CCHT EXAM BEST TEST QUESTIONS STUDYING MATERIAL WITH VERIFIED ANSWERS LATEST VERSION, Exams of Nursing

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CCHT EXAM BEST TEST QUESTIONS

STUDYING MATERIAL WITH VERIFIED

ANSWERS LATEST VERSION UPDATE

2024 - 2025

Of the following, which would not be considered correct for a boundary that the technician/nurse in the dialysis center should observe?

• Ans - Never wash hands prior to touching a patient The quality of care for the dialysis center would include all but which of the following? - Ans - Financial status of the patient Which of the following would be considered a type of dialysis access?
• Ans - Fistula Graft Hemodialysis catheter LVH stands for which of the following?
• Ans - Left Ventricular Hypertrophy When excess hydrogen ions build up in the blood, the dialysis patient can develop which of the following conditions?
• Ans - Metabolic acidosis __________ is considered a bacterial disease spread by airborne droplets?
• Ans - TB Millimeter and which of the following might be considered common metric units for volumes?
• Ans - Liter Which of the following would not be considered a time that the technician would need tochange their gloves?
• Ans - When troubleshooting a patient's access. The dialysis patient requies an increase in protein intake. Which of the following would be the correct percentage of increase in protein intake that they would need?
• Ans - 50% The classic triad of symptoms for pericarditis includes all of the following except?
• Ans - Hyperglycemia

All of the following could be considered symptoms of uremia except?

• Ans - Neck pain __________ would be considered the smallest particle of an element which retains theproperty of the element?
• Ans - Atom The reverse osmosis membrane is considered a key part of the system, filtering out orrejecting which of the following?
• Ans - Viruses Metals Chemicals The movement of fluid from an area of low concentration of solution to an area of highconcentration of solutes would be considered which of the following?
• Ans - Osmosis Which of the following would have a high biological value?
• Ans - Beef The reverse osmosis loop return and which of the following would be considered areas that the water treatment AAMI chemical analysis test should be performed on once a year?
• Ans - Portable RO machines Which of the following helps to protect the kidneys?
• Ans - Rib cage Pads of fat Of the following, which would not be considered a part of the kidney tubule?
• Ans - The central convoluted tubule Which of the following medications do not interact with heparin?
• Ans - Amoxicillin Of the following, which would be considered the serologic marker for the systemicdisease Wegener's granulomatosis?
• Ans - ANCA Hypotension is best described as which of the following?
• Ans - Low blood pressure With a hemodialysis distribution system, the _______ feed would be when the water is being directed to a storage tank?
• Ans - Indirect

Which of the following could potentially be a cause of fatty casts in the patient's urinalysis?

• Ans - Heavy proteinuria The end-stage renal disease patient has an AV graft placed. How long before this graftcan typically be used?
  • Ans - 2 weeks The technician/LPN needs to be aware of which of the following key points for counting thepatient's respirations?
  • Ans - The technician/LPN needs to know what the patient's normal respirations should be. The technician/LPN needs to know how to correctly count the patient's respirations. Which of the following would be considered potential toxic compounds that accumulate in the kidneys?
• Ans - Urea Serum proteinases Trace elements Which of the following would be considered correct for the appropriate flow rate in a water treatment system that would cause sufficient friction on the walls of the tubing to prevent bacteria from growing on the sides of the pipes?
• Ans - 3 feet per second The molecular weight for phosphorus would be considered which of the following?
  • Ans - 94.9 Da The technician/LPN should know that the two most common forms of antibiotic- resistantbacteria would include which of the following?
  • Ans - Vancomycin-resistant enterococcus The LPN/technicians role in helping to manage electrolytes could include which of the following?
  • Ans - Always double check to be certain the right dialysate is being administered to each patient. Encourage the patient to always follow their meal plans in addition to their fluid limits. EEG changes and which of the following might be considered signs and symptoms of dialysis dementia?
  • Ans - Asymmetric muscle jerking If the technician/LPN has a small adult patient, which of the following lengths would be appropriate measurements for the correct blood pressure cuff for the patient?

• Ans - 7 - 9 inches Postrenal and which of the following would be considered a category of acute renal failure?
  • Ans - Intrinsic Of the following, which formula would be correct for determining how much water to removeduring a dialysis treatment?
  • Ans - Subtract the EDW from the predialysis weight and then add the amount of fluids the patient willreceive during the treatment. The end-stage renal disease (ESRD) patient would have the hemoglobin goal of which of the following?
  • Ans - 11 - 12 g/dL Of the following, which would be considered the main functional unit of the kidney? - Ans - Nephron Food groups that are included in the end-stage renal disease patient's diet would not include?
• Ans - Calcium inhibitors Which of the following complications could be considered common for the patient thathas methicillin-resistant staphylococcus aureus (MRSA)?
  • Ans - Both A and B The acronym criteria that is typically used for classification of acute renal failure would be considered?
  • Ans - RIFLE When the dialysis center is performing their water treatment testing, which of thefollowing tests would be appropriate for testing reverse osmosis (RO) loop pre test? - Ans - Colony count LAL Continuous cycling peritoneal dialysis (CCPD) uses which of the following?
  • Ans - A cycler machine at night For which of the following reasons was fluoride added to drinking water?
• Ans - To help prevent tooth decay The different factors that could have an affect on medication rate of absorption couldinclude which of the following?
  • Ans - The area of the absorption surface Rate of dissolution

Route of administration When attempting to diagnosis acute interstitial nephritis, which of the following would be considered the "gold standard" for diagnosing?

