Free CHN Practice Questions

Question 1

Over three treatments, a mature arteriovenous fistula has required progressively longer compression after needle removal. Venous pressures have also risen at the same blood flow rate and needle gauge. Before cannulation today, the fistula is unusually pulsatile and does not collapse when the arm is elevated. Taken together, these findings most strongly suggest:

Accepted Answer

Venous outflow stenosis

Answer

Excessive systemic anticoagulation

Answer

Arterial inflow stenosis

Answer

Needle infiltration with a local hematoma

Question 2

A patient with no urine output weighs 73.2 kg before treatment; the prescribed postdialysis weight is 70.4 kg. The plan allows 4 hours of constant ultrafiltration. The patient will receive 100 mL of intravenous medication solution and 300 mL of saline during blood return. An additional 400 mL used for circuit priming was discarded before connection. No other intake or losses are expected. What ultrafiltration rate accounts for the fluid that will actually reach the patient?

Accepted Answer

800 mL/hour

Answer

600 mL/hour

Answer

700 mL/hour

Answer

900 mL/hour

Question 3

"I understand the risks, but I want to end treatment now," says a stable adult with 30 minutes of dialysis remaining. The patient has decision-making capacity and accurately explains the consequences of shortening treatment. The daughter asks staff to continue because she disagrees with the decision. Which response respects the patient's treatment rights?

Accepted Answer

Honor the refusal, disconnect safely, notify the prescriber, and document the discussion.

Answer

Continue treatment until the nephrologist authorizes early termination.

Answer

Ask the daughter to decide because she arranged treatment and will provide aftercare.

Answer

Request psychiatric clearance before accepting a refusal that could increase the patient's medical risk.

Question 4

A patient transferring to an outpatient hemodialysis unit has detectable hepatitis C virus RNA and is hepatitis B surface antigen-negative. The patient is clinically stable, and there is no other indication for isolation. Which placement follows CDC dialysis infection-control recommendations?

Accepted Answer

At a general station using rigorous dialysis-specific infection precautions.

Answer

At a station reserved for HCV-positive patients on a separate treatment shift.

Answer

In an isolation room with staff assigned only to patients with hepatitis C.

Answer

On a dedicated machine until follow-up testing shows undetectable HCV RNA.

Question 5

Forty minutes into hemodialysis, a patient develops abrupt back pain, chest tightness, and dyspnea. Blood in the venous tubing appears unusually translucent and cherry-red, and a tightly kinked segment is found in the circuit. The nurse has stopped the blood pump, clamped the bloodlines, and called for emergency assistance. What should happen to the blood remaining in the extracorporeal circuit?

Accepted Answer

Do not reinfuse it; retain the circuit for investigation.

Answer

Return it with saline at a reduced pump speed to limit circulatory stress.

Answer

Return it after replacing the kinked tubing and confirming normal line pressures.

Answer

Hold it for reinfusion once a blood sample confirms that the patient's potassium is normal.

Question 6

At a journal club, nurses review a randomized crossover trial of two dialysate temperatures. Each participant receives both temperatures in a randomly assigned order, with other treatment settings held constant. What is the principal methodological advantage of comparing the two treatments within each participant?

Accepted Answer

Stable differences between participants are controlled by within-person comparisons.

Answer

Randomizing treatment order eliminates the need to check for carryover effects.

Answer

Giving both treatments prevents clinicians' expectations from influencing symptom assessment.

Answer

Repeated measurements provide independent observations without needing an analysis that accounts for pairing.

Question 7

A monthly adequacy report shows a single-pool Kt/V increase from 1.35 to 1.80 despite an unchanged treatment prescription and no improvement in access function. Review reveals that the postdialysis BUN specimen was drawn from the arterial bloodline after saline rinse-back had begun. How should the nurse interpret the apparent improvement?

Accepted Answer

Saline dilution lowered the postdialysis BUN and falsely increased the calculated Kt/V.

Answer

Postdialysis urea rebound lowered the BUN, making the delivered dose appear higher.

Answer

The extra fluid returned during rinse-back increased clearance, so the higher dose is credible.

Answer

The result is reliable because both BUN specimens were collected during the same treatment visit.

Question 8

Medication review reveals why a patient may be struggling with phosphate control. The patient reliably takes the prescribed three daily doses of sevelamer carbonate at 6 a.m., 2 p.m., and 10 p.m., but eats meals at 8 a.m., noon, and 6 p.m. Serum phosphate remains 7.2 mg/dL; dietary intake and delivered dialysis dose have not changed. What should the nurse address before requesting a higher binder dose?

Accepted Answer

Take the prescribed sevelamer doses with breakfast, lunch, and dinner.

Answer

Switch to a calcium-based binder at the current dosing times.

Answer

Separate sevelamer from food by two hours to avoid an absorption interaction.

Answer

Lower protein intake to the level recommended for patients with predialysis CKD.

Question 9

Two dialyzers being considered for unit purchase provide similar urea clearance at the usual blood and dialysate flow rates. The committee wants greater middle-molecule removal without excessive loss of nutritional protein. Which additional pair of performance measurements is most relevant to this comparison?

Accepted Answer

Beta-2 microglobulin clearance and albumin loss

Answer

Urea mass transfer-area coefficient and creatinine clearance

Answer

Ultrafiltration coefficient and membrane area

Answer

Priming volume and blood-side pressure drop

Question 10

Repeat total-chlorine testing during a dialysis shift shows 0.18 mg/L after the first carbon tank and 0.02 mg/L after the second. Both tanks are appropriately sized, and other water-quality checks are satisfactory. The medical director has been notified, and the water-system technician is arranging primary-tank replacement. Which response is appropriate in the meantime?

Accepted Answer

Continue current treatments with total-chlorine testing after the second tank every 30 minutes.

Answer

Stop all treatments until the first carbon tank has been replaced.

Answer

Continue routine testing because the reverse-osmosis membrane will remove any residual chloramine.

Answer

Resume sampling after the first tank in four hours to establish whether the breakthrough persists.

Free CHN Practice Questions

Domain 1: Supervision/Management 10% of exam

Question 1

Question 2

Domain 2: Dialysis and Related Issues 74.5% of exam

Question 3

Question 4

Question 5

Question 6

Question 7

Domain 3: Professional Development 5.5% of exam

Question 8

Domain 4: Environmental Control 10% of exam

Question 9

Question 10

That's 10 of 1,030