Fresenius Exam Questions and Answers Already Graded A

Fresenius Exam Questions and Answers Already Graded A What are the three main blood-borne pathogen's that pose a risk to hemodialysis patients? ✔✔Hepatitis B, hepatitis C and HIV. What are the two most common causes ...

Fresenius Exam Questions and Answers Already Graded A What are the three main blood-borne pathogen's that pose a risk to hemodialysis patients? ✔✔Hepatitis B, hepatitis C and HIV. What are the two most common causes of death in hemodialysis patients? ✔✔Cardiovascular complications and infection. How is disease spread? ✔✔Direct contact, indirect contact, airborne and droplets What technique must be used for cannulation, setting up machines, giving medications, and removing patient needles? ✔✔Aseptic technique. How long must you wash your hands ✔✔40 to 60 seconds How long do you rub your hands when using hand sanitizer? ✔✔30 seconds What PPE is required when touching the extracorporeal circuit, giving meds, cannulation and removing needles? ✔✔Gloves, gown and face shield Do you need to wear gloves when touching the dialysis machine? ✔✔Yes What bleach solution is used to clean the dialysis machine and patient chair? ✔✔1:100 bleach solution How long does hepatitis B live on surfaces? ✔✔Seven days or more As a treatment nurse, can you care for a hepatitis B patient while caring for a immune deficient patient? ✔✔No May a dialysis machine being used for a hepatitis B patient be used on anyone else? ✔✔Not until the patient has been discharged from the center and is no longer a patient there at which time the machine would need to be thoroughly cleaned and disinfected inside and out prior to being used for anyone else Does hepatitis C patients need to be isolated like the hepatitis B? ✔✔No Can an active tuberculosis patient be dialyzed at an outpatient clinic? ✔✔No, they must have three consecutive tests that are all negative prior to being able to be dialyzed outpatient. How long do you need to clean the top of a multidose vial? ✔✔30 seconds with an alcohol swab Can you use more than one multidose vial to fill a syringe? ✔✔No, if there is not enough drug in the first vial you must pull up the remaining medication needed in a second syringe. Then label them one of two and two of two. Can you give a medication that was drawn up by someone else? ✔✔No What does it mean to re-circulate ? ✔✔After priming the extracorporeal circuit, you attach the arterial and venous lines together to form a loop then check the dialysate with the phoenix meter. Once the dialysate has passed Phoenix meter test, attach the red and blue Hansons to fill the dialysate compartment of the dialyzer. The system stays like this with the blood pump running until you are ready to prime and hook up the patient. Can you invert a vial of Epogen? ✔✔No,be careful not to shake the vial and do not turn the while upside down. What are the components of a dialysis order? ✔✔Dialyzer type/size, correct bath, sodium, bicarb, dialysate flow rate, Blood flow rate, needle size, time, temperature, and OL CV. What is the purpose of priming The extracorporeal circuit? ✔✔Priming takes the air and germicide out of the bloodlines and dialyzer. What is the purpose of recirculation ✔✔Recirculation keeps air and germicide out of the bloodlines and dialyzer. During recirculation, air and germicide is sent through circuit dialyze off any germicide or air that is left. The germicide travels from the blood side of the dialyzer to the dilate side and then down the drain. When inspecting the dialyzer what are you looking for? ✔✔That it is the correct dialyzer, not expired, not defective, no cracks, tears, and package is intact. Key points to learn about priming and recirculation ✔✔Air bubbles can cause blood clotting in the dialyzer and tubing during a treatment. Prime and recirculate. Make sure the air is removed from bloodlines and dialyzer. How is the correct dialysate prescription entered into the dialysis machine ✔✔Temperature, time, DFR, BFR, Na, Bicarb, UF Goal, OLCv, Needle Size, and Profile. What is theoretical conductivity ✔✔TCD is the targetconductivity for the prescribed concentrate base sodium and base bicarb. Conductivity based on a particular prescription. TCD is calculated based on what the conductivity of a solution or as ionic composition. What is the safe range of conductivity based on the TCD? ✔✔The conductivity must be within plus or -.5 of the TCD. What is the acceptable range at the Phoenix meter must be in