Download PCT FINAL EXAM QUESTIONS WITH
ANSWERS 2022/2023 UPDATE and more Exams Nursing in PDF only on Docsity!
ANSWERS 2022/2023 UPDATE
Fluid pushed thru a semipermeable membrane(answer) Ultrafiltration Known as solute drag, solute move w/ water across the semipermeable membrane. kidneys remove waste this way(answer) Convection Movement of dissolved particles across a semipermeable membrane from high to low concentration(answer) Diffusion Fluid move from low to high solute concentration(answer) Osmosis 1) Fluid Balance (ultrafiltration)
- Electrolyte balance (diffusion) 3) Acid/Base balance(answer) Kidneys excretory functions 1) Renin (angiotensin aldosterone system)
- Erythropoiesis 3) Vitamin D & Calcium regulation(answer) Kidneys endocrine functions Function of Bicarbonate(answer) Maintains acid-base balance and help clean blood by functioning as the primary buffer in the body How do we replace excretory functions?(answer) Hemodialysis removes urea, salt, excess water from blood which normalizes electrolytes and metabolic acidosis
ANSWERS 2022/2023 UPDATE
1 / 19 Hormones replaced by medications such as Epogen, Iron, Antihyperten- sive (ACE inhibitors), Phosphate binders, Vitamins D, Calcimetric agents(answer) - How we replace endocrine functions? 1) Edema & Pulmonary Edema
- Hypertension
- Chronic Heart Failure
- Shortness of breath 5) Headaches(answer) Signs & symptoms of fluid imbalance Hypertension leads to(answer) Left Ventricular Hypertrophy (LVH) Why is sodium balance important?(answer) Sodium holds onto water, thirst and blood pressure control 1) Extreme muscle weakness
- Irregular heart rhythm (Brady)
- Wide QRS 4) Cardia arrest(answer) Signs and symptoms of Hyperkalemia 1. Fatigue
- Muscle weakness
- Respiratory failure
- Irritable heart muscle
ANSWERS 2022/2023 UPDATE
3) * More antibiotics & anti-inflammatory meds*(answer) Treatment of Pericarditis
20. Recommend fatty lotions, lukewarm water, antihistamine (allergy reliev- ers), pat not rub skin dry and checking phosphorus levels(answer) If patient is com- plaining of dry, itchy skin 21. What would you do if patient complaints of Peripheral Neuropathy (nerve pain)?(answer) Check water temperature, wear good shoes, no barefeet, and observe/in- spect feet
- Calcium
- Phosphorus
- PTH (Parathyroid Hormone) 4) Calcium/Vitamin D(answer) Four key elements affected in CKD-MBD 23. What is AKI?(answer) Acute Renal Injury (Failure), Kidneys can't filter waste from blood on their own.
- Blood loss (Hemorrhaging)
- Blood clots
- Burns Not getting blood flow to kidneys(answer) Examples of Pre- renal causes of AKI
- Medications
- Dyes
- Not getting blood inside the kidneys*(answer) Examples of Intra- renal causes of AKI
- Kidney stones
- Neurogenic bladder
- Vesicoureteral reflux (reflux from bladder > ureter)
ANSWERS 2022/2023 UPDATE
Blockage to kidneys(answer) Examples of Post-renal causes of AKI
ANSWERS 2022/2023 UPDATE
- Surgical masks
- Sterile gloves/gown 3) Avoid touching exposed surfaces(answer) Three strategies recommended by KDOQI to decrease risk of infection when working w/ CVC's 39. Hepatitis B surface Antigen (HBsAg) are performed...?(answer) Monthly 40. Anti-HBs(answer) Hepatitis B surface antibody 41. nti-HBclgm(answer) Hepatitis B Core antibody 42. The manual conductive value must match +/- on the Fresenius (FMC) dialysis delivery system displayed conductivity.(answer) 0. 43. What is the safe dialysate pH range?(answer) 6.9 to 7.
