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

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CCHT Exam Part A ACCURATE TESTED

VERSIONS OF THE EXAM FROM 2023TO

2024 | ACCURATE AND VERIFIED | NEXT

GEN FORMAT | GUARANTEED PASS

What is the proper procedure regarding the removal of chlorine and chloramines in a two tank system?

• Ans - If sampling reveals there is a chlormaine >0.1ppm leaving first tank, second tank must be sampled Polymade membranes used for RO:
  • Ans - Have a wide pH tolerance, are very susceptible to degredation by free chlorine What is an advantage of RO water treatment?
• Ans - Rejects bacteria, viruses, and pyrogenic material if membrane is intact What type of water is produced by deionozers?
  • Ans - Water of high ionic purity How is UV light used in treating water?
  • Ans - To destroy microorganisms The max level of endotoxins in water used to prepare dialysate must not exceed:
• Ans - 2 EU/mL If water quality standards are not met, who may be cited as the negligent party?
• Ans - MD When preparing a dialyzer for pt use, the tech must ensure:
  • Ans - There is no air in the dialyzer What is the order in which the dialyzer is primed?
  • Ans - 1) prime normal saline into the dialyzer from bottom 2) run the bloodlines to the dialyzer, dialyzer upside down 3) run saline through arterial bloodline, through dialyzer then to the venous bloodline 4) tap dialyzer to get all air out How much saline is needed to prime dialyzer?
  • Ans - 500 - 1000mL When would a reused dialyzer be rejected?
• Ans - Renalin exposure was 4 hours total Two people must verify that __ and that __ before using a reprocessed dialyzer:

• Ans - the dialyzer is correct for the specific pt, the disinfectant is negative Name two guidelines concerning hand washing:
• Ans - 1) when decontaminating hands via alcohol, rub until dry 2) clinics must have dedicated 'clean' sinks for handwashing only Hep B: - Ans - 1) highly transmissible 2) live on a surface for a week How is a pt who is Hep B + safely dialyzed?
• Ans - Using an isolation room with dedicated machine, and using dedicated supplies If a staff member is immune to Hep B d/t vaccines, what will the labs show?
• Ans - Anti HBc - and Anti- HBs + A staff member tests positive for IgM to Hep B. What does that mean?
• Ans - He has had a recent infection w/ Hep B What is the CDC recommendation for Hep C screening?
• Ans - Monitoring all pts for liver enzyme elevation How can pts with antibiotics resistant infections be safely treated?
• Ans - Following standard precautions, and making sure all reusable equipment is sanitized before reuse When a dialysis pt is infected with CRC, what type of precautions should be used? - Ans - Contact iso What solution is used to clean machines, chairs, IV pumps, etc?
• Ans - Bleach, 1:100 or 1: After heparin is given, what adverse event is more common?
• Ans - Bleeding How long is the half life of heparin?
• Ans - 90 minutes When citrasate acid is used:
• Ans - hypocalcemia is no longer a concern, anti-coagulation is improved What is the preferred access for ESRD pts?
• Ans - Radial cephalic arteriovenous AV fistula What precautions should pts with stage 4 or 5 follow?
• Ans - Wear a medical bracelet that discourages use of vessels that may be needed for dialysis

What are the advantages of having a proximal radial artery AV fistula placed?

• Ans - Good for pts with advanced arteriosclerosis and inhibit steal syndrome What are two advantages of a graft vs a fistula?
  • Ans - Quicker healing time, easier to cannulate What is the most common complication of AV fistulas?
  • Ans - Thrombosis When a pt is dilayzed at a high BFR with a small needles, what may result?
  • Ans - Hemolysis of RBCs What are the s/s of severe re-circulation by stenosis?
• Ans - pH below 7 and very dark blood What are some of the responsibilities and requirements of the medical director of a dialysis facility?
  • Ans - Being knowledgeable of and responsible for the integrity of the water treatment system in the facility Prior to beginning dialysis, what must the physician order include?
  • Ans - Specific dialyzer, BFR, Duration To sit for the CCHT-A exam, the tech must have what?
  • Ans - Hold another national certification such as CCHT, and have worked at least 5,000 hours as a hemo tech What abilities are required of a dialysis tech?
• Ans - Some understanding of anat/phy and pathophys of CKD, full understanding of the principles of dialysis and tx complications, math skills What certification program offers the dialysis tech the most cognitive content related to water tx principles?
  • Ans - Cert biomedical nephrology technology What consents are needed for dialysis?
• Ans - 1 for treatment, 1 for access procedures If a patient decides to terminate dialysis, what should the staff do?
  • Ans - Realize it is well within the pts right to choose termination. Who was the first person to use the term 'dialysis'?
• Ans - Thomas Graham What was the primary anticoagulant used in the first artificial kidney?

