Bonent Review Exam Flashcards

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Questions and Answers

When the hemodialysis machine detects a blood leak, what happens?

Blood pump will stop (correct)

Air detector will alarm

Machine will go into bypass

Conductivity alarm will occur

Management of pericarditis might include all of the following EXCEPT?

Aggressive blood pressure control (correct)

Use of anti-inflammatory drugs

Increased frequency of dialysis

Controlled heparinization during dialysis

A patient telephones the dialysis unit to complain of shortness of breath. This symptom is indicative of?

High serum potassium

Fluid overload (correct)

Cardiac problems

Disequilibrium syndrome

Which organization is primarily concerned with providing dialysis unit staff with educational opportunities?

Council of Nephrology Nurses and Technicians (CNNT) Signup and view all the answers

Which of the following is NOT essential to the successful completion of a research project?

Publication of results Signup and view all the answers

Which of the following statements concerning feedback is INCORRECT?

It is ineffective when negative Signup and view all the answers

When a pyrogenic reaction occurs, the water treatment system should be cultured for?

Gram-negative bacteria Signup and view all the answers

In the event of a natural disaster, the primary responsibility of the technicians in the dialysis setting is the protection of the?

Patients Signup and view all the answers

If the dialysis machine has been disinfected with formaldehyde, what should be tested for after rinsing?

Patient exposure to formaldehyde Signup and view all the answers

In hemodialysis, the most commonly used volume expander is 0.9% NaCl. What is this solution called if it has the same effective osmolarity as body fluids?

Isotonic Signup and view all the answers

Which of the following is NOT a possible sequela of hepatitis B?

Pancreatitis Signup and view all the answers

In the event a MAJOR fire is discovered in an area occupied by patients, what should be the first action?

Remove the patients Signup and view all the answers

Which factor had the greatest impact on the efficiency and safety of hemodialysis treatment?

Educated and motivated staff and properly maintained equipment Signup and view all the answers

Homeostasis can best be defined as?

The steady state of internal environment Signup and view all the answers

Decreased glomerular filtration rate of the kidney may be due to all of the following EXCEPT?

Fluid overload Signup and view all the answers

Hemolysis of red blood cells will occur if which of the following dialyzing fluids is delivered to the dialyzer?

Hyperthermic Signup and view all the answers

The dose of heparin required for anticoagulation in dialysis generally aims to maintain the degree of anticoagulation at?

1.5-2 times baseline clotting studies Signup and view all the answers

The normal kidneys compensate for fluid loss by retaining which of the following?

Sodium and water Signup and view all the answers

The primary reason for anemia in chronic renal failure is?

Decreased erythropoietin production Signup and view all the answers

Performance of creatinine clearance test requires?

A timed urine collection and serum creatinine measurement Signup and view all the answers

Which of the following is a cause of hemolysis during dialysis?

Improper dialysate preparation Signup and view all the answers

Hypertension is a complication of renal failure. It may be influenced by all of the following EXCEPT?

Use of bicarbonate dialysate Signup and view all the answers

Correct needle placement is important in the initiation of dialysis to minimize the risk of all of the following EXCEPT?

Steal syndrome Signup and view all the answers

Cyclers used for peritoneal dialysis are automatic exchange devices which?

Regulate instillation and drainage of the dialysis solution Signup and view all the answers

The best way to define the term anastomosis is?

Surgical connection Signup and view all the answers

In the expression kt/v, the 'k' stands for?

Urea clearance of the dialyzer Signup and view all the answers

If a patient's venous needle falls out, what is the first thing the technician would do?

Turn off the blood pump, clamp venous line, and put pressure on the puncture site Signup and view all the answers

All of the following are potential problems associated with the use of bicarbonate dialysate EXCEPT?

Carbon dioxide levels in the bicarbonate dialysate becoming dangerously high Signup and view all the answers

A patient who has gone on high-efficiency dialysis now dialyzes for 3 hours per session instead of 4. Which of the following findings would indicate that the current prescription is inadequate?

A kt/v value = 0.8, routine Qb = 400 cc/mm, absence of edema, and increased hematocrit value Signup and view all the answers

The role of the renal dietician is best described as?