- What is "strikethrough" of an external pressure transducer?(answer) blood cont- amination 45. Why is strikethrough important?(answer) Fluid could have enter the machine and contaminated the internal pressure and transducer protector provider a revivor for microorganisms which can lead to blood infections 46. Why is it important for patient care teammates to know when the water treatment system disinfection was performed?(answer) It will introduce disinfectant solution in the dialysis delivery systems thru water inlet lines 47. 1) Following standard care makes the care given defensible and avoids negligence's part of the ...(answer) Reasonable & Prudent Standard Care for Nephrology Nursing Key Concept
- When supervising non -licensed techs it is the responsibility of the to ensure these teammates also meet standard of care(answer) li- censed nurse
- Davita provides standard of care
- Acting accordingly to Davita & is "prima facie" (first sight) evidence to compliance 3) Davita & serves "best demonstrated practice"(answer) P
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& P (Policy and Procedure)
50. What are risks of doing it your way?(answer) civil liability 51. Six occurrences when to chart(answer)(answer) 1) change from assessment
- change of patient condition
- change of procedure/tx
- change of medication/patient response
- patient education/teaching
- care plan review and interventions 52. These are done prior to initaition for treatment and must be documented within an hour(answer) Pre-treatment safety checks 53. Pre-treatment data collection(answer) are done prior to treatment, 10 second access listen, feel, and raise arm to see flatten 54. open for questions or attack on care(answer) possible consequences of poor or incomplete documentation (leaving a blank space or N/A) 55. What does SMART communication stand for?(answer) Simple Meaningful Actual Read Teach 56. What are the 5 W's?(answer) Who When What Where Why
- Three things to not include in a REM (Risk Event Mangement)(answer) personal opinions, speculations, rendattas 58. When is post-treatment assessment by the licensed nurse required? (answer) Re- quired by state; or if data collection includes abnormal findings
ANSWERS 2022/2023 UPDATE
- Diameter >.6cm
69. Describe a beginner cannulator(answer) < 6 months experience < 10 successful cannulations 70. Describe intermediate cannulator(answer) > 6 months experience
10 successful cannulations
- When evaluating an an access(answer) Look at the entire access, look for signs of steal syndrome for bruit, whistle sound indicates stenosis for thrill, should be soft, compressible, and warm(answer) Listen, Feel
- Meets KDOQI rule of 6's
- Nephrologist ordered to be cannulated 3) Only advanced cannulators can cannulate(answer) Newly matured AVF
- Tolerates maximum needle size & BFR for at least 6 tx's
- Intermediate cannulator can cannulate(answer) Mature AVF
- Access has been cannulated w/ 2 needles for 2 months w/o complica- tions
- Beginner cannulator can cannulate(answer) Established AVF 75. The needle gauge for initial cannulation.(answer) 17 76. What does BESTIPS stand for?(answer) Bleeding Erosion Stenosis Thrombosis Infection Pseudo aneursym Steel syndrome 77. What is the distance should be from a anastomosis ?(answer) 1.5 inches same as for needle tips 78. What is K in Kt/V?(answer) clearance of urea 79. Treatment factors that increase K(answer) DFR, BVP, UF goal, adequate antico- agulation (heparin) 80. Decrease in *BFR and DVP *
ANSWERS 2022/2023 UPDATE
Inadequate heparin(answer) Can decrease K in Kt/V
- T in Kt/V stands for time of dialysis session What factors influence T?(answer) Longer blood/dialysate contact time Frequent/extra tx's 82. V stands for volume for patient's body water, which urea is distributed What factors influence V?(answer) sex, body weight, height, age, and amputations
- What is the suggested BFR for the following needle gauges? 17 (answer) 16 (answer) 15 (answer) 14 (answer) Note the smaller the needle size the larger the BFR(answer) 17 (answer) 200-250 16 (answer) 250- 15 (answer) 350- 14 (answer) > 84. What should you do for a post BUN lab draw?(answer) 1) Turn off/decrease UF to 50 mL/hr
- Decrease DFR to 300 or place in bypass
- Reduce BFR to 100 and wait for 15 seconds
- Drawing from venous line
- Not waiting for the full 15 seconds HINT Opposite of negative(answer) Lab draw mistakes that would falsely increase Kt/V
- What are lab draw mistakes that would decrease Kt/V? HINT Opposite of positive(answer) 1) Accidentally diluting arterial line with saline
- Waiting longer than 15 seconds 87. At what time are medications containing a preservative discarded? (answer) 28 days 88. What is the time frame during which a single use medications should be prepared and administered?(answer) 4 hours
ANSWERS 2022/2023 UPDATE
high? (answer) Repeat it and if still too high test the secondary carbon tank. If secondary tank is within limits contact BIOMED and test every 30 min
100. What if secondary tank results are too high?(answer) stop dialysis, contact BIO- MED and FA
- In hardness testing what is being removed? and why is it important(answer) 1) Calcium and magnesium (these also causes muscle weakness).
