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

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CCHT Exam ACCURATE TESTED

VERSIONS OF THE EXAM FROM 2023TO

2024 | ACCURATE AND VERIFIED | NEXT

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What are some of the barriers to effective patient education? 1.Lack of time to spend one-on-one with the patient 2.Lack of patient-appropriate education materials 3.Cultural variables such as language differences 4.Anxiety, depression, or fear on the part of the patient

• Ans - All of these factors are barriers to effective patient education What can patients expect when they decide not to initiate dialysis and elect palliative care instead? 1.To die pain-free with dignity 2.That all further treatment options will be discontinued 3.That death will occur in a matter of days 4.That treatment for fluid overload symptoms will be withheld
• Ans - To die pain-free with dignity With the dialysis patients which of the following medications may result in sexual dysfunction? 1.Antihypertensives 2.Long-term antibiotics 3.Phosphate-binding agents 4.Calcium supplements
• Ans - Antihypertensives What key points should be discussed when orienting new staff to professional boundaries? 1.Spending time with patients outside of the workplace is not recommended 2.Gifts, monetary, or otherwise, should never be accepted from a patient or family member 3.Socializing with patients is acceptable as long as family members are present 4.It is acceptable to establish a business relationship with patients who have experience in the field about which you are seeking information
• Ans - 1 & 2 A dialysis patient is participating in an in-center self-care program in which he shares responsibility with the clinic staff for performing the dialysis treatment. What activities may this patient perform? 1.Pre- and post treatment weight measurements

2.Preparation and cannulation of his vascular access device 3.Setting up and programming the dialysis machine 4.Cleaning and sanitizing the machine and dialyzer

• Ans - 1,2, & 3 What is the amount of saline required to prime the dialyzer? 1.500-1000 mL 2.200-300 mL 3.350-450 mL 4.1200-1500 mL
• Ans - 500 - 1000mL When would a reused dialyzer be rejected?

1. Renalin exposure time was 4 hrs total 2.TCV is 90% of initial volume 3.Applied pressure causes the dialyzer to maintain pressure 4.Visual inspection reveals a few clotted fibers

• Ans - Renalin exposure time was 4 hrs total Many dialysis units require two people to verify and document that ___ & that _____ before using a reprocessed dialyzer 1.The dialyzer is correct for the specific patient 2.The disinfectant test is negative 3.A blood sample was obtained from the correct patient 4.Heparin is available in the med cart prior to beginning dialysis
• Ans - 1 & 2 Hepatitis B:

1. Is highly transmissible 2.Is treatable utilizing ultra-filtrate dialysis 3.Is not transmitted by percutaneous exposure 4.Can survive for several days on environmental surfaces at room temp

• Ans - 1 & 4 A staff member is immune to hepatitis B due to vaccination series. What will laboratory results show? 1.HBsAg positive 2.Anti-HBc negative 3.Anti-HBs positive 4.IgM anti-HBc negative
• Ans - 2 & 3 A staff member tests positive for IgM antibody to hepatitis B core antigen (IgM anti- HBc). What does this mean? 1.He is a chronic carrier of hepatitis B 2.He has had a recent infection with hepatitis B virus

3.He is immune to hepatitis B 4.He has been exposed to hepatitis B but is immune

• Ans - He has had a recent infection with hepatitis B virus What is the CDC recommendation for hepatitis C serological screening? 1.Routine screening of staff for the HCV antibody 2.Routine screening of patients for the hepatitis C virus (HCV) antibody 3.Monitoring all patients monthly for liver enzyme elevations 4.Bi-monthly testing for anti-HCV
  • Ans - Monitoring all patients monthly for liver enzyme elevations How can patients who are infected with methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant enterococci (VRE) be safely cared for in the dialysis unit? 1.By following standard precautions, making sure to wear gloves if touching soiled skin or clothing 2.By hanging IV antibiotics and infusing throughout the entire dialysis treatment 3.By isolating patients with draining wounds in a room dedicated to all infectious patients 4.By making sure that reusable equipment is not used for the care of other patients until it has been sanitized
  • Ans - 1 & 4 When a patient is infected with carbapenem-resistant enterbacteriaceae (CRE), what type of precautions should be implemented? 1.airborne 2.standard precautions alone 3.Contact 4.Droplet
• Ans - Contact What is the half-life of heparin? 1.60 minutes 2.30 minutes

3. 1.5 hours
4. 4 hours

• Ans - 1.5 hours When Citrasate dialysate is used: 1.Additional blood testing is required 2.Hypocalcemia is not a concern 3.Anticoagulation is improved, preventing clotting of fibers in the dialyzer 4.The risk of bleeding is increased
  • Ans - 2 & 3 What is the preferred vascular access in patients undergoing chronic hemodialysis?

1. Brachiocephalic AV fistula 2.Radial-cephalic AV fistula 3.Transposed brachiobasilic fistula 4.Polytetrafluoroethylene graft
   • Ans - Radial-cephalic AV fistula What precautions should patients with stage 4-5 CKD follow? 1.Have an AV graft implanted at least 6 mnths in advance to needing dialysis 2.Wear a Medic Alert bracelet signaling healthcare providers to avoid vessels for venipuncture that may be needed for dialysis access 3.Drink fluids frequently to maintain residual urine output 4.Consent to have a venous catheter placed several months in advance before beginning dialysis
   • Ans - Wear medic alert bracelet What are some advantages of having a proximal radial artery AV fistula placed for access to dialysis? 1.This type of access placement avoids synthetic grafts 2.They are useful for patients with advanced arteriosclerosis 3.Circulatory complications, such as steal syndrome, do not develop 4.Only one needle needed for cannulation

• Ans - 2 & 3 What is the most common complication of AV fistulas? 1.Thrombosis 2.Infection 3.Edema 4.Aneursym
  • Ans - Thrombosis When patient is dialyzed at high BFR with small gauge needle, what may result? 1.Hemolysis of RBC 2.Infiltration 3.Increase in pressure readings 4.Inadequate removal of waste products
  • Ans - Hemolysis of RBC What are the signs/symptoms of severe recirculation ("black blood" syndrome), caused by stenosis of the fistula? 1.pH below 7 2.Very dark blood 3.Elevated arterial pressure reading 4.Visible clots in the lines
  • Ans - 1 & 2 What is the patient with low post-dialysis weight at risk for?

1.Developing cachexia 2.Hypovolemia 3.Clotting of the vascular access 4.Hyponatremia and hyperkalemia

• Ans - 2 & 3 What are some of the responsibilities & requirements of the medical director of a dialysis facility?

1. Writing policies & procedures that show compliance with the standards of the local medical community.
2. Accessing fistulas or grafts prior to the beginning of the dialysis session.
3. Being physically present in the dialysis unit whenever a patient is receiving a dialysis treatment.
4. Being knowledgeable of & and responsible for the integrity of the water treatment system in the facility.

• Ans - 4. Being knowledgeable of & responsible for the integrity of the water treatment system in the facility. Prior to the beginning of the dialysis, what must the physician order include?

1. Specific dialyzer
2. Blood flow rate 3.Duration of dialysis
3. Three units of packed red blood cells
   • Ans - 1,2 & 3 To be eligible to sit for the Certified Clinical Hemodialysis Technician - Advanced (CCHT- A) exam, the technician must have which of the following?
4. Hold another national certification such as CCHT
5. Have been employed as a hemodialysis tech for 3 yrs of continuous employment 3.Have worked at least 5000 hours as a CCHT
6. Have been eligible for & paid to take the exam within the past 12 months.

• Ans - 1 & 3 What abilities are required of a dialysis tech? 1.Some understanding of human anatomy & physiology & the pathophysiology of chronic kidney disease (CKD) 2.The knowledge to administer intravenous medication if an emergency arises 3.Full understanding of the principles of dialysis and treatment complications 4.Math skills
  • Ans - 1,3 & 4 Which of the following credentialing certification programs offer the dialysis tech the most cognitive content related to water treatment principles?

1. Certified clinical nephrology tech

2. Certified hemodialysis tech
3. Certified clinical hemodialysis tech
4. Certified biomedical nephrology technologist

• Ans - 4. Certified biomedical nephrology technologist Which of the following statements about informed consent for treatment is accurate?

1. A written consent for dialysis includes consent for placement of an access catheter.
2. A renal patient who has been admitted to the hospital with sepsis has given implied consent upon signing the initial admission paperwork.
3. Two consents are needed for dialysis; one for the dialysis itself & one for access procedures or modifications.
4. In an emergency, such as aspirin overdose, it is not necessary to have consent prior to beginning hemodialysis.
   • Ans - 3. Two consents are needed for dialysis; one for the dialysis itself & one for access procedures or modifications. If a patient chooses to terminate dialysis, what should the renal staff do?
5. Call the legal team for the hospital/clinic and speak with an attorney
6. Keep the patient on the clinical unit until he or she can talk with the physician and determine if a court order is needed 3.Realize that is well within a patient's rights to choose to terminate dialysis 4.Notify the physician and verify that all members of the health care team agree with the decision
   • Ans - 3. Realize that is well within a patient's rights to choose to terminate dialysis Who was the first person to use the term dialysis? 1.John Abel 2.Thomas Graham 3.Leonard Rowntree 4.Bernard Turner
   • Ans - 2.Thomas Graham What was the primary anticoagulant used in the first artificial kidney? 1.Salicylic acid 2.Hirudin
7. Low-molecular weight heparin 4.Warfarin

• Ans - 2.Hirudin Dr. William Kolff created the first dialyzer suitable for human use (rotating drum dialyzer) in 1943. What material was used to construct the hollow tubes on this device? 1.Rubber 2.Teflon 3.Cellophane 4.Glass
  • Ans - 3.Cellophane

The first arteriovenous (AV) shunt for chronic renal patients was placed:

1. Via surgical cutdown
2. Externally, using teflon tubes 3.Internally in the carotid vessels
3. Intravascularly, using 4 inch catheters

• Ans - 2.Externally, using teflon tubes Which U.S. President signed the bill that allowed Medicare coverage to pay for treatment for all patients with chronic kidney disease? 1.Roosevelt 2.Nixon 3.Ford 4.Carter
  • Ans - 2.Nixon In 1989, FDA approval of this medication diminished the need for blood transfusions in the chronic renal disease patients: 1.Lovenox 2.Epoetin alfa (epogen)

