DAVITA(RN) FINAL EXAM ACTUAL EXAM 200
QUESTIONS AND CORRECT DETAILED ANSWERS(100%
VERIFIED ANSWERS)|ALREADY GRADED A+
Explain the four transport mechanisms that play a role in hemodialysis - ANSWER: ●
Ultrafiltration: Fluid is pushed through a semipermeable membrane.
● Convection: Or solute drag means that solutes move with the water across the
semipermeable membrane. In this way, convection adds to the clearance achieved
through diffusion as solutes are dragged along with the ultrafiltrate.
● Diffusion: Is the movement of dissolved particles across a semipermeable
membrane from the side with the higher concentration to the side with the lower
concentration. This difference in solute concentration on each side of the membrane
is called concentration gradient. The higher the concentration gradient, the faster
diffusion occurs. Once the concentration of a dissolved particle is the same on both
sides of the semipermeable membrane, diffusion stops.
● Osmosis: Is a chemical process by which dissolved chemicals will migrate from an
area of high concentration to one of low
concentration. Essentially if you dissolve something in a liquid, the dissolved
compounds (called solutes) will spread out until there is
an equal concentration of solute everywhere.
What are the kidneys excretory functions - ANSWER: To normalize electrolytes,
remove wastes, provide fluid and nutrient balance
What is the function of the acid concentration - ANSWER: Provides the concentration
gradient for diffusion and helps normalize electrolytes
What is the function of bicarbonate - ANSWER: Buffers the acid concentrate
Signs and symptoms of hyperkalemia - ANSWER: > 5.5 mEq: extreme muscle
weakness, abnormal heart rhythm, possible cardiac arrest
Signs and symptoms of hypokalemia - ANSWER: < 3.5 mEq: fatigue, muscle
weakness, paralysis, respiratory failure, cardiac instability, arrhythmias, cardiac
arrest
What are the kidneys endocrine functions - ANSWER: Renin secretion, Erythropoeitin
secretion, Vit D Activation
How do we replace normal endocrine kidney functions - ANSWER: Provide
medications
,How much of normal kidney function is replaced by hemodialysis - ANSWER: 15%
What is uremia and how does it affect the body? - ANSWER: Uremia is a buildup of
wastes in the blood due to kidney failure and affects all body systems.
What are the most common causes of CKD in the usa? - ANSWER: Diabetes
Hypertension
Polycystic Kidney Disease
Outline the treatment goals for a patient with CKD - ANSWER: -slowing the
progression of ckd
-managing comorbidities and complications
-controlling symptoms
-minimizing the effects of ckd on patients' lifestyles
-kidney replacement therapy modality education
-encouraging patients to actively participate in their healthcare
Why is it important to know what caused your patients CKD - ANSWER: So the nurse
and PCT can inquire about possible problems during data collection and assessment
Why is sodium balance important? - ANSWER: Leads to volume expansion, increased
cardiac output, increased peripheral vascular resistance, and increased blood
pressure
Signs and symptoms of fluid imbalance - ANSWER: Edema, hypertension, shortness
of breath
Systemic effects of CKD what would you advise for a patient who complains of: dry
itchy skin, peripheral neuropathy(nerve pain in extremities) and gi problems -
ANSWER: Use hyper-fatted soaps and lotions, monitor patient for changes in motor
function and inform RN and physician of any bleeding
problems/constipation/diarrhea
What is the consequences of prolonged fluid overload and hypertension - ANSWER:
Left ventricular hypertrophy
What is Percarditis? - ANSWER: Inflammation of the membrane (pericardial sac)
around the heart
What is a common cause of hypertension in dialysis patients - ANSWER: fluid
overload
Left ventricular hypertrophy leads to - ANSWER: Ischemic heart disease, arrhythmia,
myocardial infarction, and sudden death
, Why are dialysis patients anemic? - ANSWER: 1. the lifespan of their red blood cell is
60 days 1/2 of the normal 120 days.
