Rise Final Exam Questions with Answers, Exams of Medicine

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Rise Final Exam Questions with Answers

You are assisting a patient to step onto the scale by holding the patient's hand. Such a casual contact ✔ Does not require gloves but you must preform hand hygiene afterwards. What should be done to the heparin infusion line if a patient does not have hourly heprain prescribed? ✔ Clamp and knot the heparin line When the lab recieves a laboratory test tube with double labeling: ✔ The double labeled specimin will be rejected at the laboratory for patient safety DaVita Quality Index (DQI) success is achieved ✔ all of the above What will cause a more negative pre-pump arterial pressure? ✔ Kinking of the arterial blood line between the vascular access and arterial monitor. If you notice that a patients caretaker is struggling to meet demands of the patients treatment regime you should ✔ Notify the Social Worker because he/she is there for patients and their families Teammates MUST be able to readily identify patients who may require additional assistance in the event of an emergency evacuation. This will include patients who need help with or are able to ✔ Both b and c B. Complete the emergency takeoff procedure C. Evacuate in a safe and timely manner To assist in survey readiness you should ✔ all of the ABOVE: know and follow policies and procedures be accountable and take initiatives live out our Mission and Core Values Upon completing machine setup and before treatment initiation it is important to verify the prescription and machine settings: ✔ Both B and C B. To challenge the Nephrologists order C. To validate that all saftey features are working properly. What problems will cause a more positive ( less negative) pre-pump arterial pressure?

✔ Arterial needle infiltration Which of the following factors would decrease the K of the Kt/V formula? ✔ Inadequate anticoagulation The Pct notes that a patient still has considerable edema in the legs. In addition to informing the nurse what should the pct document ✔ Document the noted swelling and that the RN was informed Which of the following may be, but doesn't have to be a sign of hemolysis ✔ Cherry red colored blood in the venous line V tags cite deiciencies, provide interpretive guidance, and provide a condition that must be met for each regulation. How can knowledge of V-tags affect the practice of patient care providers? ✔ All of the above Provide patient care within CMS Understand rationales for specific regulations Assist in the development of P&Ps Water and dialysate cultures are drawn every month in the dialysis unit to monitor ✔ Bacteria and endotoxins The nephrologist orders a blood flow rate (BFR) of 450ml/min for a patient with an estabished fistula. What neede gauge would be appropriate? ✔ 15 gauge The maximum ultra-filtration rate should not exceed ______ because it may lead to hyptensive episodes which increases the risk of organ stunning or mortality. ✔ 13 mL/kg/hr Which statement is true about sinks used for handwashing? ✔ Handwashing sinks must be dedicatef for handwashing purposes only and should remain clean Which statement is true regarding the "Reasonable and Prudent" Standard of care ✔ When supervising pct and other non-licensed personell, it is the responsibity of the nurse to ensure these teammates aso meet the standard of care If clotting occurs in a high flux dialyzer, the transmembrane pressure (TMP) will ✔ Decrease A patient wirh Acute Kidney Injury (AKI) dialyzes in the outpatient facility. With regards to the patients target weight, why is being "wet" better than being to dry ✔ Being wet helps to avoid hypovolemia and hypotensive episodesC

At what time do you preform water hardness testing? ✔ At the end of the treatment day Dialysis replaces only ___ percent of normal kidney function ✔ 15% What steps are preformed during the recirculation of blood in the extracorporeal circut when there has been a treatment interruption? ✔ The saline infusion line remains clamped and the heprain pump remains on The Urea Reduction Ratio calculates ✔ The amount of urea removed during the diaysis treatment Which fluid amount is considered excessive? ✔ Greater than 5% The clinical pyramid includes: ✔ The fundamentals, complex programs, and quality of life What must be completed prior to medication preparation? ✔ All of the above Put on PPE and preform hand hygeine Wearing PPE, disinfection of surface area Visually inspecting Ampules When documenting patient care, it is important to include all of these except ✔ A confrontation between two patients The most common infectious complication for hemodiaysis patients is ✔ Vascular access infection In the event of a patient experiencing a seizure, the dialysis treatment should be ✔ Discountinued if the seizure is severe or the patient does not respond to treatment Which infectious disease requires frequent handwashing instead of using alchol based gels ✔ Active Clostridoides difficile infection (C-diff) Water treatment is needed in the diaysis setting to: ✔ Provide patient saftey and prevent equipment damage The waiting time after administration of the inital heprain loading dose prior to initiation of hemodialysis is a minimum of ✔ 3-5 minutes What is one method surveyors use to verify infection control training and education?

✔ Documentation of infection control training in teammates file or transcript How do you verify that the patient is stable and safe for discharge after treatment? ✔ Evaluate the effectivness of the treatment by comparing data to pre-diaysis findings Flipping the arterial vascular access needle ✔ is not necessary since all arterial needles now have a back eye What are the three steps included in the vascular access assessment? ✔ Look, Listen, Feel Phosphate binders are prescribed to prevent phosphrous in meals from being absorbed. When is the best time to take them? ✔ With a meal The patient position used for a suspected air embolism is ✔ Trendelenburg, left side Per DaVita policy, fever is defined as ✔ Any temperature greater than 100° F or increase over baseline of 2°F with symptoms Ultrafiltration is defined as ✔ controlled fluid removal by manipulation of hydrostatic pressure Your patient asks whether it is okay to take over-the-counter cold remedy. What is your appropriate reponse? ✔ Let's ask your nephrologist what they reccommend to treat your cold symptoms? left ventricular hypertrophy leads to ✔ Ischemic heart disease, arrhythmia, myocardial infarction, and sudden death Knowing what caused your patients' CKD ✔ is important because the underlying disease could cause health complications that can impact the dialysis treatment What are three things you should NOT include in a REM report ✔ Personal opinions, speculation, vendettas What is an important action prior to returning patients blood using the hand crank method in the event of a power failure ✔ Remove the venous line from the line clamp All documentation on machine setup and pre-treatment patient information ✔ Must be entered into the computer before the treatment is initiated

