*** Dialysis replaces only ---- percent of normal kidney function ANSWER: 15% *** If clotting occurs in a high flux dialyzer, the transmembrane pressure (TMP) will ANSWER: decrease *** 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 *** Intra-renal causes of Acute Kidney Injury (AKI) ANSWER: Sepsis, trauma, anaphylaxis, drugs, Acute Glomerulonephritis *** Left Ventricular Hypertrophy leads to ANSWER: ischemic heart disease arrhythmia, myocardial infarction, and sudden death *** Per DaVita policy, fever is defined as ANSWER: Any temperature greater than 100F or increase over baseline of 2F with symptoms *** Per the Centers for Disease Control and Prevention (CDC), which is the most common factor contributing to bacterial infections in dialysis patients? ANSWER: the use of catheters for hemodialysis *** Post treatment data collection and assessment is performed ANSWER: After the treatment is terminated *** Prior to use, how should the medication preparation surface area be disinfected? ANSWER: With 1:100 bleach solution and disposable wipes *** Scrubbing of each hub as part of CVC care is done for: ANSWER: 15 seconds *** The endocrine functions of the kidneys are ANSWER: Renin and erythropoietin secretion, activation of vitamin D**
*** The maximum ultra-filtration (UF) rate should not exceed ______ because it may lead to hypotensive episodes which increases the risk of organ stunning or mortality.F ANSWER: 13 mL/kg/hr *** The nephrologist orders a blood flow rate (BFR) of 450 ml/min for a patient with an established AV Fistula. What needle gauge would be appropriate for this BFR? ANSWER: 15 gauge *** To assist in survey readiness you should ANSWER: all of the above *** To prevent the formation of aneurysms and pseudoaneurysms the following should be practiced ANSWER: Good needle site rotation and complete needle site clotting techniques *** Ultrafiltration is defined as ANSWER: Controlled fluid removal by manipulation of hydrostatic pressure *** Water and dialysate cultures are drawn every month in the dialysis unit to monitor ANSWER: Bacteria and endotoxins *** What amount of fluid weight is considered excessive? ANSWER: Greater than 5% *** What could be the reason(s) for a conductivity alarm on the dialysis machine? ANSWER: all of the anove *** 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 ppm or mg/L *** What is the most likely reason for a blood leak detector alarm during recirculation? ANSWER: Air bubbles in dialysate or a dirty sensor *** What type of blood/dialysate flow within the dialyzer increases the rate of diffusion providing optimal dialysis for patients? ANSWER: Counter-current flow
*** Which infectious disease requires frequent hand-washing instead of using alcohol based hand gels? ANSWER: Active Clostridioides difficile infection (C-diff) *** Which of the following factors would decrease the K of the Kt/V formula? ANSWER: inadequate anticoagulation *** Which statement is true regarding the "Reasonable and Prudent" Standard of Care? ANSWER: When supervising patient care technicians and other non-licensed personnel, it is the responsibility of the licensed nurse to ensure these teammates also meet the Standard of Care. *** You are assisting a patient to step onto the scale by holding the patient's hand. Such a casual contact ANSWER: Does not require wearing gloves but you must perform hand hygiene afterwards A patient with acute kidney injury (AKI) dialyzes in the out-patient facility. With regards to the patient's target weight, why is being "wet" better than being too dry? ANSWER: Being wet helps avoid hypovolemia and hypotensive episodes A patient's target weight is: ANSWER: both A & B - Prescribed and determined by physician order. - Modified by physician based on patient tolerance A PCT greets a patient and the patient reports feeling short of breath. The PCT notices that the patient's lips have a blue hue. The PCT would: ANSWER: Not start treatment, immediately notify the nurse A recommended intervention for muscle cramps is ANSWER: Turning the ultrafiltration rate (UFR) off A standing post-treatment blood pressure reading of ----- is considered an abnormal finding & should be reported to a licensed nurse ANSWER: both A & B - Standing systolic BP greater than 140 mm/Hg or less than 90 mm/Hg - Standing diastolic BP greater than 90 mm/Hg or less than 50 mm/Hg
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: Normalizing electrolytes All documentation on machine setup and pretreatment patient information ANSWER: Must be entered into the computer before the treatment is initiated At what time do you perform water hardness testing? ANSWER: At the end of the treatment day Can you document patient vital signs under another