Fresenius RN Exam Questions With 100% Correct Answers 2023-2024, Exams of Nursing

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Fresenius RN Exam Questions With 100%

Correct Answers 2023-

What are the anatomical structures of the urinary system? Answer- 2 Kidneys 2 Ureters Bladde r Urethr a Anatomical structure of kidneys, order of urine flow? Answer- kidneys, ureters, urinary bladder, urethra Kidneys produce urine which is transported by the ureters to the bladder where it is stored and eventually excreted from the body via the urethra. What is a nephron? Answer- Nephrons are the functional units of the kidney. They are a tubular structure that filter blood to form urine. What are nephrons composed of? Answer- Glomerulus and Tubules What is a glomerulus composed of? Answer- Tangled cluster of capillaries surrounded by the Bowman's capsule. How does blood enter the kidney? Answer- Through the renal artery What is the acronym for the 7 functions of the kidneys? Answer- A Wet Bed What does A Wet Bed stand for? Answer- A - acid base balance maintenance W - water balance maintenance E - electrolyte balance T - toxin removal B - blood pressure regulation E - erythropoietin production D - vitamin d metabolism What is Glomerular Filtration Rate (GFR) in the 5 stages of kidney disease? Answer- GFR describes the flow rate of filtered fluid through the kidney. GFR of the 5 stages of kidney disease? Answer- 1. 90 or greater 2. 60-

3. 30-

4. 15-

5. less than 15 Descriptions of the 5 stages of kidney disease? Answer- 1. Normal kidney function but urine or other abnormalities point to kidney disease.
6. Mildly reduced kidney function, urine or other abnormalities point to kidney disease.
7. Moderately reduced kidney function. 4. Severely reduced kidney function.
8. Very severely reduced kidney function (also called CKD) What are the types of kidney failure? Answer- Acute and chronic What can cause acute renal failure? Answer- Drug toxicity MVA Dehydration Characteristics of acute renal failure? Answer- Sudden Onset Severe Usually reversible What can cause chronic renal failure? Answer- Diabetes Hypertension Glomerulonephritis What are some characteristics of chronic renal failure? Answer- Slow onset Progressive Permanent Other causes of Renal Failure can include: Answer- Polycystic Kidney Disease Interstitial Nephritis Goodpasture Syndrome Wilm's Tumor Systemic Lupus Erythematosus Alport's Disease Sickle Cell Disease Drug Toxicity (Heroin, cocaine, NSAIDs, acetaminophen) AIDS Obstructio ns Scleroderm a Classic signs of renal failure? Answer- Elevated serum BUN/creatinine, phosphorus, potassium Anemia Nerve damage Yellow-gray appearance of the skin Fluid overload

SOA

Edema

Hypertensi on Proteinuria Classic symptoms of renal failure? Answer- Uremia Lethargy Weakness Headache Itching Fatigue Nausea Restlessnes s Mental Status changes Loss of appetite What is anemia? Answer- Lack of Red Blood Cells RBC's What causes anemia? Answer- Decreased of lacking erythropoietin production Shortened RBC lifespan Decreased iron absorption Blood loss during dialysis How is anemia treated? Answer- Erythropoietin stimulating agents (ESA's) are administered. ESAs stimulate RBC production in the bone marrow. Examples of ESA's include Epogen, Aranesp, and Mircera. Signs and symptoms of anemia? Answer- Fatigue Decreased energy levels SOA Decreased sense of well-being Hgb range for ESRD patients is 10- Role of iron and iron medications with Anemia? Answer- Iron bind with RBC's Formulates Hgb Allows RBC to transport oxygen Examples include Venofer, Ferrlicit RN administration is usually 50 mg IVP every other week. Given IV due to absorption and constipation properties seen with oral preparations. Which functions of healthy kidneys are replaced by dialysis? Answer- Removal of waste products Regulation of fluid balance What are 3 modalities of treatment for ESRD? Answer- Hemodialysis Peritoneal dialysis Transplantation Describe hemodialysis Answer- Uses a vascular access to draw blood from the patient and send to the dialyzer and into the semi permeable

membrane where diffusion removes the waste products and ultrafiltration removes the fluid.

