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Question 1. Which vessel layer is primarily responsible for controlling vessel diameter and blood flow regulation? A) Tunica intima B) Tunica media C) Tunica adventitia D) Endothelium Answer: B Explanation: The tunica media contains smooth muscle fibers that regulate vessel diameter and blood flow, making it the primary layer responsible for vasoconstriction and vasodilation. Question 2. What is the main function of the lymphatic system in relation to vascular access? A) Oxygen transport B) Immune response and fluid balance C) Blood pressure regulation D) Hormone delivery Answer: B
Explanation: The lymphatic system helps maintain fluid balance and immune surveillance, which are crucial in preventing infections associated with vascular access. Question 3. Which of the following best describes microcirculation? A) Blood flow through large arteries B) Blood flow through capillary networks in tissues C) Blood flow in the vena cava D) Blood flow in the heart chambers Answer: B Explanation: Microcirculation involves blood flow through capillaries, arterioles, and venules, essential for tissue perfusion and healing at access sites. Question 4. Which neurovascular bundle is most relevant during vascular access procedures in the wrist? A) Median nerve, brachial artery, and median basilic vein B) Radial nerve, radial artery, and cephalic vein C) Median nerve, radial artery, and cephalic vein
Question 6. Which hemodynamic parameter primarily reflects resistance to blood flow? A) Blood pressure B) Cardiac output C) Vascular resistance D) Blood viscosity Answer: C Explanation: Vascular resistance directly influences blood flow resistance; increased resistance can reduce flow in vessels or grafts. Question 7. Which factor most significantly affects blood flow in a native arteriovenous fistula? A) Blood viscosity B) Vessel diameter and patency C) Heart rate D) Blood pH Answer: B
Explanation: Vessel diameter and patency are critical determinants of flow rate in AVFs; larger, unobstructed vessels favor higher flow. Question 8. Which physiological response is most commonly observed after creation of a vascular access? A) Decreased cardiac output B) Increased cardiac preload and cardiac output C) Decreased peripheral resistance D) Vasoconstriction of access vessels Answer: B Explanation: The creation of AV access causes increased preload and cardiac output due to increased venous return. Question 9. Which of the following is NOT a common modality of vascular access for hemodialysis? A) Arteriovenous fistula (AVF) B) Central venous catheter (CVC) C) Peritoneal dialysis catheter D) Peripheral intravenous line
C) Dacron D) Silicone Answer: A Explanation: PTFE is the most common synthetic material used for AVGs due to its biocompatibility and durability. Question 12. When inserting a tunneled central venous catheter, which site is preferred for long-term access? A) Femoral vein B) Internal jugular vein C) Saphenous vein D) Popliteal vein Answer: B Explanation: The internal jugular vein is preferred for tunneled CVCs because it has a lower infection risk and easier maintenance. Question 13. Which imaging modality is most useful for preoperative vein mapping?
A) MRI
B) Ultrasound with Doppler C) X-ray D) CT scan Answer: B Explanation: Ultrasound with Doppler provides real-time assessment of vessel size, flow, and patency for mapping. Question 14. In the context of multidisciplinary teams managing vascular access, which professional is primarily responsible for performing surgical fistula creation? A) Nephrologist B) Vascular surgeon C) Nurse practitioner D) Radiologist Answer: B Explanation: Vascular surgeons are trained to perform surgical procedures like AVF creation.
Explanation: Ensuring suitable vessel size and flow during surgery is critical for successful fistula maturation. Question 17. Which is a common site for arteriovenous fistula creation? A) Radial artery and cephalic vein (radiocephalic fistula) B) Femoral artery and great saphenous vein C) Carotid artery and jugular vein D) Ulnar artery and basilic vein Answer: A Explanation: The radiocephalic fistula at the wrist is a common, preferred site for AVF creation. Question 18. When placing an arteriovenous graft, what is a key consideration in tunneling the graft? A) Minimizing graft length to reduce infection risk B) Avoiding twisting or kinking of the graft C) Placing the graft superficial to the skin D) Using only non-absorbable sutures
Answer: B Explanation: Proper tunneling avoids twisting or kinking, which can compromise flow and increase complications. Question 19. Which site is most commonly used for initial central venous catheter insertion? A) Femoral vein B) Internal jugular vein C) Subclavian vein D) Cephalic vein Answer: B Explanation: The internal jugular vein is often preferred due to ease of access and lower complication rates. Question 20. During ultrasound-guided CVC insertion, what is the primary benefit? A) Increased risk of pneumothorax B) Improved visualization of vessels and surrounding structures
A) Antibiotics B) Anticoagulants such as heparin C) Thrombolytics D) Vasodilators Answer: B Explanation: Heparin is used to prevent clot formation within catheters and grafts, maintaining patency. Question 23. Which medication class is used to dissolve thrombi in thrombosed access? A) Antibiotics B) Thrombolytics C) Antiplatelet agents D) Vasoconstrictors Answer: B Explanation: Thrombolytics, such as alteplase, are used to dissolve blood clots obstructing access.
Question 24. Which patient history detail is critical before creating an AVF? A) History of bleeding disorders B) History of allergy to shellfish C) Previous use of peripheral IVs only D) Prior cardiac surgery Answer: A Explanation: Bleeding disorders can increase risk of bleeding complications during surgery and must be considered. Question 25. Which physical exam finding suggests a mature AVF suitable for cannulation? A) Palpable thrill and auscultated bruit B) Absence of pulse distal to access C) Skin ulceration at the site D) Pain and swelling Answer: A
Answer: B Explanation: Dialysis nurses monitor access function, perform surveillance, and detect early signs of dysfunction. Question 28. Which physical examination finding indicates possible stenosis in an AVF? A) Decreased thrill or bruit over the access site B) Palpable thrill and loud bruit C) Skin warmth and erythema D) Excessive bleeding at cannulation sites Answer: A Explanation: Loss of thrill or bruit suggests stenosis or narrowing of the vessel, impairing flow. Question 29. What is the primary purpose of surveillance ultrasound in vascular access? A) Detecting infections B) Measuring flow rates and identifying stenosis
C) Visualizing bone structures D) Assessing vessel wall calcification Answer: B Explanation: Ultrasound surveillance assesses flow and detects stenosis before clinical symptoms develop. Question 30. Which needle size is typically recommended for cannulating an AV fistula? A) 14G B) 17G C) 21G D) 23G Answer: B Explanation: A 17G needle is commonly used for AVF cannulation to facilitate adequate flow while minimizing trauma. Question 31. Which is a key strategy in reducing pain during AV access cannulation?
Question 33. Which dressing protocol is recommended to prevent infection at a CVC site? A) Occlusive sterile dressing, changed regularly B) No dressing needed after insertion C) Gauze dressing with daily changes D) Transparent dressing only if no signs of infection Answer: A Explanation: Sterile, occlusive dressings reduce contamination risk and are changed regularly. Question 34. Which complication is most associated with subclavian vein catheterization? A) Pneumothorax B) Hemorrhage C) Thrombosis of the internal jugular vein D) Infection Answer: A
Explanation: Subclavian access carries a higher risk of pneumothorax due to proximity to the lung apex. Question 35. Which is an early sign of catheter infection? A) Fever and chills B) Thrombosis C) Aneurysm formation D) Hematoma Answer: A Explanation: Fever, chills, and systemic signs suggest infection related to the catheter. Question 36. Which intervention is appropriate for a thrombosed AV fistula? A) Thrombolytic therapy or angioplasty B) Immediate surgical ligation C) Antibiotics D) Observation only
