Fresenius RN Exam : Complete Study Guide – 300+ Questions & Answers for Dialysis Nurse Certification

Pass the Fresenius RN Exam on your first attempt with this comprehensive study guide for the testing cycle. This document contains over 300 real exam-style questions and verified answers with detailed rationales, covering all essential dialysis nursing competencies required for Fresenius Medical Care (FMC) RN certification and clinical practice. What’s Included – Complete Content Coverage: Infection Control & PPE: PPE for disinfecting dialysis station or cleaning blood spill – gloves, gown, mask, AND goggles. Fresenius mission statement – improving the quality of life of patients. Hand sanitizer acceptable – when leaving patient station (not after restroom, not for visibly soiled hands, not for C. diff). Blood spill 10 mL – clean with 1:10 bleach followed by 1:100 bleach. Hand hygiene with soap and water – 40-60 seconds. Hand sanitizer – 20-30 seconds. Check both arms for fistula/graft before taking blood pressure. Sharps containers – empty when 2/3 to 3/4 full. NOT a risk factor for infection in CKD patients – socioeconomic status (frequent hospitalizations, repeated invasive procedures, immunocompromised ARE risk factors). Hepatitis B – staff who care for HBsAg positive patients should also care for immune patients (same staff cohorting). Dialysis functions – removal of excess fluid and waste from blood. Most common cause of CKD – diabetes. Dialysis prescription includes – blood flow rate. Transducer protectors – must be kept dry and unclamped. Machine disinfection – acid disinfection completed daily. Vascular access needles – both arterial and venous can be placed with the flow of blood; arterial needle only can be placed against the flow of blood. Pre-treatment weight minus estimated dry weight – available weight. Hypertonic solution – high conductivity; hypotonic solution – low conductivity. Staff member CANNOT leave patient's chairside during blood reinfusion if patient is alert (INCORRECT – they must stay). Diffusion – movement of solutes from higher to lower concentration. KECN values stable – blood flow rate set at prescribed rate. CMS trigger during survey – multi-dose medication vial punctured with previously used needle/syringe. Sharps containers in flood – lock, seal, place in biohazard storage room. Good infection control for medications – prepare as close to time of use as possible, no more than 4 hours prior. IV iron side effects – hypotension, rash, pruritus, wheezing. Anticoagulants – patient should be assessed for recent falls before administration. Emergency hand crank – monitor for air in line after venous chamber. Adverse event – failure to follow procedures causing patient injury or death. Ultra low total chlorine testing – sample cup must be rinsed 3 times. Total chlorine limit – less than 0.1 ppm. HMIS labels – required on all hazardous materials including individual bicarbonate containers (True). Diasafe filter – allows production of ultrapure dialysate. Normal saline – used to rinse and prime ECC tubing to remove sterilant and air. Air removed from ECC – because trapped air in dialyzer may cause clotting. Most likely cause of contamination of ECC – bloodlines open in prime bucket with end caps. Low-level arterial drip chamber – can result in air entering system causing air embolism or clotting. Conductivity – ability of substance to conduct electrical charge. Alarm and Pressure Holding Tests (PHT) – before each treatment. Saline removes air during priming. Conductivity alarm parameters – set at +/- 0.5 of machine's theoretical conductivity. Disinfect with heat after treating with acid. In addition to safety checks – conductivity and pH tests. Compare machine conductivity to meter – to ensure machine display is accurate. Allowable variance – +/- 0.3. Vascular Access & Cannulation: Pre-treatment evaluation of internal vascular access – palpating for thrill. Needle flipped after insertion – damage to internal lining of vessel. Cannulating new AVF – always apply tourniquet, stay at least 1.5-2 inches from anastomosis. Pre-pump arterial pressure should not exceed – 250 mmHg. Venous needle infiltrated – insert new needle above infiltrate, apply ice. Removing needles – needle safety device should be engaged. Access recirculation – can jeopardize adequacy. Apply access needle safety devices – as needle is being removed. Arterial pressure reading negative 270 – can cause hemolysis. Report blood pressure over 180/100 to nurse. Report pulse less than 60 or greater than 100 to nurse. Clean cannulation site for at least 30 seconds. Place tape directly over butterfly