Describe Peritoneal dialysis Answer- There are 2 types: Continuous cycle peritoneal dialysis (CCPD) and continuous ambulatory peritoneal dialysis (CAPD) Both types use a permanently placed catheter in the patients highly vascularized peritoneal cavity. The peritoneum is the membrane surrounding the organs in the abdomen During CAPD, dialysate is infused into the peritoneal space, allowed to "dwell" for a period of time as ordered by the physician and then drained. Through osmosis and diffusion, excess fluid and waste products are removed. Describe Transplantation Answer- A working kidney is surgically implanted Kidney is from a living or cadaveric donor Patient must take anti-rejection medications for the life of the kidney Where HD vs PD is done? Answer- HD is done usually outpatient or home HD is done in home. PD is done in the patient's home. What filters waste in HD vs PD? Answer- A dialyzer (artificial kidney) filters the waste from blood in HD. The patient's peritoneal membrane acts as the semi-permeable membrane and filters waste in PD. How long does HD vs PD take? Answer- HD usually lasts 3-4 hours, 3 times a week. PD is performed daily with several exchanges during the day, or done during sleeping hours with a cycler. How is fluid removed in HD vs PD? Answer- Fluid removal is done through ultrafiltration in HD. Fluid removal occurs via osmotic pressure and concentration gradients caused by dextrose solution and dwell times in PD. What are the body fluid compartments? Answer- Intracellular - inside the cells. Extracellular - outside the cells. Intravascular - inside the blood vessels. Interstitial - between the cells. What is diffusion? Answer- Movement of solutes across a semi- permeable membrane from higher to lower concentration. What is osmosis? Answer- Movement of fluid from a lower concentration of solutes to a higher concentration. What is ultrafiltration? Answer- Uses both negative and positive pressure to remove excess fluid from the patient. Why is water used for dialysis treated? Answer- Water contains contaminants, electrolytes, and impurities. Because dialysis patients are exposed to large amounts of water each treatment, these impurities must be removed to protect the patient form harm.

What is chloramine and how is it different from chlorine? Answer- Some water treatment facilities use a combination of chlorine and chloramine to treat water. Chloramine is a combination of bleach and ammonia, whereas chlorine is bleach alone. What is the diasafe filter? Answer- It is found on the back of the hemodialysis machine and allows for the delivery of ultrapure dialysate. What factors impact the rate of diffusion? Answer- Concentration gradient Temperature Molecular weight of solutes Nature of the solution Membrane permeability Surface area Flow geometry convection What happens to diffusion when dialyzer fibers clot? Answer- Diffusion is decreased. Clotted fibers cause the permeability of the fiber to be reduced or eliminated, causing a decrease in treatment adequacy. As a result, diffusion does not occur as particles cannot diffuse across the membrane. At what point during the hemodialysis treatment will diffusion cease to occur? Answer- Diffusion will continue throughout the dialysis treatment until the concentration gradient of each electrolyte found in the patient's blood is equal to the electrolyte concentration in the dialysate. What is the largest factor that impacts ultrafiltration? Answer- Pressure. What happens when the dialysate flow is turned off during the treatment? Answer- The patient's blood is not cleaned and adequacy will decrease. What are the compartments of the dialyzer and what separates them? Answer- There are two compartments, the blood and dialysate compartment. The two are separated by a semipermeable membrane. What is a semi-permeable membrane? Answer- A membrane made from protein, with small pores or holes. Only certain molecules can fit through. What is countercurrent flow? Answer- Blood and dialysate flow in opposite directions-called countercurrent flow, which means as blood flows down into the dialyzer (arterial to venous), dialysate flows up (venous to arterial) What are 3 types of solutions? Answer- Hypotonic - containing less particles Isotonic - containing equal particles Hypertonic - containing more particles pH scale Answer- Less than 7 = acidic Greater than 7 = alkaline Equal to 7 = acid and base ions are equal