What can you do to avoid contributing to lower hemoglobin and blood loss in dialysis
patients - ANSWER: Verify correct Erythropoietin Stimulating Agent (ESA) dose is
administered, rinse back until venous line is pink tinged, and avoid repeat lab draws
What are the 4 key elements contributing to CKD-mineral bone disorder(MBD) -
ANSWER: 1. Calcium
2. Phosphorus
3. PTH
4. Vitamin D (Calcitriol)
What are the symptoms of CKD-MBD in addition to bone disease - ANSWER: Soft
tissue calcification, itching, muscle weakness, pathological fractures, tendon
ruptures, compression of vertebrae, atherosclerosis, heart disease
What is your role in CKD-MBD management - ANSWER: *report symptoms * urge
patients to take meds (home & treatment)
*report noncompliance problems related to nonadherence
Define the term AKI - ANSWER: - Term incorporates a wide spectrum of kidney issues
- Includes acute kidney failure as well as less catastrophic kidney function changes
- May dialyze in an out-patient facility until kidney function recovers
Give 3 examples of pre-, intra- and post-renal causes of AKI - ANSWER: Pre:
Obstruction, volume depletion, impaired cardiac function.
Intra: ischemic ATN, sepsis, SIRS, septic shock, anaphylaxis drugs, Goodpasture
Syndrome, Acute Glomerulonephritis, Trauma, open heart surgery.
Post: Obstruction, Oliguric, bladder rupture, pregnancy.
Explain the difference between AKI and CKD - ANSWER: Eliminating the cause of the
AKI can often lead to the return of kidney function. You
cannot eliminate the cause of CKD which is HTN, Diabetes, genetic disorders (PKD)
Outline the treatment goals for a patient with AKI dialyzing in the out-patient facility
- ANSWER: - Find cause of AKI to restore function
- Careful to avoid catheter related infections
- Avoid substances to the kidney which may be toxic (NSAIDS, radiographic contrasts,
etc.
What do you need to consider in regards to their vascular access - ANSWER: Patients
will typically have a dialysis catheter, be careful to avoid catheter related infections
How do you protect kidneys from further injury - ANSWER: Avoid substances to the
kidney which may be toxic (radiographic contrast, amphotericin
QUESTIONS AND CORRECT DETAILED ANSWERS(100%
VERIFIED ANSWERS)|ALREADY GRADED A+
Explain the four transport mechanisms that play a role in hemodialysis - ANSWER: ●
Ultrafiltration: Fluid is pushed through a semipermeable membrane.
● Convection: Or solute drag means that solutes move with the water across the
semipermeable membrane. In this way, convection adds to the clearance achieved
through diffusion as solutes are dragged along with the ultrafiltrate.
● Diffusion: Is the movement of dissolved particles across a semipermeable
membrane from the side with the higher concentration to the side with the lower
concentration. This difference in solute concentration on each side of the membrane
is called concentration gradient. The higher the concentration gradient, the faster
diffusion occurs. Once the concentration of a dissolved particle is the same on both
sides of the semipermeable membrane, diffusion stops.
● Osmosis: Is a chemical process by which dissolved chemicals will migrate from an
area of high concentration to one of low
concentration. Essentially if you dissolve something in a liquid, the dissolved
compounds (called solutes) will spread out until there is
an equal concentration of solute everywhere.
What are the kidneys excretory functions - ANSWER: To normalize electrolytes,
remove wastes, provide fluid and nutrient balance
What is the function of the acid concentration - ANSWER: Provides the concentration
gradient for diffusion and helps normalize electrolytes
What is the function of bicarbonate - ANSWER: Buffers the acid concentrate
Signs and symptoms of hyperkalemia - ANSWER: > 5.5 mEq: extreme muscle
weakness, abnormal heart rhythm, possible cardiac arrest
Signs and symptoms of hypokalemia - ANSWER: < 3.5 mEq: fatigue, muscle
weakness, paralysis, respiratory failure, cardiac instability, arrhythmias, cardiac
arrest
What are the kidneys endocrine functions - ANSWER: Renin secretion, Erythropoeitin
secretion, Vit D Activation
How do we replace normal endocrine kidney functions - ANSWER: Provide
medications
,How much of normal kidney function is replaced by hemodialysis - ANSWER: 15%
What is uremia and how does it affect the body? - ANSWER: Uremia is a buildup of
wastes in the blood due to kidney failure and affects all body systems.
What are the most common causes of CKD in the usa? - ANSWER: Diabetes
Hypertension
Polycystic Kidney Disease
Outline the treatment goals for a patient with CKD - ANSWER: -slowing the
progression of ckd
-managing comