Peritoneal Dialysis (PD) is a vital home-based renal replacement therapy that offers patients with end-stage renal disease greater flexibility and autonomy compared to traditional hemodialysis. While PD provides life-sustaining clearance, it comes with its own unique set of management challenges, particularly the risk of peritonitis and specific considerations for medication dosing. As covered in the Patient Care 4 curriculum’s module on dialysis, understanding the principles and pharmacotherapy of PD is a key competency for pharmacists. This quiz will test your knowledge on the process, complications, and medication management associated with Peritoneal Dialysis.
1. Peritoneal dialysis uses what part of the body as the semipermeable membrane for dialysis?
- a. An external artificial kidney
- b. The patient’s own peritoneal membrane
- c. The glomerular basement membrane
- d. The wall of the small intestine
Answer: b. The patient’s own peritoneal membrane
2. What is the primary osmotic agent used in peritoneal dialysate to achieve ultrafiltration (fluid removal)?
- a. Sodium
- b. Potassium
- c. Albumin
- d. Dextrose
Answer: d. Dextrose
3. The most common and serious complication of peritoneal dialysis is:
- a. Hypotension during exchanges
- b. Anemia
- c. Peritonitis
- d. Muscle cramps
Answer: c. Peritonitis
4. A patient on PD presents with cloudy effluent fluid and abdominal pain. This is highly suggestive of:
- a. A successful dialysis exchange.
- b. Dehydration.
- c. Peritonitis.
- d. A fluid leak.
Answer: c. Peritonitis.
5. The preferred route of administration for antibiotics to treat uncomplicated PD-associated peritonitis is:
- a. Intravenous (IV)
- b. Oral (PO)
- c. Intramuscular (IM)
- d. Intraperitoneal (IP), administered into the dialysate bag.
Answer: d. Intraperitoneal (IP), administered into the dialysate bag.
6. The “Drug Individualization-Dialysis; Hemodialysis and Peritoneal Dialysis” is a specific “Transcending Concept” in which course?
- a. PHA5784C Patient Care 4
- b. PHA5104 Sterile Compounding
- c. PHA5703 Pharmacy Law and Ethics
- d. PHA5878C Patient Care 3
Answer: a. PHA5784C Patient Care 4
7. Which of the following best describes Continuous Ambulatory Peritoneal Dialysis (CAPD)?
- a. A machine automatically performs exchanges overnight.
- b. The patient performs manual exchanges 3-5 times during the day.
- c. Dialysis is performed three times a week at a clinic.
- d. It is a continuous, 24-hour machine-driven therapy.
Answer: b. The patient performs manual exchanges 3-5 times during the day.
8. Automated Peritoneal Dialysis (APD) typically uses a machine called a:
- a. Centrifuge
- b. Hemodialyzer
- c. Cycler
- d. Infusion pump
Answer: c. Cycler
9. The most common causative organisms in PD-associated peritonitis are:
- a. Gram-negative rods from the gut.
- b. Anaerobic bacteria.
- c. Fungi.
- d. Gram-positive skin organisms like Staphylococcus epidermidis and S. aureus.
Answer: d. Gram-positive skin organisms like Staphylococcus epidermidis and S. aureus.
10. A common empiric antibiotic regimen for PD-associated peritonitis would include coverage for both Gram-positives and Gram-negatives, such as:
- a. Vancomycin alone
- b. Cefazolin plus ceftazidime
- c. Metronidazole alone
- d. Doxycycline
Answer: b. Cefazolin plus ceftazidime
11. The “Dosing in Dialysis” lecture is part of the Patient Care 4 curriculum.
- a. True
- b. False
Answer: a. True
12. A patient needs more fluid removed during a PD exchange. Which dialysate solution should be used?
- a. One with a lower dextrose concentration (e.g., 1.5%).
- b. One with a higher dextrose concentration (e.g., 4.25%).
- c. One with a lower sodium concentration.
- d. One with no dextrose.
Answer: b. One with a higher dextrose concentration (e.g., 4.25%).
13. A significant metabolic complication of long-term PD is:
- a. Weight loss
- b. Hypoglycemia
- c. Hyperglycemia and hyperlipidemia due to glucose absorption from the dialysate.
- d. Hypokalemia
Answer: c. Hyperglycemia and hyperlipidemia due to glucose absorption from the dialysate.
14. What is meant by the “dwell time” in peritoneal dialysis?
- a. The time it takes for fluid to be instilled into the peritoneum.
- b. The time the dialysate fluid remains in the peritoneal cavity to allow for exchange.
- c. The time it takes for fluid to be drained out.
- d. The total time the patient is connected to the cycler.
Answer: b. The time the dialysate fluid remains in the peritoneal cavity to allow for exchange.
15. A key advantage of PD compared to hemodialysis is:
- a. A lower risk of infection.
- b. It allows for a less restrictive diet.
- c. It provides a more continuous, gentle form of dialysis, leading to better hemodynamic stability.
