CCHT Exam 323 Questions with Verified Answers,100% CORRECT

CCHT Exam 323 Questions with Verified Answers Which of the following practices helps to build a patient's immunity to hepatitis B? - CORRECT ANSWER Vaccination A patient asks the technician, "What does uremia mea ...

CCHT Exam 323 Questions with Verified Answers Which of the following practices helps to build a patient's immunity to hepatitis B? - CORRECT ANSWER Vaccination A patient asks the technician, "What does uremia mean?" The technician response should be based on the understanding that uremia is - CORRECT ANSWER an increase of wasters in the blood A central venous catheter may be used as a vascular access when a - CORRECT ANSWER patient has inadequate blood vessels in the limbs Before a dialysis treatment, the patient tells the technician, "Yesterday, I felt terrible and vomited up some blood. I feel much better today." The technician can expect the patient's treatment will be modified by - CORRECT ANSWER decreasing the heparin dose The technician is unsure which one of a patient's arteriovenous (AV) graft's anastomoses is arterial and which one is venous. In order to differentiate between the two, the technician should - CORRECT ANSWER compress the graft in the middle and palpate each side At the end of a patient's treatment, which of these findings, if observed by the technician, should be reported to the nurse? - CORRECT ANSWER A pulse rate of 55bpm (normal HR 60-100bpm) A patient asks the dialysis technician, "Why am I getting vitamin D therapy?" What is the accurate response? - CORRECT ANSWER Vitamin D is needed for healthy bones Why are dialysis patients more likely to become infected with germs like MRSA? - CORRECT ANSWER They usually have weak immune systems The technician prepares and cannulates an arteriovenous (AV) fistula. AV fistula is an example of what? - CORRECT ANSWER a peripheral access placed in the arm A patient says to the tech "The doctor says that I have mineral bone disorder, what does that mean?" what should be the tech's response? - CORRECT ANSWER It is pretty complicated. I'll ask the nurse to explain it to you A tech notices a patient has a notebook where he/she records all lab results, weights, and, meds. What should the tech conclude? - CORRECT ANSWER The patient is feels empowered and is self managing During the last hour of a patient's dialysis treatment, their blood pressure measures 82/40. After changing the fluid removal rate, what should the tech do? - CORRECT ANSWER Place patient in Trendelenburg position Legally, if a treatment was performed but not charted in the patient's record, it was - CORRECT ANSWER not done The most common cause of low conductivity alarm during hemodialysis - CORRECT ANSWER a exhausted concentrate supply A patient who has diabetes mellitus should be observed for signs of low blood sugar, which include - CORRECT ANSWER anxiety, confusion, hunger, sleepiness, or dizziness How is low blood sugar treated - CORRECT ANSWER by giving carbohydrates Linda Chase target weight 70kg. she weights at 72kg before treatment. How much fluid should be removed? - CORRECT ANSWER 2kg True or False At Linda Chase target post dialysis weight of 70kg , she is most likely normotensive - CORRECT ANSWER True what is the water supply to the water system called - CORRECT ANSWER feed water What is feed water? - CORRECT ANSWER is the water that comes from outside of the dialysis center and must pass through water treatment system before it is used for mixing concentrates and making dialysate what is the primary goal of QAPI in a dialysis facility is to - CORRECT ANSWER achieve better patient outcomes After Linda Chase treatment her standing bp was 90/58. She complains if feeling dizziness but insists she can walk to the scale. What is the first thing to do? - CORRECT ANSWER instruct her to sit down How do you know if an access is clotted - CORRECT ANSWER a bruit was absent What is the most common reason for high venous pressure alarm - CORRECT ANSWER clotted blood in access In dialysis the term "reuse" refers to cleaning and disinfecting of what? - CORRECT ANSWER dialyzers A patient tests positive for hepatitis B What should the tech do to prevent the spread of hepatitis B? - CORRECT ANSWER Dialyze the patient using a dedicated machine in an assigned area A patient tells tech that they have a preschedule routine every morning and now will have to stop. What should the tech do? - CORRECT ANSWER Exploring changing treatment time so patient can continue regular schedule what part of the water system removes endotoxins - CORRECT ANSWER ultrafilter Why would a patient need ultrafiltration profiling? - CORRECT ANSWER minimize hypotension What occurs when the dialysis machines alarms and goes into bypass - CORRECT ANSWER dialysate stops following through the dialyzer Care provides must wash hands with soap and water when - CORRECT ANSWER their hands are visibly soiled How does a tech properly lift a box? - CORRECT ANSWER bend with knees and hold box close to the body AAMI Chemical analysis of water used for hemodialysis is tested - CORRECT ANSWER annually A 58 year old patient who is blind comes in for treatment with his wife. How should the tech interact with the patient? - CORRECT ANSWER Describe activities in the immediate environment Tech sees blood on the surface of a patient's dialysis machine. What should you do? - CORRECT ANSWER Clean the machine immediately A dialysis