• How to manage Pericarditis: - ANSWER controlled heparinization, increased

frequency of dialysis, use of anti-inflammatory drugs

• A pt telephones the clinic to c/o s.o.b. this symptom is indicative of what? -

ANSWER fluid overload

• Which organization is primarily concerned with providing the unit staff with
educational oppotunities? - ANSWER Council of Nephrology Nurses and
Technicians of the National Kidney Foundation

• All of these are essential to the successful completion of a research project:. -

ANSWER Review literature in the problem area, problem definition, obtaining
permission of the unit manager and study subjects

• When a pyrogenic reaction occurs, the water tx system should be cultured for: -
ANSWER Gram-negative bacteria

• If a dialysys machine has been disinfected with formaldehyde, it is important to

test the for residual formaldehyde after rinsing to minimize the risk of : -
ANSWER Pt exposure to formaldehyde

• In hemodialysis, the most commonly used volume expander is 0.9% NaCI. If this
solution has the same effective osmolality as body fluids it is called: - ANSWER Isotonic

• A possible sequela of hep B is : - ANSWER Pancreatitis

•In the event of a MAJOR fire is discovered in an area occupied by pt's the first
action should be to: - ANSWER Remove the patients

• The greatest impact on the efficiency and safety of a hemodialysis tx is : -

ANSWER V educated and motivated staff and properly maintained equipment

• Homeostasis is best defined as : - ANSWER The steady state of internal

enviroment

• Decreased glomerular filtration rate of the kidney may be due to all of the
following: - ANSWER shock, dehydration, cardiac decompensation

• Hemolysis of red blood cells will occur will occur if: - ANSWER Hyperthermic fluid is
delivered to the dialyzer

• The goal of anticoagulation in dialysis is to maintain the degree of anticoagulation

at: - ANSWER 1.5 to 2 times the baseline clotting studies

• The normal kidneys compensate for fluid loss by retaining: - ANSWER Sodium and Water

• During pre-treatment patients evaluation what is the best question for the PCT to
ask? - ANSWER How have you been since your last dialysis treatment?

• During the set- up of a machine the alarm test for conductivity fails. Which action
would be best for the pet to take - ANSWER Contact the biomed equipment
tech

• The dialysis industry strives to improve the quality of patient outcomes. One way
this is done is through continuous quality improvement (CQI) process.
What is a model of the CQI process? – ANSWER Plan, do, check, and act

• Nephron - ANSWER The functional unit of the kidney is called the

•Diabetes - ANSWER The number one reason for chronic kidney failure is the US
• What is the acid-base imbalance commonly seen in patients with chronic renal
failure? - ANSWER Metabolic acidosis

• What are the functions of the kidney? - ANSWER Fluid balance

Electrolvte balance, Elminates metabolic waste

• Approximately what percent of the cardiac output is received by the kidney's? -

ANSWER 23%

• What is considered an elevated serum potassium level for a dialysis patient? -

ANSWER 5.5 mEq/L

• Hormones made by the kidney are? - ANSWER Erythropoietin

Calcitriol, Renin

• Hyperkalemia may cause - ANSWER Serious or even deadly changes in the

heart rhythm

• What is the PCT's role in patient teaching? – ANSWER Reinforce teaching

the patient may have received from the nurse, physician, dietitian, or other
teammates

• What type of vascular access has fewest complications? - ANSWER The a/v Fistula

• Risks associated with a deionization (D.I) water treatment system? - ANSWER

Once a DI system is exhausted it releases all of the ions it once held.

DI has caused most of the water treatment related deaths in patients.

DI does not remove bacteria

• The absence of pathogens - ANSWER Asepsis

• What organization establishes dialysis water quality standards? - ANSWER

Association for the Advancement of Medical Instrumentation (AAMI)

To make public drinking water safe municipal water supplies commonly treat
water with chemical additives. These same additives must be removed from the
water supply used for hemodialysis.

• Common drinking water additives are? ANSWER Chlorine and Ammonia

Fluorine, Aluminum

• Hemolysis - ANSWER Bursting of red blood cells

• Hemodialysis infection control precautions are? - ANSWER Dispose of

needles in a puncture resistant color coded box.

Always wear a protective gown where there is potential for contact with blood or
body fluids. Promptly clean blood spills/splashes with appropriate disinfecting agent
For patient or equipment contact. When troubleshooting the vascular access.