teammate already signed into the computer? ANSWER: No- Log into the computer system under your credentials and document 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: hyperkalemia DaVita Quality Index (DQI) success is achieved ANSWER: All of the above Documentation in the medical record ANSWER: Provides data for continuity and planning of patient care Fever caused by a pyrogenic reaction will most likely occur at what time during the treatment? ANSWER: Within 45 to 75 minutes Flipping the arterial vascular access needle ANSWER: Is not recommended or necessary since all arterial needles have a back eye For patents' with Acute Kidney Injury (AKI) which statement is Correct? ANSWER: A nursing assessment prior to treatment initiation is always required
How do you verify that the patient is stable and safe for discharge after the dialysis treatment? ANSWER: All of the above - Evaluate the effectiveness of the treatment by comparing data to pre-dialysis findings - PCT notify the nurse if there are any unusual findings - Nurses perform a post treatment assessment as required If you notice that a patient's caretaker is struggling to meet the demands of the patient's treatment regime you should ANSWER: Notify the Social Worker because he/she is there for patients and their families If your facility dialyzes 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 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: To the nurse before treatment Initiation Interventions for a patient complaining of chest pain include ANSWER: Decrease blood flow rate (BFR) to 150mL/hr. decrease ultrafiltration rate (UFR), take vital signs, and administer oxygen as ordered Intradialytic treatment monitoring and data collection is performed every ANSWER: 30 minutes Knowing what caused your patients' renal failure ANSWER: Is important to identify possible problems during data collection and assessment Per physician order and based on individual patient needs, Chronic Kidney Disease Mineral & Bone Disorder (MBD) is treated with ANSWER: Phosphate binders, vitamin 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 settings including dialysis
centers? ANSWER: Contact transmission Performing a procedure "your way" rather than following the dialysis facility's policies & procedures (P&P) ANSWER: Can lead to personal and/or organizational liability in the event of an adverse patient outcome, in addition to survey citations and risk regardless of whether an adverse patient outcome occurs Phosphate binders are prescribed to prevent phosphorus in meals from being absorbed. When is the best time to take them? ANSWER: With a meal Poor wound healing is directly related to ANSWER: Inadequate protein intake 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 &C - Complete the emergency take off procedure - Evacuate in a safe and timely manner due to impairment (i.e. Use of mobility assistance devices, issues with sight/hearing/cognitive function, or other physical limitations) The blood flow rate is reduced to 100 ml/min for ----- before obtaining post dialysis blood specimen for Kt/V ANSWER: 15 second The Clinical Pyramid includes: ANSWER: The Fundamentals. Complex Programs, and Quality of Life. The definition of Health Literacy is ANSWER: The degree to which individuals understand basic health information The dialysis team prevents additional blood loss by ANSWER: Providing appropriate heparin dose per physician order, using good cannulation technique, and proper rinse back after treatment The excretory function of the kidneys include ANSWER: Fluid balance, electrolyte balance, waste removal, and acid base balance
The most common infectious complication for hemodialysis patients is ANSWER: Vascular access infection The nephrologist has ordered the use of hemostatic sponges, such as 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 sites with sterile gauze or band aid The nephrologist has prescribed a 400 blood flow rate (BF) for your patient. You would expect the physician order to also include ANSWER: 15 gauge needles for this prescribed BFR The patient is using a central venous catheter (CVC) for dialysis and has a new arteriovenous fistula (AVF) present in his lower arm. What observation/assessment should the PCT perform for the AVF? ANSWER: Checking for the bruit and thrill every treatment day The patient position used for a suspected air embolism is ANSWER: Trendelenburg, on left side The patient's treatment time is 3 hours, He has brought a 10 oz, cup of coffee (300 ml), has an IV antibiotic of 100 ml to be administer ANSWER: 1000 ml/hr The PCT notes that a patient still has considerable edema 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 