Fresenius Nurse Final Exam Part 1 Latest 2023 Graded A

Fresenius Nurse Final Exam Part 1 Latest 2023 Graded A The 3 reasons that dialysis is a high risk area: ✔✔1. There is frequent exposure to blood 2. Patients & Staff are in close proximity 3. Dialysis patients are imm ...

Fresenius Nurse Final Exam Part 1 Latest 2023 Graded A The 3 reasons that dialysis is a high risk area: ✔✔1. There is frequent exposure to blood 2. Patients & Staff are in close proximity 3. Dialysis patients are immunocompromised All dialysis surfaces must be disinfected with _____ bleach solution until surfaces is glistening _____ and then allow to ✔✔1:100/ wet/ air dry A ______ bleach solution is used to disinfect a large spill greater than ______ ✔✔1:10/ 10 ml The following are examples for what process: during initiation and termination of dialysis; cannulation of an access; needle adjustment; changing a transducer; setting up a dialysis machine ✔✔Examples of procedures where exposure may occur and PPE must be worn What 3 blood borne pathogens are found in a dialysis unit? ✔✔hep b, hep c, and HIV What steps should you take in the event of an exposure incident? ✔✔1. Wash/ rinse area immediately 2. Report incident to clinical manager or charge nurse 3. Seek medical tx within 1-2 hrs Hep B is extremely contagious and can live in the environment and remain viable on surfaces for at least ____ days ✔✔7 How are Hep B patients dialyzed? ✔✔In an isolation room with their own dedicated equipment such as BP cuff and stethoscope, tourniquet, etc These should be used to work on computer information in the isolation room. ✔✔Clean Gloves True or False? Tx sheets and medical records can enter the isolation room ✔✔False: If tx sheets are used, the tx sheets cannot enter the isolation room. Nor can medical records Staff members should not care for these two types of patients on the same shift at the same time. ✔✔HBV and patients that are susceptible to HBV Where do hep c patients dialyze and why? ✔✔In the clinical area, hep c is not contagious and is is not known to survive for very long outside of the body How is hep c transmitted? ✔✔Through contaminated blood transfusions in the past or from sexual contact How is hep a transmitted? ✔✔contaminated food and the oral-fecal route Which blood test indicates infection with Hep B? ✔✔HbsAg (HBsAg is the surface antigen of the hepatitis B virus. It indicates current hepatitis B infection.) Which blood test indicates the presence of immunity against Hep B? ✔✔HBsAb (The HBsAb test, or hepatitis B surface antibody test, looks for antibodies that your immune system makes in response to the surface protein of the hepatitis B virus.) Which vaccines provides long-term immunity to Hep B? ✔✔Recombivax or Engerix Is latent TB contagious? ✔✔Latent tuberculosis is not contagious, but can become active w/o tx The following are signs and symptoms for what???Night sweats, productive, persistent cough, unexplained weight loss, chills and fever, blood-tinged sputum ✔✔Tubercolosis How is TB spread? ✔✔TB is spread by droplet nuclei produced from infected individuals when they cough, sneeze, sing or speak Where do TB patients dialyze? ✔✔Not in the Clinic!!!! In accordance with FMS policy what must TB patients have before they are allowed to return to the clinic??? ✔✔3 consecutive negative sputum cultures, ppd testing and chest x-rays According to the new FMS policy, hands should be washed with soap and water for _____ seconds and sanitized with alcohol for ___ seconds ✔✔40-60 seconds/ 20-30 seconds What are the 3 basic PPE's? ✔✔1. Long sleeve gown 2. face shield w/mask 3. gloves What are the anatomical structures of the urinary system in order of urine flow? ✔✔1. (2) kidneys 2. (2) ureters 3. (1) bladder 4. (1) urethra The functions of the kidney include: removal of waste products such as _______, _______, and ________. The kidney also regulate ______, ______, and _______. ✔✔removal of: creatinine, urea, uric acid regulate: fluid, acid base, electrolytes The kidney also has hormonal functions that include: production of renin to help regulate ________; production of erythropoietin, which stimulates bone marrow for __________; and the regulation of calcium/phosphorus balance through the