• Ans - Kidney biopsy Of the following, which would be correct regarding the distance around the patient's arm if they require a large adult cuff?
• Ans - 13 - 17 inches TFC stands for which of the following?
• Ans - Thin Film Composite The technician/LPN needs to do a thorough assessment prior to cannulation. Which of thefollowing would be correct for the interventions for assessing this patient?
• Ans - - Check for patient for patency or circulation.
• Visibly observe the access site for such things as signs of infection and inform the registered nurse of any unusual findings.
• Check the skin for bruising, discoloration, and pain. If hemodialysis is being performed on the patient by way of a central venous line access, when the pre-labs are being drawn, which of the following should be considered the first step?
• Ans - Draw back 5 ml of blood and discard prior to drawing the labs Which of the following would be considered one the three classes of analgesics that aretypically used for the patient with chronic kidney disease (CKD)?
• Ans - NSAIDs Non-narcotic drugs Narcotic drugs The colony count and which of the following would be considered appropriate test that the dialysis facility would perform on their water treatment for testing reverse osmosis (RO) loop pre?
• Ans - LAL Which of the following practice areas is not included in the CCHT (CertifiedClinical Hemodialysis Technician) content?
• Ans - Supervisory ___________ would be considered the major risk involved with a kidney transplant? - Ans - Rejection The technician has calculated the target weight loss for a patient's hemodialysis session, but the patient insists that the technician has made an error and that the target is 1 kg too high. The technician should

• Ans - recalculate the target weight loss. Peritoneal dialysis (PD) differs from hemodialysis in which of the following ways?
• Ans - PD access is by an intra-abdominal catheter The main difference between an arteriovenous shunt (AVS) and an arteriovenous fistula (AVF) is an:
• Ans - AVF is entirely within the arm. Which of the following dialyzers is used currently?
• Ans - Hollow tube Which of the following kidney structures connects with and delivers urine directly to the ureter?
• Ans - Pelvis The glomerular filtration rate is an important index of renal function and in the normal adult is approximately:
• Ans - 125 mL/min/1.73 m2. All of the following substances are produced by the kidney EXCEPT:
• Ans - aldosterone. The most likely cause of post-renal failure is:
• Ans - benign prostatic hypertrophy. The most common cause of chronic kidney disease in the United States is:
• Ans - diabetes. Which of the following conditions is LEAST likely to be caused uremia?
• Ans - Urinary tract infection All of following conditions are associated with chronic kidney failure EXCEPT:
• Ans - hypoparathyroidism. What percentage of transplanted kidneys are functional 1 year after transplantation? - Ans - 90% Which hemodialysis schedule is likely to be most efficient?
• Ans - Short daily home hemodialysis, 2-3 hours a session, 5-7 days a week The fluid restriction for most patients undergoing in-center hemodialysis is equal to urine volume/day plus:
• Ans - 1 L.

Failure to excrete beta2-microglobulin in patients with kidney failure predisposes the patient to: - Ans - amyloidosis. Blood tests for ferritin are performed in hemodialysis patients: - Ans - to check for iron stores. Which of the following phosphate binders would best control hyperphosphatemia with the fewest side effects in patients with end stage kidney disease? - Ans - Lanthanum carbonate Hemodialysis patients should be taught to: - Ans - put in their own needles, weigh themselves and record it, check their dialyzer settings and dialysate All of the following statements about vitamins in dialysis patients are true EXCEPT: - Ans - dialysis does not remove water-soluble vitamins Osmosis is best defined as - Ans - diffusion of solvent through a semipermeable membrane from low-to high-solute concentration In hemodialysis, blood and dialysate have which of the following properties? - Ans - They flow in opposite directions In the dialyzer, water may be removed from: - Ans - intravascular compartment Which site in the hemodialysis pathway has the highest positive pressure? - Ans - Blood entering the dialyzer fibers The term "sieving coefficient of a membrane" refers to the: - Ans - fraction of solute that passes through the membrane by convection. Water moves from one body compartment to another by: - Ans - osmotic forces. Biocompatibility is best illustrated by - Ans - reprocessed dialyzers that have a better biocompatibility than new ones The amount of fluid to be taken from the patient during hemodialysis: - Ans - may be calculated by adding the patient's pre-dialysis weight and the amount of fluid the patient receives during treatment. The ultrafiltration coefficient of a dialyzer refers to the: - Ans - fluid that passes through the membrane in 1 hour. The molecular weight cutoff of a dialyzer is 12,000 daltons. Which of the following molecules would not pass through the membrane into the dialysate? - Ans - Albumin

