold water to settle the stomach
- C.Check the blood pressure and the rest of the vital signs✓ Answer
- D.Lower the dialysate temperature setting
Nausea and vomiting during hemodialysis are most often the first manifestation of falling blood pressure, so measuring the vital signs identifies the underlying problem before anything is treated symptomatically. If the patient is hypotensive, ultrafiltration is reduced or stopped and the protocol for hypotension is followed; other causes such as disequilibrium, uremia or a dialyzer reaction also depend on the vital signs to sort out. Protecting the airway and preventing aspiration, notifying the nurse and documenting follow.
Source: NNCC CCHT content outline, Clinical practice area (monitor the patient during treatment; identify and report changes in the patient's general physical state)Report a problem with this question
8. A patient receiving one of his first hemodialysis treatments, with a very high pre-treatment BUN, develops headache, nausea, restlessness, and a rising blood pressure. Which mechanism explains these findings?
- A.Air entering the venous bloodline and traveling to the brain
- B.Complement activation by the dialyzer membrane
- C.Urea is removed from the blood faster than from brain tissue, creating an osmotic gradient that draws water into the brain✓ Answer
- D.Bacterial endotoxin crossing from contaminated dialysate into the blood
This is dialysis disequilibrium syndrome: rapid clearance of urea from the blood leaves brain urea comparatively high, and the osmotic gradient pulls water into brain tissue, producing cerebral edema. That is why the picture is hypertension with neurologic symptoms rather than the hypotension seen with excessive fluid removal, and why the highest risk is in the first few treatments, in patients with a very high pre-treatment BUN, and in the elderly, pediatric, and neurologically impaired.
Source: NNCC CCHT content outline, Clinical practice area (recognize and report changes in cognitive or mental status; recognize and report an emergency clinical situation)Report a problem with this question
9. For the patient in the previous scenario, which set of actions reflects correct management of dialysis disequilibrium syndrome?
- A.Clamp the venous line, discard the blood in the circuit, and remove the needles
- B.Sit the patient upright and continue unchanged, since headache is expected on dialysis
- C.Increase the blood flow rate so the treatment can be completed sooner
- D.Notify the nurse immediately and, per order, make the treatment less efficient by lowering the blood and dialysate flow rates and reducing fluid removal✓ Answer
Because the syndrome is caused by clearing solute too fast, the treatment is deliberately made less efficient so the osmotic gradient stops widening; severe cases are terminated and mannitol may be ordered. Speeding the treatment up makes the gradient worse, and neurologic symptoms during dialysis are never dismissed as expected. The technician recognizes the change, reports it to the nurse at once, and adjusts the treatment only as directed.
Source: NNCC CCHT content outline, Clinical practice area (recognize and report an emergency clinical situation; monitor the patient during treatment)Report a problem with this question
10. A patient suddenly develops shortness of breath, coughing, and chest tightness, and the technician sees foam and churning bubbles in the venous bloodline. What should the technician do FIRST?
- A.Return the blood quickly so the patient can be moved
- B.Raise the venous drip chamber level and continue the treatment
- C.Take a blood pressure and call the nurse to the chair
- D.Clamp the venous bloodline and stop the blood pump✓ Answer
Air embolism is one of the few events where a physical action comes before calling for help, because every second the pump runs sends more air into the patient. Clamping the venous line and stopping the pump halts the entry of air; the blood is never returned. Only then does the technician position the patient, give oxygen per protocol, and call the nurse and emergency response.
Source: NNCC CCHT content outline, Clinical practice area (recognize and report an emergency clinical situation; monitor the patient during treatment)Report a problem with this question
11. After the bloodline has been clamped and the pump stopped for a suspected air embolism, how should the patient be positioned?
