FRESENIUS RN ACTUAL UPDATED QUESTIONS AND
ANSWERS GRADED A+
✔✔Patient assessment during pre-treatment: - ✔✔Ambulation status
Mental status
Changes in condition
Pre-weight
Blood pressure
HR
Respirations
Edema
GI status
Skin color
Access evaluation
Hospitalizations since last treatment
New complaints or life changes
Cramping
✔✔Patient assessment during treatment: - ✔✔Current time of eval/assessment
Blood pressure
BFR/DFR
Safety checks
AP/VP
Fluid removed/administered
Access check - connections and site visible
Hemosafe device attached to CVC
Patient overall status
Interventions and patient response
Change in dialysis prescription
✔✔Patient assessment post treatment: - ✔✔Ambulation status
Mental status
Changes in condition
Post weight
BP
Temp
HR
Respirations
Edema
Any new complaints
Access eval
Presence of a thrill
Condition of dressing
Escort patient to scale and waiting room
,✔✔Steps for treating an infiltrated access: - ✔✔Stop dialysis, turn off blood pump and
clamp blood lines
Notify RN
Disconnect blood lines from fistula lines and recirculate blood per procedure. Flush non
infiltrated needle with normal saline.
If infiltration happened after heparin administration, cap end of needle and secure,
remove at the end of treatment. Apply ice once secured. (if infiltration continues to
enlarge or patient is in extreme pain, pull the needle and apply pressure for 10 minutes
and notify nephrologist. If possible, next cannulation should be above the infiltrate.
Instruct patient to apply ice for 24 hours and watch for complications.
✔✔When should conductivity and pH of dialysate be checked? - ✔✔Prior to the
initiation of every treatment.
✔✔Air Embolism Treatment - COLT - ✔✔Clamp venous line - prevents additional air
from getting to the patient.
Off with the blood pump - Pressure will build in lines with the venous clamp clamped.
Turning off the blood pump stops this.
Left side positioning - Air rises, so positioning the patient on the left helps prevent air
from entering the heart.
Trendelenburg - Placing the patient in this position helps prevent air from entering the
heart, brain and lungs.
*** Additionally administer oxygen and give CPR if indicated ***
✔✔Advantages of a AV Fistula - ✔✔Uses the patients own vessels
Requires one anastomosis
Longer life span
Decreased rate of complications
Collateral circulation develops
✔✔Disadvantages of AV Fistula - ✔✔Length of time to develop - generally 1-4 month
Isometric exercises may aid in development
Lower blood flows are sometimes necessary when the fistula is immature; results in
poor clearance
Collateral circulation develops
✔✔Why would placement of an AV Fistula be difficult? - ✔✔Patients with co morbid
conditions such as diabetes, hypertension, poor circulation, and obesity make
placement more difficult.
Aneurysms can develop as a result from cannulating the same areas too often.
, ✔✔What is always required with a AV Fistula? - ✔✔A tourniquet
✔✔Advantages of an AV Graft - ✔✔Large surface area for cannulation
Technically easy to cannulate
Healing time is short
Variety of shapes and configurations
Easy to implant, construct, and surgically repair
✔✔Disadvantages of AV Grafts - ✔✔Increased rate of stenosis; increased clotting
Increased infection rates
Increased bleed time at the end of treatment
Require replacement over time, especially if cannulation sites are not rotated
No collateral circulation develops
✔✔Advantages of a CVC - ✔✔Immediate use after verification of placement
No need for patient to achieve homeostasis at the end of treatment
✔✔Disadvantages of CVC - ✔✔Higher potential for air embolism
Prone to infection and clotting
Last option and sometimes only option for patients
Lower BFR's = increased treatment time to improve adequacy
Long-term use can lead to major vessel stenosis
Reversing the lines will cause increased recirculation and decreased adequacy
✔✔List 4 things you can teach a patient to prevent their access from clotting: - ✔✔1.
Avoid wearing tight fitting clothing or jewelry on access arm
2. Avoid sleeping on access arm
3. Avoid lab draws or blood pressure sticks in the access arm
4. Avoid carrying heavy objects in their access arm
✔✔What is Emla cream? - ✔✔Lidocaine 2.5% and Prilocaine 2.5%. Used at least an
hour before cannulation to numb the area.
✔✔What is included in the PRE-treatment evaluation? - ✔✔Look - skin one color, any
incisions are clean, dry and intact, no s/sx of infection, prior cannulation sites healing,
side by side comparison with other arm.
Listen - audible "whoosh" heard - should be same throughout access, low-pitched,
louder on arterial side.
Feel - thrill- a vibration or buzz throughout the length of the access, pulse - slight
beating like a heartbeat, no areas warmer or cooler than other areas.
✔✔When admitting a new patient, what is performed before taking a blood pressure
reading? - ✔✔Inspect both arms for the presence of a vascular access.
