CCHT Review Exam 2022/2023 Graded A

The functional unit of the kidney, or the structure in the kidney that does the work is the: - ANSWER nephron A nephron is made up of: - ANSWER a glomerulus and tubule The endocrine functions of the kidney include: ...

The functional unit of the kidney, or the structure in the kidney that does the work is the: - ANSWER nephron A nephron is made up of: - ANSWER a glomerulus and tubule The endocrine functions of the kidney include: - ANSWER Making erythropoietin and the active form of Vitamin D The leading cause of CKD for adults in the US is: - ANSWER Diabetes Patients with kidney failure often complain of itching, which is likely to be caused by: - ANSWER Hyperphosphatemia Why do kidney patients often have bone disease? - ANSWER Kidneys stop producing calcitriol Symptoms that a patient may need more dialysis time include: - ANSWER Anorexia, fatigue, swelling A semipermeable membrane is a porous barrier that: - ANSWER Allows for only certain sized particles to cross Diffusion is a movement of particles - ANSWER By filtration through a biocompatible membrane Negative pressure is pressure created when - ANSWER Fluid is pulled through a restriction During Dialysis, ultrafiltration occurs when: - ANSWER Water is removed from blood because there is a pressure gradient between blood and dialysate. At which point in the ECC is the blood usually under negative pressure? - ANSWER The arterial line before the blood pump Which of the following will increase the amount of solutes that will diffuse across the semipermeable membrane? - ANSWER High concentration gradients The components of the dialysate treatment that affect clearance include: - ANSWER Dialysate flow, time of treatment, dialyzer size, blood flow rate Two things that affect the dialyzers ability to removes wastes from the body include: - ANSWER surface area and molecular weight cutoff Dialysate is the fluid that helps remove waste from the body. It contains a number of substances. Choose the group below that might be prescribed for a dialysate solution: - ANSWER Bicarbonate, Sodium, Potassium What is the most important safety monitor during a dialysis treatment? - ANSWER The dialysis technician Dialysate conductivity means: - ANSWER The total electrical charge of a solution Dialysate that has too much sodium may cause patient injury. Too much sodium or hypernatremia can cause: - ANSWER Headaches, high BP, and shriveling of RBCs Dialysate that has too much calcium can cause: - ANSWER Vomiting, confusion and irritability Dialysate that has too little sodium can cause - ANSWER Low blood pressure, cramping, and bursting of red blood cells Dialysis treatment adequacy has been linked to patient outcomes. Delivering an adequate "dose" of dialysis is the responsibility of the patient care staff in a dialysis unit. Things that can affect dialysis adequacy include all of the following except: - ANSWER Luer Lock connections Normal body temperature taken orally is: - ANSWER 98.6 The instrument used for measuring blood pressure is called a: - ANSWER Sphygmomanometer A rapid pulse of 104 beats/min would indicate that the patient has: - ANSWER Tachycardia Seizures during dialysis may be caused by all of the following except: - ANSWER Sudden decrease in dialyzer clearance The normal range for a resting pulse rate in an adult is: - ANSWER 60 to 100 beats/min Which of the following situations will cause an increase in VP during dialysis? - ANSWER Venous needle infiltration The TMP has been gradually changing during the last 1-1 1/2 hours of dialysis. You suspect clotting in the dialyzer. The first action you should take is to: - ANSWER Rinse the dialyzer with normal saline If there is a decrease in the patient's URR or Kt/V, which of the following factors should be looked at? (Choose all that apply) - ANSWER Increased access recirculation Diminished dialyzer performance due to reprocessing Inadequate anticoagulation of the blood Blood pump speed Which of the following is the first symptom that a patient developing dialysis equilibrium syndrome is most likely to exhibit? - ANSWER Headache A patient who is fluid overloaded will probably have which of the following sets of symptoms: Symptoms may be mild or severe. - ANSWER Tachycardia, hypertension, dyspnea "First Use Syndrome" is a hypersensitivity reaction to a dialyzer. It is characterized by: - ANSWER Back pain, anxiety, tachycardia, wheezing, circulatory collapse Dialyzer performance can be affected by reuse. Which of the following sets of potential