FRESENIUS RN EXAMS TEST PAPER ACTUAL QUESTIONS
AND ANSWERS GRADED A+
✔✔What does a steady decline in KECN test results signify? - ✔✔Indicates that dialyzer
clearance of waste from blood is decreasing.
✔✔When is the machine temperature checked? - ✔✔Read the machine temperature
when the conductivity and temperature are stable. Document before treatment.
✔✔What items are considered when administering medications to renal failure patients?
- ✔✔Kidneys are major route of excretion for drugs and metabolites. Loss of renal
function will decrease the elimination of these medications and potentially cause
toxicity, increased potency/duration of drug's effects, increased frequency of side
effects.
✔✔Can medications be pre-drawn? - ✔✔Medications may be pre drawn up to 4 hours
prior to administration. They must be labeled and stored appropriately until time to
administer.
✔✔What if the patient doesn't come for treatment and the medications were pre-drawn?
- ✔✔The syringe can be relabeled and administered to another patient as long as the
dosage matches the next patient and the medication never left the prep area.
✔✔What lab is evaluated to determine adequacy of treatment? - ✔✔BUN
✔✔What is the procedure for drawing post treatment lab work (post BUN)? - ✔✔1. Turn
the UF off. Turn the dialysate flow off. Decrease BFR to 100 for 15 seconds.
2. Stop blood pump. Clamp arterial and venous needle lines.
3. Clean arterial bloodline port with alcohol. Use needle attached to the vacutainer and
obtain sample with the collection tube.
4. Obtain specimen. Dispose of needle.
5. Invert blood sample gently, 5-10 times.
6. Turn dialysate flow on.
7. Open clamps on needle lines.
8. Return blood per termination procedure.
✔✔What complications require RN involvement and assessment? - ✔✔All findings
outside of normal or expected patient evaluation findings.
✔✔What is bradycardia and to whom is it reported? - ✔✔Bradycardia is a pulse of less
than 60 bpm. Considered severe bradycardia below 50 bpm. All episodes of
bradycardia should be reported to the RN.
,✔✔Why do patients become hypoglycemic and what are the signs and symptoms? -
✔✔Some glucose (blood sugar) is removed during treatment and some patients may
experience s/s of hypoglycemia (low blood sugar). Patient may experience faintness,
double vision, irritability, hunger, can proceed to coma and death if not treated. Notify
the RN.
✔✔What can lead to hemolysis? - ✔✔Incorrect conductivity (hypotonic solution)
Chlorine or chloramine breakthrough
High machine temperatures
Kinks in the bloodlines
✔✔What steps are taken when hemolysis is suspected? - ✔✔1. RN notified immediately
turns off blood pump and clamps VENOUS line. DO NOT return blood.
2. Turn UF off
3. Administer oxygen per physician order
4. Recirculated the patients blood - maintain sterility of line ends in the event blood is
not hemolyzed and can be safely returned to the patient. Flush needles lines or catheter
lumens with 10 ml of NS. Leave syringes in place and clamp needle lines or catheter
lumens.
5. Notify physician and provide vital signs, s/s, estimated time potential before
hemolysis was detected, estimated potential amount of hemolyzed blood, hgb & hct
results. The physician may order: fluid replacement, transport of the patient to the
hospital for further evaluation and possible transfusion, treatment resumed on different
set up and machine, blood returned if not hemolyzed, blood samples.
6. Remain with the patient. Monitor VS and cardiac rhythm (regular vs irregular),
monitor for dysrhythmias, hypotension, and shortness of breath. Monitor for potential
deterioration in patient condition.
7. Immediately report to the physician any change in patients condition. Call EMS if the
patient becomes unstable (hypotension not responding to saline, HR irregular or greater
than 120, less than 60 and not normal for patient, respiratory distress.)
8. Obtain physician order and draw the following blood samples to evaluate degree of
hemolysis: hct/hgb; electrolytes, free hgb, amylase, lipase, LDH.
✔✔What is crenation and what causes it to occur? - ✔✔Crenation is the shriveling of
RBC's caused by too high of a concentration of sodium in the dialysate (hypertonic
dialysate).
