BONENT Certified Peritoneal Dialysis Nurse (CPDN) Practice Test

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Question 1. A patient reports taking an over-the-counter decongestant for several days and now has persistently higher blood pressure. Weight, edema, urine output, and ultrafiltration are unchanged. Which factor should the nurse consider?

A. Medication-related blood pressure elevation
B. Definite ultrafiltration failure
C. Loss of residual kidney function as the only cause
D. Peritoneal infection

Correct Answer: A

Answer Explanation:
Some over-the-counter decongestants can increase blood pressure through vasoconstrictive effects. The timing of the blood pressure change, combined with stable weight, edema, urine output, and ultrafiltration, makes medication-related hypertension an important possibility. The nurse should perform medication reconciliation, including nonprescription products, and communicate the findings to the healthcare team. Volume-related hypertension should still be assessed, but the stable fluid indicators make an external medication contributor particularly relevant. Patients should be taught to consult the renal care team before using over-the-counter products because kidney disease can change medication safety considerations.

Why the other options are incorrect:
Option A is correct because the new medication provides a plausible explanation for the BP change.
Option B is incorrect because stable UF and fluid indicators do not establish UF failure.
Option C is incorrect because the patient’s urine output has remained stable.
Option D is incorrect because there are no findings suggesting peritonitis.

Study Guide:
Medication reconciliation should include prescription, over-the-counter, and supplemental products. Some common medications can affect blood pressure, fluid status, or electrolyte balance. Patients with PD should check renal safety before starting new nonprescription medications.

Question 2. A patient has repeated low Kt/V results. The patient insists that all prescribed exchanges are completed, but review shows that urine collections are frequently incomplete because the patient forgets to save every urine void. What should the nurse recognize?

A. Inaccurate urine collection can distort the adequacy calculation
B. Incomplete urine collection always makes Kt/V appear falsely high
C. Urine collection has no role in PD adequacy
D. The patient must immediately increase exchange volume

Correct Answer: A

Answer Explanation:
Residual renal clearance is incorporated into total PD adequacy when residual kidney function is present. If the urine collection is incomplete, the measured urinary clearance may be inaccurate, which can distort the overall adequacy calculation. The nurse should review the collection procedure, identify why voids are being missed, provide a simple collection strategy, and use teach-back to confirm understanding. The direction and magnitude of the resulting calculation error depend on the circumstances, so it is not correct to assume that incomplete collection always produces a falsely high result. Prescription changes should not be made until the adequacy data are reliable.

Why the other options are incorrect:
Option A is correct because inaccurate urine collection can compromise the validity of adequacy assessment.
Option B is incorrect because incomplete collection does not universally produce the same directional error.
Option C is incorrect because residual urine contributes to total clearance assessment.
Option D is incorrect because prescription changes should not be based on unreliable collection data.

Study Guide:
Adequacy assessment depends on accurate collection and documentation. When residual urine contributes to clearance, incomplete urine collection can distort the calculated result. Patients should receive clear collection instructions and demonstrate understanding before repeat testing.

Question 3. A patient asks why a medication dose may need to be changed after residual urine output decreases substantially. Which explanation is best?

A. Reduced renal clearance can cause some medications to remain in the body longer
B. All medications are completely removed by PD
C. Reduced urine output makes every medication ineffective
D. PD always increases medication clearance as kidney function declines

Correct Answer: A

Answer Explanation:
Many medications are eliminated partly or primarily by the kidneys. When residual renal function declines, renal clearance may decrease, increasing the medication’s exposure or duration in the body. The effect depends on the specific drug and its pharmacokinetic properties. PD clearance also varies among medications based on molecular size, protein binding, volume of distribution, and treatment characteristics. Therefore, a decline in urine output should prompt medication review rather than an automatic dose change in one direction. Pharmacists and prescribers can determine whether dose adjustment, monitoring, or alternative therapy is appropriate.

