DAVITA(RN) FINAL EXAM-with 100% verified solutions 2024-2025, Exams of Nursing

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DAVITA(RN) FINAL EXAM-with 100%

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Hemodialysis helps normalize body pH through Diffusion of bio carbonate from the dialysate into the blood The endocrine function of the kidney are Renin and erythropoietin secretion ,activation of vitamin D The excretory function of the kidney is To normalize electrolytes Which of the following is a basic principle of patient self management Dealing with the consequences of illness rather than just the physical disease Which statement is true regarding the stages of grief Sometimes people can get stuck in one stage If you notice that a patient caretaker is struggling to meet the Demands of the patient's treatment regime you should Notify the social worker because he or she is there for patients and their families

The psychosocial assessment completed by the social worker Is completed initially and annually Ultra filtration is defined as Controlled fluid removal by manipulation of hydrostatic pressure Convection is defined as Solutes are dragged across the semi permeable membrane along with fluid The acronym DARN stand for Desire, ability, reason, need The three core communication skills used in motivation interviewing are Asking, listening, informing Summarizing during reflective listening Includes the main aspects of what the patient said during the entire communication The best way to help patient successfully change behaviors is to

Inspire behavior change to support, compassion, and empathy Left ventricular hypertrophy (LVH) is caused by Hypertension Hemodialysis replaces what % of normal kidney function 15% What does CKD-MBD lead to? Abnormalities in Ca, PO4,PTH and vit D Metabolism with soft tissue calcification and bone disease Your patient complains of dry itchy skin you would advise her to Use hyper fatted soaps and lotions Peripheral neuropathy is a complication and chronic renal failure which affects sensory and motor nerve fibers. If you're patient complains of a burning sensation in the feet, you should advise him Not to walk barefoot, be careful with foot care, and check the bathwater temperature with a thermometer Some lab tubes contain additives to assess blood to clot or prevent it from clotting. To prevent specimens from being contaminated with another tubes additives you should

Follow the order of the draw The centrifuge to spine blood samples must be balanced to avoid shaking and the centrifuge losing its balance. To balance the centrifuge Only tubes of the same kind, size, and fill level should be placed opposite each other If a patient presents with dialysis associated Pericarditis, treatment includes more frequent dialysis and Heparin restriction to prevent bleeding into the pericardium and tamponade A patient with hyperkalemia will present with Extreme muscle weakness and an abnormal heart rhythm Gloves are in essential part of hand hygiene. What is their function? Gloves reduce the risk of hand contamination and prevent the transfer of organisms already on the hands Which statement is true about sinks use for handwashing? Handwashing sinks must be dedicated for handwashing purposes only and should remain clean Attention to infection control, proper hand hygiene, cleaning and disinfection procedures are of upmost importance in the dialysis setting. Which of the following statements is true?

Viable MRSA bacteria can remain on surfaces for days with plastic and vinyl being most favorable to their survival. If your facility dialyze is hepatitis B positive patients, which assignment would not be an appropriate patient care assignment? Caring for HBsAG positive and hepatitis B susceptible patients at the same time Per the CDC, which is the most common factor contributing to bacteremias in dialysis patients? The use of catheters for hemodialysis Per the CDC, which is the most important route by which pathogens are transmitted in healthcare settings including dialysis centers? Contact transmission Practicing meticulous infection control to prevent healthcare associated infections (HAIs) in dialysis patients is of upmost importance because? Kidney failure weekends a person some uses them making these pieces much more vulnerable to infections Infections are the second most common cause of death in this population The hemodialysis procedure requires prolong access to the patient's blood The tags for CMS survey state specific regulations to be met within a condition such as infection control, provide interpretive guidance for each

regulation, and site deficiencies by tag number. How can knowledge of these V tags affect the practice of patient care providers Provide patient care with in CMS condition for coverage Understand rationales for specific regulations as outlined in the interpretive guidance Assist in the development of policies and procedures Teammates decrease the risk of infection when working with a central venous catheter (CVC) by Wearing a face mask Washing hands and wearing clean gloves Avoiding touching dirty services when providing CVC care Why is meticulous hand hygiene so important in healthcare? It is the single most important intervention in preventing HAIs When sodium loading is present during dialysis treatment It leads to an increase in theaters in larger fluid weekends between treatments and can contribute to post dialysis hypertension and headaches Target weight is Prescribed and determined by physician order Modified by physician based on patient tolerance Attempting to remove a large amount of fluid weight gain from the patient

Can lead to hypovolemia during the treatment which is associated with an increased mortality rate With the patients calculated UF goal exceeds the maximum UFR ordered by the nephrologist Calculated UF goal must be adjusted to not exceed the ordered maximum UFR in the reason documented The PCT notes that a patient still has considerable Adema in her legs when performing the post treatment data collection. In addition to informing the nurse,what should the PCT document? Document the noted swelling and that the nurse was informed Poor or incomplete documentation Can open an attack on your care What are three things you should not include in an REM? Personal opinion, speculation, vendettas The clinical pyramid includes The fundamentals, complex programs, and quality of life DQI success is achieved by Managing individual patients first and allowing scores to follow Knowing each team members role in improving the DQI scores