tech observes all of the below options on the treatment floor, which is an environmental risk? A) about one ounce of fluid on the floor B) A patient's family is present during initiation of treatment C) Charts are lying on bedside tables D) The wheels of the dialysis machine are locked - CORRECT ANSWER A) about one ounce (30ml) fluid is on the floor A patient asks a tech to dinner because he is lonely and depressed. After tech politely declines offer what should tech do? - CORRECT ANSWER Refer patient to social worker A fistula connects - CORRECT ANSWER an artery and a vein A marker used to determine the middle molecule clearance of a dialyzer is - CORRECT ANSWER vitamin B12 A mixed-bed DI tank contains - CORRECT ANSWER cations and anions Nephron is made up of - CORRECT ANSWER A glomerulus and a tubule system A patient complains of pain at the venous needle and tech observes swelling along with venous pressure rising. What should the tech suspect? - CORRECT ANSWER infiltration A patient who is to receive their first dialysis treatment is prone to? - CORRECT ANSWER Dialysis disequilibrium syndrome A slow pulse of 54 beats/minute would indicate the patient has - CORRECT ANSWER bradycardia A patient tells the technician that the dietitian reviewed high-potassium foods with her. During the conversation she states she routinely eats the following foods. Which one is the highest in potassium? A) Bananas B)Pasta C) Ice Cream D) Rice - CORRECT ANSWER A) Bananas What is a reason why a tech is to be certified - CORRECT ANSWER it is CMS requirement A rise in transmembrane pressure in a low flux dialyzer during hemodialysis is indicative of - CORRECT ANSWER clotting of the extra corporeal circuit A teammate asks you to document the normal saline he gave to his patient, what would you do? - CORRECT ANSWER Never document what someone else did A true aneurysm can be dangerous because it - CORRECT ANSWER may rupture and cause the patient to bleed profusely A rapid pulse of 104 bpm would indicate a patient has - CORRECT ANSWER tachycardia A patients lab results indicate that the predialysis BUN level was lower than the post dialysis BUN level. What should a tech consider after those findings? - CORRECT ANSWER Was the post dialysis sample drawn correctly adequacy - CORRECT ANSWER is the patient receiving enough dialysis to feel well, reduce systemic effects of uremia, improve quality of life, and live longer When is a patient's adequacy checked? - CORRECT ANSWER Monthly What os the 'K' in kt/v? - CORRECT ANSWER clearance of urea What treatment factors decrease 'K' in kt/v? - CORRECT ANSWER inadequate coagulation, decreased BFR, poor priming, and patients not staying full treatment time What treatment factor increase "K' in kt/v? - CORRECT ANSWER Increased BFR, correct DFR, dialyzer, and target weight What is the 't' in kt/v? - CORRECT ANSWER time what is the 'v' in kt/v? - CORRECT ANSWER volume of urea distributed/ volume of patient's body water in which urea is distributed what factors influence 'v' in kt/v? - CORRECT ANSWER height, amputation, sex, age type of access How does type of access influence 'v' in kt/v? - CORRECT ANSWER less efficient access reduces the volume of patient's blood processed what are symptoms of uremia - CORRECT ANSWER metallic taste in mouth, vomiting, nausea, lack of energy What is the goal of dialysis? - CORRECT ANSWER Removing waster products and fluid maintaining bone health & vitamin D stimulating red blood cell production to help control blood pressure regulating phosphorus & calicum Approximately when should a patient begin to fill better after started dialysis? - CORRECT ANSWER usually 30 days Why does symptoms of uremia start in patients with kidney failure? - CORRECT ANSWER Since the kidneys do not function properly the fluid and waste builds up in the blood True of False A normal Kidney function translate into a weekly Kt/v of 20-25 - CORRECT ANSWER True What should the patient's monthly kt/v be? - CORRECT ANSWER greater than of equal to 1.2 What is the suggested BFR range for 17g needles - CORRECT ANSWER 200-250 What size needles has a BFR range of 350-450 - CORRECT ANSWER 15g needles what is the suggested BFR range for 16g needles - CORRECT ANSWER 250-350 What size needles has a BFR range greater than 450 - CORRECT ANSWER 14g needles Mrs. Miller has a new AV-fistula which is cannulated with 17g needles. Her dialysis orders include BFR of 400ml/min and 3.5 hr treatment time. Her labs show kt/v below 1.2 and her machine frequently alarms for AP & VP. What is happening and what are your interventions? - CORRECT ANSWER BFR does not match need size and let rn know 17g = 200-250 What is the procedure for a Post BUN lab draw? - CORRECT ANSWER 1. Turn off UFR or Decrease to 50 2. Decrease DFR to 300 or put in bypass 3. Decrease BFR to 100 4. Wait 15 seconds for all access types 5. Draw post lab What are mistakes that falsely increase kt/v - CORRECT ANSWER BFR not reduced, waiting only 5 seconds, & drawing post lab from venous line what mistakes would falsely decrease kt/v - CORRECT ANSWER accidently diluting pre treatment arterial bun blood sample with saline and waiting longer than 15 seconds to draw blood Today is lab day; you patient wants to end his treatment early against medical advice. What should you do? - CORRECT ANSWER Notify RN, make sure patient signs AMA and have nurse schedule make up treatment so lab draw can be rescheduled What is an AKI and