relation to the conductivity on the machine ✔✔The phoenix meter and the machine must be within plus or -.3 of each other. What do you do if a blood leak occurs? ✔✔Stop the treatment without returning the patient's blood since it could be contaminated and cause infection. When the blood leak alarms what do you do? ✔✔Use the Hemastix strip to check for blood it will change colors if positive. If blood or pink can be seen in the dialysate path this is a major leak. If the dialysate is clear and the Hemastix is positive this is a minor leak. clear dialysate and a negative Hemastix is a false alarm. When are the safety checks completed? ✔✔Safety checks are completed prior to attaching the patient. The dialysis orders are entered into the computer. The extracorporeal circuit is primed. The machine is put into test. Once test complete and all tests have passed, drain 100 mL the blue Hanson and check with the Phoenix meter. Then attach Hansons and flip the kidney arterial side up for the filling program. What is being tested during the safety checks? ✔✔During the safety checks: the machine is tested for blood leaks, TMP low and high, high and low pressure, all of the dialysate alarms: low water, pump failure, blockage, Bloodflow, dialysate flow, temperature, conductivity, venous and arterial pressure. What do you do if the machine fails the test? ✔✔Check set up and rerun the test. If the machine keeps failing, all the machine and Tag it for biomed to check it. What is pH testing ✔✔pH testing is a measure of how acidic or alkaline a solution is. What is the pH of bleach ✔✔The pH of bleach is 11.0. Bleach is alkaline What is the pH of vinegar ✔✔The pH of vinegar is 2.9 it's very acidic What is the pH of the blood ✔✔The normal range of blood pH is 7.35 to 7.45 What is the acceptable pH range for dialysate? ✔✔6.9 to 7.4 How is a second signature obtained? ✔✔Both people must verify the Phoenix meter readings, dialysis order entered correctly in the machine Explain the process of keeping extracorporeal circuit up for more than two hours ✔✔ If the patient has a heparin pump, when must this be shut off ✔✔The heparin pump must be turned off at least 30 to 45 minutes prior to returning the patient. What are some signs and symptoms of too much heparin in during dialysis ✔✔Nosebleeds, bleeding in the whites of the eyes, ecchymosis, prolonged bleeding from the access after treatment. What are some signs and symptoms of not enough heparin during dialysis ✔✔Blood clots seen in the venous drip chamber, blood clots in dialyzer, very dark colored blood in the lines and shadows or streaks in the dialyzer. What are the signs and symptoms of an air embolism ✔✔Chest pain, coughing, blue lips and fingers or toes, visual difficulties, confusion, coma and death. What do you do if you suspect a patient has suffered from an air embolism? ✔✔Immediately clamp all lines, call for help, place patient in Trendelenburg on left side to trap air in the right ventricle of the heart. Give oxygen, call 911, attached normal saline line to arterial access to provide route for IV medications and give a saline bolus if patient is hypotensive. What do you do if you think your patient is having anaphylaxis ✔✔Call for help, stop suspected therapy to prevent further adverse reaction, Claybaugh lines, stop dialysis, and do not return the blood, and monitor vital signs. Call 911 and the patient's dr. and give medications per physician order. Administer oxygen if patient is short of breath. What are signs and symptoms of anaphylaxis? ✔✔Symptoms usually occur in the first 5 to 10 minutes and get worse over time. Symptoms include: hypotension, hives, itching, anxiousness or restlessness, numbness and tingling around the mouth, low back pain, tachycardia, cardiac arrest, and burning/pain at the Venus needle site if disinfectant is infused that usually happens quickly. What are signs and symptoms of angina ✔✔Pain or tightness in the chest,arms, or jaw. Patient may be cold, sweating and or have trouble breathing. Patient may be hypotensive. What do you do for Angina or chest pain ✔✔Slow blood flow rate to 150 ML per hour to decrease stress on patient heart. Decrease the ultrafiltration rate to prevent further fluid loss and stress on the heart. Monitor vital signs. Give saline bolus if patient is hypotensive. Call for help. Call patient-doctor give medications per physician order. Give oxygen if patient is short of breath. What are signs and symptoms of an arrhythmia? ✔✔Skipped or extra