CCHT Exam ACCURATE TESTED VERSIONS OF THE EXAM FROM 2023TO 2024 | ACCURATE AND VERIFIED, Exams of Nursing

Download CCHT Exam ACCURATE TESTED VERSIONS OF THE EXAM FROM 2023TO 2024 | ACCURATE AND VERIFIED and more Exams Nursing in PDF only on Docsity!

CCHT Exam ACCURATE TESTED

VERSIONS OF THE EXAM FROM 2023TO

2024 | ACCURATE AND VERIFIED | NEXT

GEN FORMAT | GUARANTEED PASS

What are the medicare rules that apply to the US Dialysis clinics?

• Ans - Conditions for coverage Hyponatremia can occur if dialysate is not mixed correctly and can cause
• Ans - Muscle cramps, confusion, headaches, fatal brain swelling What must occur to stop the processes of diffusion or osmosis
• Ans - Equilibrium/ the solutes or water level are the same on both sides of a membrane How does diffusion occur?
• Ans - Molecules have energy of their own bump into each other and spread out What type of blood pump pressure is always positive
• Ans - Post pump Dialysate enters a dialyzer through the _______ and exits through the _____
• Ans - Bottom & top Hiw many compartments does a dialyzer contain & what are they?
• Ans - Two blood & dialysate What information on a dialyzer must never be covered up by a patient's label
• Ans - Model/Lot numbers & arrows for blood, dialysate flow How are germs able to get inside a dialyzer
• Ans - Non sterile dialysate water that has germs in it What makes hollow finer dialyzers well-suited for reuse
• Ans - They are strong and can be rinsed using high pressure What step can you take that may improve the flow of blood during treatment with a catheter
• Ans - Adjust patients position Which is the safest way to lift a patient who cannot bear weight
• Ans - Use a lift device

What is the minimum level of kt/v for standard in-center hemodialysis

• Ans - 1. Chlorine are added to tap water to remove what?
• Ans - Microbes According to AAMI standards, the total microbial count of dialysate shall not exceed... – Ans
• 200 CFU/mL According to AAMI standards, the total endotoxin count of dialysate shall not excess what
• Ans - 2 Eu/ml According to AAMI standards, when should bacteriologic testing for water and dialysate take place?
• Ans - Monthly True or False When a patient leaves at their target weight, they should have no edema or shortness of breath
• Ans - True Blending valve keeps water at what temperature
• Ans - 77 degrees True or false The body normally secretes 1-2 liters of utine each day
• Ans - True CMS dialyzers labeling require what?
• Ans - Must remain readable through reprocessing and not covering the model number When a conductivity alarm sounds
• Ans - The dialysate is in bypass mode countercurrent flow
• Ans - The blood flows in one direction and dialysate flows in the opposite Creatinine
• Ans - waste product of muscle metabolism, filtered out of the blood by the kidneys, and excreted in urine concurrent flow
• Ans - when blood and dialysate travels in the same direction

countercurrent flow

• Ans - When blood flows in one direction and dialysate flows in the opposite direction Dialysis quality of care is measured in terms of what?
• Ans - Outcomes A fistula access places additional strain on the heart. What is the required increase in cardiac output to have a fistula?
• Ans - 10% How are dialysis clinics paid by Medicare for dialysis treatment?
• Ans - Contract pricing How far should needle insertion be done from the anastomosis
• Ans - 1 inch How frequently should the carbon tanks be checked for chlorine
• Ans - Each shift How long can hepatitis B virus survive on surfaces
• Ans - one week How long must water treatment system be running before you perform you first test - Ans - 15 mins How many carbon tanks are required by CMS
• Ans - At least 2 How often should the RO operating parameters be checked
• Ans - Daily The medicare conditions for coverage requires that dialysis centers follow what standards for infection control
• Ans - CDC True or false The nephron is located mostly in the cortex or the kidney
• Ans - True A nephron is made up of
• Ans - glomerulus and tubule What are some complications of flipping the needle in an AVF cannulation
• Ans - Infiltration, stretching the needle hole, tearing the lining of the vessel What are the 2 components of the water softening system