Clearance of low-molecular-weight molecules by dialysis is accomplished mostly by: - Ans - diffusion. A hollow fiber dialyzer has which of the following properties? - Ans - Very fine fiber tubes held in place by polyurethane material Synthetic membranes have which of the following properties? - Ans - They have thick fiber walls If a dialyzer has a urea clearance rate (K) of 200 mL/min and a blood flow rate (Qb) of 300 mL/min, what volume of the blood will be cleared of urea in 1 minute? - Ans - 200 mL To determine the most accurate clearance rate of a particular solute, one should: - Ans - measure the solute concentrations of blood going into and out of the dialyzer. All of the following substances are added to the dialysate EXCEPT: - Ans - phosphate. Sodium modeling refers to: - Ans - changing the concentration of the dialysate sodium during the course of dialysis Conductivity is best defined as: - Ans - a method of checking electrolyte levels in the dialysate Which of the following statements about the proportioning system is correct? - Ans - It relies on a continuous supply of fresh concentrate and treated water An advantage of high-flux dialysis is: - Ans - fast removal of fluid A disadvantage of high-flux dialysis is: - Ans - pyrogen reactions are common All of the following statements regarding home dialysis are true EXCEPT: - Ans - it cannot be done during sleep. In most dialysate systems, the temperature: - Ans - is maintained by a thermistor- controlled heater Dialysate flow rate has which of the following properties? - Ans - Low water pressure may set off an alarm Which of the following statements about blood leaks in the dialysis system is correct? - Ans - They are detected by use of a light source and photocell Dialysate pH is kept in which of the following ranges? - Ans - 7.0-7.

Which of the following statements about fluid removal from the blood is correct? - Ans - It depends on the transmembrane pressure (TMP) Dialysis machines control the rate of fluid removal by: - Ans - either volume or flow control. Drip chambers in the extracorporeal circulation do all the following EXCEPT: - Ans - pump blood into the dialyzer. Which of the following statements about extracorporeal circulation is correct? - Ans - Approximately 100-250 mL are outside the patient's body at any time Which of the following statements about transducer protectors is correct? - Ans - They use hydrophobic membranes to keep fluid from passing through Blood flow into the dialyzer is usually: - Ans - done by manual hand cranking Which pressure in the dialysis circuit is usually negative? - Ans - Arterial pressure Which of the following will set off the pre-pump high-pressure alarm? - Ans - A decrease in the blood pump speed A low-pressure alarm in the venous (post-dialyzer) line is likely to be set off by: - Ans - a blockage in the blood tubing before the monitoring site. Which of the following statements about an air detector is correct? - Ans - It uses an ultrasonic device to detect air in the blood path How is the anticoagulant heparin given during the dialysis treatment? - Ans - Intermittently As a single bolus By continuous infusion By all of the above ways A sorbent is best described as a: - Ans - continuous dialysate disinfection system that removes bacteria and endotoxins Which of the following statements about sorbent dialysis is correct? - Ans - In preparing the dialysate, 6 liters of water are added to premixed chemicals Which type of arteriovenous fistula is likely to result in high blood flow with the fewest complications? - Ans - Artery side to vein end For which type of dialysis patient is a central venous catheter blood access appropriate?

• Ans - All of the above patients

Which of the following statements about arteriovenous grafts is correct - Ans - They are more prone to thrombosis than arteriovenous fistulae. Care of a new arteriovenous fistula should include all of the following EXCEPT: - Ans - cannulating the vessel to see if the blood flow is adequate. An antiseptic that kills bacteria when wet is: - Ans - 70% alcohol Which of the following arteries is most commonly used for an arteriovenous fistula? - Ans - Radial artery The hemodialysis technician who is about to insert a needle into the arteriovenous fistula should first do all of the following EXCEPT: - Ans - place the needle into a previous cannulation spot. During needle insertion, it is important for the hemodialysis technician to always: - Ans - cannulate the venous access in an antegrade manner (with the blood flow). Using the buttonhole technique for blood access, the technician should: - Ans - use a sharp followed by a blunt needle. To diminish vasovagal reactions and needle phobia in the dialysis patient, the technician should ask the patient to: - Ans - lie down in a recumbent position. tense the muscles in the nonaccess hand for 10-20 seconds during needle insertion. cannulate his or her own vessels. do all of the above. Recirculation refers to: - Ans - mixing dialyzed venous blood with blood entering the arterial needle A diabetic patient undergoing dialysis complains of tingling, numbness, and cold in the hand below the access site. The most likely cause is: - Ans - steal syndrome. Common sites of stenosis in patients with an arteriovenous fistula include all the following EXCEPT: - Ans - the artery next to the anastomosis. A thrombosis is LEAST likely to develop with which of the following vascular access methods? - Ans - An arteriovenous fistula High-output cardiac failure is a complication of arteriovenous fistula or grafting. All of the following actions are a part of this condition EXCEPT: - Ans - decreased cardiac workload. Which of the following statements about grafts used for arteriovenous shunts for dialysis patients is correct? - Ans - They can be made from collagen or expanded polytetrafluoroethylene