Why the other options are incorrect:
Option A is correct because reduced renal clearance can increase exposure to renally eliminated drugs.
Option B is incorrect because PD does not completely remove all medications.
Option C is incorrect because reduced kidney function can increase, decrease, or have little effect on medication exposure depending on the drug.
Option D is incorrect because PD does not universally increase medication clearance.

Study Guide:
Residual kidney function affects medication pharmacokinetics as well as dialysis adequacy. Declining renal clearance can increase exposure to some medications. Drug-specific references should be used because PD removal varies according to pharmacokinetic characteristics.

Question 4. A patient with APD says the treatment record shows the prescribed ultrafiltration amount, but the patient cannot explain how that number was obtained. When asked to demonstrate, the patient reads the expected UF from the prescription rather than the cycler’s actual result. What should the nurse do?

A. Provide focused education on locating actual UF data and use return demonstration
B. Tell the patient to stop keeping records
C. Tell the patient to estimate UF from body weight
D. Assume the patient’s treatment is adequate because the cycler completed

Correct Answer: A

Answer Explanation:
The patient has a specific documentation misunderstanding: confusing prescribed or expected ultrafiltration with the actual treatment result. The nurse should demonstrate where actual UF information is found on the cycler or treatment record and then ask the patient to repeat the process. Accurate actual UF data help the PD team evaluate fluid removal and identify trends. Weight can supplement treatment data but cannot replace actual UF documentation. A completed cycler program also does not prove that expected fluid removal occurred. Focused education and return demonstration are appropriate because the error is specific and correctable.

Why the other options are incorrect:
Option A is correct because it directly addresses the identified knowledge gap and verifies competency.
Option B is incorrect because treatment records remain clinically important.
Option C is incorrect because weight cannot substitute for actual UF data.
Option D is incorrect because programmed completion does not guarantee expected UF.

Study Guide:
Patients should understand the difference between prescribed settings and actual treatment results. Accurate UF documentation supports assessment of fluid balance and treatment performance. When documentation errors occur, focused instruction followed by return demonstration is effective.

Question 5. During a routine visit, a patient who has been independent with PD for several years reports new difficulty reading small print, distinguishing similar dialysate bags, and seeing connection components clearly. What should the CPDN do?

A. Reassess visual function and determine whether the patient can safely continue the current technique
B. Assume the patient will adapt without assistance
C. Tell the patient to memorize the bag positions
D. Increase the number of exchanges to compensate for visual errors

Correct Answer: A

Answer Explanation:
New visual impairment can create significant safety risks during PD, including selecting the wrong dialysate concentration, misreading expiration information, or compromising sterile connections. The nurse should reassess the patient’s functional vision and determine which steps are affected. Appropriate adaptations may include improved lighting, magnification, clearly differentiated storage and identification systems, or trained caregiver assistance when necessary. The patient should demonstrate safe solution identification and connection technique after adaptations are introduced. Memorization is not a reliable substitute for visual verification, and increasing exchange frequency does not address the safety problem. Functional reassessment is particularly important because the patient was previously competent but has developed a new limitation.

Why the other options are incorrect:
Option A is correct because visual changes can directly affect safe PD performance and require functional reassessment.
Option B is incorrect because assuming adaptation could expose the patient to preventable errors.
Option C is incorrect because memorization does not reliably prevent solution-identification errors.
Option D is incorrect because additional exchanges do not correct visual or connection safety problems.

Study Guide:
Vision changes can affect solution identification, equipment handling, and aseptic technique. Nurses should assess functional ability rather than relying on previous competency. Adaptive strategies and caregiver support should be individualized and validated through direct observation and return demonstration.

Question 6. A patient performing CAPD reports that the effluent becomes pink-tinged during the first exchange after strenuous exercise but returns to clear on subsequent exchanges. The patient has no abdominal pain, dizziness, or hypotension. What should the nurse do?