• Ans - Brine tank and softening tank What is acceptable level of post softner hardness
• Ans - 0.8 grains/gallon What is the action level for EU (endotoxin unit)
  • Ans - 1EU/ml What is the acceptable range for total chlorine check
• Ans - 0 - 0. What is the action level for CFU (colony forming unit)
• Ans - 50 CFU/ml & greater What is the function of the back flow prevention device
  • Ans - Prevents back flow and leading back to city water What is the empty bed contact time of chlorine tanks?
  • Ans - 5 min/tank What is the function of the carbon tanks
• Ans - To removing chlorine & chloamines What is the function of the temperature blending valve
  • Ans - Maintains optimum temperature What is the lab value for albumin
  • Ans - Greater than 4g/dL What is the main purpose of using high dialysate flow rate during dialysis
  • Ans - To maintain a wide concentration gradient What is the optimum temperature range for water entering the treatment system – Ans - 77 - 82 degrees F What is the purpose of the bypass function in a dialysis delivery system
  • Ans - To protect the patient from dialysate that is not within safety margins What is the lab target for creatinine
• Ans - 10 - 18mg/dl What is the target lab value for sodium
  • Ans - 135 - 146mEq/L When checking chemical monitoring for sulfates the AAMI requires dialysis water to contain no more than how many mg/L in total sulfates

• Ans - 100mg/L When the high temperature alarm goes off, what is the first thing PCT should do?
• Ans - Verify the machine is in bypass mode What is the organization that sets the standards and recommendations for dialyzer reprocessing
• Ans - AAMI Excess calcium and magnesium in water used for dialysis can cause
• Ans - Muscle weakness Excess calcium and sodium in water used for dialysis can cause
• Ans - Hypertension Aluminum in water used for dialysis can cause
• Ans - Nausea & vomitting What is the action level for water endotoxin testing results
• Ans - 0.12 EC/mL to 0.25EC/mL Access Assesment
• Ans - Look signs of infection, listen for bruit, feel thrill Peritoneal Dialysis differs from hemodialysis in what ways A) PD access is by an intra-abdominal catheter b) PD requires both vascular & abdominal access C) STerlile dialysate is not required for PD D) PPD cannot be done at home
• Ans - PD Access is by an intra-adbominal catheter Which of the following practices helps to build a patient's immunity to hepatitis B? - Ans
• Vaccination A patient asks the technician, "What does uremia mean?" The technician response should be based on the understanding that uremia is
• Ans - an increase of wasters in the blood A central venous catheter may be used as a vascular access when a
• Ans - patient has inadequate blood vessels in the limbs Before a dialysis treatment, the patient tells the technician, "Yesterday, I felt terrible and vomited up some blood. I feel much better today." The technician can expect the patient's treatment will be modified by
• Ans - decreasing the heparin dose

The technician is unsure which one of a patient's arteriovenous (AV) graft's anastomoses is arterial and which one is venous. In order to differentiate between the two, the technician should

• Ans - compress the graft in the middle and palpate each side At the end of a patient's treatment, which of these findings, if observed by the technician, should be reported to the nurse?
• Ans - A pulse rate of 55bpm (normal HR 60-100bpm) A patient asks the dialysis technician, "Why am I getting vitamin D therapy?" What is the accurate response?
• Ans - Vitamin D is needed for healthy bones Why are dialysis patients more likely to become infected with germs like MRSA?
• Ans - They usually have weak immune systems The technician prepares and cannulates an arteriovenous (AV) fistula. AV fistula is an example of what?
• Ans - a peripheral access placed in the arm A patient says to the tech "The doctor says that I have mineral bone disorder, what does that mean?" what should be the tech's response?
• Ans - It is pretty complicated. I'll ask the nurse to explain it to you A tech notices a patient has a notebook where he/she records all lab results, weights, and, meds. What should the tech conclude?
• Ans - The patient is feels empowered and is self managing During the last hour of a patient's dialysis treatment, their blood pressure measures 82/40. After changing the fluid removal rate, what should the tech do?
• Ans - Place patient in Trendelenburg position Legally, if a treatment was performed but not charted in the patient's record, it was
• Ans - not done The most common cause of low conductivity alarm during hemodialysis
• Ans - a exhausted concentrate supply A patient who has diabetes mellitus should be observed for signs of low blood sugar, which include
• Ans - anxiety, confusion, hunger, sleepiness, or dizziness How is low blood sugar treated
• Ans - by giving carbohydrates

