BONENT CHN Practice Questions (2026) — Free Sample Questions with Answers

Answer: D

Continue treatments as scheduled because the family has objected to stopping: A patient with decision-making capacity has the right to refuse or withdraw treatment; family objection does not override that right.

Explain that stopping dialysis is not allowed while the patient remains medically stable: Withdrawal from dialysis is an ethically and legally accepted option for a capable patient; it is not prohibited.

Request an immediate psychiatric hold so the request can be treated as suicidal intent: A considered request to withdraw life-sustaining treatment is not, by itself, suicidal ideation; screening for depression is appropriate, but a hold is not.

Acknowledge the request, notify the nephrologist and plan a care conference: Correct. The request triggers shared decision-making: confirm capacity, screen for treatable causes such as depression, and involve the nephrologist, social worker, patient and family.

Respect autonomy: a patient with capacity may withdraw from dialysis; the team's job is shared decision-making, evaluation for reversible causes and palliative support.

Answer: B

A 4-hour run at a blood flow of 450 mL/min with a large high-efficiency dialyzer: Aggressive, prolonged clearance causes a rapid fall in plasma urea, the main cause of disequilibrium.

A 2-hour run at a blood flow near 200 mL/min with a small-surface-area dialyzer: Correct. A short, gentle first treatment limits urea reduction (often to about 30–40%), preventing the osmotic shift that causes cerebral edema.

A standard 3.5-hour run with a low-sodium dialysate to remove more fluid: Low dialysate sodium lowers plasma osmolality further and increases, rather than reduces, disequilibrium risk.

Isolated ultrafiltration alone until the BUN falls below 100 mg/dL: Isolated ultrafiltration removes fluid with little urea clearance, so it will not lower the BUN as intended.

Disequilibrium follows rapid urea removal (headache, nausea, restlessness, seizures); make first treatments short, slow and small.

Answer: B

Arterial inflow stenosis limiting blood delivery: Inflow stenosis typically causes very negative arterial pressures and a weak, flat access, not rising venous pressures.

Venous outflow stenosis near the venous anastomosis: Correct. Obstruction downstream raises intra-access pressure, prolonging bleeding and producing a pulsatile 'water-hammer' pulse; refer for evaluation.

Distal hypoperfusion (steal) of the access hand: Steal presents with a cold, pale, painful hand, not with high venous pressure and prolonged bleeding.

Infection of the graft at the cannulation sites: Graft infection presents with redness, warmth, drainage or fever, not these pressure changes.

High venous pressures + prolonged post-needle bleeding + pulsatile access = outflow stenosis; very negative arterial pressure + flat access = inflow problem.

Answer: C

About 35 to 40 grams per day: This is roughly 0.5 g/kg/day, a very-low-protein level that would risk protein-energy wasting on dialysis.

About 42 to 56 grams per day: This (0.6–0.8 g/kg) reflects protein restriction for CKD not on dialysis, not the higher needs of a dialysis patient.

About 70 to 84 grams per day: Correct. KDOQI 2020 recommends 1.0–1.2 g/kg/day for stable maintenance hemodialysis patients: 70 × 1.0 = 70 g to 70 × 1.2 = 84 g.

About 105 to 126 grams per day: This (1.5–1.8 g/kg) exceeds the recommendation and adds phosphorus and urea load without proven benefit.

Dialysis removes amino acids, so protein needs rise to about 1.0–1.2 g/kg/day; multiply by dry weight.

Answer: D

A descriptive survey of nurses' cannulation preferences: A survey describes opinions; it cannot show that one technique causes fewer infiltrations.

A retrospective chart review of past infiltration rates: Retrospective reviews can show associations but are subject to confounding and cannot establish causation.

A qualitative study of patients' cannulation experiences: Qualitative designs explore experiences and meaning, not causal effects.

A randomized controlled trial comparing the two techniques: Correct. Random assignment balances confounders, so differences in outcome can be attributed to the technique.

To test cause and effect, randomize: RCTs sit at the top of the evidence hierarchy for single studies.

Answer: C

Dialyze on the open floor if the machine is bleach-disinfected after each use: HBsAg-positive patients require separation in an isolation room or area; disinfection alone is not sufficient.

Dialyze in isolation with a dedicated machine and dialyzer reuse permitted: CDC recommends that HBsAg-positive patients not participate in dialyzer reuse.

Dialyze in isolation with a dedicated machine, equipment and supplies: Correct. Use a separate room, dedicated machine, equipment, instruments, supplies and medications, and staff who are not caring for HBV-susceptible patients at the same time.

Dialyze in isolation only if the patient is also HBeAg positive: Isolation is based on HBsAg positivity, not on HBeAg status.

HBsAg-positive: isolation room, dedicated machine and supplies, no reuse, and staff not simultaneously caring for susceptible patients.