- A.On the left side with the head and chest lowered✓ Answer
- B.Flat on the back in Trendelenburg position only
- C.Sitting upright in high Fowler's position
- D.On the right side with the head of the chair elevated
The position needs both parts: left lateral decubitus plus head and chest down. Turning the patient onto the left side with the head lowered traps air at the apex of the right ventricle, away from the pulmonary outflow tract, so it cannot be pumped onward as an air lock. Head-down alone or the right side does not do this. Oxygen is then given per order or standing protocol, needles are left in place until directed, and the nurse and emergency response are activated.
Source: NNCC CCHT content outline, Clinical practice area (participate as directed in emergency and resuscitative measures)Report a problem with this question
12. A patient complains of back pain, chest tightness, and shortness of breath. The blood in the venous line looks unusually bright cherry-red, and two other patients on the same machine bank report similar symptoms. Which complication and cause should the technician suspect?
- A.A Type B dialyzer reaction caused by complement activation
- B.Disequilibrium syndrome caused by rapid removal of urea
- C.Hemolysis from overheated or hypotonic dialysate or a water treatment failure✓ Answer
- D.Air embolism from a loose arterial connection
Cherry-red or port-wine blood in the line with back pain, chest tightness, dyspnea, chills and hypotension is the classic hemolysis picture, and more than one patient affected at once points to something shared: dialysate that is too hot or too dilute, or a water contaminant such as chloramine. The technician stops the pump, clamps the lines, does not return the blood, calls for the nurse and emergency response, gives oxygen per protocol, and preserves the dialyzer, tubing and samples so the machine and water system can be investigated.
Source: NNCC CCHT content outline, Clinical and Technical practice areas (recognize and report an emergency clinical situation; report adverse events related to equipment malfunction)Report a problem with this question
13. When hemolysis is suspected, why must the blood in the extracorporeal circuit NOT be returned to the patient?
- A.Returning it would dilute the patient's remaining red blood cells
- B.The blood has cooled in the circuit and would cause a chill reaction
- C.Returning it would push air trapped in the dialyzer into the patient
- D.Lysed red cells release potassium, so returning that blood can cause severe hyperkalemia and cardiac arrest✓ Answer
Hemolysis ruptures red cells and spills their intracellular potassium into the plasma of the circuit. Returning that volume delivers a sudden potassium load that can produce muscle weakness, paresthesias, peaked T waves, arrhythmia and cardiac arrest. The circuit blood is discarded, the patient is monitored for arrhythmia and prepared for transfer, and the equipment and samples are saved for investigation and reported as an adverse occurrence.
Source: NNCC CCHT content outline, Clinical practice area (recognize and report adverse patient occurrences)Report a problem with this question
14. The blood leak alarm sounds and the blood pump stops. A test strip of the dialysate effluent is positive for blood. What is the correct action?
- A.Notify the nurse, terminate the treatment without returning the blood, and document the event per facility protocol✓ Answer
- B.Keep the treatment running but lower the transmembrane pressure
- C.Tape over the detector so the treatment can be finished, then report it afterward
- D.Reset the alarm and continue, because the detector is usually triggered by air bubbles
A positive test strip confirms that the dialyzer membrane has ruptured and blood has crossed to the dialysate side, so that blood is considered contaminated and is not returned. Air in the dialysate or a dirty optical sensor can cause a false alarm, which is exactly why the alarm is investigated and confirmed rather than reset blindly. A safety monitor is never taped over, silenced or bypassed to keep a treatment running.
Source: NNCC CCHT content outline, Technical practice area (troubleshoot equipment malfunction; report adverse events related to equipment)Report a problem with this question
15. Over the past hour the venous pressure has risen from 120 to 250 mmHg and the transmembrane pressure has climbed as well. The technician sees dark streaks in the dialyzer fiber bundle and foaming in the venous drip chamber. What do these findings indicate and what should be done?