activation of ________, which enables us to absorb our dietary calcium, thereby promoting continued good bone health. ✔✔blood pressure, red blood cell production, vitamin D This is the functional unit in the kidney, it filters blood to form urine. ✔✔Nephron This is a network (tuft) of capillaries that performs the 1st step of filtering blood. ✔✔glomerulus What is the synthetic form of Erythropoietin? ✔✔The synthetic form of erythropoietin is called Recombinant Epoetin Alfa (Epogen), a drug given by licensed nursing staff to dialysis patient, to treat anemia What is the synthetic form of Vitamin D? ✔✔Calcitriol is the activated form. Calcijex, Zemplar, and Hectorol (all synthetic calcitriol) are medications used in treating bone disease for hemodialysis patients. What are the 3 main causes of renal failure? ✔✔1. diabetic nephropathy (damage to kidney caused by diabetes) 2. hypertension 3. Other: polycystic kidney disease, lupus, AIDS, Drug toxicity, interstitial nephritis, etc Name 6 classic signs and symptoms of renal failure: ✔✔elevated bun/creatinine, phosphorus, and potassium, anemia, fluid overload, lethargy, weakness, headache, edema, yellow-gray appearance of skin, high bp, itching, loss of appetite, fatigue, nausea, restlessness, mental changes, shortness of breath, proteinuria, nerve damage What is the GFR for stage 1 of kidney disease? ✔✔90+ What is the GFR for stage 5 of kidney disease? ✔✔<15 When kidney function is impaired, the harmful buildup of waste products in the bloodstream is called... ✔✔uremia The kidneys control acid/base balance by excreting ________ and by producing a buffer known as ________. When kidneys fail to work it can result in _________. Dialysis contains the buffer _______ and help treat __________. ✔✔hydrogen atoms, bicarbonate, metabolic acidosis, sodium bicarbonate, metabolic acidosis Why should consideration be taken when administering medication to renal patients? ✔✔Because the loss of renal function will DECREASE the elimination of medications and potentially cause toxicity Why is a phosphate binder given to dialysis patients? ✔✔Dialysis is very inefficient at removing phosphorus. Phosphate binders are prescribed in order to control a patient's phosphorus level. How does a phosphate binder work? ✔✔A phosphate binder works by binding with phosphorus (from foods) in the gut, and then eliminating the excess phosphorus through the digestive system. The following are all examples of what? Tums, Amphojel, Alucaps, Renagel, Renvela, and Phoslo ✔✔Phosphate binders Adequate ______ are essential for Epogen to be effective. It help the RBC mature and formulate hemoglobin ✔✔Iron stores The following are examples of what? Venofer, Ferrlicit, Infed ✔✔Intravenous Iron supplement What is the desired hemoglobin level for HD patients according to the FMS policy? ✔✔10-11 g/dl (gram/deciliter) There is evidence that certain medications such as lisinopril, a _______ can slow the progression of kidney disease. ✔✔beta-blocker According to the American Diabetes Association: Fasting glucose level=______ Glucose 2 hrs post eating=_______ For individual patient always _____ ✔✔70-130 mg/dl Less than 180 mg/dl as peak Check with the physician to obtain high and low limits as lab values may vary What are 3 signs and symptoms of low blood sugar? ✔✔double vision, hunger, thirst, restlessness, rapid pulse, confusion, seizure, coma Where would you draw the patient's blood from to check their blood sugar level after the tx has started? ✔✔Arterial port What 4 things should an RN teach about foot care? ✔✔1. keep feet dry/clean 2. inspect feet daily for broken skin and sores 3. apply lotion to lubricate feet routinely/ alcohol free 4. always wear shoes and make sure shoes fit properly There are 3 tx modalities for the tx of ESRD. 1. HD uses a vascular access to draw blood from the access to the dialyzer and into the semipermeable membranes where the process of _______ removes the waste products and ______ removes the fluids. 2. PD uses a permanently placed catheter in the patient's highly vascularized peritoneal cavity. Dialysate fluid is infused in the cavity and is allowed to dwell there for a period of time. Through ___ and _____, excess fluid and waste products are removed. 