Final Exam DaVita (RN)

Final Exam DaVita (RN) When dialyzing a patient with acute kidney injury, one task of the patient care teammates is to monitor blood pressure and weight closely. Why is it important? Ans- hypovolemia and hypotensive episodes can cause renal ischemia and can further damage the kidneys CKD can have its orgin pre-renal , intra-renalm or post renal. Which of the following conditions is an intra-renal cause of CKD Ans- HTN Knowing what caused your patient's CKD Ans- is important because the underlying disease could cause health complications that can impact the dialysis treatment When a PCT documents the extent of a patient's edema, for example as +3 Ans- the PCT is preforming an assessment which is not allowed legally When a patient has an irregular heartbeat, Ans- the automatic BP reading may not be accurate Which of the following is a data collection Ans- HR 72 at what time should the post treatment data collection be completed Ans- after the treatment has been completed the A in smart communication stands for Ans- actual- just report the facts which of the following events is defined as a near miss Ans- the wrong dialyzer was set up and primed for a patient, but it was caught before dialysis was initiated and the dialyzer was replaced using the __________ approach is one way to fill out an REM Ans- SBAR What is your main priority when returning a patient's blood with the hand crank during a power outage? Ans- you must be vigilant in watching for air in the blood lines what problem will cause an increase in the patient's VP Ans- a clot in the venous drip chamber Which blood test must be performed at regular intervals on patients susceptible to HPB Ans- HBsAg who is accountable for appropriate patient and teammate scheduling in the acute setting Ansyou are dialyzing a patient and the only available HPB surveillance test is a HBsAb of 8. What are the machine disinfection requirements after dialyzing this patient? Ans- the machine must be heat disinfected at the end of each day What is the most common factor contributing to bacteremia in dialysis patients? Ans- use of catheters for HD which infectious disease requires frequent hand washing instead of using alcohol based hand gels Ansactive clostridioides difficile infection What precautions must be used when handling lab specimens? Ans- universal precautions waiting only five seconds between lowering the blood pump speed and drawing the post treatment blood sample could Ans- cause the post treatment BUN reading to be falsely low (wait 15 seconds) which may cause a decrease in the hemoglobin of a patient with ESRD Ans- infection/inflammation fluid overload and HTN lead to LVH, this means Ans- hypotensive episodes are more likely to occur during the dialysis treatment your role in CKD-MBD management includes Ans- reminding the patient who is eating a snack during dialysis to take his phosphate binder your role in anemia management includes Ans- rinsing back as much of the patient's blood as you can at the termination of each treatment the licensed nurse has delegated a specific task to a PCT, but the PCT gets called away before performing this task. Can the PCT asek another PCT to take over? Ans- no, a task delegated by the licensed nurse to a non-licenced teammate cannot be re-delegated by this teammate the licensed nurse delegated a task to the PCT, Nicole, but Nicole has not performed this task during the last 2.5 months. What is Nicole's responsibility in the delegation communication process? Ans- Nicole is to inform the nurse that she performed the task only infrequently what is the nurse's responsibility in the delegation supervision process? Ans- to determine the level of supervision needed and to monitor the NAP's performance of the task accordingly the transport mechanism when particles move from an area of higher solute concentration to an area of lower solute concentration is called Ans- diffusion during dialysis, the movement of bicarb from the dialysate into the blood Ans- helps normalize body pH the kidneys excretory functions include Ans- normalizing electrolytes what distance should be observed between needle tips and away from each other when cannulating an internal vascular access? Ans- 1.5 inches the nephrologist has ordered 16 gauge needles and a 400 BFR for your patient. You Ans- ask the nephrologist to order a 15 gauge needles for the ordered BFR your patient prefers two places on her AVG to insert the needles because they hurt a lot less than when you cannulate different sites. You tell the patient Ans- inserting the needles into the same small area can over time damage your graft what is the appropriate intervals for total chlorine testing? Ans- prior to the first patient shift and within every 4 hours what is acceptable limit for total chlorine in the water leaving the carbon filter Ans- 0.1 or less which is the primary device for purifying the water used in dialysis Ans- the RO ICEBOAT? Ans- 2 Identifiers Consent valid Equipment is functioning Hep B status Orders are complete Access is patent Documentation is timely ? any questions/concerns Your patient complains of ringing in the ears, being nauseated and having cold clammy skin. The most likely causes is Ans- Hypotension What is a likely cause for dysrhythmias? Ans- Hypotension, heart disease, or rapid changes in K In what position should you place a patient who experiences intradialytic hypotension? Ans- Supine What do you do for a patient with an air emblolism? Ans- Clamp lines, put patient on left side, Trendelenburg, attempt to aspirate the air, administer O2 per MD, monitor VS closely, initiate CPR if needed, notify code team Why is thirst control and limiting interdialytic weight gains a shared responsibilyt between the healthcare team and the patient? Ans- Caregivers can contribute to Na loading during dialysis causing an increased thirst and fluid intake between treatments Preventing hypotensive episodes during dialysis treatment is important because they are associated with Ans- a higher mortality rate The mortality risk for patient who experience two or more episodes of intradialytic hypotension per week increases to Ans- 70% which condition may impair a patient's increase in pulse rate as a response to hypovoilemia Ansautonomic neuropathy a patient's protein status is affected by nutritional and non-nutritional factors. what can you do to prevent a drop in your patient's albumin? Ans- prevent HAIs Calciphylaxis (soft tissue calcification) is a consequence of which out or range labs? Ans- Ca, PTH, Phosphorus How do phosphate binders work? Ans- they prevent the phosphorus in food from being absorbed when taken with meals The method to protect against infection by pathogenic microorganisms when preparing and administering medications is called Ans- aseptic technique Why must you wait 3-5 minutes after administering the initial heparin bolus before initiating treatment? Ans- takes 3-5 minutes for heparin to become systemic When do you take PO4 binders? Ans- with meals and snacks #1 thing we do Ans- patient safety Conductivity acceptable rrange Ans- 13-15.5 and +/- 0.4 of the machine pH of dialysate Ans- 6.9-7.6 blood pH Ans- 7.35-7.45 When is the RO checked? Ans- before the first patient and every 4 hours afterwards Bicarb lasts for how long once opened? Ans- 24 hours Acid lasts for how long when opened? Ans- 30 days if additives discard after treatment lifespan of a RBC for dialysis patient Ans- 60 days Ultrafiltration Ans- fluid passing thru a membrane Convetion Ans- solute being dragged across the semipermeable membrane Diffusion Ans- particles from high to low concentrations Osmosis Ans- fluid from lower to higher concentration How much air can cause a patient harm? Ans- 10mL What is the solution of bleach to clean up a spill? Ans- 1:10 2 independent nursing functions Ans- patient care and technical skills 2 common routes for CVC infection Ans- into cath via contact of the insertion site and via cath lumenscrub the hub for 60 seconds each limb Most common cause for CKD in USA Ans- DM What is the percent of kidney function lost before going on dialysis Ans- 75% HD replaces what percent of kidney function Ans- 15% What is the direct result of intravascular fluid overload Ans- HTN Patient with cardiac disease are 10x more likely to develop intra HTN Ans- LVH Offer a patient of this is an example of oral sodium loading Ans- broth this electrolyte is often elevated with patients with severe itching Ans- phosphorus kidneys regulate BO by realeasing Ans- renin hormone stimulated in bone marrow production Ans- erythropoeitin Excess of this electrolyte causes slowing of the hearts electrical system Ans- k mucosal alteration in the stomach of patients with AKI can lead to this Ans- anorexia what is the inflammation aroudn the heart cal