- Important for RO protection 102. When does water hardness testing occur?(answer) at the end of treatment day 103. What does RO remove?(answer) organic and inorganic materials bacteria and en- dotoxins
- Exhausts quickly
- Highly dangerous when exhausted(answer) Two concerns of using DI tanks 105. How to respond to a Final Water Quality Alarm?(answer) 1) Place all machines on Bypass
- Notify BIOMED
- If not restored, terminate all treatments
- Excessive UF
- Too much removal/too rapid removal of fluid
- Antihypertensive meds
- Dehydration (Vomiting/Diarrhea)
- OTC drugs (herbs)
- Foods 7) Inappropriate TW(answer) Causes of hypotension
- Flushing
- Yawning
- Dizziness
- Cold, clammy skin
- Ringing in the ears
ANSWERS 2022/2023 UPDATE
- Anxiety 7) Seizures & cardiac arrest(answer) Symptoms of hypotension
- Hypotension is a BP less than 90/60 or a drop by 20 mmHg. What to do in a hypotensive episode?(answer) 1) Place patient in flat supine position
- give normal saline per nephrologist order
- pct's may provide < or equal to 200 mL saline before notifying nurse
- monitor vitals, if severe give oral fluids (water) 109. Acute stress, can lead to heart failure(answer) Consequences of organ stunning of the heart 110. Release of endotoxins into circulation, and causes inflammation(answer) Con- sequences of organ stunning of the Gut 111. Loss of RRF (residual renal failure)(answer) Consequences of organ stunning of the Kidneys 112. White matter injury(answer) Consequences of organ stunning of the Brain
- Frequent assessment of TW
- Limit UFR to ,13 mL/hr
- UF profiling
- Extend tx time 5) Pure ultrafiltration(answer) How to prevent Hypotension 114. Hypertension is a pre-dialysis BP higher than 140/90 & a post BP high- er than 130/80. What can cause hypertension?(answer) Fluid overload, non taking meds, renin response (damaged kidneys producing too much renin), anxiety and DDS
- Headache
- Dizziness
- Blurred Vision
- Edema 5) Asymptomatic(answer) Symptoms of Hypertension
ANSWERS 2022/2023 UPDATE
- Notify EMS
- Disconnect pt from tx and draw labs if needed 5)Attach 10 ml syringe to arterial
- Aspirate venous line with new syringes and attach new syringe
- Rapid/excessive shifts in patient fluid volume and removal
- Exceeding maximum of UFR of 13 mL/hr
- Fluid/electrolyte imbalance
- Hypovolemia (low potassium) 5) Hypoxemia (low oxygen in tissues)(answer) Causes of Muscle cramps
- With appropriate dietary control of fluid, electrolytes, UFR of <13mL/hr, decrease sodium loading, increasing TX time and UF profiling can help prevent muscle cramps What to do if patient is experiencing muscle cramps?(answer) 1) Assist patient to stretch muscle
- Apply comfort measures (massage, applications of opposing force)
- Reduce UFR or turn off UF Must notify nurse before doing it
- PCT may give saline up to 200 mL 122. Heating pad, heated saline bags, gloves filled with heated liquid, electric blankets, any items w/ water(answer) Should NOT be used for muscle cramps 123. Seizures are involuntary muscle spasms and loss of consciousness. Seizures are caused by(answer) dialysis side effects, adverse reaction to a problem, improper prepared dialysate of severe hypotension
- Twitching
- Foaming
- Confusion 4) Change in level of consciousness(answer) Symptoms of Seizures 125. What are the interventions of seizures according to state regulations?- (answer) 1) Contact EMS
- Protect airway
- Protect patient access to avoid line separation/needle dislodgment
- Protect patient from harming themselves
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- If possible place pt on floor, note the duration
- Administer 200 ml saline if hypotensive following nurse orders
