Dialysis Nurse Management and Kidney Disease: Key Responsibilities and Practices, Exams of Medicine

Download Dialysis Nurse Management and Kidney Disease: Key Responsibilities and Practices and more Exams Medicine in PDF only on Docsity! CCHT EXAM Questions with Answers 2024 While technical staff are preforming duties in the dialysis unit which team member must always be present A. Registered nurse B. Medical director for unit C. Lab technician ✔ A. Registered nurse Two techs are heatedly discussing pt care situation. Which team member is responsible for disciplinary action A. Registered practical nurse B. Human resource manager C. Dialysis nurse manager ✔ C. Dialysis nurse manager Which credentialing agency for dialysis includes items such as water treatment and dialysate preparation and complication of dialysis as part of their practice domains A. Board of nephrology examiners nursing in technology B. Nephrology nursing certification commission C. National nephrology certification organization ✔ C. NNCO Prior to starting dialysis what must the technician and or nurse verify A. That patient has provided informed written consent for dialysis B. That the patient has not eaten any food or beverages for the last six hours C. That the patient has a driver to pick him up after dialysis ✔ A. Consent Which external agencies provide additional guidelines and standards in the areas of infectious disease testing immunizations dialysis treatment safety and infection control? A. Centers for disease control and prevention B. Centers for Medicare and Medicaid service C. Association for the advancement of medical instrumentation D. Council of nephrology ✔ A B and C Prior to passing the Social Security amendments treatment for chronic kidney disease was available only to few who met certain criteria. The amendments extended Medicare coverage for almost all patients who signed the amendment and then what year A. Jimmy Carter in 1979 B. Richard Nixon 1972 C. John f Kennedy 1961 ✔ B. Richard Nixon 1972 Which organization recently approved by CMS to be an independent organization allowed to conduct surveys for Medicare certification fostering faster approval for dialysis clinics A. National kidney foundation B. Medicare bundle dialysis prospective payment system C. National dialysis accreditation commission ✔ 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 ✔ 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 ✔ A and B Which buffer is the major plasma buffer therefor important during dialysis A. Bicarbonate B. Amino acid C. Protein ✔ 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% ✔ 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 ✔ 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 ✔ 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. Phosphate binders Patients with chronic kidney disease are at risk for developing peripheral neuropathy. How may neuropathy present in the patient A. Intolerance to touch B. Burning feet C. Restless legs ✔ B and C What are some disadvantages of using hollow-fibers dialyzers A. They're not compliant B. They require meticulous care to remove air or gas from the fiber bundle C. Blood distribution may be uneven at inflow header space D. Higher heparin doses may be needed to prevent clotting in hollow fibers ✔ B C and D If a patient is experiencing adverse reactions from the residual toxic products of ethylene oxide sterilization of the hollow fibers what other ways can you sterilize it. A. Gamma radiation B. Pure alcohol flushing C. Electron beam ✔ A and C Which manifestation would lead to the tech to suspect the patient is experiencing intradialytic complement A. Anemia B. Intradialytic hypoxemia C. Chest pain D. Back pain ✔ B C and D If the bicarbonate concentrate is over mixed what lab values will result A. Increase pH B. Decrease in serum calcium level C. Increase in magnesium level D. Decrease in RBC level ✔ A and B Which method/test is most commonly used to check the dialysate composition A. Bicarbonate concentration test B. Total conductivity C. Microbial count ✔ B. Microbial count How is the temp of the dialysate controlled A. By using one or more sensors and a micro controller circuit on the heater B. By checking accuracy regularly with a certified glass thermometer C. By using a separate center with visual and audible alarms for any out of limit state ✔ All of the above What can cause a "false" blood leak alarm A. Particulate matter and air bubbles in the dialyzer B. Reduction in the light received by a photo cell C. Change in translucency ✔ A. Particular matter What are the system requirements for high flux dialysis A. Reliable blood flow rate at at least 200 B. Hi dialysate flow rate C. Precise control of ultrafiltration volume D. Use of synthetic membrane filters ✔ B C and D Which factors affect removal of toxins in dialysis A. The higher the temperature of dialysate the greater the removal of solute B. The slower the dialysate flow the greater removal of solute's C. The slower the blood flow rate the greater removal of solute D. The more permeable the membrane the greater removal of solutes ✔ A and D To accomplish saw you removal and dialysis what is needed A. Mass transfer B. Countercurrent flow C. A difference in concentration ✔ C. Difference Why is reversed filtration important A. The bicarbonate concentrate encourages and supports bacterial proliferation B. Endotoxins may be carried across the high flux membrane into the bloodstream C. Pyrogens reaction may occur ✔ All of the above What modifications to the dialysis procedure can be made to prevent intradialytic complications associated with fluid removal A. Lower the temp of the machine B. Extend treatment times C. Check serum sodium levels every 15 min ✔ A and B Which water contaminants may cause methemoglobinemia in which red cell hemoglobin cannot transport oxygen A. Fluoride and Tin B. Nitrates and chloramines C. Zinc and aluminum ✔ B. Nitrates and chloramine What is the process utilized when two carbon tanks are used to remove chlorine and chloramine from tank water A. Adsorption B. Absorption C. Diffusion ✔ A. Adsorption What type of contaminants are removed from water used in dialysis A. Endotoxins