3. Factor VIII
4. Ruxolitinib
   • Ans - 2. Epoetin alfa (epogen) An electrolyte is a substance that dissolves in water to form:
5. charged atoms
6. solute
7. ionized particles
8. electrical current
   • Ans - 3.Ionized particles What may result if a dialysate solution contains too much sodium?
9. Water may shift into pt's blood cells, causing hypotension and cramping
10. Fluid may leave the cells, causing blood cells to shrivel
11. Pt may experience heart failure & ventricular dysrhythmias
12. Pt may experience hypertension, profound thirst, and headache
    • Ans - 2 & 4 With osmosis, water moves from areas of: 1.Lower water concentration to areas of higher water concentration
13. Low concentration of solutes to areas of high concentration of solutes
14. Acidity to areas of alkalinity
15. Higher temps to lower temps

• Ans - 2. Low concentration of solutes to areas of high concentration of solutes

Buffers minimize pH changes when an acid or a base is added to a solution. What is the major plasma buffer in the body?

1. Sodium
2. Bicarbonate
3. Potassium 4.Lactate

• Ans - 2.Bicarbonate Kidney failure causes retention of hydrogen ions. What is the result?

1. Metabolic alkalosis
2. Metabolic acidosis
3. Respiratory alkalosis
4. Respiratory acidosis

• Ans - 2. Metabolic acidosis Which of these patient populations has the lowest proportion of body water? 1.Geriatric patients

2. Adult females 3.Adult males 4.Infants – Ans
   • 2. Adult females The vasa recta capillaries surround the loop of Henle nephrons and play a major role in:
3. Electrolyte balance
4. Concentration of urine as it moves through the tubules
5. Fluid secretion and reabsorption
6. Excretion of waste products

• Ans - 2.Concentration of urine as it moves through the tubules In the formation of urine, what action is occurring in Step 2?

1. Water moves from the glomerulus into the Bowman's capsule?
2. Water & other dissolved substances move from the tubules into the blood in the peritubular capillaries
3. There is movement of selected substances from the blood in the peritubular capillaries back into the tubules
4. There is secretion of hormones into the blood capillaries which will cause the kidneys to hold onto water - Ans - 2. Water & other dissolved substances move from the tubules into the blood in the peritubular capillaries The glomerular filtration rate is the amount of filtrate produced by the kidneys per minute. What is glomerular filtration dependent on?
5. Sufficient blood circulation to the glomerulus
6. Proper reabsorption of ions & molecules
7. Adequate glucose to supply energy for renal functions
8. Maintenance of normal filtration pressures - Ans - 1 & 4

Blood urea levels are influenced by many factors. Decreased levels may result from: 1.Gastrointestinal tract bleeding

2. Low dietary protein intake 3.Overhydration 4.Steroid use - Ans - 2 & 3 At the conference for Kidney Disease: Improving Global Outcomes (KDIGO) on Chronic Kidney Disease it was recommended that stage 3 be subdivided into 3a and 3b. What is the recommended glomerular filtration rate for 3b?
3. 60-88 mL/min/1.73 m
4. 30-44 mL/min/ 1.73 m
5. 45-59 mL/min/1.73 m
6. 15-29 mL/min/1.73 m2 - Ans - 30 - 44 mL/min/1.73 m The National Kidney Foundation (NKF) recommends that all individuals be assessed for increased risk for developing chronic kidney disease (CKD). Which of these laboratory values should be included in this evaluation?
7. Blood Urea Nitrogen (BUN)
8. Creatinine level
9. Aldosterone level
10. Erythropoietin level - Ans - Creatinine level When is a patient considered to be in Stage 5 CKD?
11. When the patient has been diagnosed with stage 1 CKD with GFR of 90 mL/min/1. m
12. When the patient requires maintenance dialysis for survival
13. When he has a GFR between 60-89 mL/min/1.73 m
14. When she has moderately decreased GFR - Ans - When the patient requires maintenance dialysis for survival A patient with a diagnosis of nephroschlerosis may exhibit which of these manifestations?
15. Blood in urine
16. Proteinuria
17. Uncontrolled hypertension
18. Foamy urine - Ans - 1,2, & 3 What is a common clinical manifestation of renal cell carcinoma? 1.Excess ankle swelling 2.Blood in urine 3.Periorbital edema
19. Weight gain - Ans - Blood in urine Which of the following maybe a cause of postrenal acute renal failure?
20. Severe dehydration
21. Obstruction in the ureter or urethera