problems may be related to reuse? - ANSWER Reduced dialyzer performance, plugged hollow fibers, changed fiber bundle volume AAMI standards recommend quality control activities before a reprocessed dialyzer is used on a patient. How many people must check the dialyzer to verify quality control information? - ANSWER Two people, one of whom should be the patient Which of the following is NOT a symptom of chemical reaction due to incomplete rinsing of germicide from a reprocessed dialyzer? - ANSWER Diarrhea Dialyzers are processed before use to rinse out manufacturing residues and to: - ANSWER Establish the original fiber bundle volume of the dialyzer and check for leaks Which of the following contains two criteria for rejecting a reprocessed dialyzer? - ANSWER Less than 80% of original fiber bundle volume, aesthetic appearance Which of the following statements is true of AAMI? - ANSWER AAMI recommends voluntary standards for dialysis water treatment According to AAMI standards, bacteriological testing for water and dialysate should take place: - ANSWER Monthly According to AAMI standards, the total microbial count of dialysate shall not exceed... - ANSWER 200 CFU/mL Stenosis is a major cause of access failure which, unless corrected, can lead to thrombosis and other complications. Which of the following is a sign of stenosis? - ANSWER Changes in the thrill and bruit Describe 4 types of anastomosis for an internal arteriovenous fistula. - ANSWER artery side to vein side artery end to vein end artery end to vein side artery side to vein end 1)Anastomosis is: 2)Bruit is: 3)Thrill is: 4)Stenosis is: 5)Thrombosis is: 6)Aneurysm is: - ANSWER 1)surgical connection between two blood vessels 2)Buzzing, swooshing sound heard in a fistula or graft 3)Vibration from pulse of blood in a dialysis vascular access 4)narrowing of a blood vessel 5)blood clotting 6)ballooning of a weak spot in a blood vessel wall Infiltration refers to which of the following definitions? - ANSWER A needle tip that punctures a vessel and goes out the other side, allowing blood to seep into the surrounding tissues Which of the following statements about catheters is true? - ANSWER Internal jugular vein is the preferred insertion site for both temporary and long term catheters Which of the following statements makes the AVF as the vascular access of choice whenever possible? - ANSWER Fistulae have the lowest rates of primary failure of all known accesses During a dialysis treatment, which of the following would indicate a break in the integrity of the ECC? - ANSWER The appearance of air or foam in the bloodline During dialysis, patients should be monitored for which of the following complications? - ANSWER Separation of blood lines or rupture of an access The presence of air or foam in the line Bleeding around the needle or catheter exit sites Sudden change in blood flow or VP, or line collapse Poor blood flow during dialysis in patients with catheters is often due to which of the following factors? - ANSWER A blood clot, poor placement of the catheter within the blood vessel, a fibrin sheath that has formed around the catheter A dialyzer with a ultrafiltration coefficient of 12, (Kuf of 12) and a TMP of 120 will remove how many mL of fluid per hour? - ANSWER 1440 If a venous needle infiltrated, what would you do? - ANSWER Insert a second needle above the venous infiltration Your patient orders are for a 17 gauge needle. You know that - ANSWER He will only be able to attain a 250 mL/min -300 mL/min QB The only professional organization in the country just for dialysis technicians is - ANSWER The National Association of Nephrology Technicians Addressing a patient as "sweetie" , - ANSWER Is inappropriate because it can make the patient feel dependent on you The patients access site has bleed for thirty minutes after needle removal for the last three treatments with no change in the heparin prescription. There has also been a steady increase in venous pressure during treatment what might you suspect - ANSWER Venous stenosis The buttonhole technique results in fewer infections, missed needle insertions, hematomas, and infiltrations. Steps for creating the buttonhole include: - ANSWER Remove the scab, cannulate the same site at the same angle, by the same caregiver with sharp needles for 3-4 weeks to create a tunnel The venous pressure on a dialysis machine starts to rise but the venous needle is not infiltrated. Which items below could be responsible? - ANSWER clotting of the venous line, venospasm Factors that affect