A. Tell the patient that any blood in the effluent requires permanent discontinuation of PD
B. Assess the amount, timing, trend, associated symptoms, and recent activity, and follow the PD program’s reporting protocol
C. Immediately increase the dialysate glucose concentration
D. Tell the patient to skip all future exchanges after exercise

Correct Answer: B

Answer Explanation:
Blood-tinged effluent can have several causes, and a small transient change may occur in some circumstances, but it should not automatically be dismissed. The nurse should assess the amount and appearance of blood, timing relative to exercise, recurrence, abdominal symptoms, catheter manipulation, vital signs, and other relevant findings. The patient should follow the PD program’s instructions for reporting and evaluation. Persistent, increasing, or symptomatic bleeding requires further assessment. Permanent discontinuation of PD is not automatically indicated, and changing dialysate concentration does not treat the underlying cause. Accurate observation of trends helps distinguish a transient finding from a potentially significant complication.

Why the other options are incorrect:
Option A is incorrect because transient blood-tinged effluent does not automatically require permanent discontinuation of PD.
Option B is correct because the amount, timing, symptoms, and recurrence determine the significance of the finding.
Option C is incorrect because glucose concentration does not treat blood in the effluent.
Option D is incorrect because skipping future exchanges without assessment could compromise dialysis.

Study Guide:
Changes in effluent color should be assessed rather than automatically dismissed or assumed to represent one diagnosis. Document timing, amount, recurrence, symptoms, and possible triggers. Persistent or worsening blood-tinged effluent should be communicated to the PD team.

Question 7. A patient with APD reports that drainage is consistently slower after taking a newly prescribed medication. The medication is known to reduce gastrointestinal motility. The patient also reports decreased bowel movements. What should the nurse suspect?

A. Medication-related constipation contributing to catheter drainage problems
B. Improved peritoneal ultrafiltration
C. Increased residual kidney function
D. Reduced glucose absorption

Correct Answer: A

Answer Explanation:
A medication that slows gastrointestinal motility can cause constipation, and constipation can mechanically interfere with PD catheter drainage. The timing of the new medication, reduced bowel movements, and onset of drainage difficulty together make this a strong possibility. The nurse should assess bowel frequency, stool characteristics, abdominal symptoms, medication timing, hydration and dietary factors, and the patient’s established bowel regimen. Other mechanical causes should also be considered if drainage does not improve. The prescribing team may need to review the medication or bowel-management plan. The patient should not independently stop the medication or alter the PD prescription.

Why the other options are incorrect:
Option A is correct because medication-induced constipation can impair catheter drainage.
Option B is incorrect because improved ultrafiltration would not explain slower drainage associated with reduced bowel motility.
Option C is incorrect because residual kidney function does not directly cause positional or bowel-related catheter drainage problems.
Option D is incorrect because glucose absorption does not explain the bowel and drainage pattern.

Study Guide:
Constipation can cause or worsen PD drainage problems. Medication reconciliation should include drugs that affect gastrointestinal motility. When drainage changes after a new medication, assess bowel function and communicate medication-related concerns to the clinical team.

Question 8. A patient with PD reports a new 2-kg weight gain and increasing edema. The patient says, “My cycler is working normally, so this can’t be fluid.” Which response is most appropriate?

A. “If the cycler completes, fluid overload is impossible.”
B. “Let’s compare your actual ultrafiltration, urine output, intake, weight, and blood pressure trends.”
C. “You should immediately double your next exchange.”
D. “You should stop drinking fluids completely.”

Correct Answer: B

Answer Explanation:
Fluid status cannot be determined from cycler completion alone. Weight gain and edema suggest possible fluid accumulation, and the nurse should review actual ultrafiltration, residual urine output, sodium and fluid intake, blood pressure, treatment delivery, and recent prescription changes. A machine completing its programmed sequence does not guarantee that the expected amount of fluid was removed. The patient should not independently double exchanges or completely restrict fluids because either approach could create additional complications. A comprehensive assessment allows the PD team to determine whether the problem involves inadequate ultrafiltration, declining residual function, increased intake, or another cause.

