Davita Latest PCT Final Exam Summer 2022- Verified Q & A

What complication would you expect to see if a patient is exposed to chlorine/chloramines? - AnsHemolysis You are performing the first chlorine/chloramine testing of the day after the RO has been running for 10 minutes. Performing thetest at this time - Ans-Could result in a false negative test At what time do you perform water hardness testing? - Ans-At the end of each treatment day What is your immediate response to a final water quality alarm on the treatment floor? - Ans-Place all machines into bypass Benifits of peritoneal dialysis and home hemodialysis? - Ans-Home based Flexible schedule Fewer diatary restrictions The two types of peritoneal dialysis are - Ans-CAPD and CCPD Procedure when useing hemostatic sponges such as SureSeal? - Ans-Remove the hemostatic sponge after hemostasis has been acheived and dress needle site w bandaid or gauze - Ans-Two weeks Why should a pt be in a comfortable supine position when performing Pre dialysis CVC care? - Ans-The supine position increases pressure with in central veins and diminishes the risk of an air embolism Flipping the arterial vascular access needle - Ans-Is not necessary since all arterial needles now have a back eye A new AVF has received his post op exam and meets KDOQIs rule of 6s which NFACT cannulator would the AVF - Ans-Advanced cannulater AV graft and hear whistling sound could be indicative of - Ans-An outflow stenosis KDOQI rule of 6s - Ans-Provides guidelines for use of new AV fistula To prevent the formation of aneurysms in pseudo aneurysm the following should be practice - Ans-Good needle site rotation in complete needle site clotting techniques During cannulation of all AV fistula's - Ans-A tourniquet is to be applied to increase vein engorgement and stabilize vessel What is an important action prior to returning a patient's blood using the hand crank in the event of a power failure - Ans-Remove the venous line from the line clamp What problems will cause a more negative (high-pressure alarm) pre-pump arterial pressure - Ans- Kinking of the arterial blood line between the vascular access in the arterial monitor What problems will cause an increase in venous pressure - Ans-Clotting of the Venus drip chamber Which statement is true regarding the "reason of prudent" standard of care - Ans-When supervising patient care technicians and other non-licensed personnel it is the responsibility of the license nurse to ensure these teammates also meet the standard of care Performing a procedure "your way" rather than following to daVitas policy and procedures - Ans-Can lead to civil liability in the event of an adverse patient outcome A surveyor ask you a question which of the following statements would be a good answer? - Ans-I do not know the answer but I will find out A surveyor discovers that the chlorine checks have not been done correctly what kind of deficiency would the surveyor give the facility? - Ans-Immediate jeopardy When comparing the dialysis machines conductivity reading to your manual reading policy states that the difference between these two readings is to be - Ans-No greater than +/- 0.4 Why do we measure the pH of the dialysis solution? - Ans-To verify it's acid base balance is within the acceptable range What complication occurs if blood is exposed to dialysate that is too hot? - Ans-Hemolysis The waiting time after administration of the initial heparin loading dose prior to initiation of hemodialysis is - Ans-3-5 mins In optimal nutrition status is evidenced by - Ans-A stable desirable target weight ,adequate fat stores and muscle mass ,appropriate appetite and intake, and a serum albumin of equal to or greater than 4gm/dl Phosphate binders are prescribed to prevent phosphorus and meals from being absorbed. when is the best time to take them? - Ans-With a meal Your patient pulls out her snack during dialysis as she savers the first bite of her banana she smiles and tells you she always wants to eat foods high in potassium during dialysis so it won't harm her what is your appropriate response? - Ans-Explain to the patient that the potassium and food eaten during dialysis is not dialyzed off Definition of health literacy - Ans-The degree to which individuals understand basic health information Educational tips for auditory learners - Ans-Using word associations and mnemonic Educational tips for kinesthetic learner's include - Ans-Taking short breaks and allowing your patient to get up and walk around Educational tips for visual learners include - Ans-Selecting quiet surroundings The sign that Numbing has taken effect and it is time to stop spraying topical anesthetic onto a vascular access cannulation sites is - Ans-Blanching on the skin Unless otherwise directed by the manufacture or state specific pharmacy regulations when must medications containing a preservative be discarded - Ans-28days after opening Diffusion is defined as - Ans-Particles move from an area of higher solute concentration to an area of lower solute concentration Osmosis is defined as - Ans-Fluid moves from an area of lower solute concentration to an area of higher solute concentration Hemodialysis helps normalize body pH through - Ans-Diffusion of bio carbonate from the dialysate into the blood The endocrine function of the kidney are - Ans-Renin and erythropoietin secretion ,activation of vitamin D The excretory function of the kidney is - Ans-To normalize electrolytes Which of the following is a basic principle of patient self management - Ans-Dealing with the consequences of illness rather than just the physical disease Which statement is true regarding the stages of grief - Ans-Sometimes people can get stuck in one stage If you notice that a patient caretaker is struggling to meet the Demands of the patient's treatment regime you should - Ans-Notify the social worker because he or she is there for patients and their families The psychosocial assessment completed by the social worker - Ans-Is completed initially and annually Ultra filtration is defined as - Ans-Controlled fluid removal by manipulation of hydrostatic pressure Convection is defined as - Ans-Solutes