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What complication would you expect to see if a patient is exposed to chlorine/chloramines? ✔✔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 ✔✔Could result in a false negative test
At what time do you perform water hardness testing? ✔✔At the end of each treatment day
What is your immediate response to a final water quality alarm on the treatment floor? ✔✔Place all machines into bypass
Benifits of peritoneal dialysis and home hemodialysis? ✔✔Home based
Flexible schedule
Fewer diatary restrictions
The two types of peritoneal dialysis are ✔✔CAPD and CCPD
Procedure when useing hemostatic sponges such as SureSeal? ✔✔Remove the hemostatic sponge after hemostasis has been acheived and dress needle site w bandaid or gauze
✔✔Two weeks
Why should a pt be in a comfortable supine position when performing Pre dialysis CVC care? ✔✔The supine position increases pressure with in central veins and diminishes the risk of an air embolism
Flipping the arterial vascular access needle ✔✔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 ✔✔Advanced cannulater
AV graft and hear whistling sound could be indicative of ✔✔An outflow stenosis
KDOQI rule of 6s ✔✔Provides guidelines for use of new AV fistula
Performing a procedure "your way" rather than following to daVitas policy and procedures ✔✔Can lead to civil liability in the event of an adverse patient outcome
A surveyor ask you a question which of the following statements would be a good answer? ✔✔I do not know the answer but I will find out
A surveyor discovers that the chlorine checks have not been done correctly what kind of deficiency would the surveyor give the facility? ✔✔Immediate jeopardy
When comparing the dialysis machines conductivity reading to your manual reading policy states that the difference between these two readings is to be ✔✔No greater than +/- 0.
Why do we measure the pH of the dialysis solution? ✔✔To verify it's acid base balance is within the acceptable range
What complication occurs if blood is exposed to dialysate that is too hot? ✔✔Hemolysis
The waiting time after administration of the initial heparin loading dose prior to initiation of hemodialysis is ✔✔3-5 mins
In optimal nutrition status is evidenced by ✔✔A stable desirable target weight ,adequate fat stores and muscle mass ,appropriate appetite and intake, and a serum albumin of equal to or greater than 4gm/dl
Phosphate binders are prescribed to prevent phosphorus and meals from being absorbed.
when is the best time to take them? ✔✔With a meal
Your patient pulls out her snack during dialysis as she savers the first bite of her banana she smiles and tells you she always wants to eat foods high in potassium during dialysis so it won't harm her what is your appropriate response? ✔✔Explain to the patient that the potassium and food eaten during dialysis is not dialyzed off
Definition of health literacy ✔✔The degree to which individuals understand basic health information
Educational tips for auditory learners ✔✔Using word associations and mnemonic
The endocrine function of the kidney are ✔✔Renin and erythropoietin secretion ,activation of vitamin D
The excretory function of the kidney is ✔✔To normalize electrolytes
Which of the following is a basic principle of patient self management ✔✔Dealing with the consequences of illness rather than just the physical disease
Which statement is true regarding the stages of grief ✔✔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 ✔✔Notify the social worker because he or she is there for patients and their families
The psychosocial assessment completed by the social worker ✔✔Is completed initially and annually
Ultra filtration is defined as ✔✔Controlled fluid removal by manipulation of hydrostatic pressure
Convection is defined as ✔✔Solutes are dragged across the semi permeable membrane along with fluid
The acronym DARN stand for ✔✔Desire, ability, reason, need
The three core communication skills used in motivation interviewing are ✔✔Asking, listening, informing
Summarizing during reflective listening ✔✔Includes the main aspects of what the patient said during the entire communication
The best way to help patient successfully change behaviors is to ✔✔Inspire behavior change to support, compassion, and empathy
Left ventricular hypertrophy (LVH) is caused by ✔✔Hypertension
If a patient presents with dialysis associated Pericarditis, treatment includes more frequent dialysis and ✔✔Heparin restriction to prevent bleeding into the pericardium and tamponade
A patient with hyperkalemia will present with ✔✔Extreme muscle weakness and an abnormal heart rhythm
Gloves are in essential part of hand hygiene. What is their function? ✔✔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? ✔✔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? ✔✔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? ✔✔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? ✔✔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? ✔✔Contact transmission
Practicing meticulous infection control to prevent healthcare associated infections (HAIs) in dialysis patients is of upmost importance because? ✔✔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
The tags for CMS survey state specific regulations to be met within a condition such as infection control, provide interpretive guidance for each regulation, and site deficiencies by tag number. How can knowledge of these V tags affect the practice of patient care providers ✔✔Provide patient care with in CMS condition for coverage
Attempting to remove a large amount of fluid weight gain from the patient ✔✔Can lead to hypovolemia during the treatment which is associated with an increased mortality rate
With the patients calculated UF goal exceeds the maximum UFR ordered by the nephrologist ✔✔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? ✔✔Document the noted swelling and that the nurse was informed
Poor or incomplete documentation ✔✔Can open an attack on your care
What are three things you should not include in an REM? ✔✔Personal opinion, speculation, vendettas
The clinical pyramid includes ✔✔The fundamentals, complex programs, and quality of life
DQI success is achieved by ✔✔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 ✔✔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? ✔✔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 ✔✔Is a permanent legal record of the care provided
All documentation on machine set up and a pre-treatment patient information ✔✔Must be entered into the computer before the treatment is initiated
Post treatment data collection in assessment is performed ✔✔After the treatment is terminated
In states that do not mandate a pre-dialysis patient assessment by the register nurse ✔✔The PCT must inform the nurse of unusual data collection findings prior to treatment initiation
Intradialytic hypotension ✔✔Can have many adverse effects including impaired tissue perfusion of vital organs and organ injury
They recommended intervention for muscle cramps is ✔✔Turning the UFR off
Per Davita policy, fever and chills is defined as ✔✔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? ✔✔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 ✔✔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 ✔✔Cause the KT /V reading to be falsely high
Which of the following factors would decrease the K of the KT/V formula? ✔✔Inadequate coagulation
A patient with an acute kidney injury (AKI) is at increased risk for ✔✔Hypotension and hypovolemia
Knowing what caused your patient renal failure ✔✔Is important to inquire about possible problems during data collection and assessment
Explain the difference between AKI and CKD ✔✔AKI is short term and reversible
CKD is long-term and irreversible
Treatment goals for a patient with CKD ✔✔Slowing the progression of see KD next line controlling symptoms
Managing complications
Minimizing the effects of CKD and patients lifestyles
What treatment factors increase K? ✔✔Higher blood volume processed
Higher blood flow rate
Increasing time
Dialyzer with more surface space
What is T? ✔✔Stands for time
What factors influence T ✔✔Longer blood dialysate contact time
More frequent or extra treatments
What is V ✔✔Stands for volume
What factors influence V? ✔✔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 ✔✔17 gauge needle 200-
16 gauge needle 250-
15 gauge needle 350-
14 gauge needle more than 450
Procedure for post bun lab draw ✔✔UF off
DFR to 300 or bypass
BFR to 100
Wait 15 seconds then draw lab
Lab draw mistakes that will fastly increase KT/V ✔✔Not reducing blood flow rate
Not waiting 15 seconds
Lab draw mistakes that would possibly decrease KT/V ✔✔Waiting longer than 15 seconds
Diluting the pre-treatment sample
Who does patient assessments ✔✔Licensed nurse
Who does data collection ✔✔Non-licensed teammates
What is the role of a PCT prior to treatment initiation? ✔✔Data collection