When placing a needle into a graft, a hemodialysis technician may do which of the following? - Ans - Use three sides to cannulate the graft, not just the top Which of the following veins is most suitable for hemodialysis catheter placement? - Ans

• Right internal jugular To prevent infection in catheters, hemodialysis technicians should be sure to: - Ans - do all of the above. When the low-pressure alarm rings, signaling inadequate flow, the technician should be sure to: - Ans - flush the catheter with saline. An advantage of catheter and port catheter devices is: - Ans - needle entry is not required. A heavyset patient arrives for dialysis in a wheelchair. He has difficulty standing without assistance. Which technique would be most appropriate to transfer him to the dialysis chair? - Ans - Portable lift device If a small fire breaks out in the dialysis center, which of the following safety sequences is correct? - Ans - When using a fire extinguisher, pull the pin, aim the nozzle at the base of the flames, squeeze the handle, and spray from side to side at the base of the flames Using sterile technique, a hemodialysis technician should avoid all the following EXCEPT: - Ans - washing hands and using sterile gloves. Use of protective equipment and techniques are intended to protect both patient and staff member. Examples of include all of the following EXCEPT: - Ans - always recapping used needles. Which of the following pathogens is most likely to be spread during dialysis treatment? - Ans - Hepatitis B Which of the following should be avoided when drawing up medication into a syringe? - Ans - Changing needles after half the volume is drawn up Correct statements concerning the charting of patient data include all of the following EXCEPT: - Ans - entries must be printed for legibility. After a treatment, a patient below dry weight may have: - Ans - muscle cramping. Which of the following alarms must be checked before dialysis begins? - Ans - All of the above alarms

In a patient with a fistula in one arm and an intravenous line in the other, manual blood pressure should be taken in the: - Ans - leg with the patient supine. Which of the following vital signs is abnormal before dialysis in a 30-year-old male patient? - Ans - Blood pressure: 145/95 mm Hg To calculate the amount of fluid removal from the patient during dialysis, all of the following values are used EXCEPT: - Ans - volume of urine output. When drawing blood samples for laboratory testing, the hemodialysis technician should draw samples: - Ans - from the arterial blood line injection port. The urea reduction ratio has which of the following properties? - Ans - It requires measurement of both pre- and post-dialysis blood urea nitrogen What is the urea kinetic modeling calculation? - Ans - It gives both minimum delivered and prescribed doses For patients in whom the priming solution is to be discarded, what should the hemodialysis technician do next? - Ans - Connect the arterial tubing, and allow the priming solution to drain before connecting the venous tubing A dialysis patient has a history of heparin-induced thrombocytopenia (low platelets) and severe bleeding. What would be a good method of performing dialysis safely? - Ans - Use a regional citrate technique A dialysis patient develops a purulent discharge at the exit site of a central catheter. Which of the following pathogens is the most likely to be cultured? - Ans - Staphylococcus aureus A hemodialysis patient suddenly develops trouble breathing, hives, itching, and hypotension. The most likely cause is: - Ans - an anaphylactic reaction. A patient undergoing hemodialysis complains of muscle cramps in the calves and feet. All of the following are likely causes EXCEPT: - Ans - hypercalcemia (high-calcium level). Which of the following may cause hemolysis of red blood cells during dialysis? - Ans - Kinked blood lines Warm dialysis fluid Inadequate water treatment All of the above For centers that reuse dialyzers, reprocessing includes: - Ans - disinfecting the clamps and the outside of the dialysis machine.