✔✔Signs and symptoms of crenation - ✔✔Sudden fall in blood pressure
Facial flushing
Dark, opaque blood
Shortness of breath
Thirst
Chest pain
, ✔✔What is an air embolism? - ✔✔When one or more air bubbles enter a vein or artery
and block it. The air bubbles can also travel to the brain, heart, or lungs and cause a
stroke, cardiac arrest or respiratory failure.
✔✔Causes of an air embolism - ✔✔Improperly primed blood lines
Empty IV/NS bag
Unclamped IV line
Air leak in blood lines
Air detector not armed
Loose blood line connections
Separation of blood lines
Patient inhales while cvc is open to air
Pre-safety checks not done properly
✔✔Signs and symptoms of air emboli - ✔✔Coughing
Chest pain
SOA
✔✔What is infiltration and how is it treated? - ✔✔An inflitration is fluid seepage into the
surrounding tissue resulting in pain and swelling. Infiltrations are treated with
intermittenr ice for over 24 hours followed by intermittent ice and heat as needed. A new
venous needle should be placed above the infiltration site. For an arterial infiltration the
needle may be placed either above or below the infiltrated site.
✔✔What is hyperkalemia? - ✔✔High potassium exceeding 5.5 mEq/L and can cause
life threatening cardiac arrhythmias, leading to cardiac arrest.
✔✔Hyperkalemia can be the result of: - ✔✔Dietary intake
Tissue injury
Gi bleeding
Hemolysis
The result of blood transfusions
✔✔Treatment of hyperkalemia includes: - ✔✔Dialyzing the full prescribed dialysis time
Depending on the situation kayexalate may be prescribed by the physician and taken
orally.
✔✔Prevention of hyperkalemia is accomplished through: - ✔✔Patient and family
member education regarding diet specifically.
Strict treatment adherence
✔✔Why should sodium intake be limited in the patient on dialysis? - ✔✔Sodium attracts
fluid and makes it more difficult to remove during dialysis treatment.
AND ANSWERS GRADED A+
✔✔What does a steady decline in KECN test results signify? - ✔✔Indicates that dialyzer
clearance of waste from blood is decreasing.
✔✔When is the machine temperature checked? - ✔✔Read the machine temperature
when the conductivity and temperature are stable. Document before treatment.
✔✔What items are considered when administering medications to renal failure patients?
- ✔✔Kidneys are major route of excretion for drugs and metabolites. Loss of renal
function will decrease the elimination of these medications and potentially cause
toxicity, increased potency/duration of drug's effects, increased frequency of side
effects.
✔✔Can medications be pre-drawn? - ✔✔Medications may be pre drawn up to 4 hours
prior to administration. They must be labeled and stored appropriately until time to
administer.
✔✔What if the patient doesn't come for treatment and the medications were pre-drawn?
- ✔✔The syringe can be relabeled and administered to another patient as long as the
dosage matches the next patient and the medication never left the prep area.
✔✔What lab is evaluated to determine adequacy of treatment? - ✔✔BUN
✔✔What is the procedure for drawing post treatment lab work (post BUN)? - ✔✔1. Turn
the UF off. Turn the dialysate flow off. Decrease BFR to 100 for 15 seconds.
2. Stop blood pump. Clamp arterial and venous needle lines.
3. Clean arterial bloodline port with alcohol. Use needle attached to the vacutainer and
obtain sample with the collection tube.
4. Obtain specimen. Dispose of needle.
5. Invert blood sample gently, 5-10 times.
6. Turn dialysate flow on.
7. Open clamps on needle lines.
8. Return blood per termination procedure.
✔✔What complications require RN involvement and assessment? - ✔✔All findings
outside of normal or expected patient evaluation findings.
✔✔What is bradycardia and to whom is it reported? - ✔✔Bradycardia is a pulse of less
than 60 bpm. Considered severe bradycardia below 50 bpm. All episodes of
bradycardia should be reported to the RN.