3. Transplantation ✔✔1. diffusion; ultrafiltration 2. osmosis and diffusion . Water makes up approximately _____% of the weight of an adult. ✔✔50-70 What is homeostasis? How does the kidneys contribute to homeostasis in the body? ✔✔Homeostasis is the steady internal state of equilibrium in the body. The kidneys conserve or excrete excess fluid as needed to keep the internal environment in balance. These are charged particles that can conduct an electrical current. In the body, they control, motor, muscle, and nerve functions and maintain the body's homeostasis. ✔✔Electrolytes The most important electrolytes to consider (Boy come meet peter piper son) ✔✔Bicarbonate, Calcium, Magnesium, Phosphate, Potassium, Sodium What's the normal PH of blood? ✔✔7.35-7.45 This is the state of too much acid in the blood. ✔✔Metabolic Acidosis Bicarbonate is added to the dialysate to help maintain patient's ____ ✔✔PH Dialysate must have a pH close to that of ______ so it does not change the blood's ✔✔normal pH The following are symptoms of what? Thirst, dry mucous membranes, sunken eyes, poor skin turgor, low grade temp, decrease urine output, dry skin, weakness, cramping, low blood pressure, lethargy ✔✔dehydration The following are symptoms of what? edema/ pitting edema, productive cough, sob, increased bp, bounding pulse, neck vein distention, cyanosis, anxiety, restlessness, confusion ✔✔fluid overload The movement of solutes through a semipermeable membrane from an area of area of greater concentration of solutes to an area of lesser concentration of solutes until the concentrations equal out is called... ✔✔diffusion The movement of fluid through a semipermeable membrane from an area of lesser concentration to an area of greater solute concentration until equilibrium is reached is alled ✔✔osmosis At what point during HD will diffusion cease to occur? ✔✔Until the concentration of each electrolyte found in the patient's blood is equal to the concentration in the dialysate Dialysate is composed of these 3 things: ✔✔1. purified water 2. acid solution 3. bicarbonate solution Why is dextrose added to the dialysate? ✔✔To prevent hypoglycemia What is the purpose of checking the dialysate? ✔✔To verify that the dialysate is compatible with human pH, conductivity and temperature to prevent hemolysis (cell death) or crenation (cell shrinkage) Name the four ways dialysate is checked... ✔✔1. pH 2. Conductivity 3. Temperature 4. The dialysate is checked for residual chlorine (bleach) after routine (weekly) machine disinfection and before the first tx after the disinfection When should conductivity and pH of dialysate be checked? ✔✔Prior to the initiation of every tx using a phoenix meter with 2 individuals. True or False? Conductivity and pH of dialysate should be checked before the Hanson connectors are attached to the dialyzer. ✔✔True True or False? The sample for conductivity testing is obtained from the arterial/red dialysate line. ✔✔False!!! venous/blue dialysate line What are the normal ranges for temp, conductivity and pH of dialysate? ✔✔Temp (between 35- 39 C) pH (The approved AAMI pH range is 6.9-7.6) Conductivity (12.6-15.9) Body size, clearance needs, ultrafiltration needs and membrane biocompatibility are all ✔✔Factors used in the selection of a dialyzer for a patient Name 3 symptoms of dialyzer membrane allergy: ✔✔sneezing, itching, pain at access site, chest pain, rashing, hives, fever What type of dialyzer is recommended for dialyzer sensitiviey ✔✔Using a dialyzer sterilized by electron beam instead of ethylene oxide (FMS E-Beam Dializers) When is dialyzer sensitivity reaction usually seen? ✔✔In the first half-hour of treatment How many compartments do a dialyzer have? What are they? How are they separated?Do they mix? ✔✔2; blood & dialysate; semipermeable membrane; No A semipermeable membrane is made from ______, with small ____ or ______. These are too large to pass through a semipermeable membrane. ✔✔protein, holes or pores; red blood cells and proteins What 3 things should be checked on a dialyzer bf machine setup? ✔✔1. sterility (in package w/caps) 2. structural damage (zero cracks) 3. right type as in size and brand ordered by MD The HD machine is the Delivery system with two-systems. What