Linda Chase target weight 70kg. she weights at 72kg before treatment. How much fluid should be removed? - Ans - 2kg True or False At Linda Chase target post dialysis weight of 70kg , she is most likely normotensive - Ans - True what is the water supply to the water system called - Ans - feed water What is feed water? - Ans - is the water that comes from outside of the dialysis center and must pass through water treatment system before it is used for mixing concentrates and making dialysate what is the primary goal of QAPI in a dialysis facility is to - Ans - achieve better patient outcomes After Linda Chase treatment her standing bp was 90/58. She complains if feeling dizziness but insists she can walk to the scale. What is the first thing to do? - Ans - instruct her to sit down How do you know if an access is clotted - Ans - a bruit was absent What is the most common reason for high venous pressure alarm - Ans - clotted blood in access In dialysis the term "reuse" refers to cleaning and disinfecting of what? - Ans - dialyzers A patient tests positive for hepatitis B What should the tech do to prevent the spread of hepatitis B? - Ans - Dialyze the patient using a dedicated machine in an assigned area A patient tells tech that they have a preschedule routine every morning and now will have to stop. What should the tech do? - Ans - Exploring changing treatment time so patient can continue regular schedule what part of the water system removes endotoxins - Ans - ultrafilter Why would a patient need ultrafiltration profiling? - Ans - minimize hypotension What occurs when the dialysis machines alarms and goes into bypass - Ans - dialysate stops following through the dialyzer Care provides must wash hands with soap and water when - Ans - their hands are visibly soiled How does a tech properly lift a box? - Ans - bend with knees and hold box close to the body

AAMI Chemical analysis of water used for hemodialysis is tested - Ans - annually A 58 year old patient who is blind comes in for treatment with his wife. How should the tech interact with the patient? - Ans - Describe activities in the immediate environment Tech sees blood on the surface of a patient's dialysis machine. What should you do? - Ans - Clean the machine immediately A dialysis tech observes all of the below options on the treatment floor, which is an environmental risk? A) about one ounce of fluid on the floor B) A patient's family is present during initiation of treatment C) Charts are lying on bedside tables D) The wheels of the dialysis machine are locked - Ans - A) about one ounce (30ml) fluid is on the floor A patient asks a tech to dinner because he is lonely and depressed. After tech politely declines offer what should tech do? - Ans - Refer patient to social worker A fistula connects - Ans - an artery and a vein A marker used to determine the middle molecule clearance of a dialyzer is - Ans - vitamin B A mixed-bed DI tank contains - Ans - cations and anions Nephron is made up of - Ans - A glomerulus and a tubule system A patient complains of pain at the venous needle and tech observes swelling along with venous pressure rising. What should the tech suspect? - Ans - infiltration A patient who is to receive their first dialysis treatment is prone to? - Ans - Dialysis disequilibrium syndrome A slow pulse of 54 beats/minute would indicate the patient has - Ans - bradycardia A patient tells the technician that the dietitian reviewed high-potassium foods with her. During the conversation she states she routinely eats the following foods. Which one is the highest in potassium? A) Bananas B)Pasta C) Ice Cream D) Rice - Ans - A) Bananas What is a reason why a tech is to be certified - Ans - it is CMS requirement

A rise in transmembrane pressure in a low flux dialyzer during hemodialysis is indicative of - Ans - clotting of the extra corporeal circuit A teammate asks you to document the normal saline he gave to his patient, what would you do? - Ans - Never document what someone else did A true aneurysm can be dangerous because it - Ans - may rupture and cause the patient to bleed profusely A rapid pulse of 104 bpm would indicate a patient has - Ans - tachycardia A patients lab results indicate that the predialysis BUN level was lower than the post dialysis BUN level. What should a tech consider after those findings? - Ans - Was the post dialysis sample drawn correctly adequacy - Ans - is the patient receiving enough dialysis to feel well, reduce systemic effects of uremia, improve quality of life, and live longer When is a patient's adequacy checked? - Ans - Monthly What os the 'K' in kt/v? - Ans - clearance of urea What treatment factors decrease 'K' in kt/v? - Ans - inadequate coagulation, decreased BFR, poor priming, and patients not staying full treatment time What treatment factor increase "K' in kt/v? - Ans - Increased BFR, correct DFR, dialyzer, and target weight What is the 't' in kt/v? - Ans - time what is the 'v' in kt/v? - Ans - volume of urea distributed/ volume of patient's body water in which urea is distributed what factors influence 'v' in kt/v? - Ans - height, amputation, sex, age type of access How does type of access influence 'v' in kt/v? - Ans - less efficient access reduces the volume of patient's blood processed what are symptoms of uremia - Ans - metallic taste in mouth, vomiting, nausea, lack of energy What is the goal of dialysis? - Ans - Removing waster products and fluid maintaining bone health & vitamin D stimulating red blood cell production to help control blood pressure regulating phosphorus & calicum