peritoneal membrane permeability include: - ANSWER Peritonitis infection A shortage of oxygen-carrying RBCs is called - ANSWER anemia A patient's anemia would be monitored through what laboratory test - ANSWER Hemoglobin Which medication would a nurse administer a patient whose hemoglobin labs dropped - ANSWER Erythropoietin What practices help to build a patient's immunity to Hep B - ANSWER Vaccination What is uremia - ANSWER a build up of wastes in the blood that would normally be excreted by urine If a patient states they threw up blood the day before treatment the tech can expect the treatment will be modified by - ANSWER a nurse not giving heparin or lowering the dose A CVC can be used as a vascular access when - ANSWER A patient's limbs can not support a graft nor a fistula How do you differentiate the arterial from the venous side of a graft - ANSWER by finding the anastomosis and feeling the thrill on both sides ( the arterial is stronger) What is the normal range for a heartrate - ANSWER 60-100 beats per minute Why are dialysis patients most likely to be infected by MRSA - ANSWER they have weakend immune systems An AVF is an example of what kind of access - ANSWER a peripheal access What interventions are made on a patient with a low blood pressure - ANSWER placing them in Trendelenburg, decreasing/discontinuing fluid removal, and giving saline The MOST common cause of a low conductivity alarm is - ANSWER the bicarb or acid concentrate ran out A patient who has diabetes mellitus should be observed for signs of - ANSWER anxiety and confusion When a patient reaches their EDW they are considered - ANSWER normotensive The water supply to the water treatment system is called - ANSWER feed water When a tech suspects a clot in an access what would confirm this - ANSWER a bruit was absent A high VP alarm might indicate - ANSWER clotting of blood in the access What part of the water system removes endotoxins - ANSWER ultrafilter Why would a patient be put on a UF profile - ANSWER to minimize hypotension What body mechanics is used to lift a heavy object from the ground up - ANSWER holding the object close to the body @A substance that is cleared from the body by healthy kidneys is - ANSWER creatinine What does it mean to be anemic - ANSWER you dont have enough RBCs to carry oxygen to your blood What water test is done before each patient treatment - ANSWER chlorine and chloramine (carbon tank removes it) What vascular access has the lowest rate of infection - ANSWER arteriovenous fistula AV fistula During treatment a blood leak alarm goes off whats the first step - ANSWER verify a blood leak occurred using Hemastix strip What is a blood leak - ANSWER when the semipermeable membrane of the dialyzer tears, letting blood into the dialysate it exposes the patient to non sterile dialysate and blood loss If the water hardness test exceeds the limit what do you do - ANSWER check the salt level in the brine tank and notify the equipment technician ( if level is too low it wont be able to regenerate and soften water) What is countercurrent flow - ANSWER blood moves in one direction while the dialysate moves in another it aids diffusion by maintaining a high concentration gradient What is venous pressure - ANSWER the blood returning to the patient - measurement of the ECC before the blood renters the patient What is first use syndrome - ANSWER group of symptoms that occur shortly after treatment using a new dialyzer can be cause by sensitivity to the membrane or agent that sterilizes it What causes thrombosis - ANSWER tight bandages or clamps, hematoma formation, patient sleeping on arm Heparin dosage should stop 30 mins to an hour prior to end of treatment to prevent - ANSWER prolonged bleeding What is the initial action taken when noticing a patient experiencing fever and chills - ANSWER check that others arent experiencing the same thing What is steal syndrome - ANSWER When a new AV is created sometimes it steals too much blood away from the hand and sends it through the access causing decreased oxygen supply to the tissues (tingling, numbness to the hands, blue fingertips) What is the purpose of priming the lines - ANSWER removes disinfectant, air, matter left in the dialyzer What is the purpose of the UV light - ANSWER to change the DNA of microbes so they die or cannot multiply What can the tech do to minimize anemia - ANSWER rinse back as much of the patients blood back as possible (blood loss makes anemia worse) If a patient is taking narcotics it leads to risk of - ANSWE