Which of the following statements about the "first-use syndrome" is correct? - Ans - It may be reduced by repeated rinsing of the dialyzer Which of the following statements about preprocessing dialyzers is correct? - Ans - It can be done manually or by machine Which of the following statements about new dialyzers is correct? - Ans - They may be preprocessed to reduce noxious chemicals or materials At the end of treatment, which of the following actions should be done first? - Ans - Blood rinse back Grounds for discarding a dialyzer include which of the following? - Ans - It has been exposed to more than one germicide Which of the following germicides is most commonly used to disinfect dialyzers in the United States? - Ans - Peracetic acid What is an endotoxin? - Ans - it is a toxin produced by certain bacteria Federal regulations require a center that reuses dialyzers to have: - Ans - a system of quality assurance. a system of quality control. Which of the following substances is the most common impurity in tap water? - Ans - Calcium carbonate The average hemodialysis patient is exposed to how many liters of water a week? - Ans

• 350 L A return loop recycles water through the water treatment system because: - Ans - it reduces the amount of water required. it prevents stagnant spots. in a water treatment system, feed water is adjusted to a temperature of: - Ans - 77°F- 82°F, using hot and cold water and a blending valve. The pH of feed water is 9.0 at a certain center. Which of the following would be the best water treatment? - Ans - Add hydrochloric acid to the feed water, using a mixing chamber Which of the following statements about multimedia filters is correct? - Ans - They trap successively smaller particles Water softeners remove calcium and magnesium by: - Ans - ion exhange

Which of the following statements about carbon tank removal of chlorine and chloramine from feed water is correct? - Ans - It requires two carbon tanks in a series Which of the following statements about reverse osmosis is correct? - Ans - Hydraulic pressure is used to move water through the membrane Which of the following statements about the deionization of water is correct? - Ans - It removes both anions and cations Which of the following statements about an ultraviolet irradiator is correct? - Ans - It emits light at a wavelength of 254 nanometers Which of the following statements about biofilm is correct? - Ans - It is an aggregate of microorganisms that produce a matrix of extracellular polymeric substance (slime) Public Law 92-603, which originally passed in 1972, is concerned with which of the following? - Ans - It covers dialysis and kidney transplants Which of the following statements best describes dialysis centers today? - Ans - They are mostly owned by large dialysis organizations Inspection and standards for dialysis centers may be provided by: - Ans - the Food and Drug Administration. state health departments. the Association for Advancement of Medical Instrumentation. all of the above. Continuous quality improvement refers to: - Ans - a method for improving clinical, technical., and organizational procedures Professionalism for a hemodialysis technician includes: - Ans - refraining from talking about a patient to a colleague if the conversation may be overheard. Taking the Certified Clinical Hemodialysis Technician exam requires all of the following EXCEPT: - Ans - 6 - months of full-time (1000 hours) experience and training. Which of the following statements about certification examinations in clinical nephrology technology and in biomedical nephrology technology is correct? - Ans - They require 12 months of work experience to take the examination The National Kidney Foundation's Kidney Disease: Improving Global Outcomes includes treatment guidelines for all the following EXCEPT: - Ans - hepatitis. As part of the job of a dialysis technician, one may be required to lift equipment or assist with patient transfers. Back pain-sparing and injury prevention maneuvers include: - Ans

• lifting with the legs and holding the object close to the body.

One difference between peritoneal dialysis (PD) and hemodialysis (HD) is: - Ans - the patient is subjected to constant dialysis in PD rather than intermittent dialysis in HD. All of the following statements regarding kidney transplantation are correct EXCEPT: - Ans - the diseased kidneys are usually removed. Which of the following immunosuppressive drugs used in kidney transplant patients has renal toxicity? - Ans - Cyclosporine What is a sensitization test for a potential kidney transplant recipient? - Ans - Potential recipient serum tested with a multiple donor lymphocyte panel A diet restricting all of the following is appropriate for a renal failure patient EXCEPT for:

• Ans - calcium. All of the following are indications to start hemodialysis in a renal failure patient EXCEPT: - Ans - creatinine clearance of 25 mL/min. The nephrotic syndrome is characterized by all the following EXCEPT: - Ans - hematuria. Which of the following statements about administering erythropoietin to a hemodialysis patient is correct? - Ans - Give supplemental iron if ferritin is low A recent study published in The New England Journal of Medicine compared hemodialysis three times a week with hemodialysis six times a week. At the end of a 12- month follow-up period, the study showed the six-times-a-week group had: - Ans - fewer deaths. Which of the following statements about the nephron, the working unit of the kidney, is correct? - Ans - It makes about 180 liters of glomerular filtrate a day Acute tubular necrosis may be caused by: - Ans - shock and hypotension, rhabdomylysis, radiographic contrast material What does the expression Kt/V signify with regard to hemodialysis? - Ans - Prescribed dose of dialysis Adding extra sodium chloride to the dialysate will: - Ans - draw water out of cells and tissues into the blood. Which of the following is most likely to cause problems for the patient receiving hemodialysis treatments? - Ans - Inadequate vascular access

Which of the following action is most important in preventing spread of infection? - Ans - Hand washing To avoid environmental contamination, it is important to do which of the following? - Ans

