FRESENIUS RN EVALUATION EXAM QUESTIONS AND
ANSWERS GRADED A+
✔✔Classic signs of renal failure? - ✔✔Elevated serum BUN/creatinine, phosphorus,
potassium
Anemia
Nerve damage
Yellow-gray appearance of the 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
✔✔What is anemia? - ✔✔Lack of Red Blood Cells RBC's
✔✔What causes anemia? - ✔✔Decreased of lacking erythropoietin production
Shortened RBC lifespan
Decreased iron absorption
Blood loss during dialysis
✔✔How is anemia treated? - ✔✔Erythropoietin stimulating agents (ESA's) are
administered. ESAs stimulate RBC production in the bone marrow. Examples of ESA's
include Epogen, Aranesp, and Mircera.
✔✔Signs and symptoms of anemia? - ✔✔Fatigue
Decreased energy levels
SOA
Decreased sense of well-being
Hgb range for ESRD patients is 10-11
✔✔Role of iron and iron medications with Anemia? - ✔✔Iron bind with RBC's
Formulates Hgb
Allows RBC to transport oxygen
,Examples include Venofer, Ferrlicit
RN administration is usually 50 mg IVP every other week.
Given IV due to absorption and constipation properties seen with oral preparations.
✔✔Which functions of healthy kidneys are replaced by dialysis? - ✔✔Removal of waste
products
Regulation of fluid balance
✔✔What are 3 modalities of treatment for ESRD? - ✔✔Hemodialysis
Peritoneal dialysis
Transplantation
✔✔Describe hemodialysis - ✔✔Uses a vascular access to draw blood from the patient
and send to the dialyzer and into the semi permeable membrane where diffusion
removes the waste products and ultrafiltration removes the fluid.
✔✔Describe Peritoneal dialysis - ✔✔There are 2 types: Continuous cycle peritoneal
dialysis (CCPD) and continuous ambulatory peritoneal dialysis (CAPD)
Both types use a permanently placed catheter in the patients highly vascularized
peritoneal cavity. The peritoneum is the membrane surrounding the organs in the
abdomen During CAPD, dialysate is infused into the peritoneal space, allowed to "dwell"
for a period of time as ordered by the physician and then drained.
Through osmosis and diffusion, excess fluid and waste products are removed.
✔✔Describe Transplantation - ✔✔A working kidney is surgically implanted
Kidney is from a living or cadaveric donor
Patient must take anti-rejection medications for the life of the kidney
✔✔Where HD vs PD is done? - ✔✔HD is done usually outpatient or home HD is done in
home.
PD is done in the patient's home.
✔✔What filters waste in HD vs PD? - ✔✔A dialyzer (artificial kidney) filters the waste
from blood in HD.
The patient's peritoneal membrane acts as the semi-permeable membrane and filters
waste in PD.
✔✔How long does HD vs PD take? - ✔✔HD usually lasts 3-4 hours, 3 times a week.
PD is performed daily with several exchanges during the day, or done during sleeping
hours with a cycler.
✔✔How is fluid removed in HD vs PD? - ✔✔Fluid removal is done through ultrafiltration
in HD.
Fluid removal occurs via osmotic pressure and concentration gradients caused by
dextrose solution and dwell times in PD.
,✔✔What are the body fluid compartments? - ✔✔Intracellular - inside the cells.
Extracellular - outside the cells.
Intravascular - inside the blood vessels.
Interstitial - between the cells.
✔✔What is diffusion? - ✔✔Movement of solutes across a semi-permeable membrane
from higher to lower concentration.
✔✔What is osmosis? - ✔✔Movement of fluid from a lower concentration of solutes to a
higher concentration.
✔✔What is ultrafiltration? - ✔✔Uses both negative and positive pressure to remove
excess fluid from the patient.
✔✔Why is water used for dialysis treated? - ✔✔Water contains contaminants,
electrolytes, and impurities. Because dialysis patients are exposed to large amounts of
water each treatment, these impurities must be removed to protect the patient form
harm.
✔✔What is chloramine and how is it different from chlorine? - ✔✔Some water treatment
facilities use a combination of chlorine and chloramine to treat water. Chloramine is a
combination of bleach and ammonia, whereas chlorine is bleach alone.
✔✔What is the diasafe filter? - ✔✔It is found on the back of the hemodialysis machine
and allows for the delivery of ultrapure dialysate.
✔✔What factors impact the rate of diffusion? - ✔✔Concentration gradient
Temperature
Molecular weight of solutes
Nature of the solution
Membrane permeability
Surface area
Flow geometry convection
✔✔What happens to diffusion when dialyzer fibers clot? - ✔✔Diffusion is decreased.
