CHT. Predictive exam VI

Question 1 of 50

1. Question

A patient arrives for her hemodialysis treatment complaining of flulike symptoms and says she has been vomiting. Which of the following laboratory values should be reported immediately to the physician?

Sodium, 148 mEq/L
Chloride, 102 mEq/L
Potassium, 3.2 mEq/L
Bicarbonate, 27 mEq/L

Question 2 of 50

2. Question

A patient is diagnosed with polycystic kidney disease. She requests information about the pathophysiology of her disease. Which of the following statements is correct about adult polycystic kidney disease?

The kidneys can become markedly enlarged.
Deterioration of kidney function is always rapid.
It is an immune-related disease.
Only invasive radiology tests can diagnose this disease.

Question 3 of 50

3. Question

A patient is experiencing an anaphylactic reaction to a new antibiotic. Which of the following actions should be performed immediately?

Maintaining a patent airway
Administering a corticosteroid
Administering epinephrine (adrenaline)
Instructing the patient on the importance of obtaining a Medic-Alert bracelet

Question 4 of 50

4. Question

How do doctors know that there may be damage to the glomeruli?

The pores start to let large cells like blood cells and protein through
The pores start to keep in what the body need and let out wastes
The pores start to force water out of the blood through tiny slits
The blood flow start to reserve from its usual direct

Question 5 of 50

5. Question

You remove a patient’s usual 2 kilos, but this BP is still elevated at 180/90. What is a good question to ask?

Did you drink 2 liters during treatment?
Are you going to watch the game this weekend?
Would you like some water?
Did you forget to take your blood pressure meds today?

Question 6 of 50

6. Question

A question you can ask that can help your patients to improve their own health is:

Which channel would you like me to put on the TV for you?
What kind of health plan do you have besides Medicare?
What sorts of things do you do to stay fit?
What is your favorite ice cream flavor?

Question 7 of 50

7. Question

If alarms go off on all of the dialysis machines at the same time , what might you suspect?

Blood leaks or air bubbles
Blood clots or blood pump failures
Dialysate problems or a powers outage
Computers issues or an RO failure

Question 8 of 50

8. Question

What type of blood pump pressure is always positive?

Post-pump
Pre-pump
All of it
None of it

Question 9 of 50

9. Question

If your area has hydraulic fracking , what might you check the tap water for ?

Bacteria from sewage
Pharmaceutical drugs
Chemicals like benzene
Fungi and amoeba

Question 10 of 50

10. Question

Why must we avoid cannulating into enlarging pseudoaneurysms?

Patients could get a serious blood infection?
The weak portion of the vessel could burst
It could cause stenosis and low blood flow
A large blood clot could from in the access

Question 11 of 50

11. Question

Which technique is a way to precisely control water removal during hemodialysis without adding sodium to a patient’s blood?

UF burette
Bubble trap
Flow pump
UF profiling

Question 12 of 50

12. Question

What could a drop in pressure after the backflow prevention device mean?

Less tap water from the source
A change in a tap water temperature
Plugging up of the device
Failure of the sediment filter

Question 13 of 50

13. Question

What is the minimum of level Kt/v of standard in-center hemodialysis?

1.2
2
0.01
1.4

Question 14 of 50

14. Question

What are the main risks to patients of too much aluminum in dialysis water?

Bone disease an dementia
Lung fibrosis and pneumonia
Appendicitis and bursitis
Sudden cardiac death and hearth failure

Question 15 of 50

15. Question

What is the target serum albumin level for people on dialysis to reduce the risks of death?

0.6 g/dL or greater
2.7 g/dL or less
3.5 g/dL or less
4.0 g/dL or greater

Question 16 of 50

16. Question

What do all of the skin antiseptics that you may use to prep a fistula have in common?

They must be applied with gauze pads
They cause skin blisters and bruising
The y must be allowed to dry before cannulation
They require cannulation to be done while wet

Question 17 of 50

17. Question

What are the biggest risks of vascular access for patients who do hemodialysis ?

Body image and needle pain
Infection and running out of sites
Ultrasound imaging and liver failure
Ultrafiltration and organ stunning

Question 18 of 50

18. Question

If you start the blood pump and the patients complains of pain in the access arm , and you see a hematoma, what may have happened?