• Ans - Hirudin Dr Kolff created the first bio-compatible (rotating drum) dilyzer. What material was used to construct the hollow tubes? - Ans - cellophane The first AV shunt for CKD was placed...
• Ans - externally, using Teflon tubes Which US President signed the bill that allowed Medicare coverage for CKD tx?
• Ans - Nixon In 1989, the FDA approved a drug that diminished the need for blood transfusions in CKD
• Ans - Epogen (mircera) An electrolyte is a substance that dissolves in water to form
• Ans - Ionized particles What happens to a pt is the dialysate contains too much sodium?
• Ans - Fluid leaves the cells and they shrivel, the pt will get hypotensive, thirsty and get a headache With osmosis, water moves from areas of. . - Ans - low concentration to areas of high concentration of solutes Buffers minimize the pH changes when an acid or a base is added to a solution. What is the major plasma buffer in the body?
• Ans - Bicarbonate Kidney failure causes retention of hydrogen ions. What is the result?
• Ans - Metabolic acidosis Which of these pt populations has the lowest proportion of body water?
• Ans - Adult females The vasa recta capillaries surrounds the loop of Henle nephrons and play a major role in...
• Ans - Concentration of urine as it moves through the tubules In the formation of urine, what action is occurring in step 2?
• Ans - Water and other dissolved substances move from the tubules into the blood in the peritubular capillaries. The GFR is the amount of filtrate produced by the kidneys per minute. What is GFR dependent on?

• Ans - Sufficient blood circulation to the glomerulus , and maintenance of normal filtration pressures Blood urea levels are influenced by many factors. Decreased levels may result from: - Ans - Low dietary protein intake, overhydration At the conference 'Kidney Disease: Improving Global Outcomes on CKD' it was recommended that stage 3 be divided into 3a and 3b. What is the recommended GFR for 3b?
• Ans - 30 - 44mL/min/1.73m^ The NKF recommends that all individuals be assessed for increased risk for developing CKD. Which of these laboratory values should be included in said eval?
• Ans - Creatinine When is a pt considered to be in stage 5 CKD?
• Ans - When the pt requires maintenance dialysis for survival A patient with a diagnosis of nephrosclerosis may exhibit...
• Ans - Blood in urine, proteinuria, uncontrolled hypertension What is a common clinic manifestation of renal cell carcinoma?
• Ans - Blood in urine Which of the following may be a cause of postrenal acute renal failure?
• Ans - Obstruction in the ureter or the uthera What is the target blood pressure in pts with CKD recommended by the JNCPDETHBP?
• Ans - < 130/ A pt presents to the nephrologist office with c/o chest pain, fever, and chills. Dr hears a pericardial friction rub during auscultation. Echocardiogram confirms a pericardial tamponade. What procedure is likely next?
• Ans - A pericardiocentesis where a needle is inserted into the pericardial space to remove fluid. What are integumentary changes commonly seen in pts with chronic CKD?
• Ans - Brittle nails, ecchymosis Dialysis pts are at higher risk of infection. What increases their susceptibility?
• Ans - Diabetes, malnutrition, frequent invasive procedures The CDC recommends that DPC staff be annually tested for what infection control? - Ans - Hand hygiene, CVC dressing change, vascular access technique

What are the causes of anemia in CKD pts?