• Do all of the above All of the following are part of a standard dialysis prescription EXCEPT: - Ans - access to cannulate. A brother of a dialysis patient has blood type O and is being considered a potential kidney donor. What are the odds that he will be a complete match and a suitable donor?
• Ans - 50% A patient with kidney disease has anemia, fatigue, elevated phosphate levels, ankle edema, and elevated blood pressure. What is the most likely range of his glomerular filtration rate? - Ans - 15 - 29 mL/min Which of the following physicians is credited with inventing dialysis? - Ans - Willem J. Kolff, MD What pattern of blood chemistries would you expect in renal osteodystrophy? - Ans - Low-calcium and high-phosphate levels Which of the following terms indicates a solution that has the same concentration of solutes as blood? - Ans - Isotonic A patient's potassium level has been running high between dialysis treatments, so the patient has been working with the renal dietician to restrict potassium in the diet. Which of the following fruits should the patient avoid? - Ans - Bananas During osmosis, which of the following movements takes place? - Ans - Fluid moves from an area of lower concentration to higher. A patient's granddaughter calls the dialysis center and asks for a progress report on her father, who is a patient in the center. The technician should - Ans - state that patient information cannot be divulged. If a hematoma forms at the access site where a needle infiltrated, the usual intervention is to apply - Ans - cold compresses. Which of the following actions by a patient increases the risk of blood clots in a venous access? - Ans - Wearing a top with very tight-fitting long sleeves A patient is very anxious during an initial hemodialysis treatment and requires extra attention. When the treatment is completed, the patient offers a $20 tip. The technician should - Ans - politely decline the tip.

Which of the following statements by a hemodialysis patient suggests that the patient needs more education? - Ans - "I should stay on a low protein diet." The inner part of the kidney is the - Ans - medulla A nephron is comprised of a glomerulus and a - Ans - tubule How much urine does a patient with healthy kidneys usually excrete in 24 hours? - Ans - 1000 to 2000 mL When removing soiled gloves, the first glove removed should be - Ans - grasped in the opposite gloved hand. Which of the following hormones is produced by the kidneys? - Ans - Erythropoietin At which stage of chronic kidney disease should a patient begin dialysis? - Ans - 5 Which of the following is a genetic disorder that can lead to kidney failure? - Ans - Polycystic kidney disease Which of the following complaints by a patient may be an indication of uremia? - Ans - Itching A patient with a right-sided radiocephalic AV fistula (above the wrist) needs to have blood tests in the lab for a number of different lab tests. The blood should be drawn from the - Ans - left hand. When setting up hemodialysis equipment, the four things that need to be checked are (1) dialysate, (2) extracorporeal circuit, (3) dialyzer, and (4) - Ans - machine alarms. Generally, the optimal dialysate flow rate for hemodialysis should be - Ans - 1.5 to 2 times the blood flow rate. A patient is receiving hemodialysis with a dialyzer with an ultrafiltration coefficient (KUF) of 10 and a transmembrane pressure (TMP) of 100 mm Hg. How much fluid should the patient lose per hour of treatment? - Ans - 1000 mL If a patient has a dialyzer clearance rate of 250 mL/min with 4-hour treatment, the total volume of blood cleared is - Ans - 60 L. Under what circumstance can needles be reused for hemodialysis? - Ans - Under no circumstances

If an emergency (such as a tornado) occurs and patients need to be evacuated, which group of patients should be disconnected from dialysis machines first? - Ans - Patients able to ambulate independently For patients on hemodialysis, a 1 kg (2.2 lb.) increase in weight in 24 hours is approximately equivalent to fluid retention of - Ans - 1.0 L. A patient has been advised to avoid foods high in phosphorus. Foods that the patient should be advised to limit include - Ans - dairy products. A patient is scheduled for a serum creatinine test and asks the technician about preparation the day before the test. The patient should be advised to - Ans - avoid excessive exercise. Which of the following ethnic groups is most at risk for development of kidney failure? - Ans - African Americans A patient has buttonhole tracts for access. After the access is cleaned and prepped for treatment, what is the next step? - Ans - Use a scab picker/aseptic tweezers to remove the scabs. With buttonhole tracts, the technician should apply pressure as the needles are removed and then for - Ans - 5 to 10 minutes. If a buttonhole access frequently has long clots that are very difficult to remove, the most likely reason is - Ans - failure to use 2-finger hold for needle removal. A patient who had an AV fistula in the forearm developed an aneurysm and has had to have a new AV fistula created in the upper arm. The patient has a temporary catheter in place for dialysis until the fistula has matured. Which of the following exercises may help strengthen the AV fistula? - Ans - Bicep curl With buttonhole access sites, what should the technician do to prevent "hubbing"? - Ans

• Leave 1/16th to 1/8th inch of the needle exposed. What is the most important factor in preventing exsanguination from dialysis line separation? - Ans - Access site visibility If a patient states that she has been skipping lunch because she is too tired to eat after dialysis, the best solution is to - Ans - report this to the nurse and renal dietician. If a patient exhibits signs and symptoms of hemolysis during dialysis, the immediate action should be to - Ans - stop the blood pump and clamp the blood lines. The amount of dialysis that a hemodialysis patient is prescribed is based on the removal of - Ans - urea.

Maturation of a prosthetic arteriovenous graft usually takes - Ans - 3 to 6 weeks. The purpose of the negative germicide test is to ensure that - Ans - the reprocessed dialyzer is free of germicides. If a patient develops angina (chest pain) radiating to the neck, jaw, and left arm and the patient's blood pressure drops during treatment, the technician should notify the nurse and - Ans - decrease blood flow rate and ultrafiltration rate. The technician is reinforcing a patient's training regarding management of fluid intake. The patient, who still urinates, has a base of 1000 mL intake per day. If the patient urinates 500 mL in a 24-hour period, how much fluid is the patient allowed the following day? - Ans - 1500 mL The greatest risk of bacteremia (infection in the blood) is associated with which type of vascular access? - Ans - Dialysis catheter The external surface of the hemodialysis machine should be cleaned and disinfected at least - Ans - after every patient. When checking the water temperature in the water system, the technician records the temperature at 78°F (25.5°C). In order for the reverse osmosis (RO) equipment that is part of the water treatment system to work properly, the water temperature must be maintained at - Ans - 77°F to 82°F (25°C to 28°C). When testing the total chlorine levels in the water system, the water sample should be taken from the - Ans - first carbon tank. When considering the chain of infection, the three most common reservoirs of interest include humans, environment and - Ans - animals. A solution is a mixture of - Ans - solute and solvent When reinforcing education about weight gain, a patient should be advised that the usual goal for interdialytic weight gain is less than - Ans - 1.0 kg/d. If a high-pressure alarm for arterial pressure (pre-pump) sounds during hemodialysis, this could indicate - Ans - drop in speed of blood pump. If a low-pressure alarm for venous pressure sounds during hemodialysis, this could indicate - Ans - clotted dialyzer. According to KDOQI guidelines, when administering hemodialysis to a patient, a facemask should be worn - Ans - for all access connections.

The most common complication associated with poor needle site rotation in a graft is - Ans - pseudoaneurysm. In hemodialysis, ultrafiltration refers to extraction of - Ans - fluid. The patient has developed a small aneurysm and asks the technician to cannulate the aneurysm for the hemodialysis treatment because another patient told this patient that it would be less painful than cannulation of the fistula. The best response is to - Ans - advise the patient that cannulating an aneurysm may result in rupture. A patient experiences a cardiac arrest with no pulse or respirations during hemodialysis. After the technician calls for help, the next action should be to - Ans - stop dialysis, return blood, and flush access lines with normal saline. When auscultating a patient's AV fistula to listen for the bruit, if the technician notes that the bruit is very high pitched, this may indicate - Ans - stenosis. When using the buttonhole technique for vascular access for hemodialysis, the needles are placed in - Ans - the same sites in a fistula. When inserting a needle for hemodialysis, which of the following increases the risk of infiltration? - Ans - Rotating the needle 180 degrees The legal document that assigns a healthcare proxy to make decisions in the event that a person is unable to do so is called - Ans - durable power of attorney Carbon filters in the water system are necessary to remove - Ans - chlorine, chloramine, and organic materials. Backwashing to free residue from sediment filters in the water system should be done at least - Ans - once daily. With the formula for urea kinetic modeling (UKM), the K in the Kt/Vformula stands for - Ans - urea clearance (mL/min) plus residual urinary output. When inserting needles into a graft for hemodialysis, the needle tips be should be at least how far apart? - Ans - 2.0 inches If a patient is undergoing hemodialysis and the technician notes that a bloodline has separated and blood has pooled beneath the access site, the first intervention should be to - Ans - stop the blood pump. If a dialyzer is to be reprocessed in 3 hours, the dialyzer must be - Ans - refrigerated During hemodialysis, the technician would expect a patient's temperature to rise by about - Ans - 0.5°C.

Approximately what percentage of the total blood volume circulates in the veins? - Ans - 65% to 80% Patients should be advised to avoid eating during hemodialysis because ingestion of food may result in - Ans - hypotension. Prior to using a reprocessed dialyzer, a recirculating rinse with NS should be completed with recirculating flow rate through the blood compartment and the dialysate compartment of at least - Ans - 200 mL/min for BFR and 500 mL/min for DFR. If a hemodialysis patient tests positive for hepatitis C virus (HCV), which of the following interventions does the KDIGO guidelines recommend when providing hemodialysis treatments? - Ans - Adherence to strict infection-control procedures When documenting observations about a patient, which of the following is the most appropriate description? - Ans - "Patient is sighing and rubbing hands together." Which of the following is the most common cause of hypotension developing during hemodialysis? - Ans - Removing excessive volume of fluid Which of the following interventions is most likely to decrease hypotension that occurs during hemodialysis? - Ans - Decreasing the ultrafiltration rate If an air detector alarm sounds during hemodialysis, stopping the dialysis process, the technician should first - Ans - ensure the pump has stopped and clamp the venous line. If outflow stenosis of an AV fistula occurs, the thrill usually - Ans - is loud and higher pitched and then discontinuous. When reviewing a patient's food diary, the technician advise the patient that which of the following protein sources is of low biological value? - Ans - Dried beans Which of the following vitamins may be removed by hemodialysis? - Ans - Vitamin B The renal nutritionist has advised the patient to have a diet high in fiber, but the patient is unsure which foods to choose. Which of the following foods per serving is highest in insoluble fiber? - Ans - Kidney beans The primary purification process of the dialysis water system is - Ans - reverse osmosis. If the dialysis center uses HemaClips® on dialysis tubing to prevent disconnection, what other precautions should be utilized? - Ans - Visible access sites/line connections and documentation of integrity every 30 minutes