An infection
An infiltration
An intravenous
An injection

Question 19 of 50

19. Question

What is the purpose of triage during an emergency ?

To sort patients by how ill or injured they are
To identify who as psychosocial issues
To choose favorites and treat them first
To sort patients by health insurance coverage

Question 20 of 50

20. Question

Trouble walking and skipped heartbeats could be symptoms of ?

Low potassium levels (hypokalemia)
High potassium levels (hyperkalemia)
High phosphorus levels (hyperphosphatemia)
Low phosphorus levels (hyperphosphatemia)

Question 21 of 50

21. Question

Research has found that compared to using a new dialyzers for each treatment , patient survival with reprocessed dialyzers is :

We don't know , there are no studies
Better
Worse
About the same

Question 22 of 50

22. Question

What is the difference dual bed and mixed bed deionization systems?

Duals beds remove ions and microbes , mixed beds only remove ions
Duals beds keep anions and cations separate , mixed beds have both
Dual beds have only one tank ,while mixed beds have two
Dual beds remove only anions, mixed beds remove anions and cations

Question 23 of 50

23. Question

What are endotoxin ?

Non- living parts of the cells walls of some Gram- negative bacteria
Colony -forming parts of some Gram-negative bacteria
Non-living parts of the cells walls of some Gram-positive bacteria
Living parts of the walls of some Gram-positive bacteria

Question 24 of 50

24. Question

Just after you start a treatment with a new dialyzer, a patient becomes anxious, starts to itch , and has trouble breathing. Which of these is the most likely cause , and why?

First use syndrome , because the dialyzer may have been sterilized with ETO
Arrhythmia , because it can cause anxiety and missed or skipped heart beats
Cardiac arrest , because it can cause anxiety and trouble breathing
Pruritus , because it cause itching

Question 25 of 50

25. Question

The main risks of dialysate that is too warm is:

Blood clots inside the dialyzer
Hematocrit and hemoglobin
Hemolysis and hyperthermia
Poor dialysis treatment efficiency

Question 26 of 50

26. Question

What should you see in a water treatment system before and after and booster pump?

A pressure gauge
A sediment filter
A temperature gauge
A PH gauge

Question 27 of 50

27. Question

Very low arterial pressure during a treatament should alert you to:

Fluid overload
Anemia
A possible access problem
Hypertension

Question 28 of 50

28. Question

What step may we take to unclog sediment filters?

Backwash the filter monthly
Replace the filters monthly
Backwash the filters daily
Put an ultrafilters before the sediment filter

Question 29 of 50

29. Question

Which of the following is true about diffusion :

It works only if there is a semipermeable membrane
It will not work if a semipermeable membrana blocks the molecules
It will work with or without a semipermeable membrane
it requires alkaline pH and a hot temperature

Question 30 of 50

30. Question

What may happen if a patient exercises the right to use a new dialyzer at each treatment?

The clinic may exercise its right to not treat him or her
The patient may be required to switch to peritoneal dialysis
The nephrologist may choose to prescribe a less costly dialyzer
The patient may be asked to pay s surcharge for each dialyzer

Question 31 of 50

31. Question

What might be a a clue that a patient has had a vein transposed to create a fistula?

A large aneurysm on the inside of the arm
A skipping pulse over the length of the fistula
A cold hand and white fingertips on the fistula arm
A very long scar from thearmpit to the elbow

Question 32 of 50

32. Question

When you take a manual blood pressure at what point do you hear the systolic number?

Exactly one minute after you star deflating the cuff
When you first start to hear the patient's pulse
When you are no longer able to hear the patient's puulse
When the cuff is completely deflated

Question 33 of 50

33. Question

Why is it vital to monitor water in the water storage tank?

Because chlorine is removed , so microbes can grow
To ensure that there is enough water for dialysis
To avoid exhaustion of the deionization system
Because chlorine or chloramines could build uo

Question 34 of 50

34. Question

As a new technician , what is the best way for you to approach cannulation of a brand new fistula?