Normal blood pH Answer- 7.35-7. What is bicarbonate? Answer- (HCO3) is a buffer that helps to maintain a constant pH in a solution even if an acid or base is added. What is conductivity? Answer- The ability of a solution to transmit or conduct an electrical current. In dialysis, it is used to calculate the electrolyte concentration in the final dialysate. What is the safe conductivity from the theoretical conductivity reading from the machine? Answer- + or - 0. What is dialysate? Answer- A non-sterile solution and its function is to remove waste products from the blood and balance electrolytes. What is dialysate composed of? Answer- Purified water Acid solution Bicarbonate solution Why is dextrose added to dialysate? Answer- Dextrose is a form of glucose and is added to prevent hypoglycemia. What electrolytes are found in dialysate? Answer- Sodium Potassium Calcium Magnesiu m Chloride What are 4 ways dialysate is checked to ensure that it is safe? Answer- pH Conductivity Monitoring the machine temp A negative residual bleach strip test after weekly disinfection What causes increased arterial pressures? Answer- Kinks, clamp or occlusion on the arterial line BFR exceeds vascular access flow Needle gauge size selected compared to BFR Needle placement Clotting, stenosis, vasoconstriction or vasospasms Malposition of catheter tip, constricting sutures at insertion site or CVC thrombus Hypotension Poor cardiac output Increased blood viscosity due to high hgb or ultrafiltration What causes increased venous pressure? Answer- Kinks, clamp or occlusion on venous line Infiltration or poor needle placement Clotting in: needle, CVC, venous chamber lines or dialyzer Machine malfunction Wet or bloody transducer protectors

Venous infiltration What is the meaning of a blood leak alarm? Answer- Fibers have broken inside the dialyzer. Blood and dialysate have entered each others compartments. Inspect dialysate for pink-tinged color. Confirm this by checking effluent dialysate fluid (red hanson) with a blood leak strip. If positive, DO NOT return blood. What is the meaning of an air detector alarm? Answer- Air or foam has been detected by the machine. The machine automatically clamps off line below venous chamber. Blood pump stops to assure that no air gets to patient. DO NOT disarm. What is the meaning of a venous pressure alarm? Answer- Something is blocking the return of the blood to the access. This alarm may indicate a kink on the venous bloodline, an infiltrated venous needle, a clotted access, any clotting from the venous chamber to the patient's access. What is the meaning of an arterial pressure alarm? Answer- AP is the amount of pressure it takes to "pull" the blood from the access to get it to the dialyzer. Since it is a pull, it is a negative pressure. Anything that blocks the pull of the blood from the access to the blood pump will create an increased negative AP and will cause a low AP alarm. TOO much pressure will cause RBC's to hemolyze and release potassium into the blood stream, therefore when the pressure is too high, a high AP alarm will sound. What is the meaning of a TMP alarm? Answer- TMP measures the transmembrane or total membrane pressure - the pressure difference across the membrane fibers inside the dialyzer. It reflects the total pressure across the membrane used to achieve the desired fluid loss. As fibers clot off in the dialyzer, TMP rises. What does the blood pressure alarm mean? Answer- BP is under or above normal limits. Blood pump does not stop. What is the meaning on the conductivity alarm? Answer- When conductivity exceeds or drops below the preset parameters the dialysate will go into bypass to prevent the possibility of hemolysis or crenation. Patient safety checks are performed every. Answer- 30 minutes What to assess during patient safety checks? Answer- Bleeding Arterial pressure Venous pressure Bloodlines for kinks Color of the blood Blood flow rate (BFR) Ultrafiltration (UF) rate and fluid volume removed (FVR) Position of the dialyzer Access is not covered

Patients face is visible **Venous and arterial chambers are filled to the appropriate level Patient assessment during pre-treatment: Answer- Ambulation status Mental status Changes in condition Pre- weight Blood pressure HR Respiratio ns Edema GI status Skin color Access evaluation Hospitalizations since last treatment New complaints or life changes Cramping Patient assessment during treatment: Answer- Current time of eval/assessment Blood pressure BFR/DFR Safety checks AP/VP Fluid removed/administered Access check - connections and site visible Hemosafe device attached to CVC Patient overall status Interventions and patient response Change in dialysis prescription Patient assessment post treatment: Answer- Ambulation status Mental status Changes in condition Post weight BP Tem p HR Respiratio ns Edema Any new complaints Access eval Presence of a thrill Condition of dressing Escort patient to scale and waiting room Steps for treating an infiltrated access: Answer- Stop dialysis, turn off blood pump and clamp blood lines Notify RN

Disconnect blood lines from fistula lines and recirculate blood per procedure. Flush non infiltrated needle with normal saline.