3. Heart failure
4. Toxicity related to antibiotic administration - Ans - Obstruction in the ureter or urethera What is the target blood pressure in patients with CKD recommended by the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High BP?
5. less than 130/
6. less than 150/
7. less than 140/
8. less than 125/75 - Ans - Less than 130/ A patient presents to the nephrologist office complaining of chest pain, fever, and chills. The healthcare provider hears a pericardial friction rub during auscultation of heart and lung sounds. Echocardiogram confirms a pericardial tamponade. The renal staff should prepare the patient for which of these procedures?
9. A pericardiocentesis where a needle is inserted into the pericardial space to remove fluid
10. Immediate dialysis utilizing ultrafiltration to remove excess fluid
11. Type & cross match for at least 2 units of packed red blood cells
12. Insertion of an IV catheter and stat dose of Lasix, a diuretic - Ans - A pericardiocentesis where a needle is inserted into the pericardial space to remove fluid What are some integumentary changes commonly seen in patients with chronic CKD? 1.Brittle nails 2.Excessive sweating 3.Ecchymosis 4.Increase in number of moles - Ans - 1 & 3 Dialysis patients are at higher risk for developing healthcare-associated infection. Which of the following enhance a patient's susceptibility to infection? 1.Diabetes mellitus 2.Malnutrition 3.Bone abnormalities 4.Frequent invasive procedures - Ans - 1,2 & 4 The CDC recommends that dialysis patient care staff be assessed annually for competency in which categories related to infection control practices? 1.Hand hygiene 2.Proper use of isolation for all HIV positive dialysis patients 3.Catether dressing change technique 4.Vascular access technique - Ans - 1,3, & 4 What are some of the causes of anemia in CKD patients?
13. Decreased production of erythropoietin 2.Impaired intake of iron from foods 3.Loss of blood through the gastrointestinal tract

4.Extended life span of red blood cells - Ans - 1,2 & 3 What are some of the signs/symptoms of anemia in CKD patients? 1.Bruising & edema 2.Confusion & insomnia 3.Dyspnea & fatigue

4. Pallor & prolonged capillary refill - Ans - 1, 2, & 3 What is the recommended treatment for osteodystrophy in CKD patients? 1.Increasing intake of aluminum 2.A diet high in protein 3.Administration of phosphate-binding agents 4.Encouraging use of joint splints - Ans - Administration of phosphate-binding agents Most patients who have been on dialysis for more than _____ have dialysis amyloidosis (DA)
5. 2 yrs 2.6 months
6. 10 years
7. 3 years - Ans - 10 years CKD patients are at risk for developing peripheral neuropathy, which may manifest as?
8. An intolerance to touch 2.Increased deep tendon reflexes 3.Burning feet 4.Restless legs - Ans - 3 & 4 What are advantages of hollow-fiber dialyzers compared to parallel plate dialyzers? 1.Hollow-fiber dialyzers are compliant & hold increased blood volume as transmembrane pressure increases 2.The ultrafiltration is precisely controlled 3.They can be reused 4.There is an even distribution of blood at the inflow header space - Ans - 2 & 3 Patients sensitive to ethylene oxide sterilization techniques may benefit from having their dialyzer cleaned by ___ as this technique does not use chemicals or radioactive materials. 1.Microwave sterilization 2.Electron beam, or e-beam, sterilization 3.Gamma irradiation 4.Immersion in soapy water - Ans - Electron beam, or e-beam, sterilization What are some negative aspects of synthetic membranes? 1.They are expensive 2.They require automated ultrafiltration control 3.They can absorb proteins on the membrane surface

4.Patients have a higher degree of bio-incompatibility than with other types of membranes - Ans - 1,2, & 3 Long-term exposure to bioincompatible membranes used during dialysis has been associated with: 1.Red blood cell destruction 2.Increased incidence of infection & malignancy 3.Impaired nutritional status 4.Human immunodeficiency virus - Ans - 2 & 3 Which of the following statements about bicarbonate dialysate is accurate? 1.The bicarbonate concentrate is very susceptible to bacterial contamination 2.Calcium & magnesium are very stable in solution with bicarbonate

3. The 'A' (acidified) concentrate is made up primarily of potassium
4. The 'B' (bicarbonate) concentrate is very stable & has a long shelf life - Ans - The bicarbonate concentrate is very susceptible to bacterial contamination Which laboratory test is used to detect & quantify bacterial endotoxins? 1.Limulus amebocyte lysate (LAL)
5. Culture and sensitivity (C & S)
6. Colony-forming units (CFU)
7. Enzyme-linked immunosorbent assay (ELISA) - Ans - Limulus amebocyte lysate (LAL) What may occur if the bicarbonate concentrate is overmixed? 1.A decrease in serum calcium levels 2.An increase in sodium levels 3.A drop in phosphate levels 4.An increase in magnesium levels - Ans - A decrease in serum calcium levels During a dialysis session, it is important for the dialysis technician to monitor dialysate temp since fluid temps ____ cause hemolysis of RBC's 1.>41C 2.<36C 3.<40C 4.>30C - Ans - >41C What action should be taken if a blood leak detector alarm is activated and no blood can be confirmed on visual inspection of the site? 1.Test the dialysate with an approved blood leak test strip 2.Stop the dialysis machine & re-prime the blood lines 3.Check the dialysate with a rapid-acting protein strip 4.Turn off the alarm & proceed with the session - Ans - Test the dialysate with an approved blood leak test strip How can air enter the bloodlines?