Have the nurse guide your hand while you try
Only experienced staff cannulate new fistula
Ask an experienced technician to show you
Assess the access first and choose a spot

Question 35 of 50

35. Question

What are the biggest advantages of grafts hemodialysis access?

They do not need needles and are very biocompatible
They cause no scarring and are invisible to others
They are under the skin and can be used in 2-3 weeks
They do not alter the patient's veins or arteries

Question 36 of 50

36. Question

If patients must evacuate you are , what is a valid concern about special need shelters ?

They are overcrowded, which can spread disease
They accept pets, which could cause anxiety or allergies
They may not be able to safely care for dialysis patients
They do not admit families , and patients do not want to be alone

Question 37 of 50

37. Question

What is an aneurysm?

A serious blood infection
Ballooning of a weak spot
A narrow spot in a vessel
A large blood clot

Question 38 of 50

38. Question

Which of these signs might suggest stenosis in an arteriovenous fistula or graft?

Trouble taping needles , higher arterial pressure , leaking dark blood after treatment
Trouble leveling needles , lower venous pressures , site clotting after treatment
Trouble insetting needles, higher venous pressures , more bleeding after treatment
Trouble flipping needles , lower arterial pressures , no bleeding at all after treatment

Question 39 of 50

39. Question

What is true about a stent placed in a patient’s fistula ?

It is removed once the vessel opens up
it is a permanent repair for stenosis
It can never be removed or cannulated
Students should never be used is fistula

Question 40 of 50

40. Question

What event is a dialysis clinic should make you suspect a water treatment problem?

A patient clutches his or her throat
A patient has a heart attack during dialysis
Several patients on a shift all have symptoms at once
An elderly patient pulls out his needle

Question 41 of 50

41. Question

What is a pseudoaneurysm?

A large bubble on the surface of a graft
Ballooning of a weakened spot of a graft
A blood clot above a graft , Under the skin
A subcutaneous infection in a graft wall

Question 42 of 50

42. Question

In peritoneal dialysis, what is dwell time?

How long the fresh PD fluid stays in the patient's belly before it is drained out
How long it takes for PD fluid to drain out of the patient belly
How long it takes for PD fluid to drain into the patient's belly
How long it takes for PD fluid to be warmed enough to use for PD

Question 43 of 50

43. Question

Which statement best describes the ESRD Networks?

A group of nephrologist and nurses who met twice a year
A government agency that decides ho gets dialysis
A place where single dialysis patients can meet other sngle dialysis patients
An organization that oversees dialysis quality, investigates complaints and gathers data

Question 44 of 50

44. Question

If you see that patient’s hand on the fistula arm looks blue or pale, what could this mean?

Steal syndrome
Infection
Aneurysm
Bruising

Question 45 of 50

45. Question

How long before cannulation should a patient apply topical lidocaine cream to numb needle sites?

At least 1-2 hours
Just before treatment
At least 30 minutes
At least 15 minutes

Question 46 of 50

46. Question

Two treatments that patients commonly receive for anemia include:

Tylenol and inhalers
Hydrotherapy and platelet infusions
Iron and ESAs
Oxygen and intravenous vitamin C

Question 47 of 50

47. Question

Which of the following statement is true about the first90days on dialysis?

The first 90 days the easiest on patients, because they still have some kidney function
A new patients is twice as likely to die as a someone who has on dialysis longer
Most patients are not very sick in the first 90 days, so it is a good time to experiment
New dialysis patients tend to be well-informed about their treatment and what to except

Question 48 of 50

48. Question

How much water will you remove from a patients in a 4-hours treatment using a dialyzer with a KUF of 10 mL/hr/mmhg at a TMP of 80mmHg?

2,8000 mL
3,200 mL
4,000 mL
2,000 mL

Question 49 of 50

49. Question

All CQI efforts use a ___________________(PDCA) cycle:

People doing Continuous Assessment
Proper Deficiency Communication Announcement
Plan Do Check Act
Process Designed to Calculate Activity

Question 50 of 50

50. Question

What is true of dialyzer membrane with a high (850 mL/min) KoA?

It is better for a patient to take along on a camping trip
It is more permeable and will allow a high efficiency treatment
It removes more water , so patients can have lower fluid limits
It contains more hollow fibers , so treatments will take longer