If infiltration happened after heparin administration, cap end of needle and secure, remove at the end of treatment. Apply ice once secured. (if infiltration continues to enlarge or patient is in extreme pain, pull the needle and apply pressure for 10 minutes and notify nephrologist. If possible, next cannulation should be above the infiltrate. Instruct patient to apply ice for 24 hours and watch for complications. When should conductivity and pH of dialysate be checked? Answer- Prior to the initiation of every treatment. Air Embolism Treatment - COLT Answer- Clamp venous line - prevents additional air from getting to the patient. Off with the blood pump - Pressure will build in lines with the venous clamp clamped. Turning off the blood pump stops this. Left side positioning - Air rises, so positioning the patient on the left helps prevent air from entering the heart. Trendelenburg - Placing the patient in this position helps prevent air from entering the heart, brain and lungs. *** Additionally administer oxygen and give CPR if indicated *** Advantages of a AV Fistula Answer- Uses the patients own vessels Requires one anastomosis Longer life span Decreased rate of complications Collateral circulation develops Disadvantages of AV Fistula Answer- Length of time to develop - generally 1-4 month Isometric exercises may aid in development Lower blood flows are sometimes necessary when the fistula is immature; results in poor clearance Collateral circulation develops Why would placement of an AV Fistula be difficult? Answer- Patients with co morbid conditions such as diabetes, hypertension, poor circulation, and obesity make placement more difficult. Aneurysms can develop as a result from cannulating the same areas too often. What is always required with a AV Fistula? Answer- A tourniquet Advantages of an AV Graft Answer- Large surface area for cannulation Technically easy to cannulate Healing time is short Variety of shapes and configurations Easy to implant, construct, and surgically repair

Disadvantages of AV Grafts Answer- Increased rate of stenosis; increased clotting Increased infection rates Increased bleed time at the end of treatment Require replacement over time, especially if cannulation sites are not rotated No collateral circulation develops Advantages of a CVC Answer- Immediate use after verification of placement No need for patient to achieve homeostasis at the end of treatment Disadvantages of CVC Answer- Higher potential for air embolism Prone to infection and clotting Last option and sometimes only option for patients Lower BFR's = increased treatment time to improve adequacy Long-term use can lead to major vessel stenosis Reversing the lines will cause increased recirculation and decreased adequacy List 4 things you can teach a patient to prevent their access from clotting: Answer- 1. Avoid wearing tight fitting clothing or jewelry on access arm

2. Avoid sleeping on access arm
3. Avoid lab draws or blood pressure sticks in the access arm 4. Avoid carrying heavy objects in their access arm What is Emla cream? Answer- Lidocaine 2.5% and Prilocaine 2.5%. Used at least an hour before cannulation to numb the area. What is included in the PRE-treatment evaluation? Answer- Look - skin one color, any incisions are clean, dry and intact, no s/sx of infection, prior cannulation sites healing, side by side comparison with other arm. Listen - audible "whoosh" heard - should be same throughout access, low- pitched, louder on arterial side. Feel - thrill- a vibration or buzz throughout the length of the access, pulse

• slight beating like a heartbeat, no areas warmer or cooler than other areas. When admitting a new patient, what is performed before taking a blood pressure reading? Answer- Inspect both arms for the presence of a vascular access. In what direction are fistula needles placed? Answer- Venous needles will ALWAYS go with the blood flow; arterial needles can be placed in either direction. What do you do if you suspect Infection at vascular access? Answer- Signs and symptoms include: redness warmth and drainage. DO NOT cannulate in or near this area bc it can cause sepsis. Make sure patient has washed access prior to coming to station. Thoroughly clean area in circular motions.

What to do if suspect an aneurysm or pseudoaneurysm? Answer- Signs and symptoms include enlarged or weakened area of internal access; caused by repeated cannulations in the same area. Poor healing at previous cannulation sites, bulging in the areas of the access, thin shiny skin. Staff WILL NOT cannulate into the "bulges" - can cause exsanguination.