• Ans - Decreased production of erythropoietin, impaired intake of iron from food, loss of blood through the GI What are two of the s/s of anemia in CKD pts?
• Ans - Dyspnea and fatigue What is the recommended tx for osteodystrophy in CKD pts?
• Ans - Administration of phosphate binding agents Most pts who have been on dialysis for more than __ have dialysis amyloidosis
• Ans - 10 years CKD pts are at risk for developing peripheral neuropathy. How does it manifest?
• Ans - Burning feet, restless legs What are the advantages of hollow fiber dialyzers?
• Ans - The UF is precisely controlled, they can be reused. Pts sensitive to ethylene oxide sterilization techniques may benefit from having their dialyzer cleaned by ____ which contains no chem or radioactive materials
• Ans - Electronic beam or e-beam What are three disadvantages from using a synthetic membrane?
• Ans - They're expensive, require manual UF control, they absorb proteins Long term exposure to bio-incompatible membranes can cause:
• Ans - Increased incidence of infection and malignancy, impaired nutritional status Bicarbonate is...
• Ans - very susceptible to bacterial contamination What happens when the bicarb is overmixed?
• Ans - Decrease in serum calcium levels. Which test is used to detect and quantify bacterial endotoxins?
• Ans - Limulus amebocyte lysate During a dialysis session, a temp ____ will cause hemolysis
• Ans - Over 41 degrees What should be done if the blood leak alarm goes off, but there doesn't appear to be contamination?
• Ans - Test dialysate with an approved blood leak test strip

Where are the two places air can enter the lines? - Ans - At loose connections, and empty fluid containers What does high efficiency dialysis require? - Ans - Highly permeable cellusoc membrane with a surface Dialysis techs working with pts on tx should watch for bacterial infection. Why is blood contamination a problem with high-flux dialysis? - Ans - High flux membranes readily pass particles of 2,000-10,000 daltons in size How does flow rate affect the removal of toxins? - Ans - The greater the flow rate, the greater the removal of solutes. To achieve an optimal concentration gradient, what direction should blood and dialysate flow? - Ans - In opposite directions During UF, what happens when positive pressure is applied to the blood side of the dialyzer? - Ans - Plasma fluid will be pushed out If reverse filtration occurs and dialysate get into the blood, with might the pt experience?

• Ans - A pyrogen reaction; AKA fever What principle is used to increase tx tolerance and decrease complications d/t fluid removal? - Ans - UF profiling A pt is on a Crit-Line. If the fluid removal is greater than the pt can shift into the intravascular space, what can occur? - Ans - Hypovolemia What is the most common impurity in tap water? - Ans - Calcium carbonate What chemicals can cause methemoglobenemia, in which red cell hgb can't transport oxygen? - Ans - Nitrates and chloramines In order to remove smaller solutes, such as endotoxins, which filter should be used? - Ans – UF Peritoneal dialysis different from hemodialysis in which of the following ways - Ans - PD access is by an intra-abdominal catheter Which of the following dialyzers is used currently - Ans - Hollow tube The glomerular filtration rate is an important index to renal function and in the normal adult is approximately - Ans - 125ml/min/1.73m The most likely cause of post renal failure is - Ans - Benign prostatic hypertrophy

What percentage of transplanted kidneys is functional 1 year after transplantion - Ans - 90% Failure to excrete beta2 Microglobulin in patients with kidney failure predisposed to - Ans - Amyloidosis Uremia may cause which of the following conditions - Ans - Itching edema and anemia Blood test for ferritin are performed in hemodialysis patients - Ans - To check for iron stores Which of the following phosphate binders would best control hyperphosphamia me with the fewest side effects and patients with end-stage kidney disease - Ans - Lanthanum carbonate In the dialysis water may be removed from - Ans - The interstitial compartment Which site in the hemodialysis pathway has the highest positive pressure - Ans - Blood entering the dialyzer fibers Water moves from one body compartment to another by - Ans - Osmotic forces Biocompability to the best illustrated by - Ans - Reprocess dialyzer that have had a better biocompability than the new ones A patient with kidney disease has anemia but the elevator phosphorus levels ankle edema and elevated blood pressure what is the most likely range of his glomerular filtration rate? - Ans - 60 - 90ml/min Adding extra sodium chloride to the dialsyate will? - Ans - Draw water out of the cells and tissues into the blood What does the expression KT/v signify with regard to hemodialysis? - Ans - Prescribed dose of dialysis. Acute Tubular necrosis may be caused by - Ans - Shock and hypotension Rhabdomyolysis Radiographic contrast material 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 A recent study published in the New England Journal of Medicine compared hemodialysis three times a week with hemodialysis 6 times a week at the end of the 12 month follow up. The studies show that 6x of the group had? - Ans - Fewer deaths