wings after cannulation. Wait 3-5 minutes to initiate treatment after heparin dose. Assess bruit – auscultation. Assess thrill – palpation. Low arterial alarm – look from arterial needle through blood pump. High venous alarm – look from venous chamber to venous needle. Heparinization – adequacy compromised by. During dialysis – face and access must be uncovered. Needle infiltrates – first turn off blood pump. Large clot in venous chamber – replace venous line. Rising venous pressure with no infiltration – most likely clotted venous line. Occlusion – most likely to raise venous pressure. Air embolism – first intervention clamp patient's bloodlines. Hemolysis – complication from dialyzing on hypotonic dialysate. Hyperkalemia – can result in weakness and death. New needle placement after arterial infiltration – above or below infiltration. Minimum saline in bag during treatment – 300 mL. Large amount of blood pooling under chair – turn blood pump off, clamp lines, call for help. Kink in bloodline – most likely cause hemolysis. Excessive fluid removal plus antihypertensive – hypotension. Symptoms of uremia – loss of appetite. Final thirty minutes of dialysis with blurred vision and dizziness – evaluate for hypotension. Feelings of faintness, double vision, perspiration, irritability, hunger – hypoglycemia. Primary cause of anemia in dialysis patient – decrease in erythropoietin production. Dialysate flow stops – patient's blood no longer getting cleaned. Shortness of breath, chest pain, sudden hypotension, bright red translucent blood – hemolysis. Chloramines or bleach in dialysate can cause death due to hemolysis. Improperly primed dialyzers and bloodlines – increase risk of air embolism and clotting. Post BUN sample – turn off ultrafiltration rate. Adequacy of dialysis treatment – evaluate Blood Urea Nitrogen (BUN) lab value. Conductivity alarm – machine enters bypass mode. Prevention of hypotension – measure intake including foods that melt at room temperature. Draw PRE-treatment labs after cannulation and before heparin. Draw POST-treatment labs after treatment and before blood is returned. Draw lab samples from arterial line. Draw pre and post BUN samples on same day. Machine in bypass for 30 minutes – if clock shows 3 hours but machine shows 2.5 hours. Dialysis Adequacy & Water Quality: BFR for 17G needle – 300 mL/min. BFR for 16G needle – 300-350 mL/min (or 301-400 depending on source). BFR for 15G needle – 350-450 mL/min (or 401-500). BFR for 14G needle – 450 mL/min. Adequacy of dialysis – measurement of how well wastes are cleaned from blood. Negatively impact adequacy – inadequate heparin, access recirculation, shortened treatment time, air in dialyzer, improper priming, lower BFR, incorrect dialyzer size, lower dialysate flow rate. Patient education for early termination – full treatment as prescribed to prevent medical complications. Measure how well blood is cleaned – Blood Urea Nitrogen (BUN) levels. Four items impacting clearance – treatment time, blood flow rate, dialysate flow rate, dialyzer size (surface area). Most impact on dialyzer clearance – dialyzer size (surface area). Clearance – amount of urea cleared from blood in mL/min. spKt/V – single pool urea reduction from vascular space. eKt/V – double pool accounting for intracellular and extracellular compartments. FMCNA goal – spKt/V minimum 1.4, eKt/V minimum 1.2. Prime ECC with normal saline – to purge sterilant, particulate matter, and air. Prime at 150 mL/min to thoroughly wet fibers. 300 mL to prime dialyzer and circuit; fresh fill uses 50 mL arterial and 250 mL venous. Connect hanson connectors after fill, auto test, conductivity and pH testing. Prime at 150 mL/min. Dialyzer circulated with venous end up. E-beam dialyzer circulation – turn BFR to 300-400 mL/min, DFR to 500, tap venous end, pinch and release arterial line until air removed. After air removed – drop DFR to 300 mL/min, keep Qb at 300 mL/min. KECN – clearance effective by conductivity. Mean KECN – average of all tests during OLC, documented on flow sheet. KECN 200-300 – normal and expected. KECN less than 150 – indicative of poor clearance. KECN greater than 350 – machine may need recalibration. 