Davita Pct Final Exam A patient with acute kidney injury dialyzes in the out-patient facility. With regards to the patients target weight, why is being "wet" better that being too dry? ANSWER: a PCT greets a patient and the patient reports feeling short of breath. The PCT notices that the patients lips have a blue hue. The PCT would: ANSWER: Complete data collection and PCT must notify the RN if there are any abnormal findings prior to initiation of tx a recommended intervention for muscle cramps is ANSWER: Turning the UFR off A standing post- treatment blood pressure reading of __is considered an abnormal finding and should be reported to a licensed nurse ANSWER: A surveyor asks you a question. Which of the following statements would be a good answer ? ANSWER: I do not know the answer but I will find out. Acid concentrate replaces the excretory function of normal kidney function by ANSWER: Hemodialysis removes urea, salts, and excess water from the blood normalizing electrolytes, removes metabolic acidosis, all documentation on machine set up and pre treatment patient information ANSWER: Must be entered into the computer before the treatment is initiated Can you document patient vital signs under another teammate already signed into the computer? ANSWER: no Cynthia missed her treatment on Saturday and returns the following Tuesday for her next scheduled treatment. She complains of feeling weakness in her legs. David, a PCT, gets a wheelchair for her, helps her weigh in, and brings her back for the nurse to assess prior to starting her treatment. Which patient complication would the PCT and RN suspect
Cynthia is most likely suffering from? ANSWER: Hyperkalymia DaVita Quality Index (DQI) success is achieved ANSWER: encourage continuous improvement across aboard range of disease management processes (all of the above ) Dialysis replaces only ___ percent of normal kidney function. ANSWER: 15% documentation in the medical record ANSWER: Is a permanent legal record of the care provided fever caused by a pyrogenic reaction will most likely occur at what time during the treatment ANSWER: Within 45 to 75 minutes flipping the artireal vascular access needle ANSWER: s not necessary since all arterial needles now have a back eye For patients with Acute Kidney Injury (AKI)which statement is correct? ANSWER: A nursing assesment prior to tx initiation 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 if clotting occurs in a high flux dialyzer, the transmembrane pressure (TMP) will ANSWER: decrease If you notice that a patient's caretaker is struggling to meet the demands of the patients treatment regime you should ANSWER: contact social worker If your facility dialyzes Hepatitis B positive patients, which assignment would NOT be appropriate patient care assignment. ANSWER: caring for HBsAG positive and hepatitis B susceptible patients at the same time
in the event of a patient experiencing a seizure, the dialysis treatment should be ANSWER: Discontinued if the seizure is severe or the patient does not respond to treatment In those states that do not require a nursing assessment to be completed prior to treatment initiation, the PCT would be required to report abnormal patient data collection findings. ANSWER: yes interventions for a patient complaining of chest pain include ANSWER: Placed patient in a flat supine position place machine into bypass Intra-renal causes of AKI ANSWER: Ischemic ATN, Sepsis, SIRS, Septic Shock, Anaphylaxis Drugs, Goodpasture Syndrome, Acute Glomerulonephritis, Trauma, Open Heart Surgery intredialytic treatment monitoring the data collection is performed every ANSWER: 30 minutes Knowing what caused your patients kidney failure ANSWER: can cause complications to treatment left ventricular hypertrophy leads to ANSWER: Hypertension Per DaVita Policy, fever and chills is defined as: ANSWER: any temperature greater than 100 or increase over baseline of 2° with symptoms Per physician order and based on individual patient needs, Chronic Kidney Disease Mineral and Bone Disorder (MBD) is treated with ANSWER: phosphate binders, Vit D (Hectorol), and Cinacalcet Per the Centers for Disease Control and Prevention (CDC), which is the most important route by which pathogens are transmitted in health care setting including dialysis centers. ANSWER: contact transmission
Per The centers for disease control prevention, which is the most common factor contributing to bacterial infections in dialysis patients? ANSWER: the use of catheters for hemodialysis Performing a procedure "your way" rather than following DaVita's P&Ps a. Carriers no risk of being considered outside the Ordinary Standard of Care as long as "your way" achieves the same results b. Can lead to civil liability in the event of an adverse patient outcome c. May be defended in court by demonstrating that your way is as good as DaVita's P&Ps d. Is accepted practice since there is no one right way to performing most procedures ANSWER: b Phosphate binders are prescribed to prevent phosphorus in meals from being absorbed. When is the best time to take them ? ANSWER: with meal Poor wound healing is directly related to ANSWER: low protein intake post treatment data collection and assessment is performed ANSWER: After the tx was terminated Prior to use, how should the medication preparation surface area be disinfected ? ANSWER: with 1:100 bleach solution and disposible wipes Scrubbing of each hub as part of CVC care is done for: ANSWER: 15 seconds Teammates MUST be able to readily identify patients who may require additional assistance in the event of an emergency evacuation. This will include patients who need help with or are unable to ANSWER: both b and c the blood flow rate is reduced to 100 ml-min for ___________ before obtaining post dialysis blood specimen for kt/v ANSWER: 15 seconds The Clinical Pyramid includes : ANSWER: • The Fundamentals: Immunizations, Iron, Dialysis Access, Calcium, Phosphorus, Hb, Kt/V, Target Weight, Access,PTH, etc.• Complex Programs: Fluid