1.At connections that are not absolutely tight 2.By osmosis thru contact with blood tubing 3.From empty fluid containers attached at the infusion sidearm 4.Thru mixing of hydrogen peroxide with blood from insufficient rinsing of equipment - Ans - 1 & 3 What does high efficiency dialysis require? 1.Highly permeable cellulosic membrane with surface area of 1.5 m2 or more 2.Reliable blood flow of at least 200 mL/min 3.Dialysate flow rate of 300 mL/min or more 4.Ultrafiltration coefficients of 10-15mL/hr/mmHg - Ans - Highly permeable cellulosic membrane with surface area of 1.5 m2 or more Dialysis technicians working with patients undergoing high-flux dialysis should be alert to the development of bacterial infection. Why is blood contamination a problem with high-flux dialysis? 1.The lack of filters placed in the dialysate path so that high volumes can be maintained 2.High-flux membranes readily pass particles of 2000-10000 daltons in size 3.The inability of cleaning solutions to reach the inner portion of the membrane during reuse 4.Breaks in the blood tubing due to high volume pressure - Ans - High-flux membranes readily pass particles of 2000-10000 daltons in size Several factors affect the removal of toxins in dialysis. Which one of these principles is accurately stated? 1.The greater the flow rate, the greater the removal of solutes 2.The higher the temp, the lower the solute removal 3.The larger the molecular weight, the greater the removal of solutes 4.The lower the concentration gradient, the greater the amount of diffusion - Ans - The greater the flow rate, the greater the removal of solutes To achieve an optimal concentration gradient, which direction should blood and dialysate flow? 1.In the same direction 2.In opposite directions 3.In a cyclic fashion 4.As determined by flux - Ans - In opposite directions During ultrafiltration, what happens when positive pressure is applied to the blood side of the dialyzer? 1.Red blood cells will be pushed out 2.Plasma fluid will be pushed out 3.An increased amount of electrolytes will be pushed out 4.All endotoxins will be pushed out - Ans - Plasma fluid will be pushed out

If reverse filtration occurs and dialysis water is moved into the blood, what potential patient complication should be monitored by dialysis personnel? 1.Rupture of blood vessels 2.A pyrogen reaction(fever) 3.Water on the basin 4.Hypertensive crisis - Ans - A pyrogen reaction (fever) Which of these principles is used to increase treatment tolerance and decrease complications related to fluid removal? 1.Ultrafiltration profiling 2.Diffusion 3.Reverse filtration 4.Osmosis - Ans - Ultrafiltration profiling A patient is being dialyzed on a machine with Crit-Line Monitor. If fluid removal is greater than the volume the patient can shift into the intravascular space, the renal term should intervene before the patient becomes: 1.Hypovolemic 2.Fluid overload 3.Anemic 4.Hypotensive - Ans - Hypovolemic What is the most common impurity in tap water? 1.Calcium carbonate 2.Zinc 3.Lead 4.Mercury - Ans - Calcium carbonate Which of the following chemicals may cause methemoglobinemia, in which red cell hemoglobin cannot transport oxygen? 1.Nitrates 2.Chloramines 3.Fluoride 4.Aluminum - Ans - 1 & 2 In order to remove smaller solutes, such as endotoxins, which filter should be used? 1.Ultrafilters 2.Wound filaments 3.Membrane cartridges 4.Carbon filters - Ans - Ultrafilters Which statements regarding the removal of chlorine & chloramines from water using two carbon tanks is accurate? 1.If sampling reveals there is chloramine in excess of 0.1 ppm leaving the first tank, then water must be sampled after leaving the second tank

2.Sampling must be done to ensure that the carbon tank does not remove too many electrolytes, such as calcium and sodium 3.If a sample from the second tank contains any amount of chloramine, the dialysis session should be cancelled 4.Chlorine and chloramine testing must be done at the beginning of each treatment week - Ans - If sampling reveals there is chloramine in excess of 0.1 ppm leaving the first tank, then water must be sampled after leaving the second tank Polyamide membranes, used for reverse osmosis: 1.Have a very long service life 2.Have a wide pH tolerance 3.Degrade at temps greater than 35C 4.Are very susceptible to degradation by free chlorine - Ans - 2 & 4 What are some of the advantages of reverse osmosis water treatment? 1.Rejection of bacteria, viruses, and pyrogenic materials if the membrane is intact 2.Extremely long service life 3.Convenience:Membrane may be stored & dried between uses 4.Inability of chloramines to cross the membrane - Ans - Rejection of bacteria, viruses & pyrogenic materials if the membrane is intact What type of water is produced by deionizers? 1.Pyrogenic-free water 2.Sterile water with a neutral pH 3.Water or high ionic purity 4.Water free of micro-bubbles - Ans - Water of high ionic purity How is ultraviolet light used in treating water? 1.To break up suspended particles 2.To remove all mold & algae 3.To destroy microorganisms 4.To heat the water to the desired range - Ans - To destroy microorganisms Which of the following contaminants in water may result in the hemolysis of RBCs? 1.Alumnium 2.Nitrate 3.Cadmium 4.Copper - Ans - Nitrate The maximum level of endotoxins in water used to prepare dialysate and reprocess dialyzers must not exceed:

1. 3EU/mL
2. 2 endotoxin units per milliliter (EU/mL) 3.4 EU/mL 4.5 EU/mL - Ans - 2 endotoxin units per milliliter (EU/mL)