Clotted fibers cause the permeability of the fiber to be reduced or eliminated, causing a
decrease in treatment adequacy. As a result, diffusion does not occur as particles
cannot diffuse across the membrane.
✔✔At what point during the hemodialysis treatment will diffusion cease to occur? -
✔✔Diffusion will continue throughout the dialysis treatment until the concentration
gradient of each electrolyte found in the patient's blood is equal to the electrolyte
concentration in the dialysate.
, ✔✔What is the largest factor that impacts ultrafiltration? - ✔✔Pressure.
✔✔What happens when the dialysate flow is turned off during the treatment? - ✔✔The
patient's blood is not cleaned and adequacy will decrease.
✔✔What are the compartments of the dialyzer and what separates them? - ✔✔There
are two compartments, the blood and dialysate compartment. The two are separated by
a semipermeable membrane.
✔✔What is a semi-permeable membrane? - ✔✔A membrane made from protein, with
small pores or holes. Only certain molecules can fit through.
✔✔What is countercurrent flow? - ✔✔Blood and dialysate flow in opposite directions-
called countercurrent flow, which means as blood flows down into the dialyzer (arterial
to venous), dialysate flows up (venous to arterial)
✔✔What are 3 types of solutions? - ✔✔Hypotonic - containing less particles
Isotonic - containing equal particles
Hypertonic - containing more particles
✔✔pH scale - ✔✔Less than 7 = acidic
Greater than 7 = alkaline
Equal to 7 = acid and base ions are equal
✔✔Normal blood pH - ✔✔7.35-7.45
✔✔What is bicarbonate? - ✔✔(HCO3) is a buffer that helps to maintain a constant pH in
a solution even if an acid or base is added.
✔✔What is conductivity? - ✔✔The ability of a solution to transmit or conduct an
electrical current. In dialysis, it is used to calculate the electrolyte concentration in the
final dialysate.
✔✔What is the safe conductivity from the theoretical conductivity reading from the
machine? - ✔✔+ or - 0.5
✔✔What is dialysate? - ✔✔A non-sterile solution and its function is to remove waste
products from the blood and balance electrolytes.
✔✔What is dialysate composed of? - ✔✔Purified water
Acid solution
Bicarbonate solution
ANSWERS GRADED A+
✔✔Classic signs of renal failure? - ✔✔Elevated serum BUN/creatinine, phosphorus,
potassium
Anemia
Nerve damage
Yellow-gray appearance of the 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
✔✔What is anemia? - ✔✔Lack of Red Blood Cells RBC's
✔✔What causes anemia? - ✔✔Decreased of lacking erythropoietin production
Shortened RBC lifespan
Decreased iron absorption
Blood loss during dialysis
✔✔How is anemia treated? - ✔✔Erythropoietin stimulating agents (ESA's) are
administered. ESAs stimulate RBC production in the bone marrow. Examples of ESA's
include Epogen, Aranesp, and Mircera.
✔✔Signs and symptoms of anemia? - ✔✔Fatigue
Decreased energy levels
SOA
Decreased sense of well-being
Hgb range for ESRD patients is 10-11
✔✔Role of iron and iron medications with Anemia? - ✔✔Iron bind with RBC's
Formulates Hgb
Allows RBC to transport oxygen
,Examples include Venofer, Ferrlicit
RN administration is usually 50 mg IVP every other week.
Given IV due to absorption and constipation properties seen with oral preparations.
✔✔Which functions of healthy kidneys are replaced by dialysis? - ✔✔Removal of waste
products
Regulation of fluid balance
✔✔What are 3 modalities of treatment for ESRD? - ✔✔Hemodialysis
Peritoneal dialysis
Transplantation
✔✔Describe hemodialysis - ✔✔Uses a vascular access to draw blood from the patient
and send to the dialyzer and into the semi permeable membrane where diffusion
removes the waste products and ultrafiltration removes the fluid.
✔✔Describe Peritoneal dialysis - ✔✔There are 2 types: Continuous cycle peritoneal
dialysis (CCPD) and continuous ambulatory peritoneal dialysis (CAPD)
Both types use a permanently placed catheter in the patients highly vascularized
peritoneal cavity. The peritoneum is the membrane surrounding the organs in the
abdomen During CAPD, dialysate is infused into the peritoneal space, allowed to "dwell"
for a period of time as ordered by the physician and then drained.
Through osmosis and diffusion, excess fluid and waste products are removed.
