Want to test your procedures knowledge before the CDN exam? Below are free sample flashcards from the 130-card procedures section of our 1050-card CDN (Certified Dialysis Nurse) deck, which covers AVF, Action Levels, Maximum Allowable Levels and more.
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Why is the rope ladder technique preferred over area cannulation for a maturing arteriovenous fistula (AVF)?
Show answer →Rope ladder involves rotating cannulation sites along the entire length of the vessel. This prevents localized weakening of the vessel wall, reducing the risk of pseudoaneurysms and stenosis. Area cannulation (repeatedly hitting the same small area) leads to "one-site-itis," thinning the wall and increasing rupture risk. Exam Tip: NNCC emphasizes site rotation to extend the lifespan of the access and maintain vessel integrity over years of treatment.
A patient with a heparin-bonded ePTFE graft (e.g., Propaten) is being educated. What is the primary purpose of the heparin bonding, and does this material change the patient's systemic anticoagulation requirements during dialysis?
Show answer →Purpose: The heparin bonding (covalent attachment) is designed to reduce the risk of early graft thrombosis by inhibiting fibrin sheath formation on the graft's luminal surface. Systemic Impact: NO, the heparin is localized to the graft material; it does not provide systemic anticoagulation. The patient still requires standard heparin protocols during the HD treatment as per unit policy.
During a routine 10:00 AM check, the primary carbon tank effluent tests at 0.15 mg/L. The secondary (polishing) tank effluent tests at 0.04 mg/L. What is the immediate required protocol?
Show answer →1. Notify the Medical Director/Technical Supervisor immediately. 2. Increase testing frequency of the secondary tank effluent to every 2 hours. 3. Dialysis may continue because the secondary tank is maintaining levels below the 0.1 mg/L limit. Rationale: The secondary tank acts as a safety buffer. Breakthrough in the first tank is a warning but not an immediate cause for stopping treatment, provided the second tank is functional and monitoring is intensified.
According to AAMI/ISO 23500-3 standards, what are the specific Action Levels for bacteria and endotoxins in RO product water, and how do they differ from the Maximum Allowable Levels?
Show answer →Action Levels: Bacteria > 50 CFU/mL; Endotoxins > 0.125 EU/mL. Maximum Allowable Levels: Bacteria > 100 CFU/mL; Endotoxins > 0.25 EU/mL. Rationale: The Action Level is 50% of the maximum limit. When results reach the Action Level, the facility must initiate corrective measures (e.g., disinfection, re-testing) to prevent exceeding the maximum limit. Clinical Pearl: For Ultrapure dialysate, the limits are even stricter (Bacteria < 0.1 CFU/mL and Endotoxin < 0.03 EU/mL). The CDN exam requires knowing these thresholds to determine when a system is in compliance vs. requiring intervention.
A nurse observes the pre-pump arterial pressure is -240 mmHg at a BFR of 400 mL/min. When the BFR is reduced to 300 mL/min, the pressure improves to -150 mmHg. What does this \BFR-dependent\ pressure change signify?
Show answer →This signifies that the access flow (Qa) is insufficient to support the requested Blood Flow Rate (BFR). Rationale: When the pump outruns the access, negative pressure increases. This is a classic sign of inflow stenosis or an immature fistula. Clinical Reasoning: While reducing BFR fixes the alarm, it compromises dialysis adequacy (Kt/V). The nurse must report this trend for vascular mapping. Distractor: Do not confuse this with a kinked line, which would cause a high negative pressure regardless of moderate BFR changes.
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Try 30 free CDN cards firstThe full CDN deck contains 1050 flashcards, and 130 of them focus on procedures. This page shows 5 free samples.
Our CDN deck dedicates 130 of 1050 cards (12%) to procedures — always cross-check the official NNCC exam outline for the current blueprint weighting.
Yes — the samples on this page are free, and the CDN preview page has 30 more free cards. Full access to all 1050 cards is a one-time $7.
Assessment
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Basics
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Diagnostics
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Management
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Pathology
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Pharmacology
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Physiology
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