Using the CQI process to help identify trends and make improvements For patients with AKI A pre-treatment nursing assessment is always required How do you verify that the patient is stable and safe for discharge after the dialysis treatment? Evaluate the effectiveness of the treatment by comparing data to pre- dialysis findings PCT's notify the nurse if there are any unusual findings Nurses perform a post treatment assessment as required Documentation in the medical record Is a permanent legal record of the care provided All documentation on machine set up and a pre-treatment patient information Must be entered into the computer before the treatment is initiated Post treatment data collection in assessment is performed After the treatment is terminated You administer 100 ML saline bolus to your patient during the treatment what would be important to include in your documentation?

The reason for administering the Saline and the patient's response Which in center hemodialysis patients are at risk of experiencing signs and symptoms of dialysis disequilibrium syndrome? Since who are skipping treatments The left side Trendelenburg position is to be used for A patient who experienced an air embolism Your immediate intervention for a patient experiencing an anaphylactic reaction is Stop the blood pump, discontinue treatment, do not return the blood Interventions for a patient complaining of chest pain/angina include Decrease BFR, decrease UFR, administer oxygen As you initiate the treatment your patient complains of pain at the Venus needle site, tingling around the lips and difficulty breathing. These are signs or symptoms of A disinfectant infusion In states that do not mandate a pre-dialysis patient assessment by the register nurse

The PCT must inform the nurse of unusual data collection findings prior to treatment initiation Intradialytic hypotension Can have many adverse effects including impaired tissue perfusion of vital organs and organ injury They recommended intervention for muscle cramps is Turning the UFR off Per Davita policy, fever and chills is defined as Any temperature greater than 100 or increased over baseline of 2° with symptoms Mr. Simmons complains of shortness of breath and back pain upon inspection, the blood lines look like cherry Kool-Aid. What is this complication and what should you do? This is hemolysis and the hemodialysis treatment should be stop without returning the patient's blood In the event of a patient is experiencing a seizure, the dialysis treatment should be Discontinued if the seizure is severe or the patient does not respond to treatment

Waiting only five seconds between lowering the blood pump speed and drawing the post treatment blood sample would Cause the KT /V reading to be falsely high Which of the following factors would decrease the K of the KT/V formula? Inadequate coagulation A patient with an acute kidney injury (AKI) is at increased risk for Hypotension and hypovolemia Knowing what caused your patient renal failure Is important to inquire about possible problems during data collection and assessment Explain the difference between AKI and CKD AKI is short term and reversible CKD is long-term and irreversible Treatment goals for a patient with CKD Slowing the progression of see KD next line controlling symptoms Managing complications Minimizing the effects of CKD and patients lifestyles Renal replacement therapy modality education Encouraging patient to actively participate in their healthcare

What are the most common causes for CKD in the USA? Diabetes Hypertension Polycystic kidney disease Why is it important to know what caused your patient CKD? Helps anticipate the treatment and what to expect What is K? Stands for clearance ot urea What treatment factors decrease K? Clotting Low blood flow rate low blood volume processedNext line Low dialysate flow rate Lab draw mistakes What treatment factors increase K? Higher blood volume processed Higher blood flow rate Increasing time Dialyzer with more surface space

What is T? Stands for time What factors influence T Longer blood dialysate contact time More frequent or extra treatments What is V Stands for volume What factors influence V? A persons body is composed of 50 to 55% water A persons height, weight, sex, age and amputations are included in calculating V Needle gauge and suggested BFR 17 gauge needle 200- 16 gauge needle 250- 15 gauge needle 350- 14 gauge needle more than 450 Procedure for post bun lab draw

UF off DFR to 300 or bypass BFR to 100 Wait 15 seconds then draw lab Lab draw mistakes that will fastly increase KT/V Not reducing blood flow rate Not waiting 15 seconds Lab draw mistakes that would possibly decrease KT/V Waiting longer than 15 seconds Diluting the pre-treatment sample Who does patient assessments Licensed nurse Who does data collection Non-licensed teammates What is the role of a PCT prior to treatment initiation? Data collection Machine set up

What is the role of the license nearest prior to treatment initiation? Assess everyone Assess new patients assess AKI patients When is a pre-treatment assessment by the licensed nurse required? When there is abnormal findings during data collection New patients AKI patients Nurses have one hour to do assessment unless there are abnormal findings If the BP cuff is too small the blood pressure could read Falsly high If a blood pressure cuff is too large the blood pressure can read Falsely low When is post treatment and assessment by a licensed nurse required? All patients in Connecticut Why do we document in the medical record? Proof that here was recorded Permanent legal record