In those states that do not require a nursing assessment to be completed prior to treatment initiation, the PCT would be required to report abnormal patient data collection findings ✔ To the nurse before treatment initiation Your immediate intervention for a patient experiencing an anaphylactic reaction is ✔ Discontiue the suspected therapy. DO NOT return blood The patient is using a CVC cathetor for dialysisand has a new AVF present in the lower arm. What observation/assessment should the PCT preform for the AVF ✔ Checking for the bruitand thrill every treatment day The blood flow rate is reduced to 100 ml/min for _____ before obtaining post dialysis blood specimen for kt/v ✔ 15 seconds Fever caused by a pyrogenic reaction will most likely occur at what time during treatment? ✔ Within 45 to 75 minutes What can most likely result if the surveyor sees a patient with a covered vascular access? ✔ An immediate Jeopardy A surveyor asks you a question. Which of the following statements would be a good answer? ✔ I do not know the answer but I will find out Acid concentrate replaces the excretory function of normal kidney function by ✔ Normalizing electrolytes The nephrologist has ordered the use of hemostatic sponges, such as SureSeal, for your patient. What is the correct procedure when using these sponges? ✔ Remove the hemostatic sponge after hemostasis has been acheived and dress the needle sites with sterile gauze or band aid For patients with AKI which statement is correct? ✔ A nursing assesment prior to treatment initiation is always required Which statement is true regarding Normal saline? ✔ The teammate must remain with the patient to monitor the process until administration is complete and lines are securely clamped. You listen to your patient's AV graft and hear a whistling sound ✔ This could be indiactive of a outflow stenosis

What is an appropriate intervention with an air/foam detector alarm ✔ Look at the circut, do not return blood with air in the system, fix the problem The patients treatment time is 3 hours. He has brought a 10 oz. cup of coffee (300ml). has an IV antibiotic of 100ml to be administered during treatment, and prime/rinseback of 400 ml. The patient is 2.2Kg (2200 ml) over their target weight. What is the hourly UF removal goal? ✔ 1000ml/hr Can you document patient vital signs under another teammate already signed into the computer? ✔ No-Log into the computer system under your credentials and document What type of blood/dialysate flow within the dialyzer increases the rate of diffusion providing optimal dialysis for patients? ✔ Counter-current flow Which is the primary device for purifying the water used in dialysis ✔ The reverse osmosis The nephrologist has prescribed a 400 BFR for your patient. You would expect the physican order to also include ✔ 15 gauge needles The psychosocial Assessment completed by the social worker ✔ Is completed initally and annually Per the Centers for Disease Control and Prevention (CDC), which is the most common factor contributing to bacterial infections in dialysis patients? ✔ The use of cathers for hemodialysis Intra-renal causes of AKI ✔ Sepsis, Anaphylaxis Drugs, Acute Glomerulonephritis, Trauma, deugs The person responsible for implemenation, adherance, and training of the Facility specific emergency management plan (EMP) and applicable policy and procedure is ✔ Facility Administrator (FA) or Designee When is a pre-treatment assessment by the licensed nurse required? ✔ When it is mandated by state law When the PCT preforming a data collection notices abnormal findings When a patient reports unusual symptoms to the nurse or PCT before treatment initiation When the nurse or PCT observes unusual behaviors in a patient entering the treatment floor

When a patient is prescribed Topical Anesthetic spray, the appropriate time to clean the cannulaton sites is ✔ Before applying the spray A Pct greets a patient and the patient reports feeling short of breath. The Pct notices that the patients ips have a blue hue. The pct would: ✔ Not start treatment, immediatly notify the nurse The endocrine functions of the kidneys are ✔ Renin and erythropoietin secretion ,activation of vitamin D The definition of health illiteracy is ✔ The degree to which individuals understand basic health information Which of the following factors would influence them "T" in the Kt/v ✔ Shortened treatment time What is the acceptable mg/l or ppm limit for Total Chlorine in the water leaving the carbon filter ✔ Less than or equal to 0.1 ppm or mg/l To prevent the formation of aneurysms and psuedoanurysms the following should be practiced ✔ Good needle site rotation and complete needle site clotting techniques Which is the most likely reason for a blood leak detector alarm during recirculation ✔ Air bubbles in dialysate or a dirty sensor Prior to use, how should the medication preparation surface area be disinfected? ✔ 1:100 bleach solution and disposable wipes Per the centers for disease control and prevention (CDC), which is the most important route by which pathogens are transmitted in health-care settings including dialysis centers ✔ Contact transmission Documentation in the medical record ✔ provides data from continuity and planning of patient care If your facility dialyzes Hepatitis B positive patients, which assignment would NOT be an appropriate patient care assignment ✔ Caring for HBsAG