2023/2024 Davita PCT Final Exam 100% Verified Solutions Update, Exams of Nursing

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2023/2024 Davita PCT Final Exam 100% Verified Solutions

Update

 Water and dialysate cultures are drawn every month in the dialysis unit to monitor:

bacteria and endotoxins

 what problems will cause a more positive (less negative) pre-pump arterial

pressure.: blockage of arterial blood flow from the vascular access.

 what is the most likely reason for a blood leak detector alarm during recir- culation:

-air bubbles in the dialysate, dirty sensor

-check dialysate connections, bleach machine

 what is an appropriate interventions with an air/foam detector alarm?: look at

circuit for blood in the system. DO NOT return blood with air in the system.

 what will cause a more negative pre-pump arterial pressure?: Kinking of the

arterial blood line between the vascular access and arterial monitor

 if clotting occurs in a high flux dialyzer, the transmembrane pressure (TMP) will:

decrease

 what could be the reasons for a conductivity alarm on the dialysis machine-

: when the dialysate is mixed incorrectly or there is no water acid or bicarb.

 the person responsible for implementation, adherence, and training of the facility

specific emergency management plan (EMP) and applicable policy and procedures is:

Fa or designee

2 /  Teammates MUST be able to readily identify patients who may require ad- ditional assistance in the event of an emergency evacuation. This will include patients who

need help with or are unable to: both b and c

 what is an important action prior to returning a patients blood using the hand crank

in the event of a power failure ?: remove the venous line for the line clamp

 Per physician order and based on individual patient needs, Chronic Kidney Disease

Mineral and Bone Disorder (MBD) is treated with: phosphate binders, Vit D

(Hectorol), and Cinacalcet

 Poor wound healing is directly related to: low protein intake  Phosphate binders are prescribed to prevent phosphorus in meals from being

absorbed. When is the best time to take them ?: with meal

 The definition of Health Literacy is: ability to obtain, read, understand, and

use healthcare information in order to make appropriate health decisions

and follow instructions for treatment

 If you notice that a patient's caretaker is struggling to meet the demands of the

patients treatment regime you should: contact social worker

 The Psychosocial Assessment completed by the social worker: an evalu- ation

of a person's mental health, social status, and functional capacity within the

communityCompeted initially and annually

3 /  The Clinical Pyramid includes :: • The Fundamentals: Immunizations, Iron,

Dialysis Access, Calcium, Phosphorus, Hb, Kt/V, Target Weight, Access,PTH,

etc.• Complex Programs: Fluid Management, Infection Management,

Diabetes Manage- ment, Med Management, CVCManagement, Palliative /

EOL Care, Infection Sur- veillance, 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

 DaVita Quality Index (DQI) success is achieved: encourage continuous im-

provement across aboard range of disease management processes (all of the

above

)

 What can be the most likely result if the surveyor sees a patient with a covered

vascular access: immediate jeopardy

 A surveyor asks you a question. Which of the following statements would be a

good answer ?: I do not know the answer but I will find out.

 Intra-renal causes of AKI: Ischemic ATN, Sepsis, SIRS, Septic Shock, Ana-

phylaxis Drugs, Goodpasture Syndrome, Acute Glomerulonephritis, Trauma,

Open Heart Surgery

4 /  Knowing what caused your patients kidney failure: can cause complications to

treatment

 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?:  The excretory function of the kidneys include: remove access water, urea,

and metabolic wastes from the blood.

 Acid concentrate replaces the excretory function of normal kidney func- tion by:

Hemodialysis removes urea, salts, and excess water from the blood nor-

malizing electrolytes, removes metabolic acidosis,

 Ultrafiltration is defined as: controlled fluid removed by manipulation of

hydro- static pressure

 The endocrine functions of the kidneys are: Renin and erythropoietin secre-

tion ,activation of vitamin D

 Dialysis replaces only percent of normal kidney function.: 15%  The most common infectious complication for hemodialysis patients is: -

centenal line infections

 What is one method surveyors used to verify infection control training and

education ?: patient interview

 Which infectious disease requires frequent handwashing instead of using alcohol

based hand gels?: Active Clostridioides difficile infection C.diff

5 /  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.: contact transmission

 V-tags cite deficiencies, provide interpretive guidance, and provide a con- dition that must be met for each regulation. How can knowledge of V-tags affect the practice of

patient care providers?: all of the above

 Why is meticulous hand hygiene so important in healthcare?: its the single most

important intervention in preventing HAI's

 If your facility dialyzes Hepatitis B positive patients, which assignment would NOT

be appropriate patient care assignment.: caring for HBsAG positive and hepatitis

B susceptible patients at the same time

 Per The centers for disease control prevention, which is the most common factor

contributing to bacterial infections in dialysis patients?: the use of catheters for

hemodialysis

 upon completing machine set up and before treatment initiation it is im- portant

to verify the prescription and machine settings:: both b and c

 What should be done to the heparin infusion line if a patient does not have

maintenance (hourly)heparin prescribed?: Clamp and knot the heparin line.

 what type of blood/dialysate flow within the dialyzer increases the rate of diffusion

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providing optimal dialysis for patients ?: concurrent flow

 When is a pre-treatment assessment by the licensed nurse required?: C when it

is mandated by state.

