Dialysis Water Quality and Infection Control, Exams of Nursing

Download Dialysis Water Quality and Infection Control and more Exams Nursing in PDF only on Docsity! CCHT EXAM NEWEST ACTUAL EXAM 2 VERSIONS 2024-2025 QUESTIONS AND DETAILED CORRECT ANSWERS (VERIFIED ANSWERS) | A+GRADE VERSION 1 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 A. There is no way to satisfy a patient's protein needs with a total plant-based diet B. Plant proteins are low biological value proteins and need to be combined to get all building blocks her body needs C. No plant protein foods are considered high proteins so it will be hard for her to satisfy her protein needs Correct Answer B. For a patient with stage 5 CKD phosphorus intake should be limited to what level A. 400 to 800 B. 1200 to 1600 C. 800 to 1200 Correct Answer C. A patient with CKD is having difficulty controlling her phosphorus intake why is control of phosphorus challenging A. Phosphorus is abundant in fresh food such as vegetables and fruit B. Phosphorus is found in high amounts of coffee and tea C. Phosphorus additives are commonly found in best- selling processed foods Correct Answer C. A patient with stage 5CKD has C Dash reactive protein level of 25 what does this level suggest A. Early onset diabetes B. Inflammation in the body C. Heart attack Correct Answer B. Parathyroid hormone helps to regulate calcium and phosphorus levels low serum calcium levels stimulate secretion of parathyroid hormone this results in which change of the body A. Increase calcium absorption from small intestine B. Calcium loss in the urine is minimize C. Movement of calcium out of the bones D. Creation of a urinary buffer for acid base balance Correct Answer A B and C How can a dialysis procedure be modified for a CKD patient with severe elevated blood urea nitrogen level A. Shorten dialysis time B. Increase blood flow rate C. Increased time rinsing the equipment D. Use a larger dialyzer Correct Answer B and D Which asymptomatic patient meet the criteria for testing for diabetes or prediabetes 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 Correct Answer 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 Correct Answer 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 Correct Answer 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 Correct Answer A and D To accomplish saw you removal and dialysis what is needed A. Mass transfer B. Countercurrent flow C. A difference in concentration Correct Answer 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 Correct Answer 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 Correct Answer 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 Correct Answer 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 Correct Answer A. Adsorption What type of contaminants are removed from water used in dialysis A. Endotoxins B. Aqueous salts C. Water softeners Correct Answer 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 Correct Answer 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 Correct Answer All of the above When preparing the water used for the dialysate and reprocessing of dialyzers the CMS require "conventional A. Patient gown tied in back B. Weighted lead aprons C. Impervious isolation gowns Correct Answer C. Isolation gowns When washing hands with soap and water what's the minimum number of seconds hands should be rubbed together A. 10 B. 15 C. 30 Correct Answer B. 15 What are the most common ways Hep B virus is transmitted in a unit A. Skin penetration by contaminated sharps B. Contact of contaminated blood with broken skin C. Pts with Hep B breathing or coughing on others Correct Answer A and B Filling the accidental exposure to blood from a pt HIV positive what tx is recommended A. 3 month prescription of med to prevent HIV B. Follow up blood test three months after exposure C. 4 week 2 drug regimen is recommended within 72 hours of exposure Correct Answer C. According to the CDC health care workers exposed to needle stick involving HIV infected blood have a 0.23% chance of becoming infected if untreated. After a needle stick or sharps exposure to hep C virus what is the risk of developing infection A. 0.01% B. 0.5% C. 1.8% Correct Answer C. 1.8% What are the recommendations for dialysis personnel caring for patients with clostridium difficile colitis A. Wear gloves when treating patient B. Impervious gowns upon entering room C. Wash hands with soap and water Correct Answer All of the above 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 Correct Answer 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 Correct Answer 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 Correct Answer 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 Correct Answer 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 Correct Answer 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 Correct Answer C. How should the needles be positioned A. Please the needles in the same general area during each treatment 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 Correct Answer 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 Correct Answer 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 Correct Answer 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 Correct Answer 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 Correct Answer A. 