PCT Exam Questions and Answers for Davita, Exams of Nursing

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1. What is important when monitoring weight and BP for acute patients?: ✓✓✓ keep patients wet to avoid hypotensive episodes 2. What do you need to consider in regards to acute patents vascular access?- : ✓✓✓Usually have a CVC

• follow policy and procedure to prevent infections

3. Why is it important to know what caused your patient's CKD?: ✓✓✓ to inquireabout possible problems during data collection and assessments
4. Kt/V: What is K?: ✓✓✓clearance of urea
5. What treatment factors decrease K?: ✓✓✓ not waiting 3 - 5 minutes after giving he-parin with treatment initiation to prevent clotting
6. What factors influence V (volume)?: ✓✓✓ sex, age, weight, height, amputations
7. Needle gauge and suggested BFR: ✓✓✓17: 200 - 250 16: 250 - 350

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15: 350 - 450

14: >

8. What do you do if a patient wants to get off early?: educate and document, still draw lab on habitual patients, MUST NOTIFY NURSE
9. Lab draw mistakes that would falsely increase Kt/V: not waiting the full 15 seconds to draw the BUN
10. What is the role of the PCT prior to treatment initiation?: DATA COLLEC- TION
11. Squeezing the BP cuff can damage the machine: T/F: True
12. 4 reasons we document in the medical record: 1. proof that care was ren- dered
13. provides data continuity and planning of patient care
14. permanent legal record
15. communication tool
16. Pre-treatment patient data collection/assessment: Data collection: before initiation Assessment: 30 minutes into treatment
17. Post treatment data collection/assessments: after treatment

• NOT DURING RINSEBACK

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15. What are possible consequences of poor or incomplete documentation: - attack on your care 16. What are the six items included in charting administered medications?: - REASON FOR ADMINISTERING

17. What are the 5 W's to be used when completing an AOR: who should report an AOR what type of incident

4 / 6 when should it be reported where should they be reported why

18. What are the four consequences of sodium loading during dialysis?: - Thirsty Increase Fluid Intake Increased intradialytic weight gain Increased ultrafiltration rate

19. What is the purpose of UF profiling?: fit to the patient to prevent crashing and allow for vascular refill
20. Why do we measure the pH in the dialysate: to verify acid-base balance is within an acceptable range
21. Conductivity and pH alarm causes: no concentrate improper bicarb calcium or magnesium precipitate line of filter occlusion from debris improper calibration
22. Temperature alarm causes: lower temperature, increases BP hemolysis occurs at 42 degrees calcium which releases potassium

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23. Power: the appropriate intervention is to remove venous line from air detector clamp before starting hand crank
24. Arterial Pressure High alarm causes: separation of tubing
25. Venous pressure high alarm causes: kink in tubing infiltration clotting in the venous drip chamber
26. Davita Quality Index: the purpose of selecting the component measure for DQI is to encourage continuous improvement across a broad range of disease management processes
27. DQI success is achieved by: - managing individual patients first and allowing scores to follow

• knowing each team members role and improving DQI scores
• using the CQI (continuous quality improvement) process to help identify trends and make improvements (answer all of the above)

28. Importance of P&P: when supervising non-licensed, assistive personnel, it is the responsibility of the licensed nurse to ensure these teammates also meet the standard of care
29. What are the risks of doing it your way: it can lead to civil liability

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30. What makes dialysis patients more susceptible to HAIs?: they have weak- ened immune systems and prolonged access to blood
31. Why are dialysis patients at increased risk for acquiring a HAI at the facility?: CONTACT TRANSMISSION
32. what is the most common transmission route for HAIs?: contact transmis- sion
33. What is the most important intervention you can do to prevent HAIs?: Hand washing
34. What is the most common infectious complication in hemodialysis pa- tients?: Per the CDC, the most common factor contributing to bacteremia is CVC 35. What germ causes the most common infections in hemodialysis patients?- : MRSA
35. Why is wearing gloves so important?: Decreases risk of hand contamination
36. Who can use sinks designated for hand washing?: clean sinks must be dedicated for hand washing only
37. What is the correct procedure in regards to your hands when you have casual contact with a patient?: don't need to have gloves but must perform hand hygiene before caring for patients
38. Successful Lab draws: know the 20 tips

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• follow the order of the lan draws to prevent specimens from being contaminated with other tube additives
• double labeling tubes prohibits processing

40. rules for spinning samples: only spin tubes of same kind, size, and fill level and should be placed opposite of each other
41. hyperkalemia: potassium above 6. extreme muscle weakness cardiac arrest
42. What is the primary cause patients are anemic?: decreased production of Erythropoietin
43. How can you print contributing to blood loss?: adequate heparinization
44. What is pericarditis?: inflammation of sac around the heart
45. What is included in pericarditis treatment?: RESTRICTION OF HEPARIN more/adequate dialysis
46. What to use for Dry, itchy skin: hyper fatted soaps and lotions
47. Peripheral neuropathy: educate patient about good shoes, look at feet, don't go barefoot

• can't feel sores

48. What are the four key elements affected in CKD-MBD?: calcium

8 / 6 phosphorus

9 / 6 parathyroid hormone calcitriol (vitamin D)