If water quality standards are not met, who may be cited as the negligent party? 1.Nurse manager 2.Medical director 3.Unit secretary 4.Head renal technician - Ans - Medical director When preparing a dialyzer for patient use, the dialysis technician must ensure: 1.All air has been removed from the dialyzer 2.The dialyzer is flushed with D5W just prior to use 3.All particulate matter from the manufacturing process has been removed by visual inspection 4.Any disinfectant left behind in the cleaning process has been removed by rinsing under cold water - Ans - All air has been removed from the dialyzer Currently, what is the focus of ESRD Networks? 1.To negotiate with pharmacies the cost of commonly prescribed medications lower 2.To encourage as many patients as possible to switch to in-home dialysis 3.To improve quality and reduce the cost of ESRD 4.To collect data about individual dialysis units that are able to keep costs under budget

• Ans - To improve quality and reduce cost of ESRD What might result from a dialysis program that does not achieve satisfactory dialysis? 1.An audit by the center for medicare & medicaid service 2.Increased cost & poor financial performance if patients require hospitalization 3.A longer stay at the outpatient facility 4.A site visit from the joint commission (tjc) - Ans - Increased cost & poor financial performance if patients require hospitalization The Medicare Improvements for Patients and Providers Act (MIPPA) assists dialysis patients by: 1.Providing unlimited care for any patient over 65 years of age who requires dialysis 2.Including an educational condition to help patients with CKD manage their disease process 3.Covering the cost of most oral medications that CKD patient would be prescribed 4.Monitoring dialysis facilities use of expensive medications such as erythropoiesis- stimulating agents - Ans - Including an educational condition to help patients with CKD manage their disease process Which patient is exhibiting characteristics that indicate he may have a low health literacy rate? 1.Martha, who keeps falling asleep while you are trying to talk to her 2.Judy, who states that she just didnt have time to read the patient education pamphlets 3.Martin, who asks family to stay with him during dialysis 4.Jane, who asks staff to define certain medical terms for her - Ans - Judy, who states that she just didnt have time to read the patient education pamphlets

After forming a trusting relationship, it is now time to teach the dialysis patient. What should the renal staff members do? 1.Hand the patient a notebook of everything she needs to know and assign her to read the first two chapters 2.Make a teachable moment by talking with the patient while you are getting your second patient hooked up to the machine 3.Select the most important concepts and only present a few (3-4) at each teaching session 4.Limit the session to no longer than 15 minutes - Ans - 3 & 4 What is the significance of a new dialysis patient beginning to ask questions about his treatment regimen or procedures specific to his care? 1.The patient's anti-anxiety drugs have reached a therapeutic level 2.The patient is in the bargaining phase of grief 3.The patient is exhibiting a readiness to learn 4.The patient has finally completed the stages of grief - Ans - The patient is exhibiting a readiness to learn what is the chief iron storage in the body - Ans - serum ferritin dialysis fluids has glucose, electrolytes and purified water - Ans - true what is the purpose of a dialysis machine - Ans - to perform the job of the kidneys what is the abbreviation for hemoglobin - Ans - hgb or hb what function does the dialysis machine perform? - Ans - it removes waste and balances the salt and water levels in the body what section of the kidney sends urine drops into the renal pelvis? - Ans - the calyx how often is dialysis needed? - Ans - 3 or 4 times a week how is dialysis patients connected to a dialysis machine? - Ans - using a tube that is connected to the machine and the patient artery what do the physicians measure before starting dialysis - Ans - creatinine level acid concentrate is used to mix dialysate? - Ans - true what are the types of kidney disease? - Ans - acute and chronic the term LDO is known as? - Ans - large dialysis organization who set the quality assurance guidelines? - Ans - - association for the advancement of medical instrumentation

• joint commission on healthcare organization

• the regional ESRD networks when a large amount of blood is lost that could cause death is known as - Ans - exsanguination what is a transducer protector? - Ans - a device that causes air pressure to convert into a electronic signal what do hyponatremia refers to? - Ans - low sodium in the body peritoneal dialysis and hemodialysis are type of dialysis - Ans - true what do hypophospatemia refers to - Ans - low phosphorous bleach is a substance that can be added to municipal drinking water to make the water cleaner - Ans - true what do intravascular refer to - Ans - inside the blood vessels the clinic are paid by medicare using composite rate - Ans - true what is the level of calcium for acute dialysis - Ans - 1.5 - 1.75 mM (3.0 - 3.5 mEq/L what is the usual level of calcium concentration? - Ans - 2.5 - 3.5 mEq what do hypoglycemia refers to? - Ans - high blood sugar how is solutes removed? - Ans - convection, diffusion, and adsorption 2.what is a transducer protector? - Ans - it is used in hemodialysis bloodlines to prevent contamination the levels of > = 4.0 mg/dl of albumin is used in dialysis patients. - Ans - true peritoneal dialysis and hemodialysis are the two types of what - Ans - dialysis methods. what is the hemodialysis method? - Ans - a filter is used to filter waste, removed excess fluid from the blood, and is done 3 days a week. the method of peritoneal dialysis? - Ans - the lining of peritoneal membrane ( abdominal) is used with a solution known as dialysate to remove waste and excess fluid from the blood, the process is known as an exchange why is water softener used in water? - Ans - to discard the calcium and magnesium the renal osteodystrophy blood pattern - Ans - high-phosphate levels and low- calcium

in 1960, B scribner created the shunt - Ans - true when was a big advancements made in primitive dialysis - Ans - 1950 - 1953 during korean war when a device malfunction a report is made to what agency - Ans - FDA the renal data system (USRDS) annual report, disclose what information - Ans - the cost of treatment and the patient's morality rate what report is required annually in a clinic or region? - Ans - the united states renal data system (USRDS) annual report the hemodialysis exam and the study materials were written by - Ans - american nephrology nurses association (ANNA) and the national association of nephrology technicians (NANT) what size of molecular can pass through a membrane - Ans - any size can pass hemodialysis is a treatment for kidney failure. - Ans - true erythropoietin is secreted by the kidneys it increased the red blood cells production rate.