what does it stand for? - CORRECT ANSWER Acute kidney Injury- is a sudden of loss of kidney function that maybe partially/ completely returned what is the primary treatment goal for AKI patients and How is it done? - CORRECT ANSWER to help restore kidney function so UF goals are not set high and avoid toxic substance that would affect the kidneys (Ex: lose dose aspirin and radiographic contrast) what are some example causes for pre renal AKI - CORRECT ANSWER obstruction, volume, depletion, & impaired cardiac function what are some examples causes for intra renal AKI - CORRECT ANSWER septic shock, anaphylaxis drugs, trauma, open heart surgery These are example causes of what type of AKI? EX: Bladder rupture, pregnancy, & Oliguria - CORRECT ANSWER Post renal AKI List all goals for AKI treatment - CORRECT ANSWER Restore kidney function protect kidneys from further injury prevent fluid and waste build up take care of vascular access maintain optimal nutritional state prevent, identify and treat complications how often are aki patients monitor? - CORRECT ANSWER weekly how do you protect the kidneys from further injury - CORRECT ANSWER by identifying and treating the cause of the kidney injury to regain function AKI patients are at increased risk for which complications? - CORRECT ANSWER Hypotension & hypovolemia what is the difference between AKI and CKD - CORRECT ANSWER Eliminating the cause of AKI can lead tgo the return of kidney function, but the cause of CKD can not be eliminated What are the most common causes of CKD - CORRECT ANSWER Genetic disorders hypertension type 2 diabetes What are the treatment goals for CKD patients - CORRECT ANSWER slow progression of CKD managing morbidities minimizing the effects of CKD on patients' lifestyles renal replacement therapy modality education encouraging patients to actively participate in their healthcare True or False If patients have any complications during treatment it is not mandatory to inform nurse - CORRECT ANSWER False True or False In the event of a seizure, treatment should be discontinued if seizure is severe and does not respond to treatment - CORRECT ANSWER True What is the time frame within which a pyrogenic reaction can started after treatment is initiated? - CORRECT ANSWER 45-75 mins what causes dialysis disequilibrium - CORRECT ANSWER skipping treatments A shortage of oxygen-carrying red blood cells is called - CORRECT ANSWER anemia The tech would expect a patient's anemia to be monitored by which of the following lab test? - CORRECT ANSWER Hemoglobin A patient's lab results reveal a significant drop in hemoglobin. Which medication would the tech expect the nurse to administer during treatment? - CORRECT ANSWER Epogen/ Erythropoietin Which of the following practices helps build a patient's immunity to hep B? - CORRECT ANSWER Vaccination The primary fusion of the kidney tubules are - CORRECT ANSWER reabsorption and secretion What is the definition of hypertension? - CORRECT ANSWER Predialysis adult BP is > 140/90 and post bp is > 130/80 What are some causes of hypertension - CORRECT ANSWER fluid overload, and not taking medication consistently What are symptoms of hypertension - CORRECT ANSWER nervousness, dizziness, irritability, headache, edema What is a way to prevention hypertension - CORRECT ANSWER tanke medication as prescribed and maintain fluids Define hypotension - CORRECT ANSWER systolic BP <90 diastolic BP <60 or drops in systolic more than 20mm/Hg What are some causes of hypotension - CORRECT ANSWER Rapid/inappropriate fluid loss, anti hypertension drugs, low blood volume, unstable cardiac conditions What are symptoms of hypotension - CORRECT ANSWER flushing, yawning, dizziness, seizures, cardiac arrest, nausea, anxious feeling, cold clammy skin How do you intervene with a patient experiencing hypotension - CORRECT ANSWER Place patients in supine position, decrease UFR to minimum for less serve hypotension, give 100-200ml saline, monitor BP, tell RN What are the consequences of organ stunning, the heart, kidneys, and brain? - CORRECT ANSWER Heart; acute stress on the cardiovascular system can lead to the development of left ventricular arrhythmias to create poor cardia function Brain: causes multiple sites with white matter injury kidneys: loss of renal function and causes fibrosis What are muscle cramps and their causes in dialysis - CORRECT ANSWER painful muscles contractions that are caused by rapid or excessive fluid removal What are ways to intervene when a patient is cramping - CORRECT ANSWER Massage/apply pressure, assess dry weight, turn uf off True or False Left side Trendelenburg position is to be used for a patient experiencing an air embolism - CORRECT ANSWER True what do you do if a patient is experiencing an allergic reaction during treatment? - CORRECT ANSWER stop treatment and do not return blood What is the appropriate response to treat a patient experiencing chest pain/angina - CORRECT ANSWER decrease bar, decrease dfr and give o2 How will the patient present if they have hyperkalemia? - CORRECT ANSWER abnormal slow heart rate and muscle weakness What do you advise patients experiencing peripheral neuropathy - CORRECT ANSWER advise patient not to walk barefoot, be careful with foot care and check bath water temp before getting in What is the primary cause of anemia in dialysis patients - CORRECT ANSWER lack of erythropoietin True of False End stage renal failure kidneys stop producing