Why the other options are incorrect:
Option A is incorrect because programmed completion does not prove adequate fluid removal.
Option B is correct because multiple objective measures are needed to evaluate volume status.
Option C is incorrect because unsupervised treatment changes may cause excessive fluid removal.
Option D is incorrect because complete fluid restriction can cause dehydration and other complications.

Study Guide:
Weight gain and edema require evaluation even when the cycler appears to function normally. Actual UF, urine output, blood pressure, intake, and treatment records provide a clearer picture of fluid balance. Patients should avoid making independent prescription changes.

Question 9. A patient has a declining Kt/V despite reporting that all exchanges are completed. Review shows that the patient recently gained 12 kg of body weight. Which factor may contribute to the change in adequacy?

A. Increased body size can change the relationship between dialysis clearance and total body water
B. Weight gain always means peritonitis
C. Increased body weight always improves Kt/V
D. Body size has no relevance to adequacy assessment

Correct Answer: A

Answer Explanation:
Dialysis adequacy calculations relate clearance to the patient’s body water or distribution volume. A substantial increase in body weight can therefore affect the relationship between the amount of clearance provided and the patient’s total body water. Weight gain may also reflect fluid accumulation, which creates additional clinical concerns. The nurse should assess whether the weight increase represents fluid, tissue, or a combination, while reviewing treatment delivery, residual kidney function, adequacy data, and other relevant factors. A decline in Kt/V should not automatically be attributed to one cause, but significant changes in body size can be clinically important when interpreting adequacy.

Why the other options are incorrect:
Option A is correct because body size and total body water are relevant to adequacy calculations.
Option B is incorrect because weight gain alone does not establish peritonitis.
Option C is incorrect because increasing body size does not automatically improve normalized clearance.
Option D is incorrect because body size is an important consideration in adequacy assessment.

Study Guide:
Adequacy is influenced by dialysis clearance relative to the patient’s body water. Changes in body size can affect normalized clearance measurements. When adequacy declines, assess body size, residual kidney function, treatment delivery, membrane transport, and collection accuracy.

Question 10. A patient reports that a PD bag has an intact outer package but the solution is unusually cloudy before connection. The patient has no symptoms. What should the nurse instruct?

A. Use the solution if the package is intact
B. Shake the bag vigorously and use it if the cloudiness disappears
C. Do not use the solution and follow the established procedure for replacement and reporting
D. Add a prescribed antibiotic to the bag before use

Correct Answer: C

Answer Explanation:
An unusually cloudy PD solution before connection is abnormal and should not be used without appropriate evaluation. The patient should set the bag aside and follow the PD program’s procedure for obtaining a replacement and reporting the abnormal supply. An intact package does not guarantee that the solution itself is acceptable. Shaking the bag does not establish safety, and adding an antibiotic independently could create contamination or compatibility problems. This situation differs from cloudy effluent after dialysis, which can be a clinical sign of peritonitis; however, an abnormal solution before connection is a supply-quality concern that must be addressed before treatment.

Why the other options are incorrect:
Option A is incorrect because solution appearance must also be assessed before use.
Option B is incorrect because shaking does not make an abnormal solution safe.
Option C is correct because questionable solution should not be used and requires appropriate replacement/reporting.
Option D is incorrect because medications should never be added to a questionable solution without specific instructions and compatibility verification.

Study Guide:
Patients should inspect PD solutions before every exchange for abnormal appearance, particles, discoloration, leaks, and package problems. A questionable bag should not be used. Patients need clear instructions for obtaining a replacement and reporting supply concerns.

Question 11. A patient with PD develops nausea, weakness, and muscle cramps after several days of poor oral intake. The patient’s blood pressure is lower than usual, and weight has decreased by 2 kg. What should the nurse suspect?