Which of the following statements about administering erythropoietin to a hemodialysis patient is correct? - Ans - Give supplemental iron ferret it is low the nephrotic syndrome is characterized by all of the following - Ans - Proteinuria greater than 3.5 G/d/1.72 m2 body surface area Hyperlipidemia Hypoalbuminemia A diet restricting all of the following is appropriate for a renal failure patient - Ans - Potassium phosphate fluids What is the sensitization test for a potentional kidney transplant recipients - Ans - Potential recipit sternum tested,with a multiple donor lymphocyte panel Which of the following immunosuppressive drugs used in kidney transplant patients have renal toxicity - Ans - Cyclosporine All of the following statements regarding kidney transplantation - Ans - The rate of death is 3 to 5% range during the first year Diabetes heart disease and older age decreases the success rate There he is a ten 10% to 15% lower success rate in the first transplant is rejected Another difference in peritoneal dialysis hemodialysis is - Ans - The patient is subject to constant dialysis in PD rather than the intermittent and dialysis in HD As part of the job of a dialysis technician one may be required to lift equipment or assist with patient transfers back pain sparring and injury prevention maneuvers include - Ans

• Lifting with the legs and holding the object close to the body The National Kidney Foundation "kidney disease improving global outcomes" includes treatment guidelines for the following - Ans - Vascular access high blood pressure and anemia To take the certified hemodialysis technician exam requires all of the following - Ans - Successful completion of an accredited dialysis course a signed letter of reference from an immediate supervisor high school diploma or GED Continuous quality improvement refers to - Ans - A method for improving clinical technical and organizational procedures

Inspection and standards for dialysis centers may be provided by - Ans - - The Food and Drug Administration

• the state health depts
• the Association for advancement of medical instrumentation Which of the following statements about the ultraviolet irradiator is correct - Ans - It emits light at a wavelength of 254 nanometers What are the following statements about the deionization of water is correct - Ans - It removes both anions and cations 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 carbon tank removal of chlorine and chloramine from feed water is correct - Ans - it requires to carbon tanks in a series Water softeners remove calcium and magnesium by - Ans - Ion exchange Which of the following statements about Multimedia filters is correct. - Ans - They trap successively smaller particles The pH of water is 9.0 at a certain center which of the following would be the best water treatment - Ans - Add hydraulic acid to the feed water using a mixing chamber In a water treatment system water is adjusted to a temperature of - Ans - 77 degrees 82 degrees Fahrenheit using hot and cold water and a blending valve Every turn the recycles border to the water treatment system because - Ans - It reduces the amount of water required It prevents stagnant spots The average hemo dialysis patient is exposed to how many liters of water - Ans - 350L Which of the following substances is the most common impurity in tap water - Ans - Calcium carbonate Which of the following germicides is most commonly used to disinfect dialyzers of the United States - Ans - Peracetic acid Grounds for discarding a dialyzer include - Ans - It has been exposed to more than one germicide The following statements about new dialyzers is correct - Ans - They may be processed to reduce noxious chemicals or materials

Which of the following statements about first use syndrome is correct - Ans - It may be reduced by repeated rinsing of the dialyzer The following may cause hemolysis of red blood cells during dialysis - Ans - Kink blood lines Warm dialysis fluid Inadequate water treatment A dialysis patient develops a purulent discharge at the exit site of a central catheter which of the following pathogens is most likely to be cultured - Ans - Staphylococcus aureus For patients in whom the primer solution is to be discarded what should the hemodialysis technician do? - Ans - Connect the arterial tubing and allow the priming solution to drain before connecting the Venus tubing What is the urea kinetic modeling calculation - Ans - It gives both minimum deliver and prescribed doses The urea reduction ratio has which of the following properties - Ans - It requires measurement of both pre and post dialysis blood urea nitrogen Which of the following veins is most suitable for hemodialysis catheter placement - Ans

• Right internal jugular In placing a needle into a graft the hemodialysis technician may do which? - Ans - Use three sides to calculate the graft not just the top A thrombosis is least likely to develop which of the following vascular access methods - Ans - Fistula Common sites of stenosis in pt with an fistula include all the following - Ans - The vein next to anastomosis Along the outflow vein The large draining vein of the arm near the shoulder A diabetic patient undergoing dialysis complains of tingling numbness and cold in the hand below the access site. the most likely causes - Ans - Steal syndrome What type of fstula ls likely to result in high blood flow with the - Ans - artery side to vein end Which of the following statements about sorbent dialysis is correct - Ans - In preparing the dialysate 6 liters of water are added to premix chemicals