✔✔Describe Transplantation - ✔✔A working kidney is surgically implanted
Kidney is from a living or cadaveric donor
Patient must take anti-rejection medications for the life of the kidney
✔✔Where HD vs PD is done? - ✔✔HD is done usually outpatient or home HD is done in
home.
PD is done in the patient's home.
✔✔What filters waste in HD vs PD? - ✔✔A dialyzer (artificial kidney) filters the waste
from blood in HD.
The patient's peritoneal membrane acts as the semi-permeable membrane and filters
waste in PD.
✔✔How long does HD vs PD take? - ✔✔HD usually lasts 3-4 hours, 3 times a week.
PD is performed daily with several exchanges during the day, or done during sleeping
hours with a cycler.
✔✔How is fluid removed in HD vs PD? - ✔✔Fluid removal is done through ultrafiltration
in HD.
Fluid removal occurs via osmotic pressure and concentration gradients caused by
dextrose solution and dwell times in PD.
,✔✔What are the body fluid compartments? - ✔✔Intracellular - inside the cells.
Extracellular - outside the cells.
Intravascular - inside the blood vessels.
Interstitial - between the cells.
✔✔What is diffusion? - ✔✔Movement of solutes across a semi-permeable membrane
from higher to lower concentration.
✔✔What is osmosis? - ✔✔Movement of fluid from a lower concentration of solutes to a
higher concentration.
✔✔What is ultrafiltration? - ✔✔Uses both negative and positive pressure to remove
excess fluid from the patient.
✔✔Why is water used for dialysis treated? - ✔✔Water contains contaminants,
electrolytes, and impurities. Because dialysis patients are exposed to large amounts of
water each treatment, these impurities must be removed to protect the patient form
harm.
✔✔What is chloramine and how is it different from chlorine? - ✔✔Some water treatment
facilities use a combination of chlorine and chloramine to treat water. Chloramine is a
combination of bleach and ammonia, whereas chlorine is bleach alone.
✔✔What is the diasafe filter? - ✔✔It is found on the back of the hemodialysis machine
and allows for the delivery of ultrapure dialysate.
✔✔What factors impact the rate of diffusion? - ✔✔Concentration gradient
Temperature
Molecular weight of solutes
Nature of the solution
Membrane permeability
Surface area
Flow geometry convection
✔✔What happens to diffusion when dialyzer fibers clot? - ✔✔Diffusion is decreased.
Clotted fibers cause the permeability of the fiber to be reduced or eliminated, causing a
decrease in treatment adequacy. As a result, diffusion does not occur as particles
cannot diffuse across the membrane.
✔✔At what point during the hemodialysis treatment will diffusion cease to occur? -
✔✔Diffusion will continue throughout the dialysis treatment until the concentration
gradient of each electrolyte found in the patient's blood is equal to the electrolyte
concentration in the dialysate.
, ✔✔What is the largest factor that impacts ultrafiltration? - ✔✔Pressure.
✔✔What happens when the dialysate flow is turned off during the treatment? - ✔✔The
patient's blood is not cleaned and adequacy will decrease.
✔✔What are the compartments of the dialyzer and what separates them? - ✔✔There
are two compartments, the blood and dialysate compartment. The two are separated by
a semipermeable membrane.
✔✔What is a semi-permeable membrane? - ✔✔A membrane made from protein, with
small pores or holes. Only certain molecules can fit through.
✔✔What is countercurrent flow? - ✔✔Blood and dialysate flow in opposite directions-
called countercurrent flow, which means as blood flows down into the dialyzer (arterial
to venous), dialysate flows up (venous to arterial)
✔✔What are 3 types of solutions? - ✔✔Hypotonic - containing less particles
Isotonic - containing equal particles
Hypertonic - containing more particles
✔✔pH scale - ✔✔Less than 7 = acidic
Greater than 7 = alkaline
Equal to 7 = acid and base ions are equal
✔✔Normal blood pH - ✔✔7.35-7.45
✔✔What is bicarbonate? - ✔✔(HCO3) is a buffer that helps to maintain a constant pH in
a solution even if an acid or base is added.
✔✔What is conductivity? - ✔✔The ability of a solution to transmit or conduct an
electrical current. In dialysis, it is used to calculate the electrolyte concentration in the
final dialysate.
✔✔What is the safe conductivity from the theoretical conductivity reading from the
machine? - ✔✔+ or - 0.5
✔✔What is dialysate? - ✔✔A non-sterile solution and its function is to remove waste
products from the blood and balance electrolytes.
✔✔What is dialysate composed of? - ✔✔Purified water
Acid solution
Bicarbonate solution