- A.Hemolysis; increase the blood flow rate to clear the dialyzer
- B.Access recirculation; reverse the bloodlines and continue the treatment
- C.Clotting of the extracorporeal circuit; assess with a saline flush and notify the nurse promptly✓ Answer
- D.Venous needle dislodgement; disconnect the lines and rinse the blood back
Clot forming in the dialyzer and downstream of it obstructs flow, so the pressure the pump must generate to push blood through rises; dark blood, shadowed fibers and foaming in the drip chamber are the visual confirmation. A saline flush lets the technician see how much of the bundle is clotted, and the nurse is notified so anticoagulation can be addressed per order and the treatment ended before the whole circuit clots and that blood volume is lost to the patient. A dislodged venous needle causes venous pressure to fall, not rise.
Source: NNCC CCHT content outline, Technical practice area (monitor and troubleshoot the extracorporeal circuit); Clinical practice area (purpose and complications of heparin therapy)Report a problem with this question
16. Which practice best protects a restless patient from exsanguination if the venous needle becomes dislodged during treatment?
- A.Keeping the needles, connections, and access site secured and uncovered in full view, and observing the patient frequently✓ Answer
- B.Relying on the venous pressure alarm to detect the dislodgement
- C.Setting the venous pressure alarm limits as wide as possible to avoid nuisance alarms
- D.Covering the arm with a blanket so the patient cannot disturb the needles
The venous pressure monitor cannot be relied on to detect dislodgement: if the needle stays under the tape or in the tissue, or the limits are set too wide, the pressure may never change enough to alarm, while the pump keeps returning blood outside the vessel. Direct visibility is the real safeguard, together with proper taping, verified connections, narrow alarm limits, and closer observation of confused or restless patients.
Source: NNCC CCHT content outline, Clinical practice area (identify risks for patient exsanguination)Report a problem with this question
17. A needle pulls out during treatment and blood is spurting from the access site. After stopping the blood pump and clamping the lines, what should the technician do next?
- A.Apply a tourniquet above the access
- B.Apply firm direct pressure over the site with gauze while calling for help✓ Answer
- C.Reinsert the needle to control the bleeding
- D.Elevate the arm and wait for the nurse before touching the site
Once the pump is stopped, the bleeding is controlled by firm direct digital pressure over the site with gauze, held continuously while help is summoned. A tourniquet is not used on a vascular access because it obstructs outflow and can thrombose the access or damage the limb, and the technician does not recannulate a bleeding site. The patient is assessed for shock, the blood in the circuit is not returned if contamination is suspected, and an incident report is completed.
Source: NNCC CCHT content outline, Clinical practice area (identify risks for patient exsanguination; recognize and report an emergency clinical situation)Report a problem with this question
18. Ten minutes after the start of treatment a patient reports burning and itching at the access site, then develops hives, swelling of the lips, and wheezing. What should the technician do?
- A.Return the blood and then set up a new dialyzer to finish the treatment
- B.Slow the blood pump and continue, since these symptoms usually resolve within an hour
- C.Stop the treatment, clamp the lines without returning the blood, call the nurse and emergency response, and give oxygen per protocol✓ Answer
- D.Give an antihistamine from the unit's supply and observe the patient
Onset within the first minutes with burning at the access, urticaria, angioedema and bronchospasm is a Type A anaphylactoid reaction, a true emergency. The blood is not returned because it carries the causative agent, such as sterilant or germicide residual or a reaction between the membrane and the patient's medication. Epinephrine, antihistamines and steroids are given only on a physician's order; the technician stops the treatment, gives oxygen per standing protocol, and gets the nurse immediately.
Source: NNCC CCHT content outline, Clinical practice area (recognize and report an emergency clinical situation; recognize and report adverse patient occurrences)Report a problem with this question
19. Forty minutes into treatment a patient reports chest pain and back pain but has no hives, no swelling, and no difficulty breathing; the vital signs are stable. How should the technician respond?