All of the following statements about vitamins in dialysis patients are true EXCEPT: - Ans - Dialysis does not remove water-soluble vitamins. In the dialysizer , water may be removed : - Ans - The interstitial compartment. 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 - A very fine fiber tubes held in place by polyurethane material. 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. 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. 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 - Volume control And Flow control Which of the following statements about transducer protectors correct? - Ans - They use hydrophobic membranes to keep fluid from passing through. Blood flow into the dialer is usally : - Ans - Done by manual hand cranking. What does vomiting up blood indicate? - Ans - gastrointestinal bleeding

How would a tech differentiate between an AV graft's arterial and venous side? - Ans - The tech will compress the graft in the middle and feel the thrill on both sides. The STRONGER pulse will be arterial. the fainter pulse will be venous What is the normal range of a pulse rate? - Ans - 60 - 100 beats per minute Why might a patient be receiving Vitamin D therapy? - Ans - Vitamin D controls the balance of calcium and phosphorus that is required for bone metabolism. It is needed for healthy bones. Why are dialysis patients more likely to become infected with germs like MRSA? - Ans - They usually have weak immune systems. This makes them more likely to become infected with pathogenic organisms, such as MRSA. An AV fistula is an example of what type of access? - Ans - Peripheral Define 'peripheral' - Ans - Away from the center of the body A patients blood pressure drops from normotensive to hypotensive at 80/40 mmHg. How should you intervene? - Ans - Place the patient in Trendelenburg position. This involves raising the patient's feet higher than the heart thus increasing blood flow to the head via gravity. Placing the patient in the Trendelenburg position, decreasing/discontinuing fluid removal, and giving the patient normal saline are interventions used to INCREASE THE PATIENT'S BP. What is the most common cause of a low conductivity alarm? - Ans - Running out of either the acid or bicarbonate concentrate What is 'hypoglycemia'? - Ans - Low blood sugar, or, below normal levels of sugar in the blood. What are notable symptoms of hypoglycemia? - Ans - In a patient with diabetes mellitus, this can cause hunger, confusion, nervousness, sleepiness, or dizziness. How should you intervene when hypoglycemia occurs in your patient? - Ans - A fast- acting carbohydrate is needed, such as juice. What is the conversion of desired weight loss? HINT: 1 kg = - Ans - 1 kg = 1,000 mL edematous - Ans - An accumulation of an excessive amount of watery fluid in cells, tissues, or body cavities. Think 'edema'. How is the EDW to be considered? - Ans - The target post-dialysis weight or estimated dry weight is the patient's weight without excess fluid.

The water supply to the water treatment system is called? - Ans - FEED WATER. Feed water is the water that comes from outside of the dialysis center. Feed water must pass through all parts of a water treatment system before it is used for mixing concentrates and making dialysate. What is the main objective of QAPI? - Ans - Quality Assessment and Performance Improvement is a program required as part of Medicare's Conditions for Coverage. This includes improving safety outcomes, and increasing patient satisfaction. Which part of the water treatment system removes endotoxins? - Ans - An ultrafilter is a fine membrane filter that removes very small particles. It is the most effective water treatment component for removing bacterial endotoxins. What is the purpose of UF profiling? - Ans - the purpose of UF profiling is to minimize hypotension. Explain what UF profiling does? - Ans - UF profiling removes fluid from the patient's blood in a systematic pattern. It typically removes more fluid in the first part of the hemodialysis treatment. The entire purpose is to reduce hypotension. What might a high venous pressure alarm indicate? - Ans - Clotting of blood in the access stenosis - Ans - the abnormal narrowing of a passage in the body What is a 'thrombus' - Ans - When a blood clot forms in a blood vessel and remains there What is an 'embolism' - Ans - A clot that travels from the site where it formed to another location in the body Amyloidosis - Ans - a waxy protein building up in the patients soft tissues, bones, joints... this will cause carpal tunnel, joint pain, bone cysts, and fractures What is the function of the electrolyte 'Sodium' - Ans - Sodium helps keep body water in balance. It will also help send nerve cell signals What does the electrolyte potassium do? - Ans - - controls nerves/muscles (heart)