If during hemodialysis, blood is evident in the used dialysate, this probably indicates - Ans - tear in the membrane. If a patient asks a question to which the technician does not know the answer, an appropriate response is - Ans - "I'll find out for you." During routine hemodialysis, a patient's blood pressure should be monitored every - Ans

• 30 to 60 minutes. If a patient develops painful muscle cramps in the hands, feet, and abdomen shortly after hemodialysis begins, the most likely intervention is - Ans - saline bolus and/or decreased ultrafiltration rate. If a hemodialysis patient's temperature per tympanic membrane thermometer is 37°C, in order to reduce incidence of intradialytic (during dialysis) hypotension, the temperature of the dialysate solution should ideally be set at - Ans - 36.5°C. Foam in the venous bloodline of a dialyzer may indicate - Ans - air embolism. Prior to initiating hemodialysis, the pH of the dialysate must be verified. The pH of dialysate usually ranges from - Ans - 7.0 to 7.4. The number one cause of kidney failure in the United States is - Ans - diabetes mellitus, type 2. The use of topical anesthetics, such as EMLA, to reduce discomfort during cannulation is contraindicated with - Ans - buttonhole sites. When determining if a new AV fistula is maturing, the three factors to assess by palpation are the - Ans - thrill, vessel growth, and vessel firmness. A patient who has been very alert and shown no sign of cognitive impairment seems confused during dialysis and repeatedly asks the same question. The best initial response is to - Ans - notify the nurse. Which of the following antiseptics used for skin prep for a fistula site has the broadest spectrum antibacterial activity? - Ans - 2% chlorhexidine gluconate While a patient is undergoing hemodialysis, chloramine testing of the water system should be conducted every - Ans - 4 hours. If a patient is to undergo heparin-free dialysis, the optimal blood flow rate is - Ans - 300 to 400 mL/min. Before cannulating an AV fistula for a hemodialysis treatment, the technician examines the patient's access arm and finds that the access arm appears slightly edematous, and

the skin is pale. On further examination, the technician notes that there are small purple veins evident on the chest wall near where the arm meets the body. The technician should suspect - Ans - stenosis. In order to increase survival rates, the ultrafiltration rate for hemodialysis patients should be maintained at less than - Ans - 12 mL/kg/m. As part of fistula assessment before cannulation, the technician evaluates the thrill and then applies occlusion by placing a finger across the body of the fistula. While the fistula is occluded, the technician palpates and feels both a thrill and a pulse. This probably signifies a(n) - Ans - accessory pathway (collateral circulation). How much additional protein should a patient on hemodialysis ingest every day in comparison to a healthy person? - Ans - 50% Weight gain between hemodialysis treatments should not exceed - Ans - 5% of dry weight. The most important reason for placing hemodialysis needles in antegrade position (in direction of blood flow) is because - Ans - it causes less scarring. When preparing dialysate with a 45X concentrate, if the proportioning ratio contains 1.0 part acid and 1.72 parts bicarbonate, how many parts of water are needed? - Ans - 42.28 If conductivity monitoring stops dialysate from flowing to the dialyzer but instead sends it to the drain (bypass), this means that - Ans - the conductivity monitor detected the wrong dialysate. When using a portable digital dialysate meter, such as the D6® (Myron L Meters), to verify that inline meters are accurate regarding conductivity and pH, the technician must

• Ans - obtain an unused dialysate sample. The target ultrafiltration goal set for the patient is based on the patient's - Ans - dry weight. A patient is to receive a bolus of unfractionated heparin (25 IU/kg) at the onset of dialysis and 800 U at one-hour intervals during treatment, which is scheduled from 1 to 5 PM. The first dose is given at 1 PM and the last dose at - Ans - 4 PM. When checking the pump occlusion for the blood pump, the technician notes that the rollers appear loose. This may result in - Ans - cracking of the blood pump segment of tubing. In the hemodialysis machine, a separate air detector is usually placed - Ans - between the venous pressure gauge and the venous access.