- d. It is a faster and more efficient method of clearance.
Answer: c. It provides a more continuous, gentle form of dialysis, leading to better hemodynamic stability.
16. The “Dosing in Renal Dysfunction” module in PHA5132 provides the foundation for understanding dosing in dialysis.
- a. True
- b. False
Answer: a. True
17. Fibrin may be present in a patient’s cloudy effluent fluid. What can be added to the dialysate bag to dissolve these fibrin clots?
- a. Vancomycin
- b. Heparin
- c. Insulin
- d. Calcium gluconate
Answer: b. Heparin
18. A patient on PD should be counseled that the most important technique for preventing peritonitis is:
- a. Using sterile technique during connections and exchanges.
- b. Taking a daily prophylactic antibiotic.
- c. Limiting the number of exchanges per day.
- d. Using the highest dextrose concentration possible.
Answer: a. Using sterile technique during connections and exchanges.
19. Drug dosing for a patient on PD is generally:
- a. The same as for a patient on HD.
- b. More complex than for HD, as supplemental doses are always needed.
- c. Less reliant on post-therapy supplemental doses because the clearance is more continuous.
- d. The same as for a patient with normal renal function.
Answer: c. Less reliant on post-therapy supplemental doses because the clearance is more continuous.
20. An active learning session on dialysis is part of which course module?
- a. Module 8: Urological Disorders
- b. Module 1: PUD and GERD
- c. Module 4: Gastrointestinal Infections
- d. Module 5: Nutrition & Weight Management
Answer: a. Module 8: Urological Disorders
21. A patient on APD (Automated Peritoneal Dialysis) typically performs their dialysis:
- a. At a clinic, three times a week.
- b. Manually, four times a day.
- c. At home, overnight, using a cycler machine.
- d. Once a week.
Answer: c. At home, overnight, using a cycler machine.
22. Which of the following can lead to a loss of ultrafiltration capacity (membrane failure) in long-term PD?
- a. Recurrent episodes of peritonitis.
- b. The high glucose concentration in the dialysate.
- c. The patient’s underlying disease.
- d. All of the above.
Answer: d. All of the above.
23. The pharmacist’s role in managing a patient on PD includes:
- a. Counseling on sterile technique.
- b. Managing the pharmacotherapy of peritonitis.
- c. Dosing medications based on the patient’s continuous clearance.
- d. All of the above.
Answer: d. All of the above.
24. The renal system module in Patient Care 4 covers dialysis.
- a. True
- b. False
Answer: a. True
25. A patient on PD with peritonitis is treated with intraperitoneal gentamicin. The pharmacist must be concerned with monitoring for:
- a. Hepatotoxicity
- b. Ototoxicity and nephrotoxicity (despite ESRD)
- c. Hypertension
- d. Hyperkalemia
Answer: b. Ototoxicity and nephrotoxicity (despite ESRD)
26. Which of the following is an absolute contraindication to peritoneal dialysis?
- a. Diabetes
- b. A history of hypertension.
- c. Multiple, extensive prior abdominal surgeries leading to adhesions.
- d. A patient’s preference for home therapy.
Answer: c. Multiple, extensive prior abdominal surgeries leading to adhesions.
27. To treat gram-positive coverage empirically for peritonitis, which antibiotic is often added to the dialysate?
- a. Ciprofloxacin
- b. Metronidazole
- c. Cefazolin or Vancomycin
- d. Tobramycin
Answer: c. Cefazolin or Vancomycin
28. An active learning session on dialysis is part of which course?
- a. PHA5784C Patient Care 4
- b. PHA5163L Professional Skills Lab 3
- c. PHA5781 Patient Care I
- d. PHA5782C Patient Care 2
Answer: a. PHA5784C Patient Care 4
29. Compared to hemodialysis, peritoneal dialysis generally removes large molecules:
- a. More effectively.
- b. Less effectively.
- c. At the same rate.
- d. It does not remove large molecules.
Answer: b. Less effectively.
30. The “Dosing in Dialysis” lecture is part of the Patient Care 4 curriculum.
- a. True
- b. False
Answer: a. True
31. A common non-infectious complication of the PD catheter is:
- a. Exit-site leak
- b. Kinking or migration of the catheter
- c. Pain during infusion
- d. All of the above
Answer: d. All of the above
32. The “dwell” is the part of the PD exchange when:
- a. The dialysate is flowing into the peritoneum.
- b. The dialysate is being drained from the peritoneum.
- c. The dialysate sits in the peritoneal cavity, allowing for diffusion and ultrafiltration.
- d. The patient is disconnected from all tubing.
Answer: c. The dialysate sits in the peritoneal cavity, allowing for diffusion and ultrafiltration.
33. A patient on PD should be counseled that their dietary needs will likely include:
- a. A low-protein diet.
- b. A high-protein diet to account for protein loss into the dialysate.
- c. A diet high in potassium and phosphorus.
- d. No fluid restrictions.
