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Davita Finals Exam 100 Questions & Answers
Which is the primary device for purifying the water used in dialysis? (Ans- The reverse osmosis What is an appropriate intervention(s) with an air/foam detector alarm? (Ans- Look at the circuit, do not return blood with air in system, fix problem Water treatment is needed in the dialysis setting to: (Ans- Provide patient safety and prevent equipment damage Which statement is true regarding the "Reasonable and Prudent" Standard of Care? (Ans- When supervising patient care technicians and other non- licensed personnel, it is the responsibility of the licensed nurse to ensure these teammates also meet the Standard of Care. Acid concentrate replaces the excretory function of normal kidney function by (Ans- Normalizing electrolytes
Dialysis replaces only ---- percent of normal kidney function (Ans- 15% A patient's target weight is: (Ans- both A & B
- Prescribed and determined by physician order.
- Modified by physician based on patient tolerance The waiting time after administration of the initial heparin loading dose prior to initiation of hemodialysis is a minimum of (Ans- 3 - 5 minute A PCT greets a patient and the patient reports feeling short of breath. The PCT notices that the patient's lips have a blue hue. The PCT would: (Ans- Not start treatment, immediately notify the nurse When the lab receives a laboratory test tube with double labeling: (Ans- The double labeled specimen will be rejected at the laboratory for patient safety
A standing post-treatment blood pressure reading of ----- is considered an abnormal finding & should be reported to a licensed nurse (Ans- both A & B
- Standing systolic BP greater than 140 mm/Hg or less than 90 mm/Hg
- Standing diastolic BP greater than 90 mm/Hg or less than 50 mm/Hg Per physician order and based on individual patient needs, Chronic Kidney Disease Mineral & Bone Disorder (MBD) is treated with (Ans- Phosphate binders, vitamin D (Hectorol), and Cinacalcet For patents with Acute Kidney Injury (AKI) which statement is Correct? (Ans- A nursing assessment prior to treatment initiation is always required Prior to use, how should the medication preparation surface area be disinfected? (Ans- With 1:100 bleach solution and disposable wipes The nephrologist orders a blood flow rate (BFR) of 450 ml/min for a patient with an established AV Fistula. What needle gauge would be appropriate for this BFR? (Ans- 15 gauge
If you notice that a patient's caretaker is struggling to meet the demands of the patient's treatment regime you should (Ans- Notify the Social Worker because he/she is there for patients and their families When is a pretreatment assessment by the licensed nurse required? Check all that apply: (Ans-
- When it is mandated by state law (pre-treatment initiation vs within 1 hour after start of treatment)
- When the PCT performing a data collection notices abnormal findings
- When the patient reports unusual symptoms to the nurse or PCT before treatment initiation
- When the nurse or PCT observes unusual behaviors in a patient entering the treatment floor The Psychosocial Assessment completed by the social worker: (Ans- Is completed initially and annually A surveyor asks you a question. Which of the following statements would be a good answer? (Ans- I do not know the answer but I will find out
The endocrine functions of the kidneys are (Ans- Renin and erythropoietin secretion, activation of vitamin D** DaVita Quality Index (DQI) success is achieved (Ans- All of the above Which infectious disease requires frequent hand-washing instead of using alcohol based hand gels? (Ans- Active Clostridioides difficile infection (C-diff) At what time do you perform water hardness testing? (Ans- At the end of the treatment day What are three things you should NOT include in a Risk Event Management (REM) report? (Ans- Personal opinions, speculation, vendettas Fever caused by a pyrogenic reaction will most likely occur at what time during the treatment? (Ans- Within 45 to 75 minutes What is the most likely reason for a blood leak detector alarm during recirculation? (Ans- Air bubbles in dialysate or a dirty sensor
You listen to your patient's arteriovenous graft (AVG) and hear a whistling sound. (Ans- This could be indicative of an outflow stenosis The Urea Reduction Ratio calculates (Ans- The amount of urea removed during the dialysis treatment Documentation in the medical record (Ans- Provides data for continuity and planning of patient care Left Ventricular Hypertrophy leads to (Ans- ischemic heart disease arrhythmia, myocardial infarction, and sudden death What should be done to the heparin infusion line if a patient does not have maintenance (hourly) heparin prescribed? (Ans- Clamp and knot the heparin infusion line The most common infectious complication for hemodialysis patients is (Ans- Vascular access infection The person responsible for implementation, adherence, and training of the facility specific emergency management plan (EMP) and applicable policy and procedures is (Ans- Facility Administrator (FA) or Designee
What can be the most likely result if the surveyor sees a patient with a covered vascular access? (Ans- An Immediate Jeopardy Per the Centers for Disease Control and Prevention (CDC), which is the most common factor contributing to bacterial infections in dialysis patients? (Ans- the use of catheters for hemodialysis The Clinical Pyramid includes: (Ans- The Fundamentals. Complex Programs, and Quality of Life. If clotting occurs in a high flux dialyzer, the transmembrane pressure (TMP) will (Ans- decrease The nephrologist has prescribed a 400 blood flow rate (BF) for your patient. You would expect the physician order to also include (Ans- 15 gauge needles for this prescribed BFR A patient with acute kidney injury (AKI) dialyzes in the out-patient facility. With regards to the patient's target weight, why is being "wet" better than being too dry? (Ans- Being wet helps avoid hypovolemia and hypotensive episodes The nephrologist has ordered the use of hemostatic sponges, such as SureSeal, for your patient. What is the correct procedure when using