,✔✔Why do patients become hypoglycemic and what are the signs and symptoms? -
✔✔Some glucose (blood sugar) is removed during treatment and some patients may
experience s/s of hypoglycemia (low blood sugar). Patient may experience faintness,
double vision, irritability, hunger, can proceed to coma and death if not treated. Notify
the RN.
✔✔What can lead to hemolysis? - ✔✔Incorrect conductivity (hypotonic solution)
Chlorine or chloramine breakthrough
High machine temperatures
Kinks in the bloodlines
✔✔What steps are taken when hemolysis is suspected? - ✔✔1. RN notified immediately
turns off blood pump and clamps VENOUS line. DO NOT return blood.
2. Turn UF off
3. Administer oxygen per physician order
4. Recirculated the patients blood - maintain sterility of line ends in the event blood is
not hemolyzed and can be safely returned to the patient. Flush needles lines or catheter
lumens with 10 ml of NS. Leave syringes in place and clamp needle lines or catheter
lumens.
5. Notify physician and provide vital signs, s/s, estimated time potential before
hemolysis was detected, estimated potential amount of hemolyzed blood, hgb & hct
results. The physician may order: fluid replacement, transport of the patient to the
hospital for further evaluation and possible transfusion, treatment resumed on different
set up and machine, blood returned if not hemolyzed, blood samples.
6. Remain with the patient. Monitor VS and cardiac rhythm (regular vs irregular),
monitor for dysrhythmias, hypotension, and shortness of breath. Monitor for potential
deterioration in patient condition.
7. Immediately report to the physician any change in patients condition. Call EMS if the
patient becomes unstable (hypotension not responding to saline, HR irregular or greater
than 120, less than 60 and not normal for patient, respiratory distress.)
8. Obtain physician order and draw the following blood samples to evaluate degree of
hemolysis: hct/hgb; electrolytes, free hgb, amylase, lipase, LDH.
✔✔What is crenation and what causes it to occur? - ✔✔Crenation is the shriveling of
RBC's caused by too high of a concentration of sodium in the dialysate (hypertonic
dialysate).
✔✔Signs and symptoms of crenation - ✔✔Sudden fall in blood pressure
Facial flushing
Dark, opaque blood
Shortness of breath
Thirst
Chest pain
, ✔✔What is an air embolism? - ✔✔When one or more air bubbles enter a vein or artery
and block it. The air bubbles can also travel to the brain, heart, or lungs and cause a
stroke, cardiac arrest or respiratory failure.
✔✔Causes of an air embolism - ✔✔Improperly primed blood lines
Empty IV/NS bag
Unclamped IV line
Air leak in blood lines
Air detector not armed
Loose blood line connections
Separation of blood lines
Patient inhales while cvc is open to air
Pre-safety checks not done properly
✔✔Signs and symptoms of air emboli - ✔✔Coughing
Chest pain
SOA
✔✔What is infiltration and how is it treated? - ✔✔An inflitration is fluid seepage into the
surrounding tissue resulting in pain and swelling. Infiltrations are treated with
intermittenr ice for over 24 hours followed by intermittent ice and heat as needed. A new
venous needle should be placed above the infiltration site. For an arterial infiltration the
needle may be placed either above or below the infiltrated site.
✔✔What is hyperkalemia? - ✔✔High potassium exceeding 5.5 mEq/L and can cause
life threatening cardiac arrhythmias, leading to cardiac arrest.
✔✔Hyperkalemia can be the result of: - ✔✔Dietary intake
Tissue injury
Gi bleeding
Hemolysis
The result of blood transfusions
✔✔Treatment of hyperkalemia includes: - ✔✔Dialyzing the full prescribed dialysis time
Depending on the situation kayexalate may be prescribed by the physician and taken
orally.
✔✔Prevention of hyperkalemia is accomplished through: - ✔✔Patient and family
member education regarding diet specifically.
Strict treatment adherence
✔✔Why should sodium intake be limited in the patient on dialysis? - ✔✔Sodium attracts
fluid and makes it more difficult to remove during dialysis treatment.