Management, Infection Management, Diabetes Management, Med Management, CVCManagement, Palliative / EOL Care, Infection Surveillance, Transition of Care, CKDEducation, Depression, Missed Treatments, etc.• Measures of Effectiveness • Mortality, Hospitalization /Re-hospitalization, Patient Experience of Care• What Matters Most • Our patient's health-related Quality of Life The definition of Health Literacy is ANSWER: ability to obtain, read, understand, and use healthcare information in order to make appropriate health decisions and follow instructions for treatment The dialysis team prevents additional blood loss by ANSWER: providing appropiate heparin dose per physician order using good cannulation and proper rinseback after tx. The endocrine functions of the kidneys are ANSWER: Renin and erythropoietin secretion ,activation of vitamin D The excretory function of the kidneys include ANSWER: remove access water, urea, and metabolic wastes from the blood. the maximum ultrafiltration rate should not exceed ___ because it may lead to hypotensive episodes which increase the risk of organ stunning or mortality. ANSWER: An UFR >13 ml/hr/Kg The most common infectious complication for hemodialysis patients is ANSWER: centenal line infections the nephrologist has prescribed a 400 bfr for your patient. you would expect the physician order to also include ANSWER: 15 gauge needle for the prescribed BFR the nephrologist orders a blood flow rate of 450 ml/min for a patient with established AV fistula. what needle gage would be appropriate for this BFR ANSWER: 15 the neuprologist has ordered the use of hemostatic sponges, sureseal, for your patient. what is the correct procedure when using these sponges ? ANSWER: Remove the hemostatic sponge after hemostasis has been achieved and dress the needle site with sterile gauge or band-aid.
The patient is using a central venous catheter for dialysis and has a new arteriovenous fistula (AVF) present in his lower arm, What observation/assessment should the PCT perform the AVF? ANSWER: checking for the bruitand thrill every time treatment day the patient position used for a suspected air embolism is ANSWER: Trendelenburg, on the left side The patients target weight is ANSWER: Both a and B prescribed and determined by physicians order the pct notes that a patient still has considerable in edma in her legs when performing the post treatment data collection, in addition to informing the nurse, what should the pct document? ANSWER: Document the swelling and that RN was informed. the person responsible for implementation, adherence, and training of the facility specific emergency management plan (EMP) and applicable policy and procedures is ANSWER: Fa or designee The Psychosocial Assessment completed by the social worker ANSWER: an evaluation of a person's mental health, social status, and functional capacity within the communityCompeted initially and annually the sign that numbing has taken affect and it is time to stop spraying topical anastetic on the vascular access canulation sites is when ANSWER: Blanching of skin the urea reduction ratio calculates ANSWER: The amount of urea removed during the dialysis treatment The waiting time after administration of the initial heparin loading dose prior to initiation of hemodialysis is ANSWER: 3-5 minutes to prevent the formation of aneurisms and pseudo aneurysms the following should be practiced ANSWER: Good needlesites rotation and complete needle site clotting techniques
Ultrafiltration is defined as ANSWER: controlled fluid removed by manipulation of hydrostatic pressure upon completing machine set up and before treatment initiation it is important to verify the prescription and machine settings: ANSWER: both b and c V-tags cite deficiencies, provide interpretive guidance, and provide a condition that must be met for each regulation. How can knowledge of V-tags affect the practice of patient care providers? ANSWER: all of the above Water and dialysate cultures are drawn every month in the dialysis unit to monitor ANSWER: bacteria and endotoxins water treatment is needed in the dialysis setting to ANSWER: Meet renal networks standards what amount of fluid weight is considered excessive ANSWER: 5% of target weight is considered excessive what are the three steps included in the vascular access assessment ANSWER: look, listen and feel what are the three things you should not include in a Risk Event Management (REM) report ANSWER: personal opinions What can be the most likely result if the surveyor sees a patient with a covered vascular access ANSWER: immediate jeopardy what complication would you expect to see if a patient is exposed to chlorine/chloramines ANSWER: Hemodialysis what could be the reasons for a conductivity alarm on the dialysis machine ANSWER: when the dialysate is mixed incorrectly or there is no water acid or bicarb.