• Handling blood/body fluid samples. - ANSWER Gloves must be worn

• The heparin sodium concentration commonly used in hemodialysis is - ANSWER

1ml 1,000 units

• When should the PCT verify the absence of residual sterilant? - ANSWER
Immediately before initiating treatment

• If the extracorporeal circuit clots, it would be most important to monitor the

patients? - ANSWER Hemoglobin level

• One reason normal saline is used to prime the extracorporeal circuit prior to
initiating treatment is to - ANSWER Remove air

• What is the name of the instrument used to measure blood pressure? - ANSWER
Sphygmomanometer

• What would improve the adequacy of the dialysis treatment - ANSWER

Increase the treatment time

• During a hemodialysis treatment a patient goes into cardiac arrest. What should the
PCT do first? - ANSWER Call for help

• Prior to cannulation the technician notices the patient's a/v fistula is red and warm
to the touch. These symptoms are most likely due to - ANSWER Clotting

•Lab results indicate the patient's pre-treatment BUN value was lower than the post
treatment BUN value. A potential cause could be - ANSWER The pre-
dialysis sample was taken from the venous line after the treatment started

WATER TREATMENT
• What policies and procedures are incorporated into infection control? - ANSWER -
surveillance
 monitoring activities for
 water treatment
 dialyzer reuse
 bacterial contamination
 transmission of blood borne and other infectious diseases

• What is CDC and what do they issue and update? - ANSWER CDC - Centers
for Disease Control and Prevention
issue and update blood borne infection control strategies and precautions including standard
precautions over ther years for dialysis centers as well as for other healthcare agencies.

• What is the CMS and what do they require? - ANSWER VCMS - Centers for
Medicare and Medicaid Services
require dialysis providers to follow the CDC documents "Recommendations for
Prevention and Transmission of Infections among Chronic Hemodialysis Patients"
and "Prevention of Intravascular Catheter Related Infections"
• What is OSHA and what blood bourne pathogen regulations have they provided? -
ANSWER OSHA - Occupational Safety and Health Administration

Regulations provide specific measures that healthcare workers and their employers
can take together to substantially reduce the risk of healthcare workers contracting
a blood borne diseae while on the job.
• What are standard precautions? - ANSWER A recommendation that blood
and body fluid precations be used consistently for all patients, regardless of their
blood borne infection status, is the basic tenet of standard precautions. ASSUMES
ALL PATIENTS ARE INFECTIOUS.

• Why is handwashing so important? - ANSWER The most common method

of transferring pathogen from patient to patient or staff to patient is by the hands.

• What is the Needlestick Safety and Preventioni Act? - ANSWER went into
effect on April 18. 2001
- GOAL: protecting healthcare workers from accidental exposure to blood borne diseases

• In center hemo must be done - ANSWER 3x a week for about 4 hours

• Cons of in center HD - ANSWER Most limitation on Diet, fluid than other modalities
Requires the most medication Most symptoms

• Patients who run 4 hour tx - ANSWER Are 30% less likely to die than pts
who run shorter times

• Each 30 mins extra of tx increase life by 7%

• Patients are 50% more likely to die after - ANSWER 2 day no treatment
weekend, the last 12 hours of the 2 days the risk of death triples

• diastolic blood pressure - ANSWER When the heart is at rest.

• Benefits of nocturnal in center - ANSWER You get 2x as many txs as

standard because it is longer and more gentle with fluid removal
Rarely cramp, Easy on heart, Fewer limitations on food and drink
Free days 72% better survival rate than standard in center

• Nocturnal in center hemo must be done - ANSWER 3x a weeks about 8 hours

per tx

PERITONEAL DIALYSIS

• Benefits of nocturnal home hemo - ANSWER Better protein level

Don't need binders, No fluid limits, Fewer symptoms
Less heart damage
Live as long as people who get a deceased kidney transplant

• If BP site is above the heart.... - ANSWER The reading will be to low

• Home hemo must be done - ANSWER 3x a week 4-6 hours per tx

• Benefits of PD - ANSWER Can do alone at home or work

Only need 1-2weeks of training
Allows for a more normal diet, Allows pt to feel more normal

• Peritonitis - ANSWER inflammation of the peritoneum, this can scar the

peritoneum and make PD no longer possible, can be avoided by doing a sterile
exchange