• keeps body's water balanced
• helps body to use glucose What does the electrolyte Calcium do? - Ans - - controls blood clotting, enzymes, hormones, nerves, and muscles
• found in bones/teeth

What is the consequence of 'hypocalcemia'? - Ans - this is low levels of Calcium in the blood, and this can occur when the blood does not/cannot absorb Calcium.... or if phosphorus levels are too high. When phosphorus levels are to high calcium and phosphorus can bond and blood calcium levels will drop. What are some symptoms of Hypocalcemia? - Ans - - numbness

• seizures
• tetany (tremors, facial twitches, muscle spasms, and muscle pain) What is Hyperphospatemia? - Ans - This is when there is to much Phosphorus in the blood putting patient at risk for symptoms from itching to even bone disease. What is the purpose of phosphate binders? - Ans - These are taken when a patient has hyperphospatemi. Phosphate binders must be taken with every meal/snack... the binders will bind phosphate in the gut so less will be absorbed. Erythroprotein - Ans - A protein created by the kidneys which will tell bone marrow to make RBC's. In a dialysis patient, EPO will be given by injection. How much of a patient's blood will be outside the body during a dialysis treatment? - Ans - Only about 1/2 cup of blood at a time Solution - Ans - a mixture of a solvent and a solute where:
• solvent = a fluid
• solute = a substance that can be dissolved (in dialysis = electrolytes and glucose) .... What is the solution in dialysis? - Ans - In dialysis, dialysate is the solution and treated water is the solvent. What are the two concentrates used to make dialysate so that solids will not form? - Ans
• Acid (which contains calcium and magnesium) and bicarbonate What does PTH do to bones? - Ans - PTH pulls Calcium out of the bones What are the 4 steps in the process of 'Diffusion'? - Ans - - two solutions come in contact through a semipermeable membrane
• Each has a different level of solutes, also known as different concentration levels
• Solutes will move back and forth through the membrane on their own
• The solutes movement will go on until the concentration on both sides of the membrane are the same Hypotonic - Ans - a lower level of solutes than blood. Isotonic - Ans - the same level of solutes as blood. EXAMPLE: normal saline has the same concentration of sodium chloride as blood

Hypertonic - Ans - a higher level of solutes than blood Surface area - Ans - the amount of membrane that touches a fluid. A larger surface area will allow for more diffusion. Osmosis - Ans - A solvent (fluid) moves through a semipermeable membrane toward a higher solute concentrate. Osmosis is used to pull blood out of a patient during dialysis. Filtration - Ans - This occurs when fluid is pushed through a filter by hydraulic pressure. Fluid will always move from higher to lower pressure. The filter will trap any matter that is to large to pass through it. Ultrafiltration - Ans - This removes water from the blood during dialysis by pushing it across a semipermeable membrane. Convection - Ans - the transfer of heat and solutes by physical circulation or movement or movement of the parts of a liquid or gas. Fibrin - Ans - A fibrous non-globular protein involved in the clotting of blood. TMP - Ans - On the machine, the pressure difference between the blood and dialysate sides of the dialyzer controls fluid removal. This difference across the membrane is transmembrane pressure, or TMP What happens if the UFR is higher than patients' capillary refill rate? - Ans - The patients blood pressure will drop. *The capillary refill rate is the amount of time for water in between cells to move back into and refill the bloodstream. Potassium, a major electrolyte inside cells, has a main function. What is it? - Ans - Potassium enables the body to send nerve signals. We add potassium to dialysate to bring the patient to a normal plasma level. Magnesium, an electrolyte found inside plasma, plays what key function? - Ans - Magnesium is vital to the nerves and muscles. It also triggers enzymes that are key to carbohydrate use. The electrolyte Calcium, can be found both inside and outside of cells within the body. What is its main function? - Ans - Calcium builds bones and teeth.

