CCHT EXAM | ACCURATE QUESTIONS AND DETAILED ANSWERS | GUARANTEED PASS | GRADED A, Exams of Nursing

Download CCHT EXAM | ACCURATE QUESTIONS AND DETAILED ANSWERS | GUARANTEED PASS | GRADED A and more Exams Nursing in PDF only on Docsity! CCHT EXAM | ACCURATE QUESTIONS AND DETAILED ANSWERS | GUARANTEED PASS | GRADED A | LATEST UPDATE The emergency department is sending a patient to the dialysis unit due to a drug overdose which condition should the dialysis tech be aware of prior to patient arrival A. Hypertension B. Respiratory apnea C. Severe acid base in balance - Ans - B and C A new client with CKD asks the tech what does nocturnal intermittent peritoneal dialysis mean how do you answer A. The initial volume will be small but will increase to a total volume infused every morning B. The machine will provide 3 to 5 exchanges every night but only minimal or no dwelling during the day C. You will receive dialysis 3 to 4 times a week with dry periods In between treatments - Ans - B. The patient has had an expected progression of CKDN needs urgent start peritoneal dialysis what problems may be present in the patient who has been prescribed urgent start A. Fluid volume overload B. New onset jaundice C. High BUN and creatinine levels - Ans - A and C What is considered the advantage of coiled catheters for peritoneal dialysis A. Improve patient comfort B. Better flow fluid C. Les linking - Ans - A. Which complication of peritoneal dialysis should the tech report when he observes Cloudy effluent A. Tunnel infection B. Fibrin formation C. Peritonitis - Ans - C. Which patient complaint leads to tech to suspect air has entered the peritoneal cavity A. Shoulder pain B. Swelling in the neck C. Scrotal Adema - Ans - A. A family member asks what is the most frequent complication of peritoneal dialysis how would you answer A. Formation of Fibrin stands B. Peritonitis C. Leakage of dialysate - Ans - B. What are some disadvantages of a kidney transplant that should be shared with patient and family A. Abdominal pain due to incising muscles B. Need for lifelong immunosuppression C. That's potential complications of immunosuppression - Ans - B and c A patient ask the tech how long does a patient have to stay in the hospital after undergoing a kidney transplant what is the response A. 2 to 3 months until kidneys functioning B. One month C. Three to five days - Ans - C. Following transplantation which electrolyte abnormalities are treated with dialysis A. High potassium level B. Acidosis C. Low magnesium levels - Ans - A and B Transplant patient who is undergoing dialysis for hyperkalemia asks which vaccination should I avoid after I have this new kidney which one should be avoided A. Flu shot B. Small pox vaccine C. Bacillus calmette-guerin - Ans - B and C Which diagnostic indicator leads to the staff to suspect the patient is experiencing rejection of her transplant kidney A. Low hemoglobin level B. Elevated serum BUN C. Elevated serum creatinine - Ans - C. - Ans - C. NDAC What is the composition of saline A. 10% salt added to water B. Albumin C. 0.9g of sodium chloride and 100ml of water - Ans - C. 0.9g of sodium and 100ml of h2o When caring for a patient if the dialysate solution contains two little sodium the water may shift into the patient's blood cells which signs or symptoms would you see A. Hypotension B. Cramping C. Thirst D. Headache - Ans - A and B Which buffer is the major plasma buffer therefor important during dialysis A. Bicarbonate B. Amino acid C. Protein - Ans - A. Bicarbonate While reviewing the body weight for a dialysis patient the tech knows that ——— of the total amount of water is contained in the intracellular fluid compartment A. 20% B. 30% C. 40% - Ans - C. 40% How much water is lost through evaporation form lungs every day A. 250-499 ml of water B. 700-1,000 ml of water C. 1500-2000 ml of water - Ans - B. A patient asks to explain what the normal kidney does in addition to making urine what's the response A. Regulate fluid volume in body B. Regulate pH in blood C. produce erythropoietin that controls red blood cell production D. I receptor sites for several hormones - Ans - All of the above A patient with a renal failure asks if his candies will regenerate how does the technician answer A. With a diet low in sodium and exercise there's a good chance you'll get some function back B. If nephrons are damaged they do no regenerate C. If the heart can pump in a blood to the kidney there is a possibility that some of the nephrons can regenerate - Ans - B. If nephrons are damaged they won't regenerate This patient's kidneys have permanently lost most of their ability to remove waste and maintain fluid in chemical balance what's the patient's