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 Correct Answer 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 Correct Answer 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 Correct Answer 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 Correct Answer 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 Correct Answer 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 Correct Answer 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 B. 60-89 ml/min/1.73 C. 30-44 ml/min Correct Answer A. Less than 15 The patient asks the dialysis technician if there's anything she can do to slow the progression of her kidney disease. Which risk factor could the technician mention during the conversation A. Control your blood glucose levels if you're a diabetic B. Maintain healthy weight C. Control cholesterol levels D. Stop use of alcohol Correct Answer A B and C Which recommendation would've nephrologist likely make for a patient who has read stages three or four chronic kidney disease A. We'll tele health visits discussing daily urine output B. Dietary restriction on sodium phosphorus and protein C. Monitoring for mineral bone disease D. Education on cardiovascular disease Correct Answer B,C and D Which patient would be considered at higher risk for developing chronic kidney disease A. Hispanic female who is unaware that she is hypertensive B. White female with family history of diabetes who watches her exercise and diet C. Asian male who schedules regular visits with healthcare provider D. African-American female whose parents both died following stroke Correct Answer A and D Patient with chronic kidney disease asks what her goal hemoglobin level should be what level as recommended by the national kidney foundation kidney disease guidelines A. 9% B. 7% C. 11% Correct Answer B.7% Patient with chronic kidney disease arrives at the center after his nephrology visit he relays to the staff that the doctor said he was hardening of the kidneys what is the cause of this condition A. Prolonged severe hypertension B. Daily ingestion of sugar sweetened drinks C. High fat diet D. Too much calcium in the diet along with hypertension Correct Answer A. What is one cause of postrenal failure A. Renal trauma B. Prostrate disease C. Fluid volume shifts D. Kidney infections Correct Answer B. Prostate disease The family member of a dialysis technician has noted blood in his urine the tech also noted the weight loss and rubbing of the flank to ease the cramping pain which disease comes to mind A. Nephrotic syndrome B. Bladder infection C. Kidney stones D. Renal carcinoma Correct Answer D. Renal carcinoma Which integumentary changes are commonly seen in patients with chronic kidney disease A. Brittle nails B. Excessive sweating C. Bruising D. Increase number of moles Correct Answer A and C Monday also patients infection account for about one and 10 fatalities which condition increases a patient's susceptibility to infection A. Diabetes B. Malnutrition C. Bone abnormalities D. Frequent invasive procedures Correct Answer 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 Correct Answer C. Phosphate binders Which of the following practices helps to build a pts immunity to hep B A. Isolation B. Vaccination 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 Correct Answer 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 Correct Answer 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 Correct Answer 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 Correct Answer 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 Correct Answer 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 Correct Answer 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 Correct Answer 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 Correct Answer 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 Correct Answer 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 Correct Answer 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 Correct Answer 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 Correct Answer B. The patient has had an expected progression of CKDN needs urgent start peritoneal dialysis what problems may C. Elevated serum creatinine Correct Answer C. In a two year old which serum creatinine level would indicate kidney failure A. 0.4 B. 1.0 C. 0.7 Correct Answer B 1.0 Which dialyzer is appropriate and pediatric hemodialysis A. Dialyzer surface area should approximate the child's body surface area B. Regular adult dialyzer will work on pediatric patient C. Any dialyzer will work as long as ultrafiltration is kept at a low level Correct Answer A. What precaution should be address when restraining a pediatric patient for needle insertion A. All children under 10 must be restrained during assessing their fistula B. Children weighing less than 15 KG should be swaddled C. No matter the type of restraint a medical order should be written and refreshed with each dialysis treatment Correct Answer C. When would it be appropriate to isolate a child during hemodialysis treatment session A. Experiencing a runny nose and itchy eyes B. Exposed to chickenpox and now running a fever and has a red bumpy rash C. Confirmed lab test positive for blood-borne pathogen's Correct Answer B and C If a 13-year-old child has a blood pressure of 140/90 for three days in a row what blood pressure category/stage would this child be diagnosed with A. Normal blood pressure B. Stage two hypertension C. Stage one hypertension Correct Answer B. Which child is at high risk for developing latex allergy A. Young child born with spina bifida B. Child with allergies to cats and dogs and most grasses C. Child with urologic problems who requires frequent catheter placement Correct Answer A and C VERSION 2 1.Which of the following best describes the reason for wearing gloves when handling machine prior to blood? a) patient comfort b) asepsis c) universal precautions d) HIV Correct Answer c) universal precautions 2 You test for sterilant levels in a hemodialysis machine prior to patient use. The test is positive for sterilant. This means the machine: a) is sterile & bacteria free b) needs further rinsing c) needs more sterilant d) is in conductivity Correct Answer b) needs further rinsing 3.Choose the correct statement regarding serum abnormalities in renal failure: a) creatinine, BUN, & phosphorus are elevated b) creatinine BUN creatinine, BUN, & phosphorus are depressed c) calcium & bicarbonate are elevated d) calcium & bicarbonate are depressed Correct Answer a) creatinine, BUN, & phosphorus are elevated 4.Hemodialysis requires a means to channel the patient's blood to the hemodialyzer & then back to the body. It's called: a) vascular access b) hemodialyzer c) dialyzing fluid delivery system d) infusion pump Correct Answer a) vascular access 5.Which of the following is correct regarding a fistula? a) usually created in the leg, near the ankle b) usually created in the forearm, near the wrist c) are made of salastic tubing d) none of the above Correct Answer b) usually created in the 13.The following are factors in poor clearance during dialysis except: a) poor dialyzer reuse b) access recirculation c) low hematocrit d) low blood flow rate Correct Answer c) low hematocrit 14.The movement of water from an area of low solute concentration to an area of high solute concentration is called: a) diffusion b) osmosis c) ultrafiltration d) dialysis Correct Answer b) osmosis 15.Potting compound, casing, fibers and headers are part of a: a) dialysis machine b) water treatment system c) R. O. system d) dialyzer Correct Answer d) dialyzer 16.Mr. Jones has a dry weight of 72 kg. He weighed 73 kg after last treatment. Today he weighs 75.5 kg. Assume prime and rinse back =500 ml total. What is Mr.Jones' fluid removal goal for today? a) 2.5 liters or 2500 ml b) 3.0 liters or 3000 ml c) 4.0 liters or 4000 ml d) 4.5 liters or 4500 Correct Answer c) 4.0 liters or 4000 ml 17.A hematocrit test indicates which of the following? a) concentration of platelets b) concentration of creatinine in the blood c) concentration of red blood cells in the blood d) concentration of white blood cells in the blood Correct Answer c) concentration of red blood cells in the blood 18.What factors should be considered when establishing a patient's dry weight? a) blood pressure b) patient well being c) evidence of dehydration or fluid overload d) all of the above Correct Answer d) all of the above 19.In a dialysis machine, the proportioning system does what? a) prepare the dialysate to the proper pH b) warm the dialysate to the proper temperature c) appropriately mix the dialysate concentrates with water d) to monitor the dialysate flow rate Correct Answer c) appropriately mix the dialysate concentrates with water 20.The complication in which blood has a "cherry pop"appearance is: a) blood leak b) air embolism c) hemolysis d) none of the above Correct Answer c) hemolysis 21.The use of high a sodium dialysate may predispose a patient to: a) fluid overload b) hypertension c) thirst d) all of the above Correct Answer d) all of the above 22.The capability of a dialyzer to remove fluid, expressed as ml/mmHg/hr is: a) UF Coefficient b) clearance c) surface area d) priming volume Correct Answer a) UF Coefficient 23.A pre-pump arterial pressure reading is measuring: a) the pressure required to pump the blood through the dialyzer b) resistance to blood flow out of the access c) pressure within the dialyzer d) none of the above Correct Answer b) resistance to blood flow out of the access through the dialyzer 24.What determines the surface area of a hollow fiber dialyzer? a) number of fibers b) internal diameter of fibers c) length of fibers d) mg% Correct Answer b) mm/Hg 34.TPM is measured as: a) mL/hr b) mm/Hg c) mL/min d) none of the above Correct Answer b) mm/Hg 35.The hemodialysis machine continuously monitors many parameters. Which of these parameters must be verified by an external measuring device? a) blood flow b) dialysate flow c) pH and conductivity d) temperature and transmembrane pressure Correct Answer c) pH and conductivity 36.Prior to each patient shift, it would be essential to perform a water quality check for which of these substances? a) calcium and magnesium b) chlorine and chloramine c) organic contaminants d) inorganic contaminants Correct Answer b) chlorine and chloramine 37.The term pH is a measurement of the concentration of: a) all ions in solution b) hydrogen ions c) bicarbonate ions d) acetate ions Correct Answer b) hydrogen ions 38.The technician's role in patient teaching should be to: a) assess the patient"s barriers to learning b) check the patient's readiness to learn new information c) determine the patient's learning needs d) Reinforce teaching that the patient has received from other team members Correct Answer c) determine the patient's learning needs 39.What can dialysis staff do to reduce the risk of being infected with a blood borne pathogen? a) proper hand washing b) universal precautions c) proper sharps disposal d) all of the above Correct Answer d) all of the above 40.Which of the following are ways to handle chemicals safely? a) wash hands before eating or drinking b) wear protective clothing c) don't eat or drink in the work area d) all of the above Correct Answer d) all of the above 41.What is the correct angle in which to cannulate a fistula? a) 10-15 degrees b) 25-35 degrees c) 35-45 degrees d) it dosen't matter Correct Answer b) 25-35 degrees 42.Which of the following affects access recirculation? a) distance between the tips of the needles b) presence of stenosis c) direction of needles d) all of the above Correct Answer d) all of the above 43.The technician observes that the hardness reading after the water softener isabove the acceptable limit. The technician should check the softener tank's level of: a) salt b) chlorine c) carbon d) sand Correct Answer a) salt 44. A technician observes all of the following in the hemodialysis unit. Which one poses an environmental risk? a) the wheels of the hemodialysis machines are locked b) charts are lying on bedside tables c) about one ounce (30 ml) of fluid is on the floor d) a patient's family member is present during treatment Correct Answer c) about one ounce (30 ml) of fluid is on the floor 45. When preparing a bleach solution for cleaning equipment, the technician accidentally spills undiluted