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DAVITA FINAL EXAM 1 | QUESTIONS & ANSWERS |ALREADY
GRADED A+| VERIFIED & UPDATED|
What complication would you expect to see if a patient is exposed to chlorine/chloramines? - answer Hemolysis You are performing the first chlorine/chloramine testing of the day after the RO has been running for 10 minutes. Performing thetest at this time - answer Could result in a false negative test At what time do you perform water hardness testing? - answer At the end of each treatment day What is your immediate response to a final water quality alarm on the treatment floor? - answer Place all machines into bypass Benifits of peritoneal dialysis and home hemodialysis? - answer Home based Flexible schedule Fewer diatary restrictions The two types of peritoneal dialysis are - answer CAPD and CCPD Procedure when useing hemostatic sponges such as SureSeal? - answer Remove the hemostatic sponge after hemostasis has been acheived and dress needle site w bandaid or gauze
- answer Two weeks Why should a pt be in a comfortable supine position when performing Pre dialysis CVC care? - answer The supine position increases pressure with in central veins and diminishes the risk of an air embolism Flipping the arterial vascular access needle - answer Is not necessary since all arterial needles now have a back eye A new AVF has received his post op exam and meets KDOQIs rule of 6s which NFACT cannulator would the AVF - answer Advanced cannulater
AV graft and hear whistling sound could be indicative of - answer An outflow stenosis KDOQI rule of 6s - answer Provides guidelines for use of new AV fistula To prevent the formation of aneurysms in pseudo aneurysm the following should be practice - answer Good needle site rotation in complete needle site clotting techniques During cannulation of all AV fistula's - answer A tourniquet is to be applied to increase vein engorgement and stabilize vessel What is an important action prior to returning a patient's blood using the hand crank in the event of a power failure - answer Remove the venous line from the line clamp What problems will cause a more negative (high-pressure alarm) pre-pump arterial pressure - answer Kinking of the arterial blood line between the vascular access in the arterial monitor What problems will cause an increase in venous pressure - answer Clotting of the Venus drip chamber Which statement is true regarding the "reason of prudent" standard of care - answer When supervising patient care technicians and other non-licensed personnel it is the responsibility of the license nurse to ensure these teammates also meet the standard of care
Educational tips for kinesthetic learner's include - answer Taking short breaks and allowing your patient to get up and walk around Educational tips for visual learners include - answer Selecting quiet surroundings The sign that Numbing has taken effect and it is time to stop spraying topical anesthetic onto a vascular access cannulation sites is - answer Blanching on the skin Unless otherwise directed by the manufacture or state specific pharmacy regulations when must medications containing a preservative be discarded - answer 28days after opening Diffusion is defined as
- answer lower solute concentration Osmosis is defined as
- answer solute concentration Particles move from an area of higher solute concentration to an area of Fluid moves from an area of lower solute concentration to an area of higher Hemodialysis helps normalize body pH through - answer Diffusion of bio carbonate from the dialysate into the blood The endocrine function of the kidney are - answer Renin and erythropoietin secretion ,activation of vitamin D
The excretory function of the kidney is - answer To normalize electrolytes Which of the following is a basic principle of patient self management - answer Dealing with the consequences of illness rather than just the physical disease Which statement is true regarding the stages of grief - answer Sometimes people can get stuck in one stage If you notice that a patient caretaker is struggling to meet the Demands of the patient's treatment regime you should - answer Notify the social worker because he or she is there for patients and their families The psychosocial assessment completed by the social worker - answer Is completed initially and annually Ultra filtration is defined as - answer Controlled fluid removal by manipulation of hydrostatic pressure Convection is defined as - answer Solutes are dragged across the semi permeable membrane along with fluid The acronym DARN stand for - answer Desire, ability, reason, need The three core communication skills used in motivation interviewing are - answer Asking, listening, informing Summarizing during reflective listening - answer Includes the main aspects of what the patient said during the entire communication The best way to help patient successfully change behaviors is to - answer Inspire behavior change to support, compassion, and empathy Left ventricular hypertrophy (LVH) is caused by - answer Hypertension Hemodialysis replaces what % of normal kidney function - answer 15% What does CKD-MBD lead to? - answer Abnormalities in Ca, PO4,PTH and vit D Metabolism with soft tissue calcification and bone disease
The centrifuge to spine blood samples must be balanced to avoid shaking and the centrifuge losing its balance. To balance the centrifuge - answer Only tubes of the same kind, size, and fill level should be placed opposite each other If a patient presents with dialysis associated Pericarditis, treatment includes more frequent dialysis and - answer Heparin restriction to prevent bleeding into the pericardium and tamponade A patient with hyperkalemia will present with - answer Extreme muscle weakness and an abnormal heart rhythm Gloves are in essential part of hand hygiene. What is their function? - answer Gloves reduce the risk of hand contamination and prevent the transfer of organisms already on the hands Which statement is true about sinks use for handwashing? - answer Handwashing sinks must be dedicated for handwashing purposes only and should remain clean Attention to infection control, proper hand hygiene, cleaning and disinfection procedures are of upmost importance in the dialysis setting. Which of the following statements is true? - answer Viable MRSA bacteria can remain on surfaces for days with plastic and vinyl being most favorable to their survival. If your facility dialyze is hepatitis B positive patients, which assignment would not be an appropriate patient care assignment? - answer Caring for HBsAG positive and hepatitis B susceptible patients at the same time Per the CDC, which is the most common factor contributing to bacteremias in dialysis patients? - answer The use of catheters for hemodialysis