likely estimated glomerular filtration rate A. Less than 15 ml/min/ B. 60-89 ml/min/1.73 C. 30-44 ml/min - Ans - A. Less than 15 The patient asks the dialysis technician if there's anything she can do to slow the progression of her kidney disease. Which risk factor could the technician mention during the conversation A. Control your blood glucose levels if you're a diabetic B. Maintain healthy weight C. Control cholesterol levels D. Stop use of alcohol - Ans - A B and C Which recommendation would've nephrologist likely make for a patient who has read stages three or four chronic kidney disease A. We'll tele health visits discussing daily urine output B. Dietary restriction on sodium phosphorus and protein C. Monitoring for mineral bone disease D. Education on cardiovascular disease - Ans - B,C and D Which patient would be considered at higher risk for developing chronic kidney disease A. Hispanic female who is unaware that she is hypertensive B. White female with family history of diabetes who watches her exercise and diet C. Asian male who schedules regular visits with healthcare provider D. African-American female whose parents both died following stroke - Ans - A and D Patient with chronic kidney disease asks what her goal hemoglobin level should be what level as recommended by the national kidney foundation kidney disease guidelines A. 9% B. 7% C. 11% - Ans - B.7% Patient with chronic kidney disease arrives at the center after his nephrology visit he relays to the staff that the doctor said he was hardening of the kidneys what is the cause of this condition A. Prolonged severe hypertension B. Daily ingestion of sugar sweetened drinks C. High fat diet D. Too much calcium in the diet along with hypertension - Ans - A. What is one cause of postrenal failure A. Renal trauma B. Prostrate disease C. Fluid volume shifts D. Kidney infections - Ans - B. Prostate disease The family member of a dialysis technician has noted blood in his urine the tech also noted the weight loss and rubbing of the flank to ease the cramping pain which disease comes to mind A. Nephrotic syndrome B. Bladder infection C. Kidney stones D. Renal carcinoma - Ans - D. Renal carcinoma Which integumentary changes are commonly seen in patients with chronic kidney disease A. Brittle nails B. Excessive sweating C. Bruising D. Increase number of moles - Ans - A and C Monday also patients infection account for about one and 10 fatalities which condition increases a patient's susceptibility to infection A. Diabetes B. Malnutrition C. Bone abnormalities D. Frequent invasive procedures - Ans - A B and D Management of renal bone disease requires that ministration of which type of medication with every meal and snack A. Potassium and substitutes B. Antacids C. Phosphate binders C. Diffusion - Ans - A. Adsorption What type of contaminants are removed from water used in dialysis A. Endotoxins B. Aqueous salts C. Water softeners - Ans - A and B When preparing for reverse osmosis what type of membranes should the tech be prepared to utilize A. Peritoneum B. Cellulose acetate C. Thin film composites D. Chlorine resistant polysulfone - Ans - B C and D Which problems may occur when using a deionizer A. It can be hard initially to obtain the maximum flow rate needed B. The service life of a deionizer may be short and essential that the filters be placed downstream C. Resin beds tend to exhaust suddenly in the tanks may need to be exchanged D. If the resin tanks are used to exhaustion previously removed ions may be released - Ans - All of the above When preparing the water used for the dialysate and reprocessing of dialyzers the CMS require "conventional dialysate" to have a max level of bacteria less than ——— CFU A. 300 B. 100 C. 200 - Ans - C. 200 How often at a minimum is it recommended to cleanse all components of the water treatment system with an approved disinfectant A. Quarterly B. Monthly C. Biweekly - Ans - B. Monthly What are the most common methods for reducing microbiological contaminants and water use during dialysis A. Infusion of antibiotics in water tank B. Applying a sub micron filter C. Use of a filtration device - Ans - B and C Which person on the team is responsible for ensuring the quality of water used for dialysis has met the standards A. Registered nurse B. Nurse manager C. Medical director - Ans - C. Medical director When a dialyzer is prepared to use what actions are required prior to beginning the session A. Prime the dialyzer B. Remove all air in the dialyzer C. Flush the dialyzer with Celine prime to remove all particulate matter D. Remove any disinfectant left behind by rinsing under cold water - Ans - B and C place the steps for a re-processing/re-using a