• 2 types of PD - ANSWER ~ Continuous ambulatory peritoneal dialysis (CAPD)

Automated peritoneal dialysis (APD) - uses cycled at night done 8-10 hours during
sleep

• During in center HD how much blood is outside of body at a time - ANSWER

V V1/2 cup

• Short Daily Home Hemodialysis must be done - ANSWER 5-6days a week

for the 2.5-4 hour per tx

• A bp cuff that is too small or to loose will cause a - ANSWER V Higher reading
Nocturnal home hemomust be done - ANSWER At home 3-7 nights a week 8
hours per tx

• A no cuff that is to big for a patients arm... - ANSWER Lower reading

• Why would someone want to do more HD than standard? - ANSWER Longer

or more frequent HID is gentle and cause fewer symptoms and may help Pt live
longer, home puts pt in charge

PERITONEAL

• Peritoneal dialysis - ANSWER the lining of the peritoneal cavity acts as the
filter to remove waste from the blood through tiny blood vessels.
Placed in abdomen and sometimes chest wall
Dialysate sits in catheter for a few hours and excess water and waste flows from
BV to the dialysate. The dialysate is then drained and replaced. (Exchange)
Pt can use a cycle mahine while they sleep
Can also be done by hand 4x a day and can be done anywhere.

• In dialysis patients the reason BP drops during or close to the end of tx is because -
ANSWER The total blood volume drops, from the water removal

• Regular respiration rate - ANSWER 12-16 breaths per minute

• In dialysis patients water may enter the lungs due to water weight gains this can
cause - ANSWER Sob or trouble breathing

• Payment for dialysis - ANSWER Medicare pays for 80% of dialysis

Medicare makes rules a clinic must follow to provide coverage of tax.
Pt who don't have Medicare before CKD a pt must wait 3 months for it to cover in
center but it will cover home-hemo right away.
2011 change how they pay for dialysis and created a "bundle" (composite rate,
labs, drugs and home training)

• Once cause of aneurysm and pseudo aneurysm - ANSWERImproper site preparation

o Needle infiltrations
o Poor rotation of site

• Fistula connects: - ANSWER An artery to a vein

• The dialyzer membrane consists of - ANSWER Hollow fiber

• Excessive elevation of ___ is a medical emergency because it may cause sudden

death. - ANSWER Phosphorus Potassium

What are the symptoms of pyrogenic reaction? - ANSWER Fever

Chills, Nausea

• The acid storage tanks for dialysate should be: - ANSWER Clearly marked
Tested regularly for proper content

• Heparin is used in hemodialysis to - ANSWER Prevent clots from forming in the

extracorporeal circuit

• Explaining how the dialysis machine works and what the dialyzer does contributes to a
patient's rehabilitation in the form of: - ANSWER Education

• The most important monitor to ensure safety during the dialysis treatment - ANSWER
The pre pump pressure alarm, The blood leak alarm

• What does the delivery system do when a conductivity or temperature alarms goes off?
- ANSWER Machine shuts off automatically

• Many organizations supervise the delivery of quality dialysis care. Which one of these
does NOT set standards for dialysis? - ANSWER Food and Dug Administration
{FDA

• The dialysis staff should not smoke, eat or drink in the dialysis treatment area or
laboratory primarily because doing so: - ANSWER Causes unpleasant odors
Is unprofessional, May spread infection

• What is the biggest risk of " one-sit-it-is" in a graft

a. clotting - ANSWER Pseudoaneurysm

• Which of the following is a cause of hypotension during and after dialysis? -

ANSWER Fluid overload

• What are the two types of ultrafiltration system: - ANSWER TMP and UFR

•Why are synthetic dialysis membranes more biocompatible? - ANSWER They

mimic the human body.
They are highly adsorptive

• A kink in tubing between monitor will sound what alarm - ANSWER Venous
pressure high alarm

• Clotting in drip chamber will cause what alarm - ANSWER Venous pressure
high alarm

• Infiltration will cause what alarm - ANSWER Venous pressure high alarm

• Needle placement can cause what alarm - ANSWER Venous pressure high

• Poorly working CVC can cause what alarm - ANSWER Venous pressure
high

• Venous stenosis will cause what alarm - ANSWER Venous pressure high

• Increase in blood flow will cause what alarm - ANSWER Venous pressure
high

• Separation of blood tubing from venous needle or evc - ANSWER Venous

pressure low

• Dislodgement of venous needle – ANSWER Venous pressure low

• Drop in blood flow rate will cause which alarm - ANSWER Venous pressure
low

• Blockage in blood tubing before the monitor will cause which alarm - ANSWER
Venous pressure low