A. Volume depletion and possible electrolyte imbalance
B. Definite fluid overload
C. Improved nutritional status
D. Increased peritoneal protein absorption

Correct Answer: A

Answer Explanation:
Poor oral intake combined with weight loss, lower blood pressure, weakness, and muscle cramps suggests possible volume depletion and electrolyte abnormalities. The nurse should assess hydration status, blood pressure including orthostatic symptoms when appropriate, weight trend, urine output, actual ultrafiltration, dietary intake, gastrointestinal losses, and laboratory values. Medication effects should also be considered. The PD team may need to reassess fluid removal and the patient’s overall treatment plan. The patient should not independently increase or decrease dialysate concentration. Recognizing the relationship between intake, ultrafiltration, and clinical volume status is important for preventing excessive fluid removal.

Why the other options are incorrect:
Option A is correct because the clinical findings are consistent with possible volume and electrolyte depletion.
Option B is incorrect because fluid overload more commonly causes weight gain, edema, and hypertension.
Option C is incorrect because the patient has poor intake and weight loss rather than improved nutritional status.
Option D is incorrect because increased protein absorption does not explain the clinical presentation.

Study Guide:
Poor oral intake can compound fluid and electrolyte losses from PD. Weight loss, hypotension, weakness, and cramps should prompt assessment of volume status and laboratory abnormalities. Actual UF and residual urine output are useful when evaluating the overall fluid balance.

Question 12. A patient reports increasing abdominal discomfort during PD and says the discomfort began after several weeks of reduced physical activity. Bowel movements have decreased from daily to twice weekly. Drainage is also slower. Which intervention is most appropriate?

A. Assess constipation and review the patient’s bowel-management plan
B. Increase dialysate glucose concentration
C. Tell the patient to skip all daytime exchanges
D. Assume the catheter has permanently failed

Correct Answer: A

Answer Explanation:
Reduced physical activity accompanied by decreased bowel frequency and slower PD drainage makes constipation an important potential contributor. Bowel distention can interfere with catheter position and drainage and may cause abdominal discomfort. The nurse should assess stool frequency and characteristics, abdominal symptoms, medications, fluid and dietary factors, and adherence to the prescribed bowel regimen. If constipation is confirmed, the patient should follow the established bowel-management plan and communicate persistent symptoms to the PD team. Other mechanical or infectious causes should be considered if symptoms do not resolve or if concerning findings develop. Increasing glucose concentration would not address the underlying bowel problem.

Why the other options are incorrect:
Option A is correct because constipation can cause abdominal discomfort and impair catheter drainage.
Option B is incorrect because glucose concentration does not correct constipation.
Option C is incorrect because skipping exchanges can reduce delivered dialysis.
Option D is incorrect because constipation is a potentially reversible contributor and does not establish permanent catheter failure.

Study Guide:
Bowel function is closely linked to PD catheter performance. Reduced activity, constipating medications, and dietary changes can increase constipation risk. Persistent constipation or drainage problems should be evaluated systematically rather than treated with unsupervised changes to PD therapy.

Question 13. A patient reports that a new medication causes severe diarrhea and asks whether to continue taking it. The patient is also receiving PD and has recently developed dizziness when standing. What should the nurse do?

A. Tell the patient to take double doses on days without diarrhea
B. Assess the diarrhea, volume status, and medication timing and communicate with the prescribing team
C. Tell the patient to stop all PD exchanges
D. Tell the patient that diarrhea cannot affect PD patients

Correct Answer: B

Answer Explanation:
Medication-associated diarrhea can cause significant fluid and electrolyte losses, which may be compounded by PD ultrafiltration. Orthostatic dizziness raises concern for volume depletion. The nurse should assess stool frequency, duration, severity, blood or other concerning features, weight, blood pressure, urine output, oral intake, actual ultrafiltration, and medication timing. The prescribing clinician or pharmacist should be informed so the medication can be evaluated. Abruptly stopping all PD or doubling medication doses is unsafe. Prompt assessment helps prevent worsening dehydration, electrolyte disturbances, and reduced residual kidney function.

