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Questions and Answers
When the hemodialysis machine detects a blood leak, what happens?
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?
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?
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?
Which organization is primarily concerned with providing dialysis unit staff with educational opportunities?
Which of the following is NOT essential to the successful completion of a research project?
Which of the following is NOT essential to the successful completion of a research project?
Which of the following statements concerning feedback is INCORRECT?
Which of the following statements concerning feedback is INCORRECT?
When a pyrogenic reaction occurs, the water treatment system should be cultured for?
When a pyrogenic reaction occurs, the water treatment system should be cultured for?
In the event of a natural disaster, the primary responsibility of the technicians in the dialysis setting is the protection of the?
In the event of a natural disaster, the primary responsibility of the technicians in the dialysis setting is the protection of the?
If the dialysis machine has been disinfected with formaldehyde, what should be tested for after rinsing?
If the dialysis machine has been disinfected with formaldehyde, what should be tested for after rinsing?
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?
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?
Which of the following is NOT a possible sequela of hepatitis B?
Which of the following is NOT a possible sequela of hepatitis B?
In the event a MAJOR fire is discovered in an area occupied by patients, what should be the first action?
In the event a MAJOR fire is discovered in an area occupied by patients, what should be the first action?
Which factor had the greatest impact on the efficiency and safety of hemodialysis treatment?
Which factor had the greatest impact on the efficiency and safety of hemodialysis treatment?
Homeostasis can best be defined as?
Homeostasis can best be defined as?
Decreased glomerular filtration rate of the kidney may be due to all of the following EXCEPT?
Decreased glomerular filtration rate of the kidney may be due to all of the following EXCEPT?
Hemolysis of red blood cells will occur if which of the following dialyzing fluids is delivered to the dialyzer?
Hemolysis of red blood cells will occur if which of the following dialyzing fluids is delivered to the dialyzer?
The dose of heparin required for anticoagulation in dialysis generally aims to maintain the degree of anticoagulation at?
The dose of heparin required for anticoagulation in dialysis generally aims to maintain the degree of anticoagulation at?
The normal kidneys compensate for fluid loss by retaining which of the following?
The normal kidneys compensate for fluid loss by retaining which of the following?
The primary reason for anemia in chronic renal failure is?
The primary reason for anemia in chronic renal failure is?
Performance of creatinine clearance test requires?
Performance of creatinine clearance test requires?
Which of the following is a cause of hemolysis during dialysis?
Which of the following is a cause of hemolysis during dialysis?
Hypertension is a complication of renal failure. It may be influenced by all of the following EXCEPT?
Hypertension is a complication of renal failure. It may be influenced by all of the following EXCEPT?
Correct needle placement is important in the initiation of dialysis to minimize the risk of all of the following EXCEPT?
Correct needle placement is important in the initiation of dialysis to minimize the risk of all of the following EXCEPT?
Cyclers used for peritoneal dialysis are automatic exchange devices which?
Cyclers used for peritoneal dialysis are automatic exchange devices which?
The best way to define the term anastomosis is?
The best way to define the term anastomosis is?
In the expression kt/v, the 'k' stands for?
In the expression kt/v, the 'k' stands for?
If a patient's venous needle falls out, what is the first thing the technician would do?
If a patient's venous needle falls out, what is the first thing the technician would do?
All of the following are potential problems associated with the use of bicarbonate dialysate EXCEPT?
All of the following are potential problems associated with the use of bicarbonate dialysate EXCEPT?
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 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?
The role of the renal dietician is best described as?
The role of the renal dietician is best described as?
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 half-life of heparin is 40-90 minutes. Which of the following is true regarding the effect of heparin in a dialysis patient?
Constipation is a common problem for dialysis patients. The primary reason for this is?
Constipation is a common problem for dialysis patients. The primary reason for this is?
All of the following are relevant factors in ensuring the accuracy of the activated clotting line ACT EXCEPT?
All of the following are relevant factors in ensuring the accuracy of the activated clotting line ACT EXCEPT?