what is an appropriate interventions with an air/foam detector alarm? ANSWER: look at circuit for blood in the system. DO NOT return blood with air in the system. what is an important action prior to returning a patients blood using the hand crank in the event of a power failure ? ANSWER: remove the venous line for the line clamp What is one method surveyors used to verify infection control training and education ? ANSWER: patient interview what is the acceptable mg/L or parts per million (ppm) limit for total chlorine in the water leaving the carbon filter ANSWER: less than or equal to 0.1 what is the most likely reason for a blood leak detector alarm during recirculation ANSWER: -air bubbles in the dialysate, dirty sensor -check dialysate connections, bleach machine what must be completed prior to medication preparation ? ANSWER: All of the above what problems will cause a more positive (less negative) pre-pump arterial pressure. ANSWER: blockage of arterial blood flow from the vascular access. What should be done to the heparin infusion line if a patient does not have maintenance (hourly)heparin prescribed? ANSWER: Clamp and knot the heparin line. what steps are performed during the recirculation of blood in the extracorporeal circuit when there has been a treatment interruption (restroom?) ANSWER: return patients blood and recirculate the extracorporeal circuit with normal saline what time do you perform water harness testing? ANSWER: at the end of each treatment day what type of blood/dialysate flow within the dialyzer increases the rate of diffusion providing optimal dialysis for patients ? ANSWER: concurrent flow
what will cause a more negative pre-pump arterial pressure? ANSWER: Kinking of the arterial blood line between the vascular access and arterial monitor when a patient is prescribed topical anastatic spray, the appropriate time to clean the canulation site is ANSWER: is prior to applying spray When is a pre-treatment assessment by the licensed nurse required? ANSWER: ⁃ when it is mandated by state. ⁃ when the pct performing a data collection notices abnormal findings ⁃ when the patient reports unusual symptoms to the nurse prior to treatment initiation. ⁃ when nurse observes initial behavior When the lab receives a laboratory test tube with double labeling: ANSWER: The double labed specimen will be rejected at the laboratory for pt safety Which infectious disease requires frequent handwashing instead of using alcohol based hand gels? ANSWER: Active Clostridioides difficile infection C.diff which is the primary device for purifying the water used in dialysis ANSWER: reverse osmosis which of the following factors would decrease the; k of the kt/v formula ANSWER: Inadequate anticoagulation which of the following factors would influence the; t of the kt/v formula ANSWER: Shortened treatment time which of the following may be, but doesn't have to be a sign of hemolysis ANSWER: Cherry red colored blood in the venous line which statement is true regarding the "Reasonable and Prudent" Standard of care ANSWER: When supervising pt care technicians an other non-licensed personnel, it is the resposibility of the licensed nurse to ensure these teammates
which statement is true regarding the administration of normal saline ANSWER: the teammate must remain with the patient to monitor their progress until administration is complete and lines are securely clamp. Why is meticulous hand hygiene so important in healthcare? ANSWER: its the single most important intervention in preventing HAI's You listen to your patient's AV graft and hear a whistling sound a. This could be inactive of an inflow stenosis b. This could be indicative of an outflow stenosis c. This could be indicative of advanced access thrombosis d. This is a normal sounding bruit ANSWER: b Your immediate intervention for a patient experiencing an anaphylactic reaction is ANSWER: Stop the blood pump, discontinue tx, and do not return blood