B. Aqueous salts C. Water softeners ✔ 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 ✔ 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 ✔ 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 ✔ C. 200 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 ✔ 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 ✔ 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 ✔ 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 ✔ 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 ✔ B. After the initial skin prep for cannulation the tech is interrupted by a coworker asking a question when she proceeds to cannulation she noticed the skin prep has dried what action should the tech take A. Proceed with cannulation B. Perform new assessment by palpating the site and then cannulate C. Re-prep the access to ensure the patient has not accidentally touch the site ✔ C. How should the needles be positioned A. Please the needles in the same general area during each treatment B. To achieve best blood flow placed the arterial needle near the anastomosis keeping the tip no closer than 1 1/2 to 2 inches from the anastomosis C. placed the arterial needle point in the direction of the flow D. Space the needles at least 1 inch apart ✔ B C and D What care should be provided for official arm between dialysis treatments A. Maintain adequate pressure over the puncture site for 10 to 20 minutes after the needles been removed B. Allow the skin over the access site to breathe by removing dressings after the bleeding has stopped C. Clean the fistula arm daily with soap ✔ A and C In patients with stage four or five chronic kidney disease which access site should be avoided to prevent risk of stenosis and thrombosis A. Fistula B. Subclavian vein catheter C. Peripherally Inserted central catheter ✔ B and C Immediately after insertion of a jugular catheter which complication should be assessed in the newly diagnosed stage five chronic kidney disease patient A. Slurred speech B. Collapsed lung C. Chest pain ✔ B. Collapsed lung According to KDOQI guidelines on goals of therapy for CKD patient on dialysis which post dialysis blood pressure goal is recommended A. Less than 140/90 B. Less than 130/80 C. Less than 150/95 ✔ B According to the centers for Medicare and Medicaid what is the maximum amount of fluid that can be safely removed during a standard treatment A. 30% of fluid way as long as the pressure is normal B. No more than 20% of total body weight C. Ultrafiltration rate of 13/ML/KG/HR or less ✔ C. Related to rapid decrease in the circulation blood volume caused by ultrafiltration what is the most common complication during treatment A. Hypotension B. Bleeding C. Dehydration ✔ A. Hypotension In a patient with gross Adema which symptoms of hypotension shared the dialysis tech be watching for A. Shortness of breath B. Flushed face and nose bleed C. Paleness D. Excessive yawning ✔ A C and D A tech reports to the RN that the blood is transparent in the circuit with a cherry soda pop color what complication should the tech suspect the patient is experiencing A. Hemolysis B. Thrombosis C. Septicemia ✔ A. Hemolysis Which symptoms will alert the tech a patient is experiencing type a dialyzer reaction A. Dyspnea B. Chest and back pain C. Sense of impending doom D. Numbness around the mouth ✔ A B and C The dialysis tech knows that reducing intake of this nutrient may be beneficial in delaying the progression of kidney disease A. Water B. Carbohydrates C. Proteins ✔ C. Albumin is a bio-marker monitored to assess the nutritional status of patients with CKD which patients are likely to have a lower serum albumin A. Patient who is dehydrated B. Patient with fatigue and low energy C. Patient with hair loss and muscle wasting ✔ B and C According to KDOQI which pre-dialysis albumin level should be the outcome goal for dialysis patient A. Equal to or greater than the normal range of four B. Equal to or greater than the normal range of three C. Equal to or greater than the normal range of one ✔ A. A 73-year-old dialysis patient is discussing with the tech her desire to convert to a total plant-based diet which statement is important for the tech to share C. Feed water ✔ C Which part of the water treatment system removes endotoxin A. Ultra filter B. Resin bed C. Softener ✔ 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 ✔ 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 ✔ 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 ✔ 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 ✔ 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 ✔ 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 ✔ 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 ✔ 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 ✔ 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 D. Fatigue ✔ A c and D What are some of the most common indications for acute dialysis A. Elevated BUN level B. Symptomatic Hypokalemia C. Weakness in one side of body D. Acute pulmonary edema ✔ A and D A patient with first used syndrome is experiencing severe symptoms including breathing difficulty and cardiac rhythm abnormalities as the tech working which action should be implemented A. Return the blood to patient as quickly as possible B. Ask the RN to dispense Benadryl C. Discard the dialyzer ✔ C. If a patient is receiving acute dialysis what adjustment to the dialysis machine will help the patient with hypertension lower it to relatively normal reading A. Infusion of normal saline B. Ultrafiltration C. Transfuse one unit of packed cells ✔ B. Which action by the dialysis staff will help prevent or minimize disequilibrium A. Decrease flow rate B. Implement isolated ultrafiltration to remove fluid C. Utilize a small dialyzer with lower clearance properties D. Lower heparin dose to 250 units/hour ✔ A and C 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 ✔ 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 ✔ 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 ✔ 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 ✔ A. Which complication of peritoneal dialysis should the tech report when he observes Cloudy effluent A. Tunnel infection B. Fibrin formation C. Peritonitis ✔ C.