CCHT PRACTICEEXAM 2024 AND PRACTICE EXAM |ACCURATE QUESTIONS AND ANSWERS| VERIFIED, Exams of Nursing

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CCHT PRACTICE EXAM 2024 AND PRACTICE EXAM T |ACCURATE QUESTIONS AND ANSWERS| VERIFIED FOR GUARANTEED PASS |GRADED A | BRAND NEW Clearance of low-molecular-weight molecules by dialysis is accomplished mostly by: a. convection b. diffusion c. absorption d. solvent drag - Ans - b. diffusion A hollow fiber dialyzer has which of the following properties? a. very fine fiber tubes in place by polyurethane material b. fibers about 1 cm in width c. a high-membrane compliance d. a high resistance in the fibers, enhancing ultrafiltration pressure - Ans - a. very fine fiber tubes in place by polyurethane material Synthetic membranes have which of the following properties? a. they are cellulose membranes in which hydroxyl groups are replaced with acetate b. they have thick fiber walls c. they have poor absorption d. they remove solute by diffusion only - Ans - b. they have thick fiber walls To determine the most accurate clearance rate of a particular solute, one should: a. use water instead of blood b. use a large-molecular-weight molecule c. reduce the manufacturer's stated rate by 10% d. measure the solute concentrations of blood going into and out of the dialyzer - Ans - d. measure the solute concentrations of blood going into and out of the dialyzer Substances that are added to the dialyzer: - Ans - chloride, bicarbonate, and sodium Sodium modeling refers to: a. changing the concentrate of the dialysate sodium during the course of the dialysis b. injecting sodium chloride directly into the patient's vein c. adjusting the sodium concentrate of the dialysate with normal saline d. none of the above - Ans - a. changing the concentrate of the dialysate sodium during the course of the dialysis Coductivity is best defined as... a. a method of checking electrolyte levels in the dialysate b. the voltage required to maintain the dialsate flow rate d. something that is measured once to check the final ionic concentrations of the dialysate – Ans - a. a method of checking electrolyte levels in the dialysate Which of the following statements about the proportioning system is correct? a. the concentrates are mixed manually b. it relies on a continuous supply of fresh concentrate and treated water c. the concentrates are heated after mixing d. fixed-ratio mixing is the only method used - Ans - b. it relies on a continuous supply of fresh concentrate and treated water An advantage of high-flux dialysis is: a. small pore size b. fast removal of fluid c. retention of beta2-microglobulin in the blood d. slow blood flow, leading to more efficient removal of toxic substances - Ans - b. fast removal of fluid A disadvantage of high-flux dialysis is: a. acetate must be used instead bicarbonate buffer b. membrane biocompatibility is reduced c. pyrogen reactions are common d. postdialysis fatigue is common - Ans - c. pyrogen reactions are common Can home dialysis be done during sleep? - Ans - Yes In most dialysate systems, the temperature: a. is maintained by a thermistor-controlled heater b. is maintained between 41oC-43oC c. of water is raised only after mixing with concentrate d. is decreased to increase diffusion - Ans - a. is maintained by a thermistor-controlled heater Dialysate flow rate has which of the following properties? a. lower flow rates improve dialysate efficiency b. it is always preset c. it may vary from 0-2000 mL/MIN c. reprocessed dialyzers that have a lower biocompatibility than new ones d. reprocessed dialyzers that have a better biocompatibility than new ones - Ans - d. reprocessed dialyzers that have a better biocompatibility than new ones The amount of fluid to be taken from the patient during hemodialysis: a. is independent of the filtration pressure b. requires the dialysate to have a higher pressure than the blood c. may be calculated by subtracting the patient's estimated dry weight from the predialysis weight and adding any fluid the patient receives during treatment d. may be calculated by adding the patient's predialysis weight and the amount of fluid the patient receives during treatment - Ans - c. may be calculated by subtracting the patient's estimated dry weight from the predialysis weight and adding any fluid the patient receives during treatment The ultra filtration coefficient of a dialyzer refers to the: a. fluid that passes through the membrane in 1 hour b. pressure in the blood compartment needed to force fluid through the membrane c. pressure difference across the membrane d. fluid that passes through the membrane in 1 minute - Ans - a fluid that passes through the membrane in 1 hour A sorbent is best described as a: a. material that moisturizes the dialysis membrane b. material that is added to the dialysate to buffer it and keep the pH constant