Counseling patients on the optimum diet for their needs and assisting them in following good dietary habits Signup and view all the answers

The half-life of heparin is 40-90 minutes. Which of the following is true regarding the effect of heparin in a dialysis patient?

The rebound effect of heparin metabolism increases the incidence of bleeding in this population Signup and view all the answers

Constipation is a common problem for dialysis patients. The primary reason for this is?

Medications such as phosphate binders or ferrous sulfate Signup and view all the answers

All of the following are relevant factors in ensuring the accuracy of the activated clotting line ACT EXCEPT?

Patient's hematocrit value Signup and view all the answers

For which of the following purposes is mannitol used?

To support blood pressure by expanding volume Signup and view all the answers

To minimize the risk of injury due to improper dialysate, one step which must be taken by each facility using bicarbonate dialysis is to?

Use key-coded and/or color-coded systems for concentrate containers and concentrate uptake lines Signup and view all the answers

The technician is setting up a dialyzer. If the test for a residual sterilant is positive after 500 cc normal saline has been infused, what should the technician conclude?

Abnormal, rinsing and retesting should be continued per protocol Signup and view all the answers

Which causes of poor blood flow in subclavian catheters are excluded?

Blood pump set higher than 150 ml/mm Signup and view all the answers

The procedure most likely ordered after placement of a subclavian catheter is?

Chest X-ray to verify catheter placement Signup and view all the answers

Complications associated with arteriovenous fistula for hemodialysis access include which of the following?

Thrombosis, infection, stenosis, arterial steal syndrome Signup and view all the answers

The total pressure in the blood circuit results from all the following EXCEPT?

Rate of dialysis fluid flow Signup and view all the answers

Minimal heparinization should be considered in patients with a history of all of the following EXCEPT?

Cataracts Signup and view all the answers

For a patient treatment session where the blood pump is set at 250 ml/mm and the technician observes jumping blood lines, what should they do?

Administer a bolus of saline because volume depletion has caused collapse in the arterial system Signup and view all the answers

The dextrose load from peritoneal dialysis solution can cause?

Hyperglycemia Signup and view all the answers

Two and one half hours into a hemodialysis treatment, a patient experiences a drop in blood pressure. Which of the following is the least common cause of hypotension during dialysis?

Increased dietary intake of sodium Signup and view all the answers

An often overlooked patient monitoring technique is?

Observing the patient for yawning, warmth, and restlessness Signup and view all the answers

Which laboratory finding is NOT affected by dietary intake and is used as an indicator of renal failure?

Creatinine level Signup and view all the answers

Clotting of vascular access is sometimes treated with thrombolytic agents or systemic anticoagulants. What potential complication should be monitored?

Hemorrhage Signup and view all the answers

Uremic pericarditis presents as?

Dyspnea, chest pain, pericardial friction rub, and uremia Signup and view all the answers

The most effective treatment for muscle cramping during dialysis is to inject a bolus of?

Hypertonic saline into the injection port on the venous blood line Signup and view all the answers

Chloride is the primary anion in which body fluid compartment?

Extracellular Signup and view all the answers

Two hours into a dialysis treatment, a 34-year-old female patient suddenly complains of chest pain and difficulty breathing. Which procedure should the technician perform immediately?

Check the extracorporeal circuit for the presence of air Signup and view all the answers

Hemodialysis is accomplished by which combination of processes?

Osmosis, diffusion, ultrafiltration Signup and view all the answers

Which of the following is true regarding Willem Kolff?

He designed and applied the first clinically successful artificial kidney Signup and view all the answers

The best way to establish hemostasis after dialysis is to apply?

Moderate pressure over the puncture site Signup and view all the answers

The BEST way to ensure that the technician's documentation on the patient's flow sheet is complete and accurate is to?

Chart as soon as possible Signup and view all the answers

According to federal law, the reused dialyzer MUST be labeled with the?

Patient's name, the number of previous uses, and the date of the last reprocessing. Signup and view all the answers

AAMI standard calls for a test to be performed to verify dialyzer performance?

For every dialyzer processed Signup and view all the answers

Chloramines are MOST EFFECTIVELY removed by which of the following components of water treatment system?