are they and what do they do? ✔✔1. Blood delivery system: circulates the patient's blood 2. Dialysate delivery: Mixes and circulates dialysate ____________ monitors the safe progression of the dialysis tx which is divided into two categories: _________ related and _________ related. ✔✔Machine alarms, blood; dialysate Arterial pressure should never be more negative than ✔✔-250 How much saline should be infused through the E-beam dialyzer and the extracorpeal circuit? ✔✔300mLs Fresh fill = 50mLs through arterial line 250 mLs through venous line Once the arterial and venous blood lines have been connected together in preparation for circulation, the automatic test sequence has been completed and the conductivity and pH testing are completed using the phoenix meter, this step can take place ✔✔The Hanson connectors (dialysate lines) can be connected to the dialyzer What position should the dialyzer be in during circulation (venous)? ✔✔Venous end straight up After successful completion of machine testing, connect and unclamp ________ and attach the _______. Turn the BFR to and DFR to _____. While the NS is circulating, ____ the venous end of dialyzer and _____ and ____ the arterial line. ✔✔transducer, Hanson connectors, 300-400; 500; tap; pinch and release While priming the dialyzer with saline run the pump at _______ml/min. ✔✔150 Running the pump hiring then the recommended during initial priming can cause: ________ and _______ ✔✔Gas vapor lock & First Use Syndrome What should be done after air is removed during circulation? ✔✔Drop the DFR to 300 How long can a dialyzer recirculate with saline bf it is considered unsafe to use? ✔✔After 2 hours, the dialyzer and bloodlines must be recirculated for 5 minutes; set a UF goal @ 170ccs; the system must be taken down after 4 hours What position should the dialyzer be in during HD (Arterial)? ✔✔Arterial end up The use of more than one type of pressure to remove fluid from the blood, usually positive and negative is called: ✔✔ultrafiltration What direction does blood flow through the dialyzer as compared to dialysate flow? ✔✔Blood and dialysate flow in countertercurrent flow; arterial flows down (arterial to venous); dialysate flows up; the opposite position allows for better clearance TMP, Transmembrane pressure is the pressure difference across the dialyzer membrane. It reflects the ____________ across the membrane used to achieve the desired fluid loss. ✔✔total pressure What are some possible causes of increased venous pressure? ✔✔Infiltration, malpositioned needle, tubing kinks, clamped tubing, system clotting, patient coughing How can you tell a dialyzer is clotting? ✔✔Rising TMP, rising venous pressure, dark blood in dialyzer, air detector alarms What is the commonly used heparin concentration in HD? ✔✔1000 units/ml After heparin is given, how long must you wait before initiating the tx? ✔✔3-5 minutes In relation to heparin the following are all reasons for what? prolonged bleeding from BOTH cannulation sites; upcoming surgery, nose bleed, GI bleed, heavy menstrual cycle, reduction of tx time or dialyzer; taking anticoagulants ✔✔Heparin dose needs to be decreased If a patient has prolonged bleeding from one cannulation site, it is most likely not the heparin but from ✔✔repeated cannulations at the same site A decreasing KECN can be an indicator that the dialyzer is losing surface area and this can be one potential cause of that loss of surface area. ✔✔Clotting For how long may a patient's blood be re-circulated during tx interruption? ✔✔Blood recirculated for longer than 15 minutes may lose oxygen and can not be returned to the patient For how long may a blood tinged saline be re-circulated during tx interruption? ✔✔30 minutes The alarm limits on the dialysis machines are set to Arterial width of _____ and venous width of ______ asymmetrical ✔✔120; 100 When is the machine temperature checked? ✔✔When the conductivity and temperature are stable; document prior to tx This measures the amount of pressure and the quality of blood flow from the access to the blood pump. ✔✔Pre-pump arterial pressure Hand cranks should be completed ________ rotations per minute; Maximum hand cranks should not exceed ______ minutes ✔✔6-10 minutes/ 15 minutes