heartbeats, slow or fast pulse, patient complains of palpitations and anxiety. How do you check for an arrhythmia? ✔✔Check vital signs, manually check pulse, decrease UFR if patient is hypotensive, assess patient, give oxygen as needed, and call patient physician and give medications as ordered. What do you do for cramps during a dialysis session? ✔✔Give saline bolus, help stretch affected muscles burning fingers and feet backwards massaging affected areas, decrease ultrafiltration rate, Chuck BP before allowing patient to stand up. What is dialysis disequilibrium syndrome? ✔✔Brain swelling most often in patients with high BUN levels. What are symptoms of disequilibrium syndrome ? ✔✔Symptoms often occur during or towards the end of treatment including: headache, nausea, hypertension, restlessness, irregular pulse, confusion, blurred vision, And seizures. What are the interventions when you suspect dialysis disequilibrium syndrome? ✔✔Notify RN in charge. Assess patient. Decrease the efficiency of the dialysis treatment as appropriate such as decreasing the blood flow rate, dialysate flow rate and or the ultrafiltration rate. Notify the physician and administer meds as ordered. Terminate the treatment if the symptoms are severe. What are the signs and symptoms of a pyrogenic reaction? ✔✔Fever and chills at the start of dialysis. Local infection: redness, swelling, tenderness, warmth, or drainage from the access or other sites When do pyrogenic reactions typically start? ✔✔45 to 75 minutes after the start of dialysis. What do you do when you suspect a pyrogenic reaction or infection.? ✔✔If infection is suspected: evaluate the patient for infections: cold, cough, flu, or local infection at the accessor bladder infection. Notify RNof high temperature. If pyrogenic reaction is suspected, stop dialysis, you may or may not return the patient. Check patient vital signs. Call the physician and draw labs/give medications as ordered. What is first use syndrome? ✔✔Sensitivity to the dialyzer membrane or reaction to ethyleneoxide gas used to sterilize some dialyzer's. What are the signs and symptoms of first use syndrome? ✔✔Symptoms of severe reaction usually occur in the first 5 to 10 minutes of treatment, 20 to 40 minutes for mild reaction and may include: itching, just and/or back pain,shortness of breath, hypotension, nausea and general discomfort. What are the interventions for first use syndrome? ✔✔Notify the nurse, assess the patient, give oxygen for shortness of breath, and give medications to relieve the symptoms of allergic reaction to pain meds per physician order. What are the symptoms of heparin overdose ✔✔Unusual bleeding around needles, longer than normal bleeding from needle sites after treatment, and high BP readings. What are the interventions for a heparin overdose? ✔✔Notified nurse, assess patient, call physician, patient may be given protamine sulfate (antidote for heparin) What are some of the signs and symptoms of hypertension? ✔✔High BP reading, No symptoms, headache, and nervousness. What are the interventions for hypertension? ✔✔Assess the patient to look for a reason hypertension and follow up as needed. What are the signs and symptoms of hypotension.? ✔✔The BP reading is low, dizziness, tachycardia, shortness of breath, cold clammy skin, restlessness, excessive yawning and sweating. What are the interventions for hypotension? ✔✔Placepatient and modified Trendelenburg position, decrease ultrafiltration rate, give saline bolus, keep checking BP until resolved. Assess patient need for oxygen and assess ultrafiltration goal. What is pruritus? ✔✔Severe itching on and off dialysis. Redskin and crusting on skin. What are some interventions for pruritus? ✔✔Assess patient, give Benadryl and recommend follow up with dietitian or skincare or consult What is the intervention for seizures? ✔✔Protect patient from harming self, check vital signs, give the saline bolus if hypotensive and notify charge RN. Call position for orders and stop dialysis if patient is unresponsive. Call 911 What are some of the causes of air embolism? ✔✔Air detector broken or not armed. A leak or loose connection in the extracorporeal circuit before the blood pump. Empty IV bags attached to the extracorporeal circuit before the blood pump. How to prevent air embolism? ✔✔Arms in the air detector, Tighten all connections in the extracorporeal circuit, check the normal Saline level in the IV back and return patient's blood with Saline with air detector on.