What to do if you suspect a thrombus? Answer- Signs and symptoms include: No thrill or bruit - caused by excessive pressure on access, tight clothing, holding 2 sites simultaneously, use of clamps, sleeping on access arm, dehydration and hypotension. Do not cannulate, arrange for declotting, if vascular access clamps are used. Use only 1 at a time to prevent excessive pressure and potential thrombus development. Encourage patient to avoid sleeping on access arm or carrying objects across access arm, holding 1 site at a time avoiding use of clamps and tight clothing. What to do if you suspect an infiltration? Answer- Signs and symptoms include pain at infiltration site, bulging at infiltration site, AP or VP changes. Cannulate above venous needle infiltrations, stop the pump if it occurs during treatment, follow guidelines for needle gauge and pump speed with new AVFs. Treat with intermittent ice for 24 hours. What to do if a patient has prolonged bleeding? Answer- Bleeding continues 20 minutes post needle removal. Notify physician, stenosis- proximal to the needle insertion site may be developing, arrange for imaging of access to rule out stenosis. Monitor access daily and report changes in thrill to staff. What is needle flipping? Answer- Prior to needles with back-eyes, needles were flipped to prevent the needle from lodging against the side of the vessel. This has shown to damage the vessel and is no longer a recommended practice. From what compartment is fluid removed? Answer- Fluid is only removed from the interstitial space during dialysis. What is the BFR for a 17 gauge needle? Answer- <300 mL/min What is the BFR for a 16 gauge needle? Answer- 300-350 mL/min What is the BFR for a 15 gauge needle? Answer- >350-450 mL/min What is the BFR for a 14 gauge needle? Answer- >450 mL/min What is adequacy of dialysis? Answer- It is a measurement of how well we are cleaning wastes from our patient's blood. What are some things that can negatively impact adequacy? Answer- Inadequate heparin Access recirculation Shortened treatment time Air in the dialyzer Improper priming Lower than ordered BFR Incorrect dialyzer size Lower than ordered dialysate flow rate.

What patient education is provided when a patient requests early termination of treatment? Answer- It is important for patients to run the full treatment as prescribed by the physician to prevent medical complications. How can we measure how well we clean our patients blood? Answer- Blood urea nitrogen levels in the blood is measured to calculate the adequacy of a treatment. By measuring the amount of wastes in the patient's blood before and after dialysis, clearance can be calculated. What four items impact clearance (adequacy of treatment)? Answer- 1. Treatment time

2. Blood flow rate
3. Dialysate flow rate
4. Dialyzer size (surface area) What has the most impact on dialyzer clearance? Answer- Dialyzer size How is clearance best described? Answer- The amount of urea cleared from the blood in milliliters per minute. It is a measurement of dialyzer effectiveness. What is the definition of spKt/V? Answer- Single pool or spKt/V is the amount of dialysis having been delivered upon completion of the hemodialysis treatment. Single pool is urea reduction from one pool of fluid (the vascular space) What is the definition of eKt/V? Answer- Double pool is the measured amount of dialysis accounting for the volume of urea distribution in both intracellular and extracellular compartments. It represents the amount of urea distribution of the entire body accounting for all body fluid compartments. What is FMCNA's goal for spKt/V? Answer- A minimum of 1.4 L for spKt/V What is FMCNA's goal for eKt/V? Answer- A minimum of 1.2 L for eKt/V Why is the extracorporeal circuit primed with normal saline? Answer- To purge the system of any sterilant or particulate matter from the manufacturer and air that is in the system. Priming at a rate of 150mL/min ensures the dialyzer fibers are thoroughly wetted and aids in clot prevention and adequate dialysis therapy. How much saline should be infused through the E-beam dialyzer and the extracorporeal circuit? Answer- It takes approximately 300 mL's to prime the dialyzer and circuit with normal saline. Then a normal saline "fresh fill" uses 50 mLs NS through the arterial line and 250 mLs through the venous line. At what point during the priming process should the hanson connectors (dialysate lines) be connected to the dialyzer? Answer- After the dialyzer and lines have been filled with saline, the arterial and venous blood lines have been connected in preparation for circulation, the automatic test sequence has been completed, and conductivity and pH testing are

completed using an independent meter such as the Phoenix meter.

At what blood pump speed is the extracorporeal circuit primed? Answer- Prime the dialyzer and circuit at 150 mL/min What position should the dialyzer be in during circulation? Answer- The dialyzer is circulated with the venous end up. How is the e-beam dialyzer circulated? Answer- After successful completion of machine testing, connect and unclamp transducers and attached the dialyzer hanson connectors. Turn blood flow rate to 300- mL/min, DFR to 500. While the NS is circulating, tap the venous end of the dialyzer and pinch and release the arterial line before the dialyzer until all air has been removed. What should I do after the air is removed during circulation? Answer- Drop the DFR to 300 mL/min. Keep the blood flow (Qb) running at 300mL/min. The machine is ready for your patient. What is KECN and at what range should it run? Answer- KECN is the acronym for clearance effective by conductivity sodium and refers to the clearance of sodium as measured by the conductivity changes during the OLC test. What is the mean KECN? Answer- This is the average of all tests performed during on-line clearance and must be documented on the hemodialysis flow sheet and in the computer system. A KECN value of 200-300 is Answer- Normal and expected A KECN value of less than 150 is Answer- indicative of poor clearance A KECN value greater than 350 indicates Answer- A machine may need recalibration of temperature or conductivity. How many KECN tests can be programmed into OLC? Answer- Between 3- 6 tests can be programmed. If a treatment is 3-4 hours in length, 6 tests should be programmed. What does a steady decline in KECN test results signify? Answer- Indicates that dialyzer clearance of waste from blood is decreasing. When is the machine temperature checked? Answer- Read the machine temperature when the conductivity and temperature are stable. Document before treatment. What items are considered when administering medications to renal failure patients? Answer- Kidneys are major route of excretion for drugs and metabolites. Loss of renal function will decrease the elimination of these medications and potentially cause toxicity, increased potency/duration of drug's effects, increased frequency of side effects.