For which of the following purposes is mannitol used?
For which of the following purposes is mannitol used?
To minimize the risk of injury due to improper dialysate, one step which must be taken by each facility using bicarbonate dialysis is to?
To minimize the risk of injury due to improper dialysate, one step which must be taken by each facility using bicarbonate dialysis is to?
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?
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?
Which causes of poor blood flow in subclavian catheters are excluded?
Which causes of poor blood flow in subclavian catheters are excluded?
The procedure most likely ordered after placement of a subclavian catheter is?
The procedure most likely ordered after placement of a subclavian catheter is?
Complications associated with arteriovenous fistula for hemodialysis access include which of the following?
Complications associated with arteriovenous fistula for hemodialysis access include which of the following?
The total pressure in the blood circuit results from all the following EXCEPT?
The total pressure in the blood circuit results from all the following EXCEPT?
Minimal heparinization should be considered in patients with a history of all of the following EXCEPT?
Minimal heparinization should be considered in patients with a history of all of the following EXCEPT?
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?
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?
The dextrose load from peritoneal dialysis solution can cause?
The dextrose load from peritoneal dialysis solution can cause?
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?
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?
An often overlooked patient monitoring technique is?
An often overlooked patient monitoring technique is?
Which laboratory finding is NOT affected by dietary intake and is used as an indicator of renal failure?
Which laboratory finding is NOT affected by dietary intake and is used as an indicator of renal failure?
Clotting of vascular access is sometimes treated with thrombolytic agents or systemic anticoagulants. What potential complication should be monitored?
Clotting of vascular access is sometimes treated with thrombolytic agents or systemic anticoagulants. What potential complication should be monitored?
Uremic pericarditis presents as?
Uremic pericarditis presents as?
The most effective treatment for muscle cramping during dialysis is to inject a bolus of?
The most effective treatment for muscle cramping during dialysis is to inject a bolus of?
Chloride is the primary anion in which body fluid compartment?
Chloride is the primary anion in which body fluid compartment?
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?
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?
Hemodialysis is accomplished by which combination of processes?
Hemodialysis is accomplished by which combination of processes?
Which of the following is true regarding Willem Kolff?
Which of the following is true regarding Willem Kolff?
The best way to establish hemostasis after dialysis is to apply?
The best way to establish hemostasis after dialysis is to apply?
The BEST way to ensure that the technician's documentation on the patient's flow sheet is complete and accurate is to?
The BEST way to ensure that the technician's documentation on the patient's flow sheet is complete and accurate is to?
According to federal law, the reused dialyzer MUST be labeled with the?
According to federal law, the reused dialyzer MUST be labeled with the?
AAMI standard calls for a test to be performed to verify dialyzer performance?
AAMI standard calls for a test to be performed to verify dialyzer performance?
Chloramines are MOST EFFECTIVELY removed by which of the following components of water treatment system?
Chloramines are MOST EFFECTIVELY removed by which of the following components of water treatment system?
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?
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?
Pyrogen reactions usually occur within 45 to 75 minutes after the start of dialysis. The initial patient complaint is?
Pyrogen reactions usually occur within 45 to 75 minutes after the start of dialysis. The initial patient complaint is?
Water used for the preparation of dialysate should be analyzed for levels of all chemicals?
Water used for the preparation of dialysate should be analyzed for levels of all chemicals?
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?
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?
Which of the following organizations is primarily concerned with testing the competency of dialysis nurses and technicians in their chosen specialty?
Which of the following organizations is primarily concerned with testing the competency of dialysis nurses and technicians in their chosen specialty?
Key steps in the research process include all of the following EXCEPT?
Key steps in the research process include all of the following EXCEPT?
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?
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?
Which of the following is recommended by the Centers for Disease Control?
Which of the following is recommended by the Centers for Disease Control?
System of water treatment that removes pyrogens as well as solutes is called?
System of water treatment that removes pyrogens as well as solutes is called?