dialyzer in the correct order A. Disinfect with chemical or heat B. Flush dialyzer to remove most of blood C. Test dialyzer D. Cleanse dialyzer with chemicals and reverse ultrafiltration - Ans - B then D then C then A According to standard precautions when should gloves be changed and hands washed A. When gloves are contaminated B. When going from clean body side to contaminated body site on the same person C. After handling infectious waste containers D. After touching patient as in preforming physical assessment - Ans - A C and D How should hand hygiene be performed A. With bar of soap and scrub brush B. With antiseptic soap and water C. With hand sanitizer D. With waterless alcohol base hand rub with 60-90% alcohol content - Ans - B and D What type of garment should be worn during processes likely to generate droplets of bodily fluids A. Patient gown tied in back B. Weighted lead aprons C. Impervious isolation gowns - Ans - C. Isolation gowns When washing hands with soap and water what's the minimum number of seconds hands should be rubbed together A. 10 B. 15 C. 30 - Ans - B. 15 What are the most common ways Hep B virus is transmitted in a unit A. Skin penetration by contaminated sharps B. Contact of contaminated blood with broken skin C. Pts with Hep B breathing or coughing on others - Ans - A and B Filling the accidental exposure to blood from a pt HIV positive what tx is recommended A. 3 month prescription of med to prevent HIV B. Follow up blood test three months after exposure C. 4 week 2 drug regimen is recommended within 72 hours of exposure - Ans - C. According to the CDC health care workers exposed to needle stick involving HIV infected blood have a 0.23% chance of becoming infected if untreated. After a needle stick or sharps exposure to hep C virus what is the risk of developing infection A. 0.01% B. 0.5% C. 1.8% - Ans - C. 1.8% What are the recommendations for dialysis personnel caring for patients with clostridium difficile colitis A. Wear gloves when treating patient B. Impervious gowns upon entering room C. Wash hands with soap and water - Ans - All of the above Why is anticoagulation therapy used in dialysis A. To foster good venous blood flow in fingers and toes B. To reduce clotting within the extracorporeal circuit C. To optimize dialyzer efficiency - Ans - B and C How is heparin commonly administered A. Initial loading dose of heparin is given before tx begins B. Directly into arterial needle C. Administered throughout tx by direct injection - Ans - A. Initial dose When blood is transfused into at risk patients during heparin free dialysis what complication should the technician be monitoring for A. Fluid removal overload B. Anaphylaxis reaction C. Increased velocity of the blood in the dialyzer - Ans - C. Increased velocity If a dialysis patient does not have adequate vessels to create an internal fistula what is the remedy A. Veins surgically transferred from other areas of the body B. Wrapping mesh around scarred veins C. Using synthetic grafts - Ans - C. Using synthetic grafts A patient tells the text that she woke up in the morning with her fistula arm underneath her head and that it has been asleep and feeling funny all day knowing this which complication should the tech assess the patient for prior to assessing her site A. Cervical disc pain resulting in nerve damage B. Thrombosis caused by compression of blood flow C. Aneurysm of the official site due to kinking of the artery - Ans - B. B. Plant proteins are low biological value proteins and need to be combined to get all building blocks her body needs C. No plant protein foods are considered high proteins so it will be hard for her to satisfy her protein needs - Ans - B. For a patient with stage 5 CKD phosphorus intake should be limited to what level A. 400 to 800 B. 1200 to 1600 C. 800 to 1200 - Ans - C. A patient with CKD is having difficulty controlling her phosphorus intake why is control of phosphorus challenging A. Phosphorus is abundant in fresh food such as vegetables and fruit B. Phosphorus is found in high amounts of coffee and tea C. Phosphorus additives are commonly found in best-selling processed foods - Ans - C. A patient with stage 5CKD has C Dash reactive protein level of 25 what does this level suggest A. Early onset diabetes B. Inflammation in the body C. Heart attack - Ans - B. Parathyroid hormone helps to regulate calcium and phosphorus levels low serum calcium levels stimulate secretion of parathyroid hormone this results in which change of the body A. Increase calcium absorption from small intestine B. Calcium loss in the urine is minimize C. Movement of calcium out of the bones D. Creation of a urinary buffer for acid base balance - Ans - A B and C How can a dialysis procedure be modified for a CKD patient with severe elevated blood urea nitrogen level A. Shorten dialysis time B. Increase blood flow rate C. Increased time rinsing the equipment D. Use a larger dialyzer - Ans - B and D Which asymptomatic patient meet the criteria for testing for diabetes or prediabetes A. African-American and Latino or Native American B. Triglyceride level of 150 MG/DL C. Patient is on antihypertensive medication - Ans - A and C A pts lab results revealed a significant drop in hemoglobin. Which med would the tech expect the nurse to administer to the pt A. Calcitrol B. Erythropoietin C. Vancomycin - Ans - B. Which of the following practices helps to build a pts immunity to hep B A. Isolation B. Vaccination C. Sequestration - Ans - B The tech is unsure which one of a patient's arteriovenous graft is arterial and which one is Venus in order to differentiate what do you do A. Cannulate both sides and observe the color B. Apply a tourniquet to the arm and feel for venous resistance C. Compressed a graft in the middle and palpate each side - Ans - C. At the end of a patient's treatment which of these findings is observed by the tech should be reported A. Pulse rate of 55 B. Temp of 98 C. Weight loss of 6.6 - Ans - A. Why are pts more likely to become infected with germs like MRSA A. Their diet is restricted B. Have weak immune systems C. Often have allergies to most antibiotics - Ans - B. A pt who has diabetes should be observed for signs of low blood sugar which include A. Fever and chills B. Thirst and weight gain C. Anxiety and confusion - Ans - C. The water supply to the water treatment system is called A. Ground water B. Carbonated water C. Feed water - Ans - C Which part of the water treatment system removes endotoxin A. Ultra filter B. Resin bed C. Softener - Ans - A. A pt asks why they need a profile on their machine the techs response should be that the understanding of the profile is to A. Minimize clotting B. Minimize hypotension C. Maximize flow rate - Ans - B. Which occurs when the machine alarms and goes into bypass A. Arterial pressure increases B. Heparin isn't administered C. Dialysate stops flowing through the dialyzer - Ans - C. Which therapy is recommended for pt with a hemoglobin level of 7.5% who watches her diet and exercises during the week A. Quadratic therapy with metformin and three meds B. Monotherapy and metformin C. Dual therapy with metformin plus one med - Ans - B. KDOQI guidelines recommend screening patients with diabetes for diabetic nephropathy which test will be ordered A. Urine for microalbuminuria B. eGGR for Values below 90 mL/min C. Fasting glucose <100 - Ans - A and B A child who has in just a large amount of poison is brought to the emergency room the tech is preparing the child for dialysis for it to remove the poison the poison must have which characteristic A. High degree of Protein binding B. Water solubility C. Low molecular weight - Ans - B and C While reviewing the latest information on hypertension the dialysis tech notes that a blood pressure of 130/80 mmHg or higher is considered hypertension in which people A. Those with diabetes B. Those with CKD C. Those this cardiovascular disease - Ans - A and B A dialysis patient regularly experiences intradialytic hypotension which medication may be given 15 to 30 minutes before dialysis for blood pressure support A. Amlodipine calcium channel blocker B. Losartan angiontensin receptor blocker C. Midodrine a vasopressor - Ans - C. A dialysis patient asked the technician why am I taking Velphoro what medication does this fall under A. Phosphate binders B. Calcium channel blocker C. Cation exchange resin - Ans - A. A patient has been diagnosed with acute kidney injury what symptoms might the family notice A. Listlessness B. Dark circles under eyes C. Confusion What are symptoms of fluid overload? - Ans - Edema, cough, SOB, increased b/p, confusion What are 3 types of solutions? - Ans - Hypertonic (containing more particles) Hypotonic (containing less particles) Isotonic (containing equal particles) What is diffusion? - Ans - The movement of solutes from an area of GREATER concentration of solutes to an area of LESSER concentration. What factors affect the rate of diffusion? - Ans - Concentration gradients, Molecular weight, temperature What is osmosis? - Ans - Movement of fluid from an are of LESSER concentration to an area of GREATER concentration. At what point during treatment will diffusion cease to occur? - Ans - Continue until the concentration of each electrolyte found in the patients blood is equal to the electrolyte concentrating in the dialysate. What is dialysate? - Ans - Non-sterile solution, composed