Approximately when should a patient begin to fill better after started dialysis? - Ans - usually 30 days Why does symptoms of uremia start in patients with kidney failure? - Ans - Since the kidneys do not function properly the fluid and waste builds up in the blood True of False A normal Kidney function translate into a weekly Kt/v of 20- 25 - Ans - True What should the patient's monthly kt/v be? - Ans - greater than of equal to 1. What is the suggested BFR range for 17g needles - Ans - 200 - 250 What size needles has a BFR range of 350- 450 - Ans - 15g needles what is the suggested BFR range for 16g needles - Ans - 250 - 350 What size needles has a BFR range greater than 450 - Ans - 14g needles Mrs. Miller has a new AV-fistula which is cannulated with 17g needles. Her dialysis orders include BFR of 400ml/min and 3.5 hr treatment time. Her labs show kt/v below 1.2 and her machine frequently alarms for AP & VP. What is happening and what are your interventions? - Ans - BFR does not match need size and let rn know 17g = 200- 250 What is the procedure for a Post BUN lab draw? - Ans - 1. Turn off UFR or Decrease to 50

2. Decrease DFR to 300 or put in bypass
3. Decrease BFR to 100
4. Wait 15 seconds for all access types
5. Draw post lab What are mistakes that falsely increase kt/v - Ans - BFR not reduced, waiting only 5 seconds, & drawing post lab from venous line what mistakes would falsely decrease kt/v - Ans - accidently diluting pre treatment arterial bun blood sample with saline and waiting longer than 15 seconds to draw blood Today is lab day; you patient wants to end his treatment early against medical advice. What should you do? - Ans - Notify RN, make sure patient signs AMA and have nurse schedule make up treatment so lab draw can be rescheduled What is an AKI and what does it stand for? - Ans - Acute kidney Injury- is a sudden of loss of kidney function that maybe partially/ completely returned

what is the primary treatment goal for AKI patients and How is it done? - Ans - to help restore kidney function so UF goals are not set high and avoid toxic substance that would affect the kidneys (Ex: lose dose aspirin and radiographic contrast) what are some example causes for pre renal AKI - Ans - obstruction, volume, depletion, & impaired cardiac function what are some examples causes for intra renal AKI - Ans - septic shock, anaphylaxis drugs, trauma, open heart surgery These are example causes of what type of AKI? EX: Bladder rupture, pregnancy, & Oliguria - Ans - Post renal AKI List all goals for AKI treatment - Ans - Restore kidney function protect kidneys from further injury prevent fluid and waste build up take care of vascular access maintain optimal nutritional state prevent, identify and treat complications how often are aki patients monitor? - Ans - weekly how do you protect the kidneys from further injury - Ans - by identifying and treating the cause of the kidney injury to regain function AKI patients are at increased risk for which complications? - Ans - Hypotension & hypovolemia what is the difference between AKI and CKD - Ans - Eliminating the cause of AKI can lead tgo the return of kidney function, but the cause of CKD can not be eliminated What are the most common causes of CKD - Ans - Genetic disorders hypertension type 2 diabetes What are the treatment goals for CKD patients - Ans - slow progression of CKD managing morbidities minimizing the effects of CKD on patients' lifestyles renal replacement therapy modality education encouraging patients to actively participate in their healthcare True or False If patients have any complications during treatment it is not mandatory to inform nurse - Ans - False

True or False In the event of a seizure, treatment should be discontinued if seizure is severe and does not respond to treatment - Ans - True What is the time frame within which a pyrogenic reaction can started after treatment is initiated? - Ans - 45 - 75 mins what causes dialysis disequilibrium - Ans - skipping treatments A shortage of oxygen-carrying red blood cells is called - Ans - anemia The tech would expect a patient's anemia to be monitored by which of the following lab test? - Ans - Hemoglobin A patient's lab results reveal a significant drop in hemoglobin. Which medication would the tech expect the nurse to administer during treatment? - Ans - Epogen/ Erythropoietin Which of the following practices helps build a patient's immunity to hep B? - Ans - Vaccination The primary fusion of the kidney tubules are - Ans - reabsorption and secretion What is the definition of hypertension? - Ans - Predialysis adult BP is > 140/90 and post bp is > 130/ What are some causes of hypertension - Ans - fluid overload, and not taking medication consistently What are symptoms of hypertension - Ans - nervousness, dizziness, irritability, headache, edema What is a way to prevention hypertension - Ans - tanke medication as prescribed and maintain fluids Define hypotension - Ans - systolic BP <90 diastolic BP <60 or drops in systolic more than 20mm/Hg What are some causes of hypotension - Ans - Rapid/inappropriate fluid loss, anti hypertension drugs, low blood volume, unstable cardiac conditions What are symptoms of hypotension - Ans - flushing, yawning, dizziness, seizures, cardiac arrest, nausea, anxious feeling, cold clammy skin