Which of the following is responsible for the ultimate disposal of medical waste?
Which of the following is responsible for the ultimate disposal of medical waste?
The maximum allowable electrical leakage from the chassis of a dialysis machine is?
The maximum allowable electrical leakage from the chassis of a dialysis machine is?
If a high venous pressure monitor alarm occurs during dialysis, which of the following should the technician do first?
If a high venous pressure monitor alarm occurs during dialysis, which of the following should the technician do first?
Systematic rotation of stock is necessary in order to?
Systematic rotation of stock is necessary in order to?
The ultimate responsibility for maintaining water purity levels for water used for hemodialysis lies with the?
The ultimate responsibility for maintaining water purity levels for water used for hemodialysis lies with the?
In selecting a dialyzer for a hemodialysis patient, which of the following is LEAST important?
In selecting a dialyzer for a hemodialysis patient, which of the following is LEAST important?
The JCAHO requires that dialysis personnel review which of the following annually?
The JCAHO requires that dialysis personnel review which of the following annually?
Air detectors monitor for the presence of air in the?
Air detectors monitor for the presence of air in the?
One of the dialysate monitoring devices is a conductivity meter or probe that continuously monitors to indicate dialysate?
One of the dialysate monitoring devices is a conductivity meter or probe that continuously monitors to indicate dialysate?
To prevent hemolysis, the thermal sensor and regulator of the dialysate delivery system should be maintained to keep the dialysate within that temperature range?
To prevent hemolysis, the thermal sensor and regulator of the dialysate delivery system should be maintained to keep the dialysate within that temperature range?
Prior to each treatment, it is essential to check the sensitivity of the?
Prior to each treatment, it is essential to check the sensitivity of the?
The dextrose concentration of a dialysate solution does NOT add to the total ionic content because it?
The dextrose concentration of a dialysate solution does NOT add to the total ionic content because it?
During initiation of dialysis, the venous pressure quickly climbs to 300 mm Hg. Which of the following situations would NOT cause this problem?
During initiation of dialysis, the venous pressure quickly climbs to 300 mm Hg. Which of the following situations would NOT cause this problem?
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?
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?
The destruction of red blood cells that causes red pigment to leave the cell and enter the surrounding fluid is known as?
The destruction of red blood cells that causes red pigment to leave the cell and enter the surrounding fluid is known as?
In which of the following ways can air enter the extracorporeal circuit?
In which of the following ways can air enter the extracorporeal circuit?
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?
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?
In performing emergency cardiopulmonary resuscitation, attention should be given to the victim's immediate needs in what order?
In performing emergency cardiopulmonary resuscitation, attention should be given to the victim's immediate needs in what order?
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?
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?
Careful rinsing of a reused dialyzer prior to use by the patient is done primarily to remove?
Careful rinsing of a reused dialyzer prior to use by the patient is done primarily to remove?
A flushed sensation, headache, profound thirst, and vomiting are all symptoms indicating that the dialysis water is high in?
A flushed sensation, headache, profound thirst, and vomiting are all symptoms indicating that the dialysis water is high in?
Which of the following descriptions best defines diffusion?
Which of the following descriptions best defines diffusion?
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?
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?
Deionization is a type of water treatment used in dialysis that utilizes?
Deionization is a type of water treatment used in dialysis that utilizes?
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?
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?
A reuse dialyzer can only be reused?
A reuse dialyzer can only be reused?
In treated water meeting AAMI standards, the maximum allowable colony count/ml of bacterial contamination is?
In treated water meeting AAMI standards, the maximum allowable colony count/ml of bacterial contamination is?
A hemodialysis patient who has volume-dependent hypertension will generally be able to control his blood pressure by?
A hemodialysis patient who has volume-dependent hypertension will generally be able to control his blood pressure by?
Removal of fluids from the body is accomplished in peritoneal dialysis by the use of?
Removal of fluids from the body is accomplished in peritoneal dialysis by the use of?
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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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