of purified water, acid solution, and bicarbonate solution. What is the function of dialysate? - Ans - To remove waste products from the blood and balance electrolytes. What electrolytes are found in the dialysate? - Ans - Sodium (NA), potassium (K), calcium (Ca), magnesium (Mg), and chloride (Cl) Why is dextrose added to dialysate? - Ans - To prevent hypoglycemia What is the purpose of checking dialysate? - Ans - To verify that the dialysate is compatible with human pH When should conductivity and pH be checked? - Ans - Manually prior to the ignition of every treatment What are normal ranges for temperature? - Ans - 35-39 C What are normal ranges for pH? - Ans - 6.9-7.6 What are normal ranges for conductivity? - Ans - 12.6-15.9 Why do we use biocompatible membranes in the dialyzer? - Ans - Closely related to the cells and tissues of the human body, less likely to cause allergic reaction What are some factors used in the selection of a dialyzer for a patient? - Ans - Body size, clearance needs, ultrafiltration needs and membrane biocompatibility. What are the compartments of the dialyzer? - Ans - 1) Blood compartment 2) Dialysate compartment What separates the 2 compartments? - Ans - The blood compartment is separated from the dialysate compartment by a semi-permeable membrane. What is a semi-permeable membrane? - Ans - A membrane made from protein, with small pores or holes. Only certain molecules can fit through. What should be checked on a dialyzer before machine set up? - Ans - Checked for sterility, structure damage, and be the size and brand ordered by the Dr How is dialysis delivered? - Ans - The Hemodialysis Machine. How much saline should be infused through the dialyzer and extracorporeal circuit? - Ans - 300 mLs to prime the dialyzer and circuit with normal saline. How much saline is used for a "fresh fill"? - Ans - 50 mLs NS through the arterial and 250 mLs NS through the venous. When should the Hanson connectors be connected to the dialyzer? - Ans - NS has been primed, both lines connected, test passed, and conductivity and pH checked. What position should the dialyzer be in during circulation? - Ans - Venous end up How long can a dialyzer recirculate with saline before it is considered unsafe to use? - Ans - 4 hours What volume should be used for fresh fill? - Ans - 50 mL of saline from arterial and 250 mL of saline from venous What 3 processes occur in the dialyzer simultaneously? - Ans - Diffusion, osmosis, and ultrafiltration What is ultrafiltration during dialysis? - Ans - More than 1 type of pressure to remove fluid from the blood, positive and negative pressure combined. What direction does blood flow through the dialyzer as compared to dialysate flow? - Ans - Blood and dialysate flow in a countercurrent flow. What is TMP? - Ans - Transmembrane pressure, the pressure difference across the dialyzer membrane. How can you tell if a dialyzer is clotting? - Ans - Rising TMP, rising venous pressure, dark blood in dialyzer, and air detector alarms. What is heparin? - Ans - Anticoagulant that prevents clotting After heparin is given, how long must you wait before initiating treatment? - Ans - 3-5 minutes When do you not give a patient heparin? - Ans - 1) Allergic to it 2) Actively bleeding 3) Scheduled for surgery/Post surgery For how long can a patients blood be re-circulated during treatment interruption? - Ans - 15 minutes, longer than 15 minutes blood needs to be given back 1 kg = - Ans - 2.2 lbs What does "estimated dry weight" mean? - Ans - Estimated weight of the patient without any s/s of edema What is adequacy of dialysis? - Ans - Measurement of how well we are cleaning waste from the patients blood How can we measure how well we clean our patients blood? - Ans - By measuring the amount of waste in the patients blood before and after dialysis. Clearance of urea is best described as? - Ans - The amount of urea cleared from the blood in milliliters per minute (ml/min) What improves clearance of urea? - Ans - Well-functioning access, proper priming, dialysate flow, blood flow, heparin Why is measuring the adequacy of the dialysis treatment important? - Ans - When treatment is more effective, patients live longer and have fewer health problems. What does Kt/V stand for? - Ans - An equation used to determine how well dialysis is occurring. K=Clearance, t=time, and V=total volume of waste in the patient What is OLC? - Ans - On Line Clearance, measures removal of waste from the bloodstream. What is the purpose of AMP lights? - Ans - To provide visual indicator for treatment adequacy What is KECN? - Ans - 'Clearance effective by conductivity sodium', refers to the clearance of sodium as measured by the conductivity changes.