How do you intervene with a patient experiencing hypotension - Ans - Place patients in supine position, decrease UFR to minimum for less serve hypotension, give 100-200ml saline, monitor BP, tell RN What are the consequences of organ stunning, the heart, kidneys, and brain? - Ans - Heart; acute stress on the cardiovascular system can lead to the development of left ventricular arrhythmias to create poor cardia function Brain: causes multiple sites with white matter injury kidneys: loss of renal function and causes fibrosis What are muscle cramps and their causes in dialysis - Ans - painful muscles contractions that are caused by rapid or excessive fluid removal What are ways to intervene when a patient is cramping - Ans - Massage/apply pressure, assess dry weight, turn uf off True or False Left side Trendelenburg position is to be used for a patient experiencing an air embolism - Ans - True what do you do if a patient is experiencing an allergic reaction during treatment? - Ans - stop treatment and do not return blood What is the appropriate response to treat a patient experiencing chest pain/angina - Ans

• decrease bar, decrease dfr and give o How will the patient present if they have hyperkalemia? - Ans - abnormal slow heart rate and muscle weakness What do you advise patients experiencing peripheral neuropathy - Ans - advise patient not to walk barefoot, be careful with foot care and check bath water temp before getting in What is the primary cause of anemia in dialysis patients - Ans - lack of erythropoietin True of False End stage renal failure kidneys stop producing erythropoietin, so we check patient's hemoglobin and RN gives Epogen to treat - Ans - True How is anemia managed in CKD? - Ans - assessing the effectiveness of heparin ensure that patient is not losing too much blood during rinse back by excessive bleeding or clotting. What does the abnormalities in Ca, PO4, PTH, and Vitamin D leads to in CKD-MBD? - Ans - soft tissues calcification and bone disease

Define fever & chills - Ans - A temp heater than or increase over baseline of 2 degree F with symptoms What are the causes of fever & chills - Ans - systemic infections, asses infection, contamination of blood or dialysate compartment How do you intervene with a patient experiencing fever or chills? - Ans - RN must assess, provide comfort measures, notify doc What is a pyrogenic reaction? - Ans - bacteria is in the dialysate and administered to patient during treatment what are the causes and symptoms - Ans - causes pyrogens symptoms chills, shaking, fever, hypotension, vomiting, muscle pains, elevated temp How do you intervene when patient is having a progeny reaction - Ans - provide support, notify doc & rn, stop treatment Define seizures - Ans - involuntary muscle spasms and loss of consciousness What are the causes of seizures - Ans - dialysis side effects, pre-existing disorders, and adverse reactions What do you do when patient is having a seizure during treatment - Ans - Discontinue treatment if severe, patient does not respond to treatment, protect patient, access arms from harm, treat hypotension, hypoglemcia and administer 02 What is the definition of dialysis disequilibrium syndrome - Ans - a condition in which rapid/drastic changes in the patients extracellular fluid affects the brain what are symptoms of dialysis disequilibrium syndrome - Ans - headache, hypertension, nausea, restlessness, blurred vision, seizures True or False Clotted dialyzer is due to insufficient anticoagulation - Ans - True How to intervene with a clotted dialyzer - Ans - ensure proper use of heparin, monitoring pressures, and maintaining proper BFR What is hemolysis and causes - Ans - Blood cells rupturing and is caused by high temps, hypotonic dialysate, exposure to disinfection, blood pump not calibrated correctly, & failure of conductivity meter what should you do in the event a patient has hemolysis - Ans - Stop blood pump, clamp lines, do not return blood, RN assess, notify doc, administer 02, check hemoglobin & potassium, monitor cardiac rhythm and vital signs

what is first use syndrome - Ans - a group of symptoms that occur shortly after starting treatment with a new dialyzer What is disinfection infusion and its causes - Ans - a bleach protocol can result in disinfectant being infused into the patient's bloodstream via dialysis machine and caused by no residual disinfectant testing, inaccurate residual testing, sterling rebound What are the symptoms of disinfection infusion and intervention - Ans - Symptoms: Pain at venous needle, itching, restlessness, respiratory distress, flushing chest pain, Intervention: Discard bicarbonate, rinse mixer according to policy and do not initiate treatment until residual tests are negative What are the causes of chest pain/angina and intervention - Ans - coronary disease intervention decrease bar to 150, decrease fur, monitor vital sings, notify doc, administer 02, tell rn and document Dysrhythmias - Ans - irregular heart beat and must treat cause what do you do if patient experiences cardiac arrest while on dialysis machine - Ans - Establish if unresponsive, call for help, start car, return blood if possible, maintain patent of needles/CVC with saline cardiac arrest - Ans - cessation of heart activity What is an air embolism? - Ans - air bubble enter blood stream and are carried to vessel small enough to be blocked by air Who does data collection at pre & post treatment - Ans - PCT Who does assessment pre & post treatment - Ans - RN What does a patient;'s medical record provide information for? - Ans - plan of patient care True or False PCT must inform the RN of any unusual finding prior to start of treatment - Ans - True When is a pre treatment assessment always required by an RN - Ans - always with patients who have Aki True or False All documentation of machine setup and pre treatment information must be entered into the computer before treatment is initiated - Ans - True True or False