Activated carbon Signup and view all the answers

According to federal law regarding the handling of concentrated toxic substances associated with dialyzer reuse, which of the following items of personal protective wear should be used?

Gloves, eye shields, respirators (when appropriate), and impervious aprons Signup and view all the answers

Pyrogen reactions usually occur within 45 to 75 minutes after the start of dialysis. The initial patient complaint is?

Chills Signup and view all the answers

Water used for the preparation of dialysate should be analyzed for levels of all chemicals?

At least weekly Signup and view all the answers

Shortly after the Monday morning dialysis shift begins, three patients on one side of the unit develop fevers, chills, and malaise. The technician should be instructed to?

Put all machines into bypass, draw blood cultures, and take samples for cultures from the dialysate and the water Signup and view all the answers

Which of the following organizations is primarily concerned with testing the competency of dialysis nurses and technicians in their chosen specialty?

Board of Nephrology Examiners Nursing and Technology (BONENT) Signup and view all the answers

Key steps in the research process include all of the following EXCEPT?

Identifying the problem Signup and view all the answers

The best method of disinfecting dialysis machines to prevent heavy bacterial growth and buildup in the blood detector, pressure reducer, and blood pump is to?

Use proper concentrations of disinfecting agents over recommended periods of time Signup and view all the answers

Which of the following is recommended by the Centers for Disease Control?

Universal isolation practices and segregation of patients positive for hepatitis B antigen Signup and view all the answers

System of water treatment that removes pyrogens as well as solutes is called?

Reverse osmosis Signup and view all the answers

Which of the following is responsible for the ultimate disposal of medical waste?

Facility at which it originated Signup and view all the answers

The maximum allowable electrical leakage from the chassis of a dialysis machine is?

100 microamperes Signup and view all the answers

If a high venous pressure monitor alarm occurs during dialysis, which of the following should the technician do first?

Check for an obstruction in the blood system, distal to the monitor site Signup and view all the answers

Systematic rotation of stock is necessary in order to?

Prevent the use of expired stock Signup and view all the answers

The ultimate responsibility for maintaining water purity levels for water used for hemodialysis lies with the?

Medical director Signup and view all the answers

In selecting a dialyzer for a hemodialysis patient, which of the following is LEAST important?

Priming volume Signup and view all the answers

The JCAHO requires that dialysis personnel review which of the following annually?

Evacuation procedures, fire safety, and CPR techniques Signup and view all the answers

Air detectors monitor for the presence of air in the?

Venous blood line Signup and view all the answers

One of the dialysate monitoring devices is a conductivity meter or probe that continuously monitors to indicate dialysate?

Ionic concentration Signup and view all the answers

To prevent hemolysis, the thermal sensor and regulator of the dialysate delivery system should be maintained to keep the dialysate within that temperature range?

37°C ± 1°C Signup and view all the answers

Prior to each treatment, it is essential to check the sensitivity of the?

Blood leak alarm Signup and view all the answers

The dextrose concentration of a dialysate solution does NOT add to the total ionic content because it?

Is not ionized Signup and view all the answers

During initiation of dialysis, the venous pressure quickly climbs to 300 mm Hg. Which of the following situations would NOT cause this problem?

Cap on venous line securely closed while discarding the saline prime Signup and view all the answers

A patient complains of excruciating pain at the site of the venous needle when dialysis is begun with a reused dialyzer. The technician's FIRST response should be?

Clamp the venous and stop the blood pump Signup and view all the answers

The destruction of red blood cells that causes red pigment to leave the cell and enter the surrounding fluid is known as?

Hemolysis Signup and view all the answers

In which of the following ways can air enter the extracorporeal circuit?

From cracked connectors, vented fluid containers, and loose connections Signup and view all the answers

If a small amount of air is detected in the venous line, the air detector monitoring device of the blood circuit should simultaneously perform which of the following functions?

Clamp the venous line, give auditory and visual alarms, and stop the blood pump Signup and view all the answers

In performing emergency cardiopulmonary resuscitation, attention should be given to the victim's immediate needs in what order?

Circulation, airway, and breathing Signup and view all the answers

In the selection and placement of water treatment components for a home hemodialysis installation, a water softener is undesirable as the final purification method because softened water is high in bacterial count and?