• Ans - true the negative side of high-flux dialysis - Ans - pyrogen reaction what is the glomerular filtration rate in a normal adult? - Ans - 125 ml/ min /1.73 m this formula is for TMP = UFR/KUF. - Ans - transmembrane pressure what is the bloods normal ph balance? - Ans - 7. electrolyte solutions dissolve in suitable ionizing solvent known as - Ans - water how is electrolyte solutions formed - Ans - when salt is put in water dialysis balances electrolytes and removes what from the body - Ans - removes wastes and excess fluid electroyles are the salt in the body - Ans - true what is the salts that carries an electrical charge - Ans - sodium ions, chloride ions and potassium ions what mineral is needed for your muscle and nerve function - Ans - sodium

what is sodium also referred to as - Ans - natrium or Na+ dizziness, vomiting, exhaustion and nausea are all symptoms of - Ans - lack of sodium what is the abnormal blood sodium levels - Ans - lower than 135mEq/l abnormal sodium levels in the blood is called? - Ans - hyponatremia when sodium levels is elevated over 145mEq/L it is - Ans - hypernatremia what helps the cells to perform its function normally - Ans - the electrical charge from the electrolytes in the blood serum seizures and possible heart failure is likely if the electrolytes become unbalanced? - Ans

• true a particle that is electrically charged is known as - Ans - ion a dialyzer is an artificial kidney devise that could be organic or synthetic. - Ans - true the barrier with microscopic pores that allows some substances to pass depending on the size - Ans - semipermeable membrane hemodialysis restores 15% of kidney function - Ans - true the first cellulosic membrane was used for dialysis in a drum in 1943 by? - Ans - willem kolff Dr. james cimino pioneered the fistulae procedure in 1966 - Ans - 1966 when using a shunts the patient is at risk of blood clotting and infection? - Ans - true what was mass marketed in 1960? - Ans - the first hollow fiber dialyzer between 1960-1973 there was a shortage of dialysis machine - Ans - true what decision did the death committee make prior to 1973? - Ans - patient with renal failure would receive care based on economic status and their families contribution to society due to the cost of dialysis some patient would choose death over treatment in what year? - Ans - before 1973 the law 92-603 was passed by congress to provide medicare benefits for patients eligible for social security. - Ans - 1972

when the law 92-603 passed medicare benefits paid pay up 80 % of allowable cost for patients eligible for social security - Ans - true in the united states 18 ESRD net works governed medicare in 1978? - Ans - true in the united states 18 ESRD networks governed medicare in 1978? - Ans - true the term IOM refer to? - Ans - institute of medicare the term cms refers to? - Ans - the center for medicare and medicare service the term DHS refer to? - Ans - the united states renal data system the term antegrade refers to? - Ans - the direction of venous in blood flow Dr. Kolff's rotating drum was the first development in dialysis - Ans - true what do pruritus means? - Ans - itching of the skin during dialysis 150-250 ml of blood is outside the patient body - Ans - true what makes up nephron? - Ans - tubule and glomerulus the reverse osmosis parameters must be checked on what basics? - Ans - daily ethylene oxide is also known as ETO - Ans - true during the korean war in 1950-1953, what was a great advancement - Ans - primitive dialysis what happen to a patient if their GFR falls bellow 15? - Ans - kidney failure when a artery is connected to a vein under your skin to make a bigger blood vessel is known as? - Ans - fistula when a artery is join to a vein using a soft synthetic tube under your skin is known as? - Ans - graft home-based treatment is called peritoneal dialysis - Ans - true peritoneal dialysis. can be used at work, home or when sleeping. - Ans - true how often is home-based treatment such as peritoneal dialysis done. - Ans - daily

what is a foreign substances to the body that causes antibodies the to be produce and fight disease - Ans - antigen high levels of phosphate in the blood is called - Ans - hyperphosphatemia a known complications of a fistulae is thrombosis - Ans - true what year was the shunt crated? - Ans - 1960 why is the instrument called sphygmomanometer used - Ans - to measure blood pressure What is a semipermeable? - Ans - A filter The extracorporeal circuit carries the blood from the access to the dialyzer apparatus and back to dialyzer apparatus and back to the access and can detect blood leakage? - Ans - True the prothrombin time test measure how long it take for blood to clot. - Ans - True The first sample of blood is discarded before obtaining the blood sample when a double lumen catheter is used for drawing a blood sample - Ans - True An air embolism is pathological condition caused by a gas bubble in the vascular system - Ans - True The patient is placed in a trendelenberg position on the left side when a air embolism occurs - Ans - True What is the sodium normal lab level? - Ans - 135 - 146 mEq/L, some labs may be higher the URR test are pre and pos BUN that is used to determine the amount of urea removed during a dialysis treatment - Ans - true rennin, erythropoietin and calctriol are substances that are produced by the kidney. - Ans - true what is the main protein of blood plasma? - Ans - serum albumin the hepatitis B virus can survive a least a week on a surface. - Ans - true when the patient has a low albumin reading they might have what disease? - Ans - liver disease what is the albumin normal range is 3.5 to 5.5 g/dl and the optimal levels is? - Ans - 4.0 g/dl