- If patient is responsive after having seizure can treatment continue? (answer) - Yes if patient does not respond to tx do not continue
- Pain in chest
- Difficulty breathing 3)* Nausea (GI distress)*
- Discomfort in jaw, neck, shoulder, back, or arms
- Dyspnea 6) Pale/ashen color(answer) Symptoms of chest pain
- Chest symptoms are usually relieved by rest/meds and lasts 5 min or less. What should be done if patient is experiencing chest pain?(answer)
- PCT's notify nurse
- Decrease BFR & UFR to 150
- If pt is hypotensive administer saline and monitor vitals 129. Preventing hypovolemia and hypotension, monitoring hemoglobin, Identifying and treating with medication may(answer) Help prevent chest pain
- Underlying heart disease (in older pt's)
- Change in electrolytes (potassium)
- Volume excess 4) Myocardial infarction (artery blockage of heart)(answer) Causes of Dysrhythmia (Arrhythmia) (irregular heart beat) 131. Lack of oxygen to the heart muscle, CVD, Hypotension, Anemia, hemo- globin and anxiety can cause(answer) Chest pain
- PCT's notify nurse of pt complaints or manually have to take HR
- Monitor vitals closely and notify nurse for further direction(answer) Interventions for Dysrhythmias
- Irregular heart rate
- Skipped or extra beats
- Slow (less than 60)
ANSWERS 2022/2023 UPDATE
- First Use Syndrome is a group of symptoms that occur shortly after starting a tx w/ a new dialyzer. What is the cause of first use syndrome? (answer) - Ethylene oxide gas (ETD) used a sterilant in dialyzer Manufacturing residues in dialyzer or patient adverse reaction to dialyzer fiber
- Nervousness
- Chest & back pain
- Palpitations
- Funny taste in mouth 5) Itching(answer) Symptoms of First Use Syndrome
- STOP DIALYSIS
- Clamp lines DO NOT RETURN BLOOD
- Support vascular status by administering saline as needed(answer) Intervention for First Use Syndrome 143. Rinsing the dialyzer well before treatment, and discussing alternative dialyzer w/ physician may(answer) Prevent First Use Syndrome
- Immune response caused by dialyzer fibers/membranes
- Allergies to meds
- Allergy to ETO
- Reaction to germicide left in dialysis machine/blood lines(answer) Causes of Ana- phylactic shock
- Difficulty breathing
- Hives/itching
- Periorbital edema (eye swelling)
- Wheezing
- Numbness/tingling around mouth 6) Tachycardia(answer) Symptoms of Anaphylactic shock 146. The plasma solute level is lowered rapidly during tx. The plasma be- comes hypotonic w/ respect to the brain cells and water shifts from the plasma into brain tissues(answer) Cause of DDS (Dialysis disequilibrium syndrome)
ANSWERS 2022/2023 UPDATE
- Missed treatment = BUN values are high (>150 mg/dl)/ new acute renal failure
- Transfer of urea from tissues to blood during dialysis is slower in the brain than the rest of the body. Fluid is moved to brain and causes brain to swell.(answer) DDS causes
- What to do if patient is experiencing an Anaphylactic shock? Similar to First Use intervention except for last step of saline administra- tion(answer) 1) Discontinue therapy (meds, blood transfusion)
- STOP dialysis, DO NOT RETURN BLOOD
- Monitor vitals
- Perform CPR if needed
- Headache * THINK OF FLUID IN BRAIN
- Hypertension
- Nausea
- Restlessness
- Blurred Vision
- Seizures 7) Confusion(answer) Symptoms of DDS
- Mechanical destruction of RBC's
- Chemicals
- Thermal (overheated dialysate) 4) Mechanical issues (excessive pressure of bloodline, hypertonic dialysate, etc)(answer) Causes of Hemolysis
- Back pain
- Cherry red blood (Kool-aid)
- Pain the venous access
- Chest pain 5) Dyspnea (SOB)(answer) Symptoms of Hemolysis
- STOP blood pump
- Clamp all lines, DO NOT RETURN BLOOD
- Draw 10 ml of blood from both arterial/venous lines then attach new syringe to arterial
- Attach new saline bag to venous line