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: Facility Administrator (FA) or Designee The Psychosocial Assessment completed by the social worker: ANSWER: Is completed initially and annually The sign that numbing has taken effect and it is time to stop spraying topical anesthetic on the vascular access cannulation sites is when ANSWER: You observe blanching of the 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 a minimum of ANSWER: 3-5 minute Upon completing machine set up and before treatment initiation it is important to verify the prescription and machine settings: ANSWER: both B & C - To confirm patient's unique prescription parameters are programmed correctly into the dialysis delivery system (DDS). - To validate that all safety features are enabled, functioning correctly, and within acceptable limits. 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 - Provide patient care within CMS Conditions for Coverage - Understand rationales for specific regulations as outlined in the interpretive guidance - Assist in the development of policies and procedures Water treatment is needed in the dialysis setting to: ANSWER: Provide patient safety and prevent equipment damage What are the three steps included in the vascular access assessment? ANSWER: Look. listen feel What are three things you should NOT include in a Risk Event Management (REM) report? ANSWER: Personal opinions, speculation, vendettas What can be the most likely result if the surveyor sees a patient with a covered vascular access? ANSWER: An Immediate Jeopardy
What complication would you expect to see if a patient is exposed to chlorine/chloramines? ANSWER: Hemolysis What is an appropriate intervention(s) with an air/foam detector alarm? ANSWER: Look at the circuit, do not return blood with air in system, fix problem 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 is one method surveyors use to verify infection control training and education? ANSWER: Documentation of infection control training in teammate's file or transcript 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: Separation of blood tubing from arterial 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 infusion line What steps are performed during the recirculation of blood in the extracorporeal circuit when there has been a treatment interruption (i.e. patient using the restroom)? ANSWER: The saline infusion line is opened and if the patient is receiving an intradialytic heparin infusion via the dialysis machine; the heparin pump remains on What will cause a more negative pre-pump arterial pressure? ANSWER: Kinking of lhe arterial blood line between the vascular access and arterial monitor When a patient is prescribed Topical Anesthetic spray, the appropriate time to clean the cannulation sites is ANSWER: Before applying the spray When documenting patient care, it is important to include all of these except ANSWER: A confrontation between two patients
When is a pre treatment assessment by the licensed nurse required? Check all that apply: ANSWER: - When it is mandated by state law (pre-treatment initiation vs within 1 hour after start of treatment) - When the PCT performing a data collection notices abnormal findings - When the patient reports unusual symptoms to the nurse or PCT before treatment initiation - When the nurse or PCT observes unusual behaviors in a patient entering the treatment floor When the lab receives a laboratory test tube with double labeling: ANSWER: The double labeled specimen will be rejected at the laboratory for patient safety Which is the primary device for purifying the water used in dialysis? ANSWER: The reverse osmosis 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 venous line Which statement is true about sinks used for handwashing? ANSWER: Handwashing sinks must be dedicated for handwashing purposes only and should remain clean Which statement is true regarding the administration of Normal Saline? ANSWER: The teammate must remain with the patient to monitor the process until administration is complete and lines are securely clamped Why is meticulous hand hygiene so important in healthcare? ANSWER: It is the single most important intervention in preventing Healthcare Associated Infections You listen to your patient's arteriovenous graft (AVG) and hear a whistling sound. ANSWER: This could be indicative of an outflow stenosis
Your immediate intervention for a patient experiencing an anaphylactic reaction is ANSWER: Discontinue the suspected therapy, stop the blood pump, do not return the blood Your patient asks whether it is OK to take an over-the-counter cold remedy. What is your appropriate response? ANSWER: Let's ask your nephrologist what they recommend to treat your cold symptoms