Only serve complications and interventions during treatment have to be documented - Ans - False, All interventions and complication during treatment must be documented including patients response List six occurrences when to chart - Ans - 1. Change in baseline.

2. Change in patient's condition.
3. Procedure or Treatment performed.
4. Meds given and patient's response.
5. Care plan given.
6. Patient Education. Why do we document in the medical record? - Ans - proof of care data continuity permanent legal record communication what are the six items included in charting administered medication - Ans - 1. Date & time
7. Route of administration
8. Patient Response
9. Reason for administering
10. Allergies
11. Dosage Target weight - Ans - is determined via doc order and should be modified by the doc based on patient tolerance , ongoing signs of fluid overload, and changes in fluid status UF Goal calculation - Ans - Preweight-target weight + Saline Prime + Rinseback + Oral infusion/intake UFR Calculations - Ans - UF Goal / Treatment time What are three consequences of sodium loading - Ans - 1. Increased Thirst
12. large fluid gains
13. more hypotension & ischemic events during treatment State 3 ways we can contribute to sodium loading during dialysis - Ans - 1. Hypertonic & Normal Saline
14. Dietary intake
15. Diffusion from dialysis Wha does UF profiling do? - Ans - Changes the way fluid is removed to allow time for more vascular refilling True or false?

If patients uf goal exceeds maximum UFR by doc, UF Goal must be changed to be in range with doc orders - Ans - True Consequences of hypervolemia - Ans - hypertension increased mortality rate cardiovascular disease What is hypervolemia? - Ans - fluid overload caused by failure of heart, liver, and kidneys What is hypovolemia? - Ans - not enough fluid in blood what are some consequences of hypovolemia - Ans - increased mortality rate, ischemia and damage to vital organs What is ischemia? - Ans - organs not getting enough blood and O2 so start to shut down What makes dialysis patients susceptible to HAIs? - Ans - Kidney failure weakens the immune system and dialysis gives long periods of time to access blood what is the most common transmission route for HAIs? - Ans - Contact transmission Why are dialysis patients at increased risk for acquiring a HAI at the facility? - Ans - Vascular access, uremia, and bacterial colonization each increases the risk of blood stream infection What germ causes the most common infections in dialysis patients? - Ans - MRSA What is the most important intervention you can do to prevent HAIs? - Ans - Hand hygiene True or False C-diff requires hand hygiene with soap and water - Ans - True Why are gloves so important - Ans - Exposure to blood and comtaminated items may cause infection risks to become high without gloves Why do you need to perform hand hygiene before and after wearing gloves? - Ans - Gloves have microscopic holes so hands can become contaminated despite having gloves on Who can use sinks dedicated for hand washing? - Ans - Teammates and patients What is the correct procedure in regards to your hands when you have causal contact with a patient? - Ans - Gloves are not necessary but must use hand hygiene

Explain the HBV nomenclature and state which test is performed monthly on HBV susceptible patients - Ans - Antigen (HBsAg) have hept B or not (monthly Antibody (anti-HBs) immunity Core Antibody (ANti-BBcIgM_ vaccine or immune What are the 5 stages of grief? - Ans - denial, anger, bargaining, depression, acceptance Is there an order to work thought the 5 stages of grief - Ans - No What does the KDQOL 36 assist the social worker with? - Ans - helps identify causes of barriers to the patient's successfully adapting to renal failure and dialysis creates tally results and develops intervention and goals for patients what is the role of a social worker - Ans - to identify barriers preventing successful treatments, help increase positive adjustment, and supports' patients' emotional adjustments Define ultrafiltration - Ans - controlled fluid removal by manipulation of hydrostatic pressure Convection - Ans - solutes dragged across semi permeable membrane along with fluids difusion - Ans - particles move from a more concentrated area to a less concentrated area Osmosis - Ans - fluid moves from lower solute concentration to high solute concentration what are the kidneys' excretory functions - Ans - normalize electrolytes, fluid balance, waste removal, acid base balance what are the dialyzer excretory functions - Ans - removal of excess fluid based on target weight, normalize electrolytes, waste removal, & reduce metabolic acidosis what is the kidney's endocrine functions and dialyzers - Ans - Kidneys secret renin and erythropoietin, and activate Vitamin D and Ca regulation Dialyzer can't do any of this can only provide medications True or False Hemodialysis normalizes body pH through diffusion of bicarbonate into the blood - Ans - True True or False