3-6 KECN tests can be programmed; 6 tests for 3-4 hour treatment. Steady decline in KECN – dialyzer clearance decreasing. Machine temperature checked when conductivity and temperature are stable, documented before treatment. Anatomy & Physiology: Urinary system anatomical structures – 2 kidneys, 2 ureters, bladder, urethra. Urine flow order – kidneys, ureters, bladder, urethra. Nephron – functional unit of kidney, tubular structure that filters blood to form urine. Nephron composed of – glomerulus and tubules. Glomerulus composed of – tangled cluster of capillaries surrounded by Bowman's capsule. Blood enters kidney through renal artery. Acronym for 7 functions of kidneys – A Wet Bed (Acid-base maintenance, Water balance, Electrolyte balance, Toxin removal, Blood pressure regulation, Erythropoietin production, Vitamin D metabolism). GFR stages – Stage 1: 90, Stage 2: 60-89, Stage 3: 30-59, Stage 4: 15-29, Stage 5: 15. Types of kidney failure – acute and chronic. Acute renal failure causes – drug toxicity, MVA, dehydration. Acute renal failure characteristics – sudden onset, severe, usually reversible. Chronic renal failure causes – diabetes, hypertension, glomerulonephritis. Chronic renal failure characteristics – slow onset, progressive, permanent. Classic signs of renal failure – elevated BUN/creatinine, phosphorus, potassium; anemia; nerve damage; yellow-gray skin; fluid overload; SOA; edema; hypertension; proteinuria. Classic symptoms of renal failure – uremia, lethargy, weakness, headache, itching, fatigue, nausea, restlessness, mental status changes, loss of appetite. Anemia – lack of red blood cells. Causes of anemia in CKD – decreased erythropoietin production, shortened RBC lifespan, decreased iron absorption, blood loss during dialysis. Anemia treatment – Erythropoietin stimulating agents (Epogen, Aranesp, Mircera). S/S of anemia – fatigue, decreased energy levels, SOA, decreased well-being. Hgb range for ESRD patients – 10-11. Role of iron – binds with RBCs, formulates Hgb, allows oxygen transport. Iron medications – Venofer, Ferrlecit; given IV (50 mg IVP every other week) due to absorption issues and constipation with oral. Functions of healthy kidneys replaced by dialysis – removal of waste products, regulation of fluid balance. Modalities of treatment for ESRD – hemodialysis, peritoneal dialysis, transplantation. Hemodialysis vs. Peritoneal Dialysis: HD uses vascular access to draw blood to dialyzer; PD uses peritoneal cavity with permanent catheter. HD done outpatient or home; PD done in patient's home. HD filter – dialyzer (artificial kidney); PD filter – patient's peritoneal membrane. HD duration – 3-4 hours, 3 times/week; PD – daily exchanges or during sleep with cycler. HD fluid removal – ultrafiltration; PD fluid removal – osmotic pressure and dextrose concentration. Fluid & Electrolyte Balance: Body fluid compartments – intracellular (inside cells), extracellular (outside cells), intravascular (inside blood vessels), interstitial (between cells). Diffusion – movement of solutes across semi-permeable membrane from higher to lower concentration. Osmosis – movement of fluid from lower concentration of solutes to higher concentration. Ultrafiltration – uses negative and positive pressure to remove excess fluid. Water treated for dialysis – because contains contaminants, electrolytes, impurities. Chloramine – combination of bleach and ammonia; chlorine is bleach alone. Factors impacting rate of diffusion – concentration gradient, temperature, molecular weight, nature of solution, membrane permeability, surface area, flow geometry convection. Dialyzer fibers clot – diffusion decreases. Diffusion continues until concentration gradient equalizes. Largest factor impacting ultrafiltration – pressure. Dialysate flow off – blood not cleaned, adequacy decreases. Dialyzer compartments – blood and dialysate compartments separated by semi-permeable membrane. Semi-permeable membrane – made of protein with small pores. Countercurrent flow – blood and dialysate flow in opposite directions. Types of solutions – hypotonic (less particles), isotonic (equal particles), hypertonic (more particles). pH scale – less than 7 acidic, greater than 7 alkaline, equal to 7 neutral. Normal blood pH – 7.35-7.45. Bicarbonate (HCO3) – buffer that maintains constant pH. Conductivity – ability of solution to conduct electrical current. Safe conductivity from theoretical – +/- 0.5. Dialysate – non-sterile solution that removes waste and balances electrolytes. Dialysate composed of – purified water, acid solution, bicarbonate solution. Dextrose added to dialysate – prevents hypoglycemia. Electrolytes in dialysate – sodium, potassium, calcium, magnesium, chloride. Ways dialysate checked for safety – pH, conductivity, machine temperature, negative residual bleach strip test. Complications & Emergency Response: Increased arterial pressures – kinks, occlusion, BFR exceeds access flow, needle gauge, needle placement, clotting, stenosis, vasoconstriction, catheter malposition, hypotension, poor cardiac output, increased blood viscosity. Increased