c. continuous dialysate disinfection system that removes bacteria and endotoxins d. type of electronic device that measures blood pressure - Ans - c. continuous dialysate disinfection system that removes bacteria and endotoxins Which of the following statements about sorbent dialysis is correct? a. it needs a continuous supply of fresh water to add to new dialysate b. in preparing the dialysate, 6 liters of water are added to premixed chemicals c. the duration of the dialysis procedure cannot be altered d. it requires a six-layered cartridge - Ans - b. in preparing the dialysate, 6 liters of water are added to premixed chemicals Which dialyzer is used currently? - Ans - Hollow tube Which type of arteriovenous fistula is likely to result in high blood flow with the fewest complications? a. Artery side to vein side b. Artery side to vein end c. Artery end to vein side d. Artery end to vein end - Ans - b. Artery side to vein end For which type of dialysis patient is a central venous catheter blood access appropriate? a. a patient waiting for fistula to mature b. a patient with acute renal failure c. a patient waiting for a peritoneal dialysis catheter d. all of the above patients - Ans - d. all of the above patients Drip chambers in the extracorporeal circulation do all the following EXCEPT: a. monitor arterial and venous pressure by attached gauges b. trap air c. prevent blood clots from reaching the patient d. pump blood into the dialyzer - Ans - d. pump blood into the dialyzer Which of the following statement about extracorporeal circulation is correct? a. Approximately 100-250 mL are outside the patient's body at any time b. The arterial tubing is blue, and the venous tubing is red c. Heparin infusion line is connected to the tubing at the venous exit d. The use hydrophobic membranes to keep fluid from passing through - Ans - d. They use hydrophobic membranes to keep fluid from passing through Blood flow into the dialyzer is usually: a. controlled by a piston type pump b. inversely proportional to the pump speed c. limited to less than 250 mL/min d. done by manual hand cranking - Ans - d. done by manual hand cranking Which pressure in the dialyzer is usually negative? - Ans - Arterial pressure Which of following statements about arteriovenous grafts is correct? a. they are more prone to thrombosis than arteriovenous fistulae b. they are less prone to cause stenosis than arteriovenous fistulae c. they are less prone to infection than arteriovenous fistulae d. they have a longer lifespan than arteriovenous fistulae - Ans - a. they are more prone to thrombosis than arteriovenous fistulae An antiseptic that kills bacteria when wet is: - Ans - 70% alcohol Which of the following arteries is mostly commonly used for an arteriovenous fistula? a. ulnar artery b. radial artery c. brachial artery d. femoral artery - Ans - b. radial artery For patients in whom the priming solution is to be discarded, what should the hemodialysis technician do next? a. connect the arterial and venous tubing before beginning dialysis b. connect the arterial tubing, and allow the priming solution to drain before connecting the venous tubing c. connect the blood lines only after the primer is discarded d. do none of the above - Ans - b. 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? a. skip the bolus dose of heparin, and give the infusion at a lower dose rate b. increase the time between bolus doses of heparin c. substitute warfarin for heparin d. use a regional citrate technique - Ans - d. 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? a. Staphylococcus aureus b. Clostridium difficile c. Enterococcus d. Mycoplasma - Ans - a. Staphylococcus aureus The venous needle insertion should always go which way? - Ans - it should always go with the blood flow A diabetic patient undergoing dialysis complains of tingling, numbness, and cold in the hand below the access site. The most likely cause is: a steal syndrome b. recirculation c. infiltration d. an aneurysm - Ans - a. steal syndrome Common sites of stenosis in patients with an arteriovenous fistula include all the following EXCEPT: a. the vein next to the anastomosis b. along the outflow vein c. the large draining vein of the arm near the shoulder d. the artery next to the anastomosis - Ans - d. the artery next to the anastomosis TRUE or FALSE: A thrombosis is least likely to develop with an arteriovenous fistula - Ans - TRUE b. an anaphylactic reaction c. angina d. disequilibrium syndrome - Ans - b. an anaphylactic reaction A patient undergoing hemodialysis complains of muscle cramps in the calves and feet. All of the following are likely causes EXCEPT: a. hypernatremia (high-sodium level) b. excess fluid removal c. hypercalcemia (high-calcium level) d. hypokalemia (low potassium) - Ans - c. hypercalcemia (high-calcium level) Substances that are produced by the kidney - Ans - renin, erythropoietin, and calcitriol The most likely cause of post-renal failure is: a. severe dehydration b. nephrotoxic drug c. glomerulonephritis d. benign prostatic hypertrophy - Ans - d. benign prostatic hypertrophy Which of the following may cause hemolysis of red blood cells during dialysis? a. kinked blood lines b. warm dialysis fluid c. inadequate water treatment d. all of the above - Ans - d. all of the above Which of the following statements about the "first-use syndrome" is correct? a. it may be reduced by repeated rinsing of the dialyzer b. it is less common in dialyzers treated with ethylene oxide c. both a and b are true d. neither a nor b are true - Ans - a. it may be reduced by repeated rinsing of the dialyzer Which of the following statements about preprocessing dialyzers is correct? a. it must be done manually b. it can be done manually or by machine c. it may be done on all commercial dialyzers d. it may be done according to the local center's protocol - Ans - b. it can be done manually or by machine Which of the following statements about new dialyzers is correct a. they should not be preprocessed b. the total cell volume (TCV) does not need checking until after reprocessing c. they may be preprocessed to reduce noxious chemicals or materials d. the TCV needs to be checked against other dialyzers after reprocessing - Ans - c. they may be preprocessed to reduce noxious chemicals or materials The most common cause of chronic kidney disease in the United States is: - Ans - diabetes Uremia may cause which of the following conditions: a. Itching b. Edema (swelling) of the extremities c. Anemia d. All of the above - Ans - d. All of the above Grounds for discarding a dialyzer include which of the following? a. the total cell volume is 85% of the original b. it has been exposed to more than one germicide c. clearance is only 95% d. a few residual streaks of blood are seen on inspection - Ans - b. it has been exposed to more than one germicide Which of the following germicides is most commonly used to disinfect dialyzers in the US? a. Formaldehyde b. Glutaraldehyde c. Heat with citric acid d. Peracetic acid - Ans - d. Peracetic acid What is an endotoxin? a. it is a germicide b. it is not absorbed by dialysis membranes c. it is a toxin produced by certain bacteria d. it is a substance that is not harmful to the patient - Ans - c. it is a toxin produced by certain bacteria These conditions are associated with chronic kidney failure - Ans - low hemoglobin, hyperkalemia, hyperphosphatemia Federal regulations require a center that reuses dialyzers to have: a. a system of quality assurance b. a system of quality control c. both a and b d. neither a nor b - Ans - c. botha and b The average hemodialysis patient is exposed tohow many liters of water a week? a. 10 L b. 100 L c. 350 L d. 1000L - Ans - c. 350 L A return loop recycles water through the water treatment system because: a. it reduces the amount of water required b. it prevents stagnant spots c. of both a and b d. of neither a nor b - Ans - c. of both a and b The pH of feed water is 9.0 at a certain center. Which of the following would be the best water treatment? a. No treatment is required b. Add hydrochloric acid to the feed water, using a mixing chamber c. Add sulfuric acid by direct injection into the water line d. Add sodium hydroxide to the feed water, using a mixing chamber - Ans - b. Add hydrochloric acid to the feed water, using a mixing chamber What percentage of transplanted kidney is functional 1 year after transplant? - Ans - 90% True or False: Short daily home hemodialysis, 2-3 hours a session, 5-7 days a week is likely to be most efficient hemodialysis - Ans - True Which of the following statements about multimedia filter is correct? a. they trap successively smaller particles b. they trap successively larger particles c. they are backwashed with added solvent d. they are not necessary if an ultrafilter is present downstream - Ans - a. they trap successively smaller particles Water softeners remove calcium and magnesium by: a. ion exchange b. absorption c. filtration d. osmosis - Ans - a. ion exchange The fluid restriction for most patients undergoing in-center hemodialysis is equal to urine volume/day plus... - Ans - 1 Liter Failure to excrete beta2-microglobulin in patients with kidney failure predisposes to: a. pericarditis b. amyloidosis c. neuropathy d. seizures - Ans - b. amyloidosis Which of the following statements about carbon tank removal of chlorine tank removal of chlorine and chloramine from feed water is correct? a. it should use activated powdered charcoal b. it requires two carbon tanks in a series c. it may be done with a continuous flow of water 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 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 - 7.0-7.4 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