Per the CDC, which is the most important route by which pathogens are transmitted in healthcare settings including dialysis centers? - answer Contact transmission Practicing meticulous infection control to prevent healthcare associated infections (HAIs) in dialysis patients is of upmost importance because? - answer Kidney failure weekends a person some uses them making these pieces much more vulnerable to infections Infections are the second most common cause of death in this population The hemodialysis procedure requires prolong access to the patient's blood
With the patients calculated UF goal exceeds the maximum UFR ordered by the nephrologist - answer Calculated UF goal must be adjusted to not exceed the ordered maximum UFR in the reason documented The PCT notes that a patient still has considerable Adema in her legs when performing the post treatment data collection. In addition to informing the nurse,what should the PCT document? - answer Document the noted swelling and that the nurse was informed Poor or incomplete documentation - answer Can open an attack on your care What are three things you should not include in an REM? - answer Personal opinion, speculation, vendettas
The clinical pyramid includes - answer The fundamentals, complex programs, and quality of life DQI success is achieved by - answer Managing individual patients first and allowing scores to follow Knowing each team members role in improving the DQI scores Using the CQI process to help identify trends and make improvements For patients with AKI - answer A pre-treatment nursing assessment is always required How do you verify that the patient is stable and safe for discharge after the dialysis treatment? - answer Evaluate the effectiveness of the treatment by comparing data to pre-dialysis findings PCT's notify the nurse if there are any unusual findings Nurses perform a post treatment assessment as required Documentation in the medical record - answer Is a permanent legal record of the care provided All documentation on machine set up and a pre-treatment patient information - answer Must be entered into the computer before the treatment is initiated Post treatment data collection in assessment is performed - answer After the treatment is terminated
As you initiate the treatment your patient complains of pain at the Venus needle site, tingling around the lips and difficulty breathing. These are signs or symptoms of - answer A disinfectant infusion In states that do not mandate a pre-dialysis patient assessment by the register nurse - answer The PCT must inform the nurse of unusual data collection findings prior to treatment initiation Intradialytic hypotension - answer Can have many adverse effects including impaired tissue perfusion of vital organs and organ injury They recommended intervention for muscle cramps is - answer Turning the UFR off Per Davita policy, fever and chills is defined as - answer Any temperature greater than 100 or increased over baseline of 2° with symptoms Mr. Simmons complains of shortness of breath and back pain upon inspection, the blood lines look like cherry Kool-Aid. What is this complication and what should you do? - answer This is hemolysis and the hemodialysis treatment should be stop without returning the patient's blood In the event of a patient is experiencing a seizure, the dialysis treatment should be
- answer Discontinued if the seizure is severe or the patient does not respond to treatment Waiting only five seconds between lowering the blood pump speed and drawing the post treatment blood sample would - answer Cause the KT /V reading to be falsely high
Which of the following factors would decrease the K of the KT/V formula? - answer Inadequate coagulation A patient with an acute kidney injury (AKI) is at increased risk for - answer Hypotension and hypovolemia Knowing what caused your patient renal failure - answer Is important to inquire about possible problems during data collection and assessment Explain the difference between AKI and CKD - answer AKI is short term and reversible CKD is long-term and irreversible
Dialyzer with more surface space Higher blood volume processed What is T? - answer Stands for time What factors influence T - answer Longer blood dialysate contact time
More frequent or extra treatments What is V - answer Stands for volume What factors influence V? - answer A persons body is composed of 50 to 55% water A persons height, weight, sex, age and amputations are included in calculating V Needle gauge and suggested BFR - answer 17 gauge needle 200- 250 16 gauge needle 250- 350 15 gauge needle 350- 450 14 gauge needle more than 450 Procedure for post bun lab draw - answer DFR to 300 or bypass BFR to 100 Wait 15 seconds then draw lab UF off Lab draw mistakes that will fastly increase KT/V - answer Not waiting 15 seconds Not reducing blood flow rate Lab draw mistakes that would possibly decrease KT/V - answer Diluting the pre-treatment sample
What is the role of the license nearest prior to treatment initiation? - answer Assess everyone Assess new patients assess AKI patients When is a pre-treatment assessment by the licensed nurse required? - answer When there is abnormal findings during data collection New patients AKI patients Nurses have one hour to do assessment unless there are abnormal findings If the BP cuff is too small the blood pressure could read - answer Falsly high If a blood pressure cuff is too large the blood pressure can read - answer Falsely low When is post treatment and assessment by a licensed nurse required? - answer All patients in Connecticut Why do we document in the medical record? - answer Proof that here was recorded Permanent legal record Provide data continuity Communication tool List six occurrences when to chart - answer Change from baseline assessment Change in patient condition Procedure or treatment
Medication given and patient response Patient teaching care plan review and interventions What are the appropriate times for documentation? - answer Pre-treatment safety checks prior to start of treatment Pre-treatment data collection assessment prior to treatment