Can medications be pre-drawn? Answer- Medications may be pre drawn up to 4 hours prior to administration. They must be labeled and stored appropriately until time to administer. What if the patient doesn't come for treatment and the medications were pre-drawn? Answer- The syringe can be relabeled and administered to another patient as long as the dosage matches the next patient and the medication never left the prep area. What lab is evaluated to determine adequacy of treatment? Answer- BUN What is the procedure for drawing post treatment lab work (post BUN)? Answer- 1. Turn the UF off. Turn the dialysate flow off. Decrease BFR to 100 for 15 seconds.

2. Stop blood pump. Clamp arterial and venous needle lines.
3. Clean arterial bloodline port with alcohol. Use needle attached to the vacutainer and obtain sample with the collection tube.
4. Obtain specimen. Dispose of needle. 5. Invert blood sample gently, 5-10 times. 6. Turn dialysate flow on.
5. Open clamps on needle lines.
6. Return blood per termination procedure. What complications require RN involvement and assessment? Answer- All findings outside of normal or expected patient evaluation findings. What is bradycardia and to whom is it reported? Answer- Bradycardia is a pulse of less than 60 bpm. Considered severe bradycardia below 50 bpm. All episodes of bradycardia should be reported to the RN. Why do patients become hypoglycemic and what are the signs and symptoms? Answer- Some glucose (blood sugar) is removed during treatment and some patients may experience s/s of hypoglycemia (low blood sugar). Patient may experience faintness, double vision, irritability, hunger, can proceed to coma and death if not treated. Notify the RN. What can lead to hemolysis? Answer- Incorrect conductivity (hypotonic solution) Chlorine or chloramine breakthrough High machine temperatures Kinks in the bloodlines What steps are taken when hemolysis is suspected? Answer- 1. RN notified immediately turns off blood pump and clamps VENOUS line. DO NOT return blood. 2. Turn UF off
7. Administer oxygen per physician order
8. Recirculated the patients blood - maintain sterility of line ends in the event blood is not hemolyzed and can be safely returned to the patient. Flush needles lines or catheter lumens with 10 ml of NS. Leave syringes in place and clamp needle lines or catheter lumens.
9. Notify physician and provide vital signs, s/s, estimated time potential before hemolysis was detected, estimated potential amount of

hemolyzed blood, hgb & hct results. The physician may order: fluid replacement, transport of the patient to the

hospital for further evaluation and possible transfusion, treatment resumed on different set up and machine, blood returned if not hemolyzed, blood samples. 6. Remain with the patient. Monitor VS and cardiac rhythm (regular vs irregular), monitor for dysrhythmias, hypotension, and shortness of breath. Monitor for potential deterioration in patient condition.