ANSWERS GRADED A+
✔✔Patient assessment during pre-treatment: - ✔✔Ambulation status
Mental status
Changes in condition
Pre-weight
Blood pressure
HR
Respirations
Edema
GI status
Skin color
Access evaluation
Hospitalizations since last treatment
New complaints or life changes
Cramping
✔✔Patient assessment during treatment: - ✔✔Current time of eval/assessment
Blood pressure
BFR/DFR
Safety checks
AP/VP
Fluid removed/administered
Access check - connections and site visible
Hemosafe device attached to CVC
Patient overall status
Interventions and patient response
Change in dialysis prescription
✔✔Patient assessment post treatment: - ✔✔Ambulation status
Mental status
Changes in condition
Post weight
BP
Temp
HR
Respirations
Edema
Any new complaints
Access eval
Presence of a thrill
Condition of dressing
Escort patient to scale and waiting room
,✔✔Steps for treating an infiltrated access: - ✔✔Stop dialysis, turn off blood pump and
clamp blood lines
Notify RN
Disconnect blood lines from fistula lines and recirculate blood per procedure. Flush non
infiltrated needle with normal saline.
If infiltration happened after heparin administration, cap end of needle and secure,
remove at the end of treatment. Apply ice once secured. (if infiltration continues to
enlarge or patient is in extreme pain, pull the needle and apply pressure for 10 minutes
and notify nephrologist. If possible, next cannulation should be above the infiltrate.
Instruct patient to apply ice for 24 hours and watch for complications.
✔✔When should conductivity and pH of dialysate be checked? - ✔✔Prior to the
initiation of every treatment.
✔✔Air Embolism Treatment - COLT - ✔✔Clamp venous line - prevents additional air
from getting to the patient.
Off with the blood pump - Pressure will build in lines with the venous clamp clamped.
Turning off the blood pump stops this.
Left side positioning - Air rises, so positioning the patient on the left helps prevent air
from entering the heart.
Trendelenburg - Placing the patient in this position helps prevent air from entering the
heart, brain and lungs.
*** Additionally administer oxygen and give CPR if indicated ***
✔✔Advantages of a AV Fistula - ✔✔Uses the patients own vessels
Requires one anastomosis
Longer life span
Decreased rate of complications
Collateral circulation develops
✔✔Disadvantages of AV Fistula - ✔✔Length of time to develop - generally 1-4 month
Isometric exercises may aid in development
Lower blood flows are sometimes necessary when the fistula is immature; results in
poor clearance
Collateral circulation develops
✔✔Why would placement of an AV Fistula be difficult? - ✔✔Patients with co morbid
conditions such as diabetes, hypertension, poor circulation, and obesity make
placement more difficult.
Aneurysms can develop as a result from cannulating the same areas too often.
, ✔✔What is always required with a AV Fistula? - ✔✔A tourniquet
✔✔Advantages of an AV Graft - ✔✔Large surface area for cannulation
Technically easy to cannulate
Healing time is short
Variety of shapes and configurations
Easy to implant, construct, and surgically repair
✔✔Disadvantages of AV Grafts - ✔✔Increased rate of stenosis; increased clotting
Increased infection rates
Increased bleed time at the end of treatment
Require replacement over time, especially if cannulation sites are not rotated
No collateral circulation develops
✔✔Advantages of a CVC - ✔✔Immediate use after verification of placement
No need for patient to achieve homeostasis at the end of treatment
✔✔Disadvantages of CVC - ✔✔Higher potential for air embolism
Prone to infection and clotting
Last option and sometimes only option for patients
Lower BFR's = increased treatment time to improve adequacy
Long-term use can lead to major vessel stenosis
Reversing the lines will cause increased recirculation and decreased adequacy
✔✔List 4 things you can teach a patient to prevent their access from clotting: - ✔✔1.
Avoid wearing tight fitting clothing or jewelry on access arm
2. Avoid sleeping on access arm
3. Avoid lab draws or blood pressure sticks in the access arm
4. Avoid carrying heavy objects in their access arm
✔✔What is Emla cream? - ✔✔Lidocaine 2.5% and Prilocaine 2.5%. Used at least an
hour before cannulation to numb the area.
✔✔What is included in the PRE-treatment evaluation? - ✔✔Look - skin one color, any
incisions are clean, dry and intact, no s/sx of infection, prior cannulation sites healing,
side by side comparison with other arm.
Listen - audible "whoosh" heard - should be same throughout access, low-pitched,
louder on arterial side.
Feel - thrill- a vibration or buzz throughout the length of the access, pulse - slight
beating like a heartbeat, no areas warmer or cooler than other areas.
✔✔When admitting a new patient, what is performed before taking a blood pressure
reading? - ✔✔Inspect both arms for the presence of a vascular access.