- A.Discard the blood immediately, as would be done for an anaphylactoid reaction
- B.Report the symptoms to the nurse at the end of the treatment
- C.Assume the pain comes from the needles and reposition the patient's arm
- D.Notify the nurse now, give oxygen per protocol, and monitor closely while the nurse assesses for cardiac and other causes✓ Answer
Chest and back pain appearing later in the run without urticaria or airway involvement fits a Type B, non-specific dialyzer reaction, which is managed supportively and usually resolves so the treatment can often continue. But chest pain in a dialysis patient can also be angina or ischemia, since cardiac disease is common and sudden cardiac death is the leading cause of death in this population, so the nurse must assess promptly rather than at the end of the run. The technician recognizes, reports and supports; the diagnosis is not his to make.
Source: NNCC CCHT content outline, Clinical practice area (identify and report changes in the patient's general physical state; administer oxygen per order or protocol)Report a problem with this question
20. A patient who was afebrile at the start of treatment develops shaking chills, a fever, and a falling blood pressure about an hour into the run. Which complication fits this pattern, and what should the technician do?
- A.Disequilibrium syndrome; slow the blood flow rate and continue
- B.A Type A dialyzer reaction; obtain epinephrine and administer it
- C.Intradialytic hypotension; give saline and finish the treatment as scheduled
- D.A pyrogenic reaction; take a full set of vital signs including temperature, notify the nurse immediately, and save the dialyzer and samples per protocol✓ Answer
A pyrogenic reaction comes from bacterial endotoxin entering the blood from contaminated dialysate, water or an improperly reprocessed dialyzer, so the patient starts the treatment afebrile and then develops rigors, fever, hypotension, nausea and myalgia partway through the run. That timing separates it from a catheter-related bloodstream infection, where the patient is often already febrile or spikes right after the catheter is accessed. Vital signs including temperature, immediate notification of the nurse, cultures and stopping treatment per order, saving samples, and an adverse-occurrence report are the correct steps, and the water and disinfection systems are then investigated.
Source: NNCC CCHT content outline, Clinical practice area (recognize signs and symptoms of infection); Environment practice area (water treatment and dialysate quality monitoring)Report a problem with this question
21. A patient begins to have a generalized seizure during treatment. What should the technician do?
- A.Call for help, stay with the patient, protect the patient from injury, stop fluid removal, and note the time and duration✓ Answer
- B.Leave the patient to get the emergency cart before doing anything else
- C.Insert a padded tongue blade into the mouth to protect the airway
- D.Hold the patient's arms and legs still so the needles are not dislodged
During a seizure the technician protects the patient from injury and protects the airway by positioning, but never restrains the limbs and never puts anything in the mouth, since both cause injury. Ultrafiltration is stopped because severe hypotension is one of the causes, along with disequilibrium, severe hypertension, hypoglycemia, electrolyte shifts and hypoxia. The patient is never left alone; help is called, the event is timed, the patient is turned on the side afterward, and the treatment is terminated as the nurse directs.
Source: NNCC CCHT content outline, Clinical practice area (recognize and report an emergency clinical situation; participate as directed in emergency measures)Report a problem with this question
22. During a routine check the technician notices that a patient who was alert and oriented at the start of treatment is now confused and cannot say where he is. The vital signs are within the patient's usual range. What should the technician do?
- A.Treat it as an expected effect of dialysis and take no action
- B.Report the change to the nurse immediately and document exactly what was observed✓ Answer
- C.Wait and document it at the end of the run, since the vital signs are normal
- D.Chart that the patient is probably just tired from the long weekend
Recognizing and reporting a change in cognitive or mental status is a defined technician responsibility, and new confusion during treatment is never dismissed as normal for dialysis; it can signal disequilibrium, hypoglycemia, hypoxia, a stroke or a developing hemodynamic problem even when the vital signs still look ordinary. Documentation must be objective and factual, recording what was seen and what was done, without speculation about the cause or explanations the technician is not qualified to give.
Source: NNCC CCHT content outline, Clinical and Role Responsibilities practice areas (recognize and report changes in cognitive or mental status; document patient care accurately)Report 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) →