are dragged across the semi permeable membrane along with fluid The acronym DARN stand for - Ans-Desire, ability, reason, need The three core communication skills used in motivation interviewing are - Ans-Asking, listening, informing Summarizing during reflective listening - Ans-Includes the main aspects of what the patient said during the entire communication The best way to help patient successfully change behaviors is to - Ans-Inspire behavior change to support, compassion, and empathy Left ventricular hypertrophy (LVH) is caused by - Ans-Hypertension Hemodialysis replaces what % of normal kidney function - Ans-15% What does CKD-MBD lead to? - Ans-Abnormalities in Ca, PO4,PTH and vit D Metabolism with soft tissue calcification and bone disease Your patient complains of dry itchy skin you would advise her to - Ans-Use hyper fatted soaps and lotions Peripheral neuropathy is a complication and chronic renal failure which affects sensory and motor nerve fibers. If you're patient complains of a burning sensation in the feet, you should advise him - Ans-Not to walk barefoot, be careful with foot care, and check the bathwater temperature with a thermometer Some lab tubes contain additives to assess blood to clot or prevent it from clotting. To prevent specimens from being contaminated with another tubes additives you should - Ans-Follow the order of the draw The centrifuge to spine blood samples must be balanced to avoid shaking and the centrifuge losing its balance. To balance the centrifuge - Ans-Only tubes of the same kind, size, and fill level should be placed opposite each other If a patient presents with dialysis associated Pericarditis, treatment includes more frequent dialysis and - Ans-Heparin restriction to prevent bleeding into the pericardium and tamponade A patient with hyperkalemia will present with - Ans-Extreme muscle weakness and an abnormal heart rhythm Gloves are in essential part of hand hygiene. What is their function? - Ans-Gloves reduce the risk of hand contamination and prevent the transfer of organisms already on the hands Which statement is true about sinks use for handwashing? - Ans-Handwashing sinks must be dedicated for handwashing purposes only and should remain clean Attention to infection control, proper hand hygiene, cleaning and disinfection procedures are of upmost importance in the dialysis setting. Which of the following statements is true? - Ans-Viable MRSA bacteria can remain on surfaces for days with plastic and vinyl being most favorable to their survival. If your facility dialyze is hepatitis B positive patients, which assignment would not be an appropriate patient care assignment? - Ans-Caring for HBsAG positive and hepatitis B susceptible patients at the same time Per the CDC, which is the most common factor contributing to bacteremias in dialysis patients? - Ans- The use of catheters for hemodialysis Per the CDC, which is the most important route by which pathogens are transmitted in healthcare settings including dialysis centers? - Ans-Contact transmission Practicing meticulous infection control to prevent healthcare associated infections (HAIs) in dialysis patients is of upmost importance because? - Ans-Kidney failure weekends a person some uses them making these pieces much more vulnerable to infections Infections are the second most common cause of death in this population The hemodialysis procedure requires prolong access to the patient's blood The tags for CMS survey state specific regulations to be met within a condition such as infection control, provide interpretive guidance for each regulation, and site deficiencies by tag number. How can knowledge of these V tags affect the practice of patient care providers - Ans-Provide patient care with in CMS condition for coverage Understand rationales for specific regulations as outlined in the interpretive guidance Assist in the development of policies and procedures Teammates decrease the risk of infection when working with a central venous catheter (CVC) by - AnsWearing a face mask Washing hands and wearing clean gloves Avoiding touching dirty services when providing CVC care Why is meticulous hand hygiene so important in healthcare? - Ans-It is the single most important intervention in preventing HAIs When sodium loading is present during dialysis treatment - Ans-It leads to an increase in theaters in larger fluid weekends between treatments and can contribute to post dialysis hypertension and headaches Target weight is - Ans-Prescribed and determined by physician order Modified by physician based on patient tolerance Attempting to remove a large amount of fluid weight gain from the patient - Ans-Can lead to hypovolemia during the treatment which is associated with an increased mortality rate With the patients calculated UF goal exceeds the maximum UFR ordered by the nephrologist - AnsCalculated UF goal must be adjusted to not exceed the ordered maximum UFR in the reason documented The PCT notes that a patient still has considerable Adema in her legs when performing the post treatment data collection. In addition to informing the nurse,what should the PCT document? - AnsDocument the noted swelling and that the nurse was informed Poor or incomplete documentation - Ans-Can open an attack on your care What are three things you should not include in an REM? - Ans-Personal opinion, speculation, vendettas The clinical pyramid includes - Ans-The fundamentals, complex programs, and quality of life DQI success is achieved by - Ans-Managing individual patients first and allowing scores to follow Knowing each team members role in improving the DQI scores Using the CQI process to help identify trends and make improvements For patients with AKI - Ans-A pre-treatment nursing assessment is always required How do you verify that the patient is stable and safe for discharge after the dialysis treatment? - AnsEvaluate the effectiveness of the treatment by comparing data to pre-dialysis findings PCT's notify the nurse if there are any unusual findings Nurses perform a post treatment assessment as required Documentation in the medical record - Ans-Is a permanent legal record of the care provided