the arterial blood line is always negative. - Ans - true venous pressure is the pressure in the blood tubing and its always positive. - Ans - true ultrafiltration happen during dialysis when water is removed from blood? - Ans - true what is hypokalemia - Ans - low potassium what is anaphylaxis? - Ans - an allergic reaction when irritation of membrane surrounding the heart that cause sharp chest pain is known as? - Ans - pericarditis hemoglobin is a red protein that transports oxygen to the vertebrates - Ans - true based on AAMI standards, how often is the bacteriologic testing for water and dialysate> - Ans - monthly what is the complication that could develop from using the subclavian vein when placing a catheter? - Ans - central venous stenosis the endotoxin count of dialysate must not exceed 2 EU? ml. - Ans - true ferritin is the body iron storage protein - Ans - true the hemodialysis has two delivery systems. - Ans - dialysate and extracorpeal what is the condition when the body has too much acid and is not being removed by the kidneys - Ans - metabolic acidosis the stage of kidney disease? - Ans - - stage 1- GFR 90>

• stage 2- GRF 89 to 60
• stage 3-GFR 59 to 44
• stage 4- GFR 44 to 30
• stage 5- GFR < 15 large amounts of aluminum used in water can cause bone disease? - Ans - true water contamination by bacteria endotoxins cause. - Ans - a pyrogenic reaction what ions hard to dialyze? - Ans - phosphorous and protein the rate of diffusion can be affected by the surface the are of the membrane? - Ans - true

what is amyloidosis? - Ans - a build up of abnormal waxy proteins on soft tissue or organ erhropoietein deficiencies primary cause of the enemia - Ans - true the needle should be inserted from the anastomosis in a graft or fistula no more than one-inch. - Ans - true blood clots are prevented in when this medication is used - Ans - heparin hyperkalemia is the medical condition that causes muscle weakness.when high levels of potassium are in the blood - Ans - true nephron is the part of the kidney that filters waste products from the uremia and blood - Ans - true what is listened for with a stethoscope before assessing a graft or fistula - Ans - bruit pseudoaneurym is also known as a false aneurysm is a complication that cause the arterial blood to leak out from an artery when the needle sites are not rotated - Ans - true the chloramines and chlorine are checked in the carbon tanks each shift. - Ans - true when the needle punctures moves outside of vessel is known as. - Ans - infiltration association for the advancement of medical instrumentation is known as? - Ans - AAMI diabetes is the cause of kidney disease for adult in the US - Ans - true flow control and volumetric UF control are types of the - Ans - ultrafiltration system the dialysate microbial count should not exceed. - Ans - 2000 CFU/ml they are three hemodialysis treatment options - Ans - nocturnal, in the center and short daily the pressure that is need to pass the water through a membrane is known as. - Ans - transmembrane pressure (TMP) the total cell volume test must be given to new dialyzers. - Ans - true water acid and bicarbonate are in the mixture for? - Ans - dialysate a ion is an electronically charge particle - Ans - true

congress developed the ESDR network in 1978 - Ans - true drops of urine are sent into the renal pelvis by - Ans - calyx what is the concentrate used when mixing dialysate? - Ans - acid concentrate with bicarbonate what is the transmembrane pressure formula? - Ans - TMP= UFR/KUF latent tuberculosis is not contagious? - Ans - true by AAMI standards, how much sodium should the water for dialysis contain. - Ans - no more than 70 mg/L by AAMM standards, how much potassium should the water for dialysis contai. - Ans - 8 mg/L where is the port for peritoneal dialysis placed on the body - Ans - the abdomen what must the creatinine levels be before they pay for dialysis medicare. - Ans - 8 non- diabetics and 6.0 in diabetics the concentration gradient in dialysis forces wastes out of the blood. - Ans - true the term CKD means. - Ans - chronic kidney disease what must be repeated, when the hemodialysis machine test positive before sterilant before using. - Ans - rinsing of the machine what do it mean when the serum levels is abnormal in renal failure. - Ans - the creatinine, BUN, and phosphorus are elevated what is it called when a patient blood is channeled to the hemodialyzer and then back to the body - Ans - vascular access the fistula is placed? - Ans - near the wrist in the forearm blood leak detectors are sensitive and can determine a leak immediately - Ans - true foods with that is high in potassium such as bananas, oranges and tomatoes should be avoided if you have kidney disease. - Ans - true what lab test is used to evaluate bone disease? - Ans - PTH, calcium and phosphorus RBC's do not dialyze because it has a large molecular weight. - Ans - true