venous pressure – kinks, occlusion, infiltration, clotting in needle/CVC/chamber/dialyzer, machine malfunction, wet/bloody transducer protectors. Blood leak alarm – fibers broken, blood and dialysate mixed; inspect dialysate for pink tinge; confirm with blood leak strip; if positive DO NOT return blood. Air detector alarm – air or foam detected, machine clamps venous line, blood pump stops, DO NOT disarm. Venous pressure alarm – something blocking return of blood to access. Arterial pressure alarm – pull pressure from access to dialyzer; low AP alarm indicates blocked pull; high AP alarm causes hemolysis. TMP alarm – transmembrane pressure; as fibers clot, TMP rises. Blood pressure alarm – BP under or above normal limits; blood pump does not stop. Conductivity alarm – dialysate goes into bypass to prevent hemolysis or crenation. Patient safety checks – every 30 minutes. Air Embolism Treatment – COLT: Clamp venous line, Off blood pump, Left side positioning, Trendelenburg. Hyperkalemia – high potassium 5.5 mEq/L, can cause life-threatening cardiac arrhythmias. Hyperkalemia causes – dietary intake, tissue injury, GI bleeding, hemolysis, blood transfusions. Treatment of hyperkalemia – full dialysis time, Kayexalate. Prevention of hyperkalemia – patient education, strict treatment adherence. Sodium intake limited – sodium attracts fluid, makes removal difficult. Potassium limited – severe cardiac problems when elevated. Phosphorus limited – interferes with calcium absorption, leads to bone disease. Fluid intake limited – adds to circulating volume, increases workload on heart and lungs. Protein limited – waste products (BUN, creatinine) build up. Calories limited – excess leads to weight gain. Leading cause of death in ESRD patients – cardiac related to fluid and function. Weight gains exceeding 4 kg – reported to RN. EDW (Estimated Dry Weight) – weight if all excess fluid removed and BP normotensive. Available weight – pretreatment weight minus EDW. Target weight – available weight plus priming and rinse back saline plus other fluids. Medications & Lab Values: Renal reference ranges – Sodium 135-145, Potassium 3.5-5.0, Phosphorus 3.0-5.5, Calcium 8.5-10.0, Albumin ≥4.0, Ferritin 100-800, Tsat 20-50%, CHr 28 pg, IPTH 150-300/600 pg/dL, WBC 5.0-10.0, C-reactive protein 5-10, Hgb A1c 7%, Alkaline Phosphatase 44-147. Digoxin – monitor potassium (hypokalemia increases toxicity, hyperkalemia decreases effectiveness). Causes of hypokalemia in dialysis patients – nausea, vomiting, diarrhea. Hypercalcemia – can lead to coma and death. Vitamin B6 and B12 – essential for anemia management. Folic acid – aids in hemoglobin development. Water soluble vitamins taken – after treatment. Emergency Preparedness: Cardiac arrest – potential causes: electrolyte imbalance, technical problems, massive air embolism, acute hemolysis, massive blood loss, anaphylactic reaction, incorrect dialysate, medications, disinfectant infusion. RN role in cardiac arrest – initiate/provide/oversee CPR, activate EMS, notify physician. PCT role – call for help, initiate CPR, pull machine off floor for biomedical testing. Biomedical staff – perform functional testing on machine. Adverse event report required for – blood loss 100 mL, wrong blood infused, cardiopulmonary arrest, contaminated needle stick, falls, incorrect dialyzer/dialysate. Tornado – go to designated safe area. Earthquake – discontinue treatments, take cover. Bomb threat – notify police and chain of command. Power failure – hand crank blood (maximum 15 minutes), remove venous line from clamp first, 6-10 rotations per minute, watch for air. Fire – R.A.C.E. and P.A.S.S. Water failure – contact water contractor, designate alternate clinic. Flood – monitor situation, move supplies to higher location, protect medical records, turn off utilities. Tsunami – monitor updates; warning – immediately discontinue treatments, move to higher ground. Patient Education & Nutrition: Limit sodium – attracts fluid. Limit potassium – severe cardiac problems when elevated. Limit phosphorus – interferes with calcium absorption, leads to bone disease. Limit fluid – adds to circulating volume. Limit protein – waste products (BUN, creatinine) build up. Limit calories – excess leads to weight gain. Avoid tight clothing or jewelry on access arm, avoid sleeping on access arm, avoid lab draws/BP on access arm, avoid carrying heavy objects with access arm. Golden rice – prevents blindness (beta-carotene). GMOs – patented, pollen can spread to nearby crops. Perfect for Fresenius RN Exam, dialysis nurse certification, hemodialysis nursing, and nephrology nursing competency assessments.