Wall box, Drain & water supply lines must be cleaned with bleach between each patient because considered a part of dialysis delivery system - Ans - True Does PCTs need to perform hand hygiene and put on clean gloves when changing acid concentrate connection, touching wall box, or swapping machines? - Ans - Yes What are the two most common routes of catheter infection - Ans - migration of bacteria through insertion site and into catheter tract contamination of the hubs what is the function of bicarbonate in the dialysate solution - Ans - buffer the acid concentrate True or false Federal law prohibits the processing of double labeled tubes - Ans - true what is the function of the acid concentration - Ans - provides the concentration gardient for diffusion What should you do to prevent contamination with other tube' additives? - Ans - Follow the order of the draw whatat are the rules for spinning samples - Ans - Must balance centrifuge by balancing with same size, kind, and fill level of tube glass and plastic tubes can't be balance together what are the four indicators of optimal nutrition status - Ans - stable target weight adequate fat stores & muscle mass albumin greater than or equal to 4 appropriate intake/ appetite True or FalseHigh potassium food eaten during dialysis is dialyzed out same day - Ans - False due to digestive system is no dialyzed out same day What does sodium help do? - Ans - Regulate body fluid volume and balance What is CKD-MBD treated with - Ans - Phospate bindeers, hectoral (vitamin D), Sensipar When should patients take their binders - Ans - with every meal At what time are medications containing a preservative discarded? - Ans - 28 days How long do we wait after administering heparin bolus prior to start of treatment? - Ans - 3 - 5 mins

How do you administer Topical Anesthetic spray - Ans - Numbing is effective when the skin blanches (turns white) what are the 3 meds PCT can administer - Ans - lidocaine, heparin , saline What is heparin and it's function? - Ans - an anticoagulant (blood thinner) used to prevent blood clots What does Epogen treat? - Ans - low number of blood cells caused by anemia What does Hectrol/Zemplar treat - Ans - secondary hyperparathyroidism in patients with CKD by decreasing PTH levels and incasing Ca levels Secondary hyperparathyroidism - Ans - is caused by high PTH levels that affects the balance of calcium and phosphorus in the body resulting in weaken bones what does Venofer/Iron treat? - Ans - anemia/iron definciency True or False Venofer and Epogen works well together to increase patients' blood cell count - Ans - True What does antibiotics do? - Ans - help stop infections by killing bacteria or stopping its reproduction What are causes of conductivity alarm? - Ans - No acid concentration, improperly prepared bicarb, calcium/magnesium precipitate What is the appropriate intervention for conductivity alarms - Ans - check before each patient what is the allowable difference between manual and machine conductivity readings when checking - Ans - +/- 0. True or False Measurement of the pH of the dialysate is important to verify the acid/base is within a acceptable range - Ans - True what do you do when returning patient's blood during a power failure - Ans - remove venous line from air sector clamp and manually crank blood pump what are causes of a more positive arterial pressure pre pump? - Ans - separation of blood tubing from arterial access and decrease in blood pump speed

what are causes of a more negative arterial pressure pre pump low alarm? - Ans - blockage of arterial blood flow from patients access, kinks, infiltration, hypotension, vasoconstriction, poorly working catheter, blood pump set too high what are causes of a more negative arterial pressure pre pump high alarm? - Ans - bloodline separation, leak, a drop in blood pump speed, infusion of saline what are causes of a low pre dialyzer pressure + post pump? - Ans - leak/separation of bloodline, blockage in blood tubing, kink, poor blood flow what are causes of a high pre dialyzer pressure + post pump? - Ans - clotted dialyzer, infiltration, rise in blood flow rate, kinks What causes low venous pressure alarm - Ans - separation of blood tubing, a drop in blood rate, blockage of blood tubing, clotted dialyzer what causes high venous pressure alarm - Ans - infiltration, poorly working cvc, clotted access, blood tubing blockage True or False A healthy access will have a whoosh-whoosh sound and a steady pules with a buzzing feel - Ans - True How does an outflow stenosis present - Ans - whistling sound & a very pronounced pulse Hows does a inflow stenosis present - Ans - sound to be faint with little or no thrill what can good needle rotation prevent - Ans - aneurysms & pseudoaneuryms True or False KDQOL rule of 6's applies to only AVFs - Ans - true does using a tourniquet increase vein engorgement in AVfs - Ans - yes when are hemostatic sponges supposed to be removed - Ans - after hemostasis and before patient leaves facility how long does it take a cannulation site to heal - Ans - 2 weeks what position is a patient supposed to be in when giving catheter care - Ans - supine position (laying flat) why is CVC care delivered with patients in the supine position - Ans - helps prevent air embolisms and increases pressure to central veins