49. What are symptoms of CKD-MBD in addition to bone disease?: severe itching, muscle weakness CALCIFICATION OF SOFT TISSUE
50. What is your role in CKD-MBD management?: encourage patients to take binders with their food! talks to patients and listen to them!
51. What does the acronym DARN stand for?: Desire to change Ability to understand Reason to change Need
52. What's the best way to help patients successfully change behaviors?: In- spire behavioral change through support, compassion and empathy
53. When should the communication style "Directing" be used?: when training to perform procedures
54. What are the three core communication skills to be used within the com- munication styles?: Asking Listening Informing
55. Righting Reflex: Intervention of a healthcare practitioner who observes a pa-

10 / 6 tient doing something detrimental to their health

56. Summarizing: includes the main aspects of what was said during the conver- sation
57. The 5 stages of grief: Denial Anger Bargaining Depression Acceptance
58. Is there an order to work through the five stages of grief?: No
59. what is KDQOL 36: an assessment tool for the social worker to identify barriers

• the social worker compiles the results and develops goals with the patient

60. Who is the social worker available for?: Caretakers struggling to meet de- mands of the patient's treatment regime
61. Ultrafiltration: (only fluid) controlled fluid removal by manipulation of hydrostatic pressure
62. Convection: (solutes and fluid) solutes are dragged across the semipermeable membrane along with fluid
63. Diffusion: (solutes) particles move from an area of high concentration to an area of low concentration

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64. Osmosis: (fluid only) fluid moves from lower solute concentration to higher solute concentration
65. What are the kidney's endocrine functions?: blood pressure control (Renin) anemia (erythropoiesis) activation of vitamin D3 and Ca Regulation (calcitriol)
66. What is the function of bicarbonate?: acts as a buffer

• diffusion of the bicarb from the dialysate to the blood helps normalize body pH

67. The 4 indicators of optimal nutrition status: 1. protein (albumin) 4.0 or higher
68. stable/desirable target weight
69. appropriate appetite
70. adequate fat stores/muscle mass
71. importance of limiting phosphorous/when to take binders: tingling bone damage take with meal
72. Consequences of organ stunning: hypotension can have many adverse af- fects including impaired tissue profusion of vital organs and organ injury
73. Muscles cramps: caused by rapid fluid removal and electrolyte shifts
74. intervention for muscle cramps: DON'T MASSAGE in case of blood clot

• stretch the affected muscle and turn off UF

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72. Fever and chills: any temp greater than 100 degrees or over 2 degrees of baseline WITH symptoms
73. pyrogen reaction: endotoxins in the water
74. seizures intervention: discontinue treatment if seizure is severe or patient does not respond to treatment
75. Dialysis disequilibrium syndrome prevention: don't skip treatments

• have to go to hospital to get dialyzed if missed more than two treatments in a row

76. Symptoms of disinfectant infusion: PAIN AT THE VENOUS NEEDLE

• respiratory distress tingling around the lips

77. intervention for chest pain/angina: mild: stop pulling fluid: turn UF off turn down BFR to 200 so we don't clot
78. Air embolism intervention: STOP PUMP lay patient on left side trendelenburg
79. what are the three basic principles of self-management: Dealing with the consequences of illness rather than just the disease itself
80. what is the definition of health literacy?: the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions

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81. What are the educational tips for visual learners?: select quiet surroundings

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82. What are the educational tips for auditory learners?: word associations or mnemonics
83. what are the educational tips for tactile learners?: short lectures with hands on activities and frequent short breaks
84. at what time are medications containing a preservative discarded?: 28 days
85. how long do we wait after administering the heparin bolus prior to treat- ment initiation?: 3 - 5 minutes
86. Explain a reason for Immediate jeopardy (IJ): insufficient or inaccurate chlo- rine checks
87. how to talk to a surveyor or what to do when a surveyor observes you or asks questions: I don't know the answer, but I will find out
88. Examples of what not to say to a surveyor: I was never told that nobody ever told me
89. explain the four AVF evaluations for maturation based on the KDOQI rule of 6's: rules of 6's proved guidelines for a FISTULA

• 6 - 8 weeks post op
• blood flow of 600
• diameter of 0.6 cm
• can't be deeper than 0.6 cm below the skin

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90. Water hammer pulse, whistling sound: outflow stenosis = whistling inflow stenosis = hammer sound
91. BESTIPS Complications and Prevention: Thrombosis: if using hemostatic sponges, we must remove before sending patient home and cover with sterile gauze
92. Cannulation site prep: use a tourniquet during cannulation on ALL AV fistula unless documentation for otherwise
93. Site rotation/ healing time: 14 days/2 weeks
94. chlorine in water used for hemodialysis causes: hemolysis which releases potassium
95. Chlorine/chloramine testing: can't be more than 4 hours apart
96. What is removed in hardness testing?: calcium and magnesium
97. When do we test for hardness?: at the end of each day
98. response to final water quality alarm: 1. put all machines in bypass mode
99. notify charge nurse, FA, boomed, Medical director
100. if water quality cannot be restored terminate all treatments
101. How do you know numbing has taken effect?: blanching of skin