7. Immediately report to the physician any change in patients condition. Call EMS if the patient becomes unstable (hypotension not responding to saline, HR irregular or greater than 120, less than 60 and not normal for patient, respiratory distress.)
8. Obtain physician order and draw the following blood samples to evaluate degree of hemolysis: hct/hgb; electrolytes, free hgb, amylase, lipase, LDH. What is crenation and what causes it to occur? Answer- Crenation is the shriveling of RBC's caused by too high of a concentration of sodium in the dialysate (hypertonic dialysate). Signs and symptoms of crenation Answer- Sudden fall in blood pressure Facial flushing Dark, opaque blood Shortness of breath Thirst Chest pain What is an air embolism? Answer- When one or more air bubbles enter a vein or artery and block it. The air bubbles can also travel to the brain, heart, or lungs and cause a stroke, cardiac arrest or respiratory failure. Causes of an air embolism Answer- Improperly primed blood lines Empty IV/NS bag Unclamped IV line Air leak in blood lines Air detector not armed Loose blood line connections Separation of blood lines Patient inhales while cvc is open to air Pre-safety checks not done properly Signs and symptoms of air emboli Answer- Coughing Chest pain SOA What is infiltration and how is it treated? Answer- An inflitration is fluid seepage into the surrounding tissue resulting in pain and swelling. Infiltrations are treated with intermittenr ice for over 24 hours followed by intermittent ice and heat as needed. A new venous needle should be placed above the infiltration site. For an arterial infiltration the needle may be placed either above or below the infiltrated site. What is hyperkalemia? Answer- High potassium exceeding 5.5 mEq/L

and can cause life threatening cardiac arrhythmias, leading to cardiac arrest. Hyperkalemia can be the result of: Answer- Dietary intake

Tissue injury Gi bleeding Hemolysis The result of blood transfusions Treatment of hyperkalemia includes: Answer- Dialyzing the full prescribed dialysis time Depending on the situation kayexalate may be prescribed by the physician and taken orally. Prevention of hyperkalemia is accomplished through: Answer- Patient and family member education regarding diet specifically. Strict treatment adherence Why should sodium intake be limited in the patient on dialysis? Answer- Sodium attracts fluid and makes it more difficult to remove during dialysis treatment. Why should potassium be limited in the dialysis patients diet? Answer- Potassium can cause severe cardiac problems when elevated. Why should phosphorus be limited in the dialysis patients diet? Answer- Phosphorus interferes with calcium absorption; leading to bone disease. Why should fluid intake be limited in the patient on dialysis? Answer- Adds to the circulating volume causing increased workload on the heart and lungs. Why should protein be limited in the patient on dialysis? Answer- Waste products of protein digestion (BUN and creatinine) build up in the blood. Why should calories be limited in the dialysis patient? Answer- Excess caloric intake will lead to weight gain. What is estimated dry weight? Answer- The weight of the patient if all excess fluid is removed and blood pressure is normotensive. What is the leading cause of death in ESRD patients? Answer- Cardiac related to fluid and function. Weight gains exceeding how much are reported to the RN for assessment and evaluation? Answer- 4 kg Signs and symptoms if estimated dry weight is too low? Answer- This means too much fluid is being removed during the treatment and the patient has probably gained actual weight. S/S include dizziness, nausea, vomiting, hypotension, need for NS boluses to stabilize BPs during dialysis treatment cramps and fatigue that sometimes persist until the next treatment. Signs and symptoms if estimated dry weight is too high? Answer- This happens when not enough fluid is being removed during the treatment

and pt has probably lost weight.

S/S include hypertension, headaches, SOA, edema, and distended neck veins. Post treatment weights, blood pressure trends during treatments, patient What is available weight? Answer- This is used during pre treatment evaluation that represent the available fluid weight that needs to be removed from the patient during todays treatment. How do you calculate the Available weight? Answer- By subtracting the EDW from the patients pretreatment weight. What is the target weight? Answer- The weight that we hope to bring the patient to post treatment. The target weight should include available weight, priming & rinse back saline, plus any other fluid the patient will receive during treatment. What components are checked for in dialysate to verify compatibility with human biochemistry? Answer- pH conductivi ty temperatu re What are dialysis precautions? Answer- a set standard of infection control practices that are used in all situations in the dialysis setting when caring for dialysis patients or performing related activities. When are dialysis precautions applicable? Answer- Anytime there is the potential or actual exposure to: blood body fluids w/ visible blood amniotic cerebrospin al pericardial pleural synovial and peritoneal fluids Who is considered infectious in dialysis precautions? Answer- All patients What is considered contaminated in dialysis precautions? Answer- All blood, body fluids, tissues, needles and sharps All used dialyzers All supplies and equipment used for a patients treatment Why do we use dialysis precautions? Answer- Patients & staff are in close proximity Dialysis patients are immunocompromised Patients experience repeated invasive procedures Dialysis is a high risk area Frequent exposure to blood or body fluids What are the 2 bleach solution concentrations that we use in dialysis? Answer- 1:100 - 1 parts bleach to 100 parts water 1:10 - 1 parts bleach to 10 parts water