Answer: b. A high-protein diet to account for protein loss into the dialysate.
34. The dialysate fluid used for PD is:
- a. Sterile, to prevent infection.
- b. Non-sterile.
- c. The same fluid used for hemodialysis.
- d. A saline solution.
Answer: a. Sterile, to prevent infection.
35. A major benefit of APD over CAPD is:
- a. It is more effective at clearance.
- b. It allows the patient to be free from exchanges during the daytime.
- c. It has a lower risk of peritonitis.
- d. The equipment is less expensive.
Answer: b. It allows the patient to be free from exchanges during the daytime.
36. A patient with PD-peritonitis caused by Pseudomonas aeruginosa requires:
- a. A single oral antibiotic.
- b. A short, 3-day course of IP antibiotics.
- c. Treatment with two different IV or IP antipseudomonal agents.
- d. No treatment, as it is a contaminant.
Answer: c. Treatment with two different IV or IP antipseudomonal agents.
37. The choice between PD and HD is often based on:
- a. Patient lifestyle and preference.
- b. Medical comorbidities.
- c. The availability of a trained caregiver.
- d. All of the above.
Answer: d. All of the above.
38. The “Drug Individualization-Dialysis” transcending concept is part of which course module?
- a. Module 8: Urological Disorders
- b. Module 1: PUD and GERD
- c. Module 4: Gastrointestinal Infections
- d. Module 5: Nutrition & Weight Management
Answer: a. Module 8: Urological Disorders
39. A patient on PD develops peritonitis. The pharmacist mixes antibiotics into the dialysate bag. This is an example of:
- a. Self-care
- b. Sterile compounding
- c. A medication error
- d. A drug-device interaction
Answer: b. Sterile compounding
40. A patient’s drained dialysate fluid should be:
- a. Clear and colorless or pale yellow.
- b. Cloudy and opaque.
- c. Bloody.
- d. Green.
Answer: a. Clear and colorless or pale yellow.
41. Which of the following is an advantage of hemodialysis over peritoneal dialysis?
- a. It can be done at home.
- b. It is more hemodynamically stable.
- c. It is more efficient and provides higher solute clearance in a shorter period.
- d. It has a lower risk of infection.
Answer: c. It is more efficient and provides higher solute clearance in a shorter period.
42. For an antibiotic administered intraperitoneally, the “dwell time” is important because:
- a. It allows for adequate absorption of the antibiotic from the dialysate into the systemic circulation and peritoneal space.
- b. It ensures the antibiotic is not active.
- c. It allows the antibiotic to be drained out quickly.
- d. It has no impact on antibiotic efficacy.
Answer: a. It allows for adequate absorption of the antibiotic from the dialysate into the systemic circulation and peritoneal space.
43. A patient on PD should have their weight monitored daily to assess:
- a. Their nutritional status.
- b. Their fluid status.
- c. The efficacy of their antibiotics.
- d. Their muscle mass.
Answer: b. Their fluid status.
44. The pharmacist’s role in peritonitis management includes recommending appropriate antibiotic doses and duration, and ensuring compatibility of drugs in the dialysate.
- a. True
- b. False
Answer: a. True
45. Which of the following is NOT a primary goal of dialysis?
- a. Removal of waste products.
- b. Removal of excess fluid.
- c. Correction of electrolyte abnormalities.
- d. Curing the underlying kidney disease.
Answer: d. Curing the underlying kidney disease.
46. A patient on CAPD performs an exchange by:
- a. Connecting to a machine at night.
- b. Going to a clinic three times a week.
- c. Manually instilling a bag of dialysate, letting it dwell, and then manually draining it.
- d. Taking an oral medication.
Answer: c. Manually instilling a bag of dialysate, letting it dwell, and then manually draining it.
47. A common cause of catheter exit-site infections in PD is:
- a. Poor hygiene during dressing changes.
- b. The dialysate fluid.
- c. The patient’s diet.
- d. Systemic antibiotics.
Answer: a. Poor hygiene during dressing changes.
48. An active learning session covering dialysis is part of which course?
- a. PHA5784C Patient Care 4
- b. PHA5163L Professional Skills Lab 3
- c. PHA5781 Patient Care I
- d. PHA5782C Patient Care 2
Answer: a. PHA5784C Patient Care 4
49. Peritoneal dialysis is a form of:
- a. Extracorporeal therapy
- b. Intracorporeal therapy
- c. Gene therapy
- d. Immunotherapy
Answer: b. Intracorporeal therapy
50. The ultimate goal of a pharmacist’s involvement in the care of a peritoneal dialysis patient is to:
- a. Ensure the patient switches to hemodialysis.
- b. Help the patient manage their complex therapy safely and effectively to prevent complications and improve quality of life.
- c. Only focus on dispensing supplies.
- d. Prevent the patient from using any extra medications.
Answer: b. Help the patient manage their complex therapy safely and effectively to prevent complications and improve quality of life.