Sodium Signup and view all the answers

Careful rinsing of a reused dialyzer prior to use by the patient is done primarily to remove?

Residual disinfectant solution Signup and view all the answers

A flushed sensation, headache, profound thirst, and vomiting are all symptoms indicating that the dialysis water is high in?

Magnesium Signup and view all the answers

Which of the following descriptions best defines diffusion?

Particles in solution moving from an area of high concentration to an area of low concentration until equilibrium is reached Signup and view all the answers

The approach recommended by the Centers for Disease Control and referred to as universal blood and body fluid precautions includes all of the following EXCEPT that?

To prevent needle stick injuries, needles should not be recapped or otherwise manipulated by hand Signup and view all the answers

Deionization is a type of water treatment used in dialysis that utilizes?

Cation and anion exchanges Signup and view all the answers

Which of the following elements, when present at excessive levels in water used in dialysis, can induce nausea, vomiting, hypertension, and muscular weakness in the dialysis patients?

Copper Signup and view all the answers

A reuse dialyzer can only be reused?

On the same patient Signup and view all the answers

In treated water meeting AAMI standards, the maximum allowable colony count/ml of bacterial contamination is?

200 Signup and view all the answers

A hemodialysis patient who has volume-dependent hypertension will generally be able to control his blood pressure by?

Maintaining an adequate fluid balance and following a proper sodium restriction in his diet Signup and view all the answers

Removal of fluids from the body is accomplished in peritoneal dialysis by the use of?

A hyperosmotic dialysis fluid Signup and view all the answers

Study Notes

Hemodialysis and Patient Monitoring

Blood leak detection in hemodialysis triggers an audio/visual alarm and stops the blood pump.
Shortness of breath in patients may indicate fluid overload, a critical condition.
In the event of an emergency, prioritization should be the protection of patients over equipment or facilities.
Correct needle placement reduces risks like hematoma formation and inadequate blood flow during dialysis.

Pericarditis Management and Complications

Management of pericarditis includes controlled heparinization and use of anti-inflammatory drugs.
Aggressive blood pressure control and increased dialysis frequency are common strategies.
Anemia in chronic renal failure is primarily due to decreased erythropoietin production.

Dialysis Procedures and Equipment Safety

Use careful monitoring to ensure hemodialysis patients remain stable, especially concerning volume status.
Accurate residual sterilant tests are crucial; positive tests necessitate adherence to cleaning protocols.
Hemolysis can occur if inappropriate dialyzing fluids are used during treatment.

Professional Standards and Patient Care

Educational organizations for dialysis staff support ongoing professional development.
The renal dietitian's role is to counsel patients on optimal dietary habits for kidney health.

Dialyzer Reuse and Regulation

Federal law mandates proper labeling for reused dialyzers, including patient details and usage counts.
Dialyzer performance must be tested for every processed dialyzer as part of quality assurance.

Emergency Protocols

In case of a fire or disaster, immediate actions should prioritize patient safety.
Monitor patients closely for symptoms of pyrogenic reactions, typically starting with chills.

Dialysis Treatment Adjustments

For adequate dialysis, physicians should regularly evaluate treatment prescriptions, especially after changes in duration or technique.
Dextrose solution from peritoneal dialysis can lead to hyperglycemia due to its composition.

Laboratory and Clinical Findings

Creatinine levels serve as an indicator of renal function and are not significantly impacted by dietary intake.
Patients receiving thrombolytic agents during dialysis require careful monitoring for the risk of hemorrhage.

Equipment and Waste Management

Chloramines in water treatment systems are effectively removed by activated carbon filters.
Protective gear, such as gloves and aprons, is essential when handling toxic substances in hemodialysis processes.

Key Terms and Definitions

Dialysis: A medical process to remove waste and excess fluid from the blood.
Homeostasis: The stable, balanced internal condition maintained by the body.
Anastomosis: Surgical connection between two structures, often blood vessels.

Additional Notes

Regular analysis of water used in dialysate preparation is critical for chemical safety and patient health.
Technicians should respond promptly to any sudden patient complaints during dialysis, particularly respiratory distress or chest pain.### Dialysis Procedures and Responsibilities
All machines should be set to bypass mode before drawing blood cultures and taking dialysate and water samples.
The ultimate responsibility for maintaining water purity in hemodialysis lies with the medical director.