erythropoietin, so we check patient's hemoglobin and RN gives Epogen to treat - CORRECT ANSWER True How is anemia managed in CKD? - CORRECT ANSWER assessing the effectiveness of heparin ensure that patient is not losing too much blood during rinse back by excessive bleeding or clotting. What does the abnormalities in Ca, PO4, PTH, and Vitamin D leads to in CKD-MBD? - CORRECT ANSWER soft tissues calcification and bone disease Define fever & chills - CORRECT ANSWER A temp heater than or increase over baseline of 2 degree F with symptoms What are the causes of fever & chills - CORRECT ANSWER systemic infections, asses infection, contamination of blood or dialysate compartment How do you intervene with a patient experiencing fever or chills? - CORRECT ANSWER RN must assess, provide comfort measures, notify doc What is a pyrogenic reaction? - CORRECT ANSWER bacteria is in the dialysate and administered to patient during treatment what are the causes and symptoms - CORRECT ANSWER causes pyrogens symptoms chills, shaking, fever, hypotension, vomiting, muscle pains, elevated temp How do you intervene when patient is having a progeny reaction - CORRECT ANSWER provide support, notify doc & rn, stop treatment Define seizures - CORRECT ANSWER involuntary muscle spasms and loss of consciousness What are the causes of seizures - CORRECT ANSWER dialysis side effects, pre-existing disorders, and adverse reactions What do you do when patient is having a seizure during treatment - CORRECT ANSWER Discontinue treatment if severe, patient does not respond to treatment, protect patient, access arms from harm, treat hypotension, hypoglemcia and administer 02 What is the definition of dialysis disequilibrium syndrome - CORRECT ANSWER a condition in which rapid/drastic changes in the patients extracellular fluid affects the brain what are symptoms of dialysis disequilibrium syndrome - CORRECT ANSWER headache, hypertension, nausea, restlessness, blurred vision, seizures True or False Clotted dialyzer is due to insufficient anticoagulation - CORRECT ANSWER True How to intervene with a clotted dialyzer - CORRECT ANSWER ensure proper use of heparin, monitoring pressures, and maintaining proper BFR What is hemolysis and causes - CORRECT ANSWER Blood cells rupturing and is caused by high temps, hypotonic dialysate, exposure to disinfection, blood pump not calibrated correctly, & failure of conductivity meter what should you do in the event a patient has hemolysis - CORRECT ANSWER Stop blood pump, clamp lines, do not return blood, RN assess, notify doc, administer 02, check hemoglobin & potassium, monitor cardiac rhythm and vital signs what is first use syndrome - CORRECT ANSWER a group of symptoms that occur shortly after starting treatment with a new dialyzer What is disinfection infusion and its causes - CORRECT ANSWER a bleach protocol can result in disinfectant being infused into the patient's bloodstream via dialysis machine and caused by no residual disinfectant testing, inaccurate residual testing, sterling rebound What are the symptoms of disinfection infusion and intervention - CORRECT ANSWER Symptoms: Pain at venous needle, itching, restlessness, respiratory distress, flushing chest pain, Intervention: Discard bicarbonate, rinse mixer according to policy and do not initiate treatment until residual tests are negative What are the causes of chest pain/angina and intervention - CORRECT ANSWER coronary disease intervention decrease bar to 150, decrease fur, monitor vital sings, notify doc, administer 02, tell rn and document Dysrhythmias - CORRECT ANSWER irregular heart beat and must treat cause what do you do if patient experiences cardiac arrest while on dialysis machine - CORRECT ANSWER Establish if unresponsive, call for help, start car, return blood if possible, maintain patent of needles/CVC with saline cardiac arrest - CORRECT ANSWER cessation of heart activity What is an air embolism? - CORRECT ANSWER air bubble enter blood stream and are carried to vessel small enough to be blocked by air Who does data collection at pre & post treatment - CORRECT ANSWER PCT Who does assessment pre & post treatment - CORRECT ANSWER RN What does a patient;'s medical record provide information for? - CORRECT ANSWER plan of patient care True or False PCT must inform the RN of any unusual finding prior to start of treatment - CORRECT ANSWER True When is a pre treatment assessment always required by an RN - CORRECT ANSWER always with patients who have Aki True or False All documentation of machine setup and pre treatment information must be entered into the computer before treatment is initiated - CORRECT ANSWER True True or False Only serve complications and interventions during treatment have to be documented - CORRECT ANSWER False, All interventions and complication during treatment must be documented including patients response List six occurrences when to chart - CORRECT ANSWER 1. Change in baseline. 2. Change in patient's condition. 3. Procedure or Treatment performed. 4. Meds given and patient's response. 5. Care plan given. 6. Patient Education. Why do we document in the medical record? - CORRECT ANSWER proof of care data continuity permanent legal record communication what are the six items included in charting administered medication - CORRECT ANSWER 1. Date & time 2. Route of administration 3. Patient Response 4. Reason for administering 5. Allergies 6. Dosage Target weight - CORRECT ANSWER is determined via doc order and should be modified by the doc based on patient tolerance , ongoing signs of fluid overload, and changes in fluid status UF Goal calculation - CORRECT ANSWER Preweight-target weight + Saline Prime + Rinseback + Oral infusion/intake UFR Calculations - CORRECT ANSWER UF Goal / Treatment time What are three consequences of sodium loading - CORRECT ANSWER 1. Increased Thirst 2. large fluid gains 3. more hypotension & ischemic events during treatment State 3 ways we can contribute to sodium loading during dialysis - CORRECT ANSWER 1. Hypertonic & Normal Saline 2. Dietary intake 3. Diffusion from dialysis Wha does UF profiling do? - CORRECT ANSWER Changes the way fluid is removed to allow time for more vascular refilling True or false? If patients uf goal exceeds maximum UFR by doc, UF Goal must be changed to be in range with doc orders - CORRECT ANSWER True Consequences of hypervolemia - CORRECT ANSWER hypertension increased mortality rate cardiovascular disease What is hypervolemia? - CORRECT ANSWER fluid overload caused by failure of heart, liver, and kidneys What is hypovolemia? - CORRECT ANSWER not enough fluid in blood what are some consequences of hypovolemia - CORRECT ANSWER increased mortality rate, ischemia and damage to vital organs What is ischemia? - CORRECT ANSWER organs not getting enough blood and O2 so start to shut down What makes dialysis patients susceptible to HAIs? - CORRECT ANSWER Kidney failure weakens the immune system and dialysis gives long periods of time to access blood what is the most common transmission route for HAIs? - CORRECT ANSWER Contact transmission Why are dialysis patients at increased risk for acquiring a HAI at the facility? - CORRECT ANSWER Vascular access, uremia, and bacterial colonization each increases the risk of blood stream infection What germ causes the most common infections in dialysis patients? - CORRECT ANSWER MRSA What is the most important intervention you can do to prevent HAIs? - CORRECT ANSWER Hand hygiene True or False C-diff requires hand hygiene with soap and water - CORRECT ANSWER True Why are gloves so important - CORRECT ANSWER Exposure to blood and comtaminated items may cause infection risks to become high without gloves Why do you need to perform hand hygiene before and after wearing gloves? - CORRECT ANSWER Gloves have microscopic holes so hands can become contaminated despite having gloves on Who can use sinks dedicated for hand washing? - CORRECT ANSWER Teammates and patients What is the correct procedure in regards to your hands when you have causal contact with a patient? - CORRECT ANSWER Gloves are not necessary but must use hand hygiene Explain the HBV nomenclature and state which test is performed monthly on HBV susceptible patients - CORRECT ANSWER Antigen (HBsAg) have hept B or not (monthly Antibody (anti-HBs) immunity Core Antibody (ANti-BBcIgM_ vaccine or immune What are the 5 stages of grief? - CORRECT ANSWER denial, anger, bargaining, depression, acceptance Is there an order to work thought the 5 stages of grief - CORRECT ANSWER No What does the KDQOL 36 assist the social worker with? - CORRECT ANSWER helps identify causes of barriers to the patient's successfully adapting to renal failure and dialysis creates tally results and develops intervention and goals for patients what is the role of a social worker - CORRECT ANSWER to identify barriers preventing successful treatments, help increase positive adjustment, and supports' patients' emotional adjustments Define ultrafiltration - CORRECT ANSWER controlled fluid removal by manipulation of hydrostatic pressure Convection - CORRECT ANSWER solutes dragged across semi permeable membrane along with fluids difusion - CORRECT ANSWER particles move from a more concentrated area to a less concentrated area Osmosis - CORRECT ANSWER fluid moves from lower solute concentration to high solute concentration what are the kidneys' excretory functions - CORRECT ANSWER normalize electrolytes, fluid balance, waste removal, acid base balance what are the dialyzer excretory functions - CORRECT ANSWER removal of excess fluid based on target weight, normalize electrolytes, waste removal, & reduce metabolic acidosis what is the kidney's endocrine functions and dialyzers - CORRECT ANSWER Kidneys secret renin and erythropoietin, and activate Vitamin D and Ca regulation Dialyzer can't do any of this can only provide medications True or False Hemodialysis normalizes body pH through diffusion of bicarbonate into the blood - CORRECT ANSWER True True or False Wall box, Drain & water supply lines must be cleaned with bleach between each patient because considered a part of dialysis delivery system - CORRECT ANSWER True Does PCTs need to perform hand hygiene and put on clean gloves when changing acid concentrate connection, touching wall box, or swapping machines? - CORRECT ANSWER Yes What are the two most common routes of catheter infection - CORRECT ANSWER migration of bacteria through insertion site and into catheter tract contamination of the hubs what is the function of bicarbonate in the dialysate solution - CORRECT ANSWER buffer the acid concentrate True or false Federal law prohibits the processing of double labeled tubes - CORRECT ANSWER true what is the function of the acid concentration - CORRECT ANSWER provides the concentration gardient for diffusion What should you do to prevent contamination with other tube' additives? - CORRECT ANSWER Follow the order of the draw whatat are the rules for spinning samples - CORRECT ANSWER Must balance centrifuge by balancing with same size, kind, and fill level of tube glass and plastic tubes can't be balance together what are the four indicators of optimal nutrition status - CORRECT ANSWER stable target weight adequate fat stores & muscle mass albumin greater than or equal to 4 appropriate intake/ appetite True or FalseHigh potassium food eaten during dialysis is dialyzed out same day - CORRECT ANSWER False due to digestive system is no dialyzed out same day What does sodium help do? - CORRECT ANSWER Regulate body fluid volume and balance What is CKD-MBD treated with - CORRECT ANSWER Phospate bindeers, hectoral (vitamin D), Sensipar When should patients take their binders - CORRECT ANSWER with every meal At what time are medications containing a preservative discarded? - CORRECT ANSWER 28 days How long do we wait after administering heparin bolus prior to start of treatment? - CORRECT ANSWER 3-5 mins How do you administer Topical Anesthetic spray - CORRECT ANSWER Numbing is effective when the skin blanches (turns white) what are the 3 meds PCT can administer - CORRECT ANSWER lidocaine, heparin , saline What is heparin and it's function? - CORRECT ANSWER an anticoagulant (blood thinner) used to prevent blood clots What does Epogen treat ? - CORRECT ANSWER low number of blood cells caused by anemia What does Hectrol/Zemplar treat - CORRECT ANSWER secondary hyperparathyroidism in patients with CKD by decreasing PTH levels and incasing Ca levels Secondary hyperparathyroidism - CORRECT ANSWER is caused by high PTH levels that affects the balance of calcium and phosphorus in the body resulting in weaken bones what does Venofer/Iron treat? - CORRECT ANSWER anemia/iron definciency True or False Venofer and Epogen works well together to increase patients' blood cell count - CORRECT ANSWER True What does antibiotics do? - CORRECT ANSWER help stop infections by killing bacteria or stopping its reproduction What are causes of conductivity alarm? - CORRECT ANSWER No acid concentration, improperly prepared bicarb, calcium/magnesium precipitate What is the appropriate intervention for conductivity alarms - CORRECT ANSWER check before each patient what is the allowable difference between manual and machine conductivity readings when checking - CORRECT ANSWER +/- 0.4 True or False Measurement of the pH of the dialysate is important to verify the acid/base is within a acceptable range - CORRECT ANSWER True what do you do when returning patient's blood during a power failure - CORRECT ANSWER remove venous line from air sector clamp and manually crank blood pump what are causes of a more positive arterial pressure pre pump? - CORRECT ANSWER separation of blood tubing from arterial access and decrease in blood pump speed what are causes of a more negative arterial pressure pre pump low alarm? - CORRECT ANSWER blockage of arterial blood flow from patients access, kinks, infiltration, hypotension, vasoconstriction, poorly working catheter, blood pump set too high what are causes of a more negative arterial pressure pre pump high alarm? - CORRECT ANSWER bloodline separation, leak, a drop in blood pump speed, infusion of saline what are causes of a low pre dialyzer pressure + post pump? - CORRECT ANSWER leak/separation of bloodline, blockage in blood tubing, kink, poor blood flow what are causes of a high pre dialyzer pressure + post pump? - CORRECT ANSWER clotted dialyzer, infiltration, rise in blood flow rate, kinks What causes low venous pressure alarm - CORRECT ANSWER separation of blood tubing, a drop in blood rate, blockage of blood tubing, clotted dialyzer what causes high venous pressure alarm - CORRECT ANSWER infiltration, poorly working cvc, clotted access, blood tubing blockage True or False A healthy access will have a whoosh-whoosh sound and a steady pules with a buzzing feel - CORRECT ANSWER True How does an outflow stenosis present - CORRECT ANSWER whistling sound & a very pronounced pulse Hows does a inflow stenosis present - CORRECT ANSWER sound to be faint with little or no thrill what can good needle rotation prevent - CORRECT ANSWER aneurysms & pseudoaneuryms True or False KDQOL rule of 6's applies to only AVFs - CORRECT ANSWER true does using a tourniquet increase vein engorgement in AVfs - CORRECT ANSWER yes when are hemostatic sponges supposed to be removed - CORRECT ANSWER after hemostasis and before patient leaves facility how long does it take a cannulation site to heal - CORRECT ANSWER 2 weeks what position is a patient supposed to be in when giving catheter care - CORRECT ANSWER supine position (laying flat) why is CVC care delivered with patients in the supine position - CORRECT ANSWER helps prevent air embolisms and increases pressure to central veins What is the cause of blood leak detector alarm and how do you intervene? - CORRECT ANSWER Cause ruptured /damaged dialyzer intervention stop treatment & inform rn What is the cause of volume control alarm and how do you intervene? - CORRECT ANSWER Cause Uf Goal met before treatment time ends intervention will not be anle to sync but continue to tun until treatment time is completed What is the cause of tmp alarm and how do you intervene? - CORRECT ANSWER Cause changes in venous pressure/clotting in dialyzer intervention TMP v adds 3 cc of air in tmp bubble TMP ^ flushes venous line with saline What is the cause of blood pump and how do you intervene? - CORRECT ANSWER Causes hemolysis /venous pressure to high, roller are loose, door not secure intervention check door to blood pimp & notify biomed What is the cause of heparin pump alarm and how do you intervene? - CORRECT ANSWER Cause clamp heparin intervention prime heparin line Whats the difference between an AVF and an AVG - CORRECT ANSWER Fistula: connection of the patient's native artery to native vein Graft: use artificial/biological material and requires 2 connections What is difference between a tunneled and a non tunneled CVC? - CORRECT ANSWER Tunneled CVC: has a cuff that the skin grows too for anchoring to the patient —> it is kept in longer uses suture when placed but can be removed Non tunneled CVC: are held in place by only sutures and no cuff present Chlorine in water used for hemodialysis causes - CORRECT ANSWER Hemolysis/ death When is water harness testing done - CORRECT ANSWER At the end of the day When is chlorine testing done - CORRECT ANSWER At the beginning of the day and every 4hrs after the RO has been running for 15mins What does the speed of water of a RO prevent - CORRECT ANSWER Bacteria growth True or False Every second water is 3ft/second for a conventional RO system with a water tank - CORRECT ANSWER True Why is it important for hardness testing - CORRECT ANSWER Remove hard ions such as calcium and magnesium For a direct feed central water production it is 1.5ft/second so required flow is also dependent on pipe size - CORRECT ANSWER For self efficient RO because produces water on as needed basis True or False Larger pipes needs higher flowrate - CORRECT ANSWER True When are the require routine culture and endotoxins testing at all point of use done - CORRECT ANSWER By biomeds monthly True or false annual analysis of post Rao water are required - CORRECT ANSWER True What is your response to final water quality alarm - CORRECT ANSWER Put all dialysis machine in bypass mode (immediate response) Notify charge RN, FA, Biomed If water quality cannot be restored, terminate all treatments, and submit a facility AOR What are two concerns with using DI tanks - CORRECT ANSWER Highly dangerous when exhausted because of ionic quality increase bacterial and endotoxin levels What are the benefits peritoneal dialysis - CORRECT ANSWER Home based flexible schedule steady gentle treatment fewer dietary/fluid restrictions needle free less anemia (bc not any blood lost) allows active lifestyle improved transplant outcomes preserved residual renal function (mimicswhat normal kidneys do bc tx 7 days/week What are treatment for ESRD - CORRECT ANSWER Palliative Care Dialysis Kidney Transplant Home dialysis benefits - CORRECT ANSWER Home based, flexible schedule fewer dietary restrictions improved clinical outcomes may allow for easier travel independent treatment authorized reuse - CORRECT ANSWER Refers to using the same dialyzer more than once for the same patient What are the steps that must be complete before a dialyzer can be reused - CORRECT ANSWER 1. dialyzer rinsed & cleaned 2. Pressure tested to look for broken fibers 3. Filled with a chemical to kill bacteria and allow to dwell for certain amount of time 4. chemical is rinsed out 5. dialyzer tested to ensure safe to ise and no germicide left True or False for reuse total cell volume must be at least 80% of initial volume to assure enough fibers are available to clean the blood - CORRECT ANSWER True Which of these factors can affect how well an patient may do on dialysis - CORRECT ANSWER Other illness and how gently the dialysis treatment is delivered What is the main job of healthy kidneys - CORRECT ANSWER Keep the body in homeostasis Which parts of healthy kidney function can dialysis replace - CORRECT ANSWER Removing some water and wastes Your job with in-center HD may routinely include what tasks - CORRECT ANSWER Setting up the machine, taking the patient's vitals signs, and explaining what you are doing In peritoneal dialysis, what is "dwell time" - CORRECT ANSWER How long the fresh peritoneal dialysis fluid stays in the patient's belly before it is drained our What are the medicare rules that apply to the US Dialysis clinics? - CORRECT ANSWER Conditions for coverage Hyponatremia can occur if dialysate is not mixed correctly and can cause - CORRECT ANSWER Muscle cramps, confusion, headaches, fatal brain swelling What must occur to stop the processes of diffusion or osmosis - CORRECT ANSWER Equilibrium/ the solutes or water level are the same on both sides of a membrane How does diffusion occur? - CORRECT ANSWER Molecules have energy of their own bump into each other and spread out What type of blood pump pressure is always positive - CORRECT ANSWER Post pump Dialysate enters a dialyzer through the _______ and exits through the _____ - CORRECT ANSWER Bottom & top Hiw many compartments does a dialyzer contain & what are they? - CORRECT ANSWER Two blood & dialysate What information on a dialyzer must never be covered up by a patient's label - CORRECT ANSWER Model/Lot numbers & arrows for blood, dialysate flow How are germs able to get inside a dialyzer - CORRECT ANSWER Non sterile dialysate water that has germs in it What makes hollow finer dialyzers well-suited for reuse - CORRECT ANSWER They are strong and can be rinsed using high pressure What step can you take that may improve the flow of blood during treatment with a catheter - CORRECT ANSWER Adjust patients position Which is the safest way to lift a patient who cannot bear weight - CORRECT ANSWER Use a lift device What is the minimum level of kt/v for standard in-center hemodialysis - CORRECT ANSWER 1.2 Chlorine are added to tap water to remove what? - CORRECT ANSWER Microbes According to AAMI standards, the total microbial count of dialysate shall not exceed... - CORRECT ANSWER 200 CFU/mL According to AAMI standards, the total endotoxin count of dialysate shall not excess what - CORRECT ANSWER 2 Eu/ml According to AAMI standards, when should bacteriologic testing for water and dialysate take place? - CORRECT ANSWER Monthly True or False When a patient leaves at their target weight, they should have no edema or shortness of breath - CORRECT ANSWER True Blending valve keeps water at what temperature - CORRECT ANSWER 77 degrees True or false The body normally secretes 1-2 liters of utine each day - CORRECT ANSWER True CMS dialyzers labeling require what? - CORRECT ANSWER Must remain readable through reprocessing and not covering the model number When a conductivity alarm sounds - CORRECT ANSWER The dialysate is in bypass mode countercurrent flow - CORRECT ANSWER The blood flows in one direction and dialysate flows in the opposite Creatinine - CORRECT ANSWER waste product of muscle metabolism, filtered out of the blood by the kidneys, and excreted in urine concurrent flow - CORRECT ANSWER when blood and dialysate travels in the same direction countercurrent flow - CORRECT ANSWER When blood flows in one direction and dialysate flows in the opposite direction Dialysis quality of care is measured in terms of what? - CORRECT ANSWER Outcomes A fistula access places additional strain on the heart. What is the required increase in cardiac output to have a fistula? - CORRECT ANSWER 10% How are dialysis clinics paid by Medicare for dialysis treatment? - CORRECT ANSWER Contract pricing How far should needle insertion be done from the anastomosis - CORRECT ANSWER 1 inch How frequently should the carbon tanks be checked for chlorine - CORRECT ANSWER Each shift How long can hepatitis B virus survive on surfaces - CORRECT ANSWER one week How long must water treatment system be running before you perform you first test - CORRECT ANSWER 15 mins How many carbon tanks are required by CMS - CORRECT ANSWER At least 2 How often should the RO operating parameters be checked - CORRECT ANSWER Daily The medicare conditions for coverage requires that dialysis centers follow what standards for infection control - CORRECT ANSWER CDC True or false The nephron is located mostly in the cortex or the kidney - CORRECT ANSWER True A nephron is made up of - CORRECT ANSWER glomerulus and tubule What are some complications of flipping the needle in an AVF cannulation - CORRECT ANSWER Infiltration, stretching the needle hole, tearing the lining of the vessel What are the 2 components of the water softening system - CORRECT ANSWER Brine tank and softening tank What is acceptable level of post softner hardness - CORRECT ANSWER 0.8 grains/gallon What is the action level for EU (endotoxin unit) - CORRECT ANSWER 1EU/ml What is the acceptable range for total chlorine check - CORRECT ANSWER 0-0.9 What is the action level for CFU (colony forming unit) - CORRECT ANSWER 50 CFU/ml & greater What is the function of the back flow prevention device - CORRECT ANSWER Prevents back flow and leading back to city water What is the empty bed contact time of chlorine tanks? - CORRECT ANSWER 5 min/tank What is the function of the carbon tanks - CORRECT ANSWER To removing chlorine & chloamines What is the function of the temperature blending valve - CORRECT ANSWER Maintains optimum temperature What is the lab value for albumin - CORRECT ANSWER Greater than 4g/dL What is the main purpose of using high dialysate flow rate during dialysis - CORRECT ANSWER To maintain a wide concentration gradient What is the optimum temperature range for water entering the treatment system - CORRECT ANSWER 77-82 degrees F What is the purpose of the bypass function in a dialysis delivery system - CORRECT ANSWER To protect the patient from dialysate that is not within safety margins What is the lab target for creatinine - CORRECT ANSWER 10-18mg/dl What is the target lab value for sodium - CORRECT ANSWER 135-146mEq/L When checking chemical monitoring for sulfates the AAMI requires dialysis water to contain no more than how many mg/L in total sulfates - CORRECT ANSWER 100mg/L When the high temperature alarm goes off, what is the first thing PCT should do? - CORRECT ANSWER Verify the machine is in bypass mode What is the organization that sets the standards and recommendations for dialyzer reprocessing - CORRECT ANSWER AAMI Excess calcium and magnesium in water used for dialysis can cause - CORRECT ANSWER Muscle weakness Excess calcium and sodium in water used for dialysis can cause - CORRECT ANSWER Hypertension Aluminum in water used for dialysis can cause - CORRECT ANSWER Nausea & vomitting What is the action level for water endotoxin testing results - CORRECT ANSWER 0.12 EC/mL to 0.25EC/mL Access Assesment - CORRECT ANSWER Look signs of infection, listen for bruit, feel thrill Peritoneal Dialysis differs from hemodialysis in what ways A) PD access is by an intra-abdominal catheter b) PD requires both vascular & abdominal access C) STerlile dialysate is not required for PD D) PPD cannot be done at home - CORRECT ANSWER PD Access is by an intra-adbominal catheter