Provide data continuity Communication tool List six occurrences when to chart Change from baseline assessment Change in patient condition Procedure or treatment Medication given and patient response Patient teaching care plan review and interventions What are the appropriate times for documentation? Pre-treatment safety checks prior to start of treatment Pre-treatment data collection assessment prior to treatment Observations during treatment every 30 minutes Post treatment data collection assessment after treatment has ended What are possible consequences of poor or incomplete documentation? Civil liability What are six items included and charting administered medications? Time Route Amount/Allergies Medication

Patient Documentation How do you document the entries? Signed by the person making the late entry Time to and dated at the time it was entered (never backdate) How to document charting errors? Draw a line through the entry in notes erroneous entry or error entry Date & sign Document correct information What does SMART communication stand for? Simple and clear Meaningful next line actual just report Facts Read make sure you send the message you attend teach others about smart communication What are 5W's to be used when completing a REM? What happened Who is involved when did it happen what was the result Where did it happen

Any witnesses What are three things you should not include in a REM? Personal opinion Speculation Vendettas What are the four consequences of sodium loading during dialysis? Hypertension Increase fluid weekend Increase fluid intake/thirst Higher mortality rate State three ways we can contribute to sodium loading during dialysis Diffusion from dialysate Normal Saline administration Dietary intake What are consequences of a patient is consistently fluid overloading (hypervolemia)? LVH CVD Hypertension Higher mortality rate

What are the consequences and risk of hypovolemia during the treatment? Intradialytic morbidities Ischemia an damage to vital organs Loss of RRF increased mortality rate The reasonable and prudent standard of care For nephrology nursing concepts When supervising the license assistive personnel it is the responsibility of the license Nurse to ensure teammates also meet the standard of care What role does Davitas policy and procedures play? Standard of care Best demonstrated practice Prima facie evidence What are the risk of doing it your way? Negligence Proximate cause Damages What Makes dialysis patients more susceptible to HAIS? Contact transmission is most important route

Why are dialysis patient is at increased risk for acquiring a HAI at the facility? Prolonged access to patient's blood Bacterial vascular access infections are the most frequent infectious complication What is the difference between OSHA and CMS infection control requirements? OSHA-requires employees to provide workers with a safe workplace CMS-concerned with patient care and patient safety What does the acronym DARN stand for? Desire - what they want for themselves Ability-what treats they have to be successful Reason-reason for change Need-why so important When should the communication style "directing" be used Being in charge give instructions expects adherence When should the communication style "following" be used?

Understanding through listening, goal is to see through the eyes of the other person When should the communication style "guiding" be used? Knowledgeable reverse assist in finding on solutions, elicits behavior change through patient's own insights and motivations What are the three core communication skills to be use within the communication styles? Asking Listening informing What does the R in RULE stand for? Resist the righting reflex What does the U in RULE stand for? Understand your patients motivations. What does the E in RULE stand for? Empower your patients What does the L in RULE stand for?

Listen to your patients Reflective listening-three skills Restating/rephrasing-providing short summary what we heard the patient say Deducing-reflecting how the patient feels and means Summarizing The five stages of grief denial, anger, bargaining, depression, acceptance What is KDQOL 36? Tool that identifies barriers What is KDQOL 36 used for? To Compile results and develop interventions and goals What is the role of the social worker? Counselor Educater advocate coach

What can PCT's do to assist the social worker? Listen Acknowledge notify social worker Four indicators of optimal nutrition status Appropriate appetite and intake Adequate fat stores in muscle mass Stable desirable target weight Albumin lower than 4.0 What's the importance of protein Maintain health Fight infection Prevent anemia Build and maintain muscles Heal wounds Attain goal level of albumin 4.0 Importance of sodium and negative affects of sodium loading +Helps regulate body fluid volume and balance -Contributes to thirst and fluid games Signs and symptoms of fluid access Edema

Shortness of breath Hypertension Congestive heart failure Importance of limiting potassium Muscle weakness Numbness in tingling of the extremities Increase and decrease heart rate and pulse Cardiac arrest Importance of limiting phosphorus and when to take binders Itching Bone damage Soft tissue calcification including heart and blood vessels Binders should be taken with meals Importance of keeping Calcium within normal levels Healthy bones Muscle contraction and relaxation Proper functioning Levels 8.4 -10.2 Importance of vitamins

Water soluble -Supplemented due to diet limitations and dialysis -taken after meals Fat soluble - not removed by dialysis therefore supplementation not recommended What are three underlying assumptions of self management? Regardless of chronic condition people have similar challenges with self management People can learn the skills needed to better manage their disease day-to- day People who understand and take control of their condition will be healthier and happier What are three basic principles of self management? Dealing with consequences of illness Focusing and problem-solving decision making in patient confidence Placing patients in care providers in partnerships with specific responsibilities for each Definition of health literacy the capacity to obtain, interpret, understand, and use health information and services to enhance health What are five ways for healthcare professionals to contribute to a patient's low health literacy? Use the teach back method Ask questions that begin with how and what Organize information so that the most important points stand out