Competency Testing

Board of Nephrology Examiners Nursing and Technology (BONENT) tests the competency of dialysis nurses and technicians.

Research Process

Key steps include analyzing data, developing the study design, and identifying the problem; eliminating unusual variation is not a key step.

Disinfection Methods

The best disinfection method for dialysis machines involves using proper concentrations of disinfecting agents over recommended periods.

Infection Control

Centers for Disease Control recommends universal isolation practices for patients positive for hepatitis B antigen, including quarterly screening of healthcare personnel.

Water Treatment

Reverse osmosis effectively removes pyrogens and solutes from the water treatment system.

Medical Waste Disposal

The facility where medical waste originated is ultimately responsible for its disposal.

Electrical Safety

The maximum allowable electrical leakage from a dialysis machine chassis is 100 microamperes.

Dialysis Operations

In case of a high venous pressure monitor alarm, the technician should first check for obstructions distal to the monitor site.
Systematic rotation of stock is necessary to prevent the use of expired products.

Dialyzer Selection

When selecting a dialyzer, priming volume is least important compared to ultrafiltration, BUN, and creatinine clearances.

Annual Review Requirements

JCAHO requires annual reviews of fire safety, electrical safety, and water quality in dialysis personnel training.

Air Detection

Air detectors primarily monitor for air presence in the venous blood line during dialysis.

Conductivity Monitoring

A conductivity meter in the dialysate system monitors the ionic concentration continuously.

Temperature Control

The dialysate delivery system should maintain temperatures within 37°C ± 1°C to prevent hemolysis.

Alarm Sensitivity Checks

Venous pressure alarm sensitivity must be checked prior to each treatment.

Dialysate Composition

Dextrose concentration in dialysate does not add to total ionic content as it is not ionized.

Venous Pressure Concerns

A venous pressure rise to 300 mm Hg can occur due to infiltrated or mispositioned venous needles, but not if the cap on the venous line is securely closed.

Addressing Patient Discomfort

If a patient experiences pain at the venous needle site, the technician should first clamp the venous and stop the blood pump.

Hemolysis Definition

Hemolysis is defined as the destruction of red blood cells, causing red pigment to leak into surrounding fluids.

Air in the Circuit

Air can enter the extracorporeal circuit through cracked connectors, vented containers, and loose connections.

Air Detector Functions

If air is detected in the venous line, the monitoring device should give auditory alarms, clamp the line, and stop the blood pump.

CPR Protocol

In emergency CPR, the order of immediate needs is circulation, airway, and breathing.

Water Treatment for Home Dialysis

A water softener is undesirable in home hemodialysis installations due to high bacterial counts related to sodium.

Dialyzer Rinsing

Rinsing a reused dialyzer helps remove residual disinfectant prior to patient use.

Water Quality Symptoms

High magnesium levels in dialysis water can cause headaches, thirst, and vomiting.

Diffusion Process

Diffusion involves particles in solution moving from areas of high to low concentration until equilibrium is reached.

Universal Precautions

The universal blood and body fluid precautions include protective measures against needle stick injuries and using protective gear during exposure to blood.

Ion Exchange in Water Treatment

Deionization in water treatment for dialysis utilizes cation and anion exchanges to purify water.

Toxic Elements in Water

Excessive copper in dialysis water can cause nausea, vomiting, hypertension, and muscle weakness.

Dialyzer Reuse Protocol

A reused dialyzer can only be used on the same patient to ensure safety and efficacy.

Bacterial Contamination Standards

AAMI standards allow a maximum of 200 colony counts/ml for bacterial contamination in treated water.

Hypertension Management

Volume-dependent hypertension in hemodialysis patients can typically be managed by maintaining fluid balance and sodium restrictions.

Fluid Removal in Peritoneal Dialysis

Fluid removal is accomplished by using a hyperosmotic dialysis fluid in peritoneal dialysis.

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Test your knowledge on hemodialysis and pericarditis management with these flashcards. This quiz covers important concepts and potential exam questions for healthcare professionals. Challenge yourself and enhance your understanding of critical topics in renal care.