Why the other options are incorrect:
Option A is incorrect because doubling medication can cause toxicity and does not treat diarrhea.
Option B is correct because both the adverse medication effect and possible volume depletion require assessment.
Option C is incorrect because stopping PD without an alternative plan can compromise treatment.
Option D is incorrect because diarrhea can significantly affect fluid and electrolyte balance in PD.

Study Guide:
Diarrhea can cause fluid and electrolyte losses that may be amplified by PD ultrafiltration. Medication-related diarrhea should be assessed for severity and timing. Orthostatic symptoms, weight loss, hypotension, or reduced urine output warrant prompt attention.

Question 14. A patient has a history of recurrent peritonitis. During a home assessment, the nurse observes that the patient keeps sterile connection supplies in an open cardboard box on the floor near a frequently used doorway. What is the most appropriate intervention?

A. Leave the supplies there because they are packaged
B. Move supplies to a clean, dry, protected storage location and review storage practices
C. Increase the patient’s dialysate concentration
D. Tell the patient to store supplies outdoors instead

Correct Answer: B

Answer Explanation:
PD supplies should be stored in a clean, dry, protected environment away from unnecessary traffic and contamination sources. Keeping sterile supplies on the floor near a frequently used doorway increases exposure to dust, moisture, accidental contact, and environmental contamination. The nurse should help the patient identify an appropriate storage location and review package integrity, expiration dates, and environmental requirements. Proper storage is one component of infection prevention and supply safety. Changing dialysate concentration has no role in preventing contamination, and outdoor storage introduces additional environmental risks.

Why the other options are incorrect:
Option A is incorrect because packaging does not eliminate environmental storage concerns.
Option B is correct because clean, dry, protected storage reduces avoidable contamination and supply damage risks.
Option C is incorrect because dialysate concentration does not affect environmental contamination.
Option D is incorrect because outdoor storage exposes supplies to uncontrolled environmental conditions.

Study Guide:
PD supplies should be protected from moisture, excessive temperature variation, dust, traffic, and accidental contamination. Patients should inspect packages before use and maintain an organized storage area. Proper storage complements aseptic connection technique in preventing infection.

Question 15. A patient asks the CPDN whether it is acceptable to document a missed exchange as completed because “the doctor won’t know anyway.” What is the nurse’s best response?

A. Agree if the patient completes an extra exchange later
B. Explain that accurate documentation is essential for safe clinical decisions and explore why the exchange was missed
C. Tell the patient that documentation is optional
D. Record the exchange as completed to preserve the patient’s confidence

Correct Answer: B

Answer Explanation:
Accurate documentation is essential because the PD team uses treatment records to evaluate adequacy, fluid balance, adherence, and potential causes of clinical changes. Falsifying a missed exchange could lead clinicians to believe the patient received more dialysis than actually occurred and could result in inappropriate clinical decisions. The nurse should respond nonjudgmentally and explore why the exchange was missed, such as work demands, treatment burden, symptoms, equipment problems, or misunderstanding. The patient should be encouraged to document the actual treatment and communicate barriers so the team can help develop a safer, sustainable plan. Professional integrity requires truthful clinical documentation.

Why the other options are incorrect:
Option A is incorrect because completing a later exchange does not make the original documentation accurate.
Option B is correct because truthful documentation protects patient safety while allowing the underlying barrier to be addressed.
Option C is incorrect because treatment documentation is an important component of PD management.
Option D is incorrect because knowingly recording inaccurate information compromises patient safety and professional integrity.

Study Guide:
Accurate PD documentation supports treatment decisions, adequacy assessment, fluid management, and quality improvement. Missed or incomplete treatments should be recorded honestly. A nonjudgmental approach helps identify barriers and encourages patients to report problems before they become more serious.