Dialysis Technician Knowledge and Responsibilities, Exams of Nursing

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CCHT Exam Part A with complete solutions 2024/2025 What are some of the responsibilities and requirements of the medical director of a dialysis facility? - ANSWER-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? - ANSWER- Specific dialyzer, BFR, Duration To sit for the CCHT-A exam, the tech must have what? - ANSWER-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? - ANSWER-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? - ANSWER-Cert biomedical nephrology technology What consents are needed for dialysis? - ANSWER-1 for treatment, 1 for access procedures If a patient decides to terminate dialysis, what should the staff do? - ANSWER- Realize it is well within the pts right to choose termination. Who was the first person to use the term 'dialysis'? - ANSWER-Thomas Graham What was the primary anticoagulant used in the first artificial kidney? - ANSWER- Hirudin Dr Kolff created the first bio-compatible (rotating drum) dilyzer. What material was used to construct the hollow tubes? - ANSWER-cellophane The first AV shunt for CKD was placed... - ANSWER-externally, using Teflon tubes Which US President signed the bill that allowed Medicare coverage for CKD tx? - ANSWER-Nixon In 1989, the FDA approved a drug that diminished the need for blood transfusions in CKD - ANSWER-Epogen (mircera) An electrolyte is a substance that dissolves in water to form - ANSWER-Ionized particles What happens to a pt is the dialysate contains too much sodium? - ANSWER- Fluid leaves the cells and they shrivel, the pt will get hypotensive, thirsty and get a headache With osmosis, water moves from areas of.. - ANSWER-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? - ANSWER-Bicarbonate Kidney failure causes retention of hydrogen ions. What is the result? - ANSWER- Metabolic acidosis Which of these pt populations has the lowest proportion of body water? - ANSWER-Adult females The vasa recta capillaries surrounds the loop of Henle nephrons and play a major role in... - ANSWER-Concentration of urine as it moves through the tubules In the formation of urine, what action is occurring in step 2? - ANSWER-Water and other dissolved substances move from the tubules into the blood in the peritubular capillaries. During a dialysis session, a temp ____ will cause hemolysis - ANSWER-Over 41 degrees What should be done if the blood leak alarm goes off, but there doesn't appear to be contamination? - ANSWER-Test dialysate with an approved blood leak test strip Where are the two places air can enter the lines? - ANSWER-At loose connections, and empty fluid containers What does high efficiency dialysis require? - ANSWER-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? - ANSWER-High flux membranes readily pass particles of 2,000-10,000 daltons in size How does flow rate affect the removal of toxins? - ANSWER-The greater the flow rate, the greater the removal of solutes. To achieve an optimal concentration gradient, what direction should blood and dialysate flow? - ANSWER-In opposite directions During UF, what happens when positive pressure is applied to the blood side of the dialyzer? - ANSWER-Plasma fluid will be pushed out If reverse filtration occurs and dialysate get into the blood, with might the pt experience? - ANSWER-A pyrogen reaction; AKA fever What principle is used to increase tx tolerance and decrease complications d/t fluid removal? - ANSWER-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? - ANSWER-Hypovolemia What is the most common impurity in tap water? - ANSWER-Calcium carbonate What chemicals can cause methemoglobenemia, in which red cell hgb can't transport oxygen? - ANSWER-Nitrates and chloramines In order to remove smaller solutes, such as endotoxins, which filter should be used? - ANSWER-UF What is the proper procedure regarding the removal of chlorine and chloramines in a two tank system? - ANSWER-If sampling reveals there is a chlormaine >0.1ppm leaving first tank, second tank must be sampled Polymade membranes used for RO: - ANSWER-Have a wide pH tolerance, are very susceptible to degredation by free chlorine What is an advantage of RO water treatment? - ANSWER-Rejects bacteria, viruses, and pyrogenic material if membrane is intact What type of water is produced by deionozers? - ANSWER-Water of high ionic purity How is UV light used in treating water? - ANSWER-To destroy microorganisms The max level of endotoxins in water used to prepare dialysate must not exceed: - ANSWER-2 EU/mL If water quality standards are not met, who may be cited as the negligent party? - ANSWER-MD When preparing a dialyzer for pt use, the tech must ensure: - ANSWER-There is no air in the dialyzer What is the order in which the dialyzer is primed? - ANSWER-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? - ANSWER-500-1000mL When would a reused dialyzer be rejected? - ANSWER-Renalin exposure was 4 hours total Two people must verify that __ and that __ before using a reprocessed dialyzer: - ANSWER-the dialyzer is correct for the specific pt, the disinfectant is negative Name two guidelines concerning hand washing: - ANSWER-1) when decontaminating hands via alcohol, rub until dry 2) clinics must have dedicated 'clean' sinks for handwashing only Hep B: - ANSWER-1) highly transmissible 2) live on a surface for a week How is a pt who is Hep B + safely dialyzed? - ANSWER-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? - ANSWER-Anti HBc - and Anti- HBs + A staff member tests positive for IgM to Hep B. What does that mean? - ANSWER- He has had a recent infection w/ Hep B What is the CDC recommendation for Hep C screening? - ANSWER-Monitoring all pts for liver enzyme elevation How can pts with antibiotics resistant infections be safely treated? - ANSWER- 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? - ANSWER-Contact iso What solution is used to clean machines, chairs, IV pumps, etc? - ANSWER- Bleach, 1:100 or 1:10 After heparin is given, what adverse event is more common? - ANSWER-Bleeding How long is the half life of heparin? - ANSWER-90 minutes When citrasate acid is used: - ANSWER-hypocalcemia is no longer a concern, anti-coagulation is improved What is the preferred access for ESRD pts? - ANSWER-Radial cephalic arteriovenous AV fistula What precautions should pts with stage 4 or 5 follow? - ANSWER-Wear a medical bracelet that discourages use of vessels that may be needed for dialysis