these sponges? (Ans- Remove the hemostatic sponge after hemostasis has been achieved and dress the needle sites with sterile gauze or band aid A recommended intervention for muscle cramps is (Ans- Turning the ultrafiltration rate (UFR) off Your patient asks whether it is OK to take an over-the-counter cold remedy. What is your appropriate response? (Ans- Let's ask your nephrologist what they recommend to treat your cold symptoms Phosphate binders are prescribed to prevent phosphorus in meals from being absorbed. When is the best time to take them? (Ans- With a meal *** What is the acceptable mg/L or parts per million (ppm) limit for Total Chlorine in the water leaving the carbon filter? (Ans- Less than or equal to 0.1 ppm or mg/L The patient position used for a suspected air embolism is (Ans- Trendelenburg, on left side *** What could be the reason(s) for a conductivity alarm on the dialysis machine? (Ans- all of the anove *** To assist in survey readiness you should (Ans- all of the above
Poor wound healing is directly related to (Ans- Inadequate protein intake What is one method surveyors use to verify infection control training and education? (Ans- Documentation of infection control training in teammate's file or transcript *** In the event of a patient experiencing a seizure, the dialysis treatment should be (Ans- Discontinued if the seizure is severe or the patient does not respond to treatment The patient's treatment time is 3 hours, He has brought a 10 oz, cup of coffee (300 ml), has an IV antibiotic of 100 ml to be administer (Ans- 1000 ml/hr Intradialytic treatment monitoring and data collection is performed every (Ans- 30 minutes When documenting patient care, it is important to include all of these except (Ans- A confrontation between two patients *** The maximum ultra-filtration (UF) rate should not exceed ______ because it may lead to hypotensive episodes which increases the risk of organ stunning or mortality.F (Ans- 13 mL/kg/hr
What steps are performed during the recirculation of blood in the extracorporeal circuit when there has been a treatment interruption (i.e. patient using the restroom)? (Ans- The saline infusion line is opened and if the patient is receiving an intradialytic heparin infusion via the dialysis machine; the heparin pump remains on What is an important action prior to returning a patient's blood using the hand crank in the event of a power failure? (Ans- Remove the venous line from the line clamp *** Water and dialysate cultures are drawn every month in the dialysis unit to monitor (Ans- Bacteria and endotoxins *** Ultrafiltration is defined as (Ans- Controlled fluid removal by manipulation of hydrostatic pressure Cynthia missed her treatment on Saturday and returns the following Tuesday for her next scheduled treatment. She complains of feeling weakness in her legs. David, a PCT, gets a wheelchair for her, helps her weigh in, and brings her back for the nurse to assess prior to starting her treatment. Which patient complication would the PCT and RN suspect Cynthia is most likely suffering from? (Ans- hyperkalemia What problems will cause a more positive (less negative) pre-pump arterial pressure (Ans- Separation of blood tubing from arterial access
Which statement is true about sinks used for handwashing? (Ans- Handwashing sinks must be dedicated for handwashing purposes only and should remain clean *** To prevent the formation of aneurysms and pseudoaneurysms the following should be practiced (Ans- Good needle site rotation and complete needle site clotting techniques The patient is using a central venous catheter (CVC) for dialysis and has a new arteriovenous fistula (AVF) present in his lower arm. What observation/assessment should the PCT perform for the AVF? (Ans- Checking for the bruit and thrill every treatment day What complication would you expect to see if a patient is exposed to chlorine/chloramines? (Ans- Hemolysis What will cause a more negative pre-pump arterial pressure? (Ans- Kinking of the arterial blood line between the vascular access and arterial monitor *** Which of the following factors would decrease the K of the Kt/V formula? (Ans- inadequate anticoagulation Performing a procedure "your way" rather than following the dialysis facility's policies & procedures (P&P) (Ans- Can lead to personal and/or organizational liability in the event of an adverse patient outcome, in
addition to survey citations and risk regardless of whether an adverse patient outcome occurs Upon completing machine set up and before treatment initiation it is important to verify the prescription and machine settings: (Ans- both B & C
- To confirm patient's unique prescription parameters are programmed correctly into the dialysis delivery system (DDS).
- To validate that all safety features are enabled, functioning correctly, and within acceptable limits. When a patient is prescribed Topical Anesthetic spray, the appropriate time to clean the cannulation sites is (Ans- Before applying the spray *** Post treatment data collection and assessment is performed (Ans- After the treatment is terminated Which of the following factors would influence the 't' of the Kt/V formula? (Ans- shortened treatment time Which statement is true regarding the administration of Normal Saline? (Ans- The teammate must remain with the patient to monitor the process until administration is complete and lines are securely clamped