C when the pct performing a data collection notices abnormal findings

C when the patient reports unusual symptoms to the nurse prior to treatment

initiation. C when nurse observes initial behavior

 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:: Complete data

collection and PCT must notify the RN if there are any abnormal findings

prior to initiation of tx

 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.: yes

 For patients with Acute Kidney Injury (AKI)which statement is correct?: 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 ?: Evaluate the effectiveness of the treatment by comparing data to

pre-dialysis findings PCT's notify the nurse if there are any unusual findings

 The patient is using a central venous catheter for dialysis and has a new arteriovenous fistula (AVF) present in his lower arm, What observation/assess-

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ment should the PCT perform the AVF?: checking for the bruitand thrill every time

treatment day

 Can you document patient vital signs under another teammate already signed

into the computer?: no

 A standing post- treatment blood pressure reading of is considered an abnormal finding and should be reported to a licensed nurse:  what are the three things you should not include in a Risk Event Manage- ment

(REM) report: personal opinions

 documentation in the medical record: Is a permanent legal record of the care

provided

 all documentation on machine set up and pre treatment patient informa- tion:

Must be entered into the computer before the treatment is initiated

 post treatment data collection and assessment is performed: After the tx was

terminated

 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?: Document the swelling and that RN was informed.

 which statement is true regarding the "Reasonable and Prudent" Standard of care:

When supervising pt care technicians an other non-licensed personnel, it is

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the resposibility of the licensed nurse to ensure these teammates

 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: b

 the maximum ultrafiltration rate should not exceed because it may lead to

hypotensive episodes which increase the risk of organ stunning or mortality.: An

UFR >13 ml/hr/Kg

 what amount of fluid weight is considered excessive: 5% of target weight is

considered excessive

 The patients target weight is: Both a and B prescribed and determined by

physicians order

 what are the three steps included in the vascular access assessment: look, listen

and feel

 Scrubbing of each hub as part of CVC care is done for:: 15 seconds

9 /  the nephrologist has prescribed a 400 bfr for your patient. you would expect the

physician order to also include: 15 gauge needle for the prescribed BFR

 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: b  to prevent the formation of aneurisms and pseudo aneurysms the fol- lowing

should be practiced: Good needlesites rotation and complete needle site

clotting techniques

 the neuprologist has ordered the use of hemostatic sponges, sureseal, for your patient. what is the correct procedure when using these sponges

?: Remove the hemostatic sponge after hemostasis has been achieved and

dress the needle site with sterile gauge or band-aid.

 flipping the artireal vascular access needle: s not necessary since all arterial

needles now have a back eye

 the sign that numbing has taken affect and it is time to stop spraying topical

anastetic on the vascular access canulation sites is when: Blanching of skin

 when a patient is prescribed topical anastatic spray, the appropriate time to clean

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the canulation site is: is prior to applying spray

 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: 15

 the urea reduction ratio calculates: The amount of urea removed during the

dialysis treatment

 which of the following factors would influence the; t of the kt/v formula: -

Shortened treatment time

 which of the following factors would decrease the; k of the kt/v formula: -

Inadequate anticoagulation

 When the lab receives a laboratory test tube with double labeling:: The double

labed specimen will be rejected at the laboratory for pt safety

 the blood flow rate is reduced to 100 ml-min for before

obtaining post dialysis blood specimen for kt/v: 15 seconds

 what steps are performed during the recirculation of blood in the extracor- poreal

circuit when there has been a treatment interruption (restroom?): return patients

blood and recirculate the extracorporeal circuit with normal saline

 intredialytic treatment monitoring the data collection is performed every-

: 30 minutes

11 /  The waiting time after administration of the initial heparin loading dose prior to

initiation of hemodialysis is: 3-5 minutes

 which statement is true regarding the administration of normal saline: the

teammate must remain with the patient to monitor their progress until

administration is complete and lines are securely clamp.

 Prior to use, how should the medication preparation surface area be

disinfected ?: with 1:100 bleach solution and disposible wipes

 what must be completed prior to medication preparation ?: All of the above  water treatment is needed in the dialysis setting to: Meet renal networks

standards

 what is the acceptable mg/L or parts per million (ppm) limit for total chlorine

in the water leaving the carbon filter: less than or equal to 0.

 which is the primary device for purifying the water used in dialysis: reverse

osmosis

 what complication would you expect to see if a patient is exposed to

chlorine/chloramines: Hemodialysis

 what time do you perform water harness testing?: at the end of each treat-

ment day

 left ventricular hypertrophy leads to: Hypertension

12 /  Cynthia missed her treatment on Saturday and returns the following Tues- day 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?: Hyperkalymia

 The dialysis team prevents additional blood loss by: providing appropiate

heparin dose per physician order using good cannulation and proper

rinseback after tx.

 fever caused by a pyrogenic reaction will most likely occur at what time during

the treatment: Within 45 to 75 minutes

 Per DaVita Policy, fever and chills is defined as:: any temperature greater

than 100 or increase over baseline of 2° with symptoms

 a recommended intervention for muscle cramps is: Turning the UFR off  which of the following may be, but doesn't have to be a sign of hemolysis-

: Cherry red colored blood in the venous line

 in the event of a patient experiencing a seizure, the dialysis treatment should be:

Discontinued if the seizure is severe or the patient does not respond to

treatment

13 /  the patient position used for a suspected air embolism is: Trendelenburg, on

the left side

 Your immediate intervention for a patient experiencing an anaphylactic reaction

is: Stop the blood pump, discontinue tx, and do not return blood

 interventions for a patient complaining of chest pain include: Placed patient in a

flat supine position place machine into bypass