• Helps muscles move
• aids blood clotting
• helps send nerve signals Catabolism - Ans - muscle breakdown

What does the presence of glucose (C6H12O6) in dialysate aid in? - Ans - - can prevent loss of blood glucose

• reduce catabolism
• gives dialysate an osmotic effect that aids UF What does Bicarbonate (HCO3-) do? - Ans - - neutralizes acids that form when cells use protein and other foods for fuel
• bicarbonate is a buffer, that is it is a substance that helps keep a constant pH in a solution metabolic acidosis - Ans - to much acid in the blood... this is a chronic issue for patients with kidney failure What do arteries do? - Ans - Arteries carry oxygen-rich blood from the heart and lungs to the rest of the body. Arteries used for fistulas are often deep below the skin and difficult to access with a needle. What do Veins do? - Ans - Veins bring oxygen poor blood back to the heart and lungs... Most veins are too small for HD and must be transposed. Why is a fistula access the least likely to clot or incur infection? - Ans - Because it is below the skin and made from the patients own tissue. Grafts, which are created with a synthetic blood vessel, are at risk for which three things? - Ans - - stenosis, which can cause thrombosis
• more prone to infection than fistulas
• last an average of 3-5 years Why most a patient be able to tolerate a 10% cardiac output increase in order to receive a fistula? - Ans - Any type of venous access will cause strain on the heart. This is because ARTERIAL blood quickly short circuits through the fistula instead of passing through capillary blood vessels. This causes the heart to work much harder. What is the main con of having a fistula? - Ans - It takes a long time to mature. 1- 4 months is average maturity time. Primary failure - Ans - When a fistula fails to mature at all When should the doctor/surgeon be notified if a new fistula has not grown? - Ans - In 2- 3 weeks What needle size and BFR is appropriate one week into a new fistula being cannulated?
• Ans - - needle size: 17 gage
• BFR: 200-250 mL/min What is the rule of 6's? - Ans - The rule of 6's is used to see if a fistula is a success...

1. less than 0.6 cm below skins surface
2. at least 0.6 cm wide
3. ultrasound shows a BFR in the new fistula of 600 mL/min or more Steal syndrome - Ans - Not enough blood flow to the hand resulting in pale, bluish nail beds, or skin What are some visible symptoms of stenosis? - Ans - - swollen access arm

• pale skin
• small blue/purple veins on the chest wall where the arm meets the body When cannulating, how far apart should each needle be? - Ans - one needle length, or 1.5 inches apart What is a good technique when checking for steal syndrome? - Ans - Have the patient squeeze your hand to see if the access hand is weaker than the other How to use alcohol cleaner for fistula? - Ans - 60 second circular rubs on each site just before placing needles How to use Iodine for cleaning access? - Ans - On dry skin, wait 3 minutes before needle placement How to use chloraprep for cleaning access? - Ans - on dry skin, scrub back/forth 30 sec.... wait 30 sec. before needle placement How to use Exsept Plus Dry for cleaning access? - Ans - Wait 2 minutes before needle placement antegrade - Ans - in the direction of blood flow Adsoprtion - Ans - when proteins stick to the membrane Conductivity will be checked at what two points? - Ans - - dialysate mixing
• before dialysate enters dialyzer What happens when the machine goes in bypass? - Ans - The circuit will stop the flow of dialysate to the dialyzer and shunts it to the drain. Bypass prevents the wrong dialysate from reaching the patient. At what temperature of dialysate can protein (including RBC's) start to break down? - Ans - 42 degrees C. Why might a BLOOD LEAK DETECTOR alarm go off? - Ans - If dialyzer membranes tear, blood and dialysate can mix. This puts the patient at risk for
• major blood loss

• the contamination of blood by the non-sterile dialysate... Do not return the patient's blood if the Hemastix strip test shows a positive result. What is the pH of blood? - Ans - 7.35-7.45, it is a weak base. What is the pH of dialysate? - Ans - 7.0-7. Pyrogens - Ans - Part of bacteria that can cause fever in patients Ultrafiltraion - Ans - is taking excess water out of the blood Sepsis - Ans - blood poisoning What should you do if a patient is losing blood through the tubing? - Ans - Turn off the blood pump and clamp the blood lines. What should you do if air enters the venous line? - Ans - Have the patient lie in Trendelenburg position (with the head lower than the feet) on his/her left side. Hematoma - Ans - Pocket of blood under the skin Platelets - Ans - cells that clump together to seal off damage. In the case of Stenosis What is the 2nd most common cause of death in HD patients? - Ans - Infection Aseptic - Ans - free from disease causing germs