What is the cause of blood leak detector alarm and how do you intervene? - Ans - Cause ruptured /damaged dialyzer intervention stop treatment & inform rn What is the cause of volume control alarm and how do you intervene? - Ans - Cause Uf Goal met before treatment time ends intervention will not be anle to sync but continue to tun until treatment time is completed What is the cause of tmp alarm and how do you intervene? - Ans - Cause changes in venous pressure/clotting in dialyzer intervention TMP v adds 3 cc of air in tmp bubble TMP ^ flushes venous line with saline What is the cause of blood pump and how do you intervene? - Ans - Causes hemolysis /venous pressure to high, roller are loose, door not secure intervention check door to blood pimp & notify biomed What is the cause of heparin pump alarm and how do you intervene? - Ans - Cause clamp heparin intervention prime heparin line Whats the difference between an AVF and an AVG - Ans - Fistula: connection of the patient's native artery to native vein Graft: use artificial/biological material and requires 2 connections What is difference between a tunneled and a non tunneled CVC? - Ans - Tunneled CVC: has a cuff that the skin grows too for anchoring to the patient —> it is kept in longer uses suture when placed but can be removed Non tunneled CVC: are held in place by only sutures and no cuff present Chlorine in water used for hemodialysis causes - Ans - Hemolysis/ death When is water harness testing done - Ans - At the end of the day When is chlorine testing done - Ans - At the beginning of the day and every 4hrs after the RO has been running for 15mins What does the speed of water of a RO prevent - Ans - Bacteria growth True or False Every second water is 3ft/second for a conventional RO system with a water tank - Ans

• True Why is it important for hardness testing - Ans - Remove hard ions such as calcium and magnesium

For a direct feed central water production it is 1.5ft/second so required flow is also dependent on pipe size - Ans - For self efficient RO because produces water on as needed basis True or False Larger pipes needs higher flowrate - Ans - True When are the require routine culture and endotoxins testing at all point of use done - Ans - By biomeds monthly True or false annual analysis of post Rao water are required - Ans - True What is your response to final water quality alarm - Ans - Put all dialysis machine in bypass mode (immediate response) Notify charge RN, FA, Biomed If water quality cannot be restored, terminate all treatments, and submit a facility AOR What are two concerns with using DI tanks - Ans - Highly dangerous when exhausted because of ionic quality increase bacterial and endotoxin levels What are the benefits peritoneal dialysis - Ans - Home based flexible schedule steady gentle treatment fewer dietary/fluid restrictions needle free less anemia (bc not any blood lost) allows active lifestyle improved transplant outcomes preserved residual renal function (mimicswhat normal kidneys do bc tx 7 days/week What are treatment for ESRD - Ans - Palliative Care Dialysis Kidney Transplant Home dialysis benefits - Ans - Home based, flexible schedule fewer dietary restrictions improved clinical outcomes may allow for easier travel independent treatment authorized reuse - Ans - Refers to using the same dialyzer more than once for the same patient What are the steps that must be complete before a dialyzer can be reused - Ans - 1. dialyzer rinsed & cleaned

2. Pressure tested to look for broken fibers

3. Filled with a chemical to kill bacteria and allow to dwell for certain amount of time
4. chemical is rinsed out
5. dialyzer tested to ensure safe to ise and no germicide left True or False for reuse total cell volume must be at least 80% of initial volume to assure enough fibers are available to clean the blood - Ans - True Which of these factors can affect how well an patient may do on dialysis - Ans - Other illness and how gently the dialysis treatment is delivered What is the main job of healthy kidneys - Ans - Keep the body in homeostasis Which parts of healthy kidney function can dialysis replace - Ans - Removing some water and wastes Your job with in-center HD may routinely include what tasks - Ans - Setting up the machine, taking the patient's vitals signs, and explaining what you are doing In peritoneal dialysis, what is "dwell time" - Ans - How long the fresh peritoneal dialysis fluid stays in the patient's belly before it is drained our