• Severely clotted dialyzer will cause which alarm - ANSWER Venous

pressure low

• Saline infusion will cause which alarm - ANSWER Venous pressure low

• What's intervention for venous pressure low alarm - ANSWER Correct

problem

• Dropped dialyzer will cause what alarm - ANSWER Blood leak detector
alarm

• Improper priming will cause what alarm - ANSWER Blood leak detector
alarm

• Improperly set goal will set off which alarm - ANSWER Volume control alarm

• Not enough pressure will cause which alarm - ANSWER Volume control
alarm

• Infiltrate will cause which alarm - ANSWER Volume control alarm

• Osmosis - ANSWER movement of fluid across a semipermeable membrane

from an area of lower concentration to higher concentration

• Diffusion - ANSWER movement of dissolved particles across a

semipermeable membrane from an area of higher concentration to lower
concentration

• Ultrafiltration - ANSWER water is removed from blood because there is

pressure gradient across the membrane

• Ultrafiltration Rate - ANSWER The rate at which fluid moves from blood
into the dialysate through the semipermeable membrane

• Calculation for Ultraflitration rate - ANSWER dividing the amount of fluid

to be removed by the minutes of tx time

• Transmembrane Pressure (TMP) - ANSWER The pressure across the

dialyzer membrane(Blood compartment plus dialysate compartment pressure)

• In dialyzer reprocessing this chemical is used for disenfection – ANSWER Paracetic acid
Amount of time water must stay in contact with charcoal in carbon tanks in order

• to allow chlorine and chlormaines to be removed - ANSWER Empty Bed

Contact Time

• Minimum number of minutes of contact time in carbon tanks - ANSWER 10

or 5 in each tank

• Diabetes - ANSWER Number one cause for CKD

• Intrarenal Failure - ANSWER Renal failure due to injury to the kidneys

• Example of Intrarenal failure - ANSWER Blow to kidneys, drug/poison,

glomeruolnephritis

• Postrenal Failure - ANSWER when a blockage causes urine to back up and

harm the kidneys

• Example of Postrenal failure – ANSWER Enlarged prostate, Stones, Kinked

Ureter

• Prerenal failure - ANSWER when kidneys dont get enough blood

•Example of Prerenal failure - ANSWER Trauma Severe dehydration, heart

disease

• Two hormones the kidneys produce - ANSWER Erythroprotein, Calcitriol

• Erythropoietin - ANSWER triggers bone marrow to make red blood cells

• Calcitriol - ANSWER V Controls the balance of calcium/phosphorus

• Location of the kidneys - ANSWER In the back of the body above the waste

• Size and weight of the kidneys - ANSWER the size of a fist, and 5 oz

• The dialyzers semipermeable membrane – ANSWER Valows some substances

such as wastes and excess water out but keeps others such as blood in
• Access for pd is through a - ANSWER Catheter

• where is the catheter placed in a pd pt - ANSWER abdomen

• what acts as a filter in pd - ANSWER lining of the abdomen

• Dialysis Disequilibrium Syndrome - ANSWER caused by the rapid removal

of urea during hemodialysis;

• Dialysis Disequilibrium Syndrome Signs/Symptoms - ANSWER Headache,

blurred vision, Restlessness, confused, tremors, convulsions, seizures, coma, death

• Back flow prevention device - ANSWER Stops water from the tx system
from flowing back into the feed water

• Large Amounts of aluminum in water can cause - ANSWER Bone Disease

• How often should the ro operating parameters be checked - ANSWER Daily

• What is added to municipal water supply to make it clearer - ANSWER aluminum

• Depthflitration - ANSWER Measuring pressure before and after filter

• When reviewing patient blood chemistry levels, what is considered the normal creatinine
range?
1. 0.6 to 1.5 mg/100 mL
2. 4.5 to 6 mg/100 mL
3. 8 to 25 mg/100 mL
4. Up to 50 mg/100 mL answer 0.6 to 1.5 mg/100 mL

• The complete killing of all microorganisms is termed

1. surgical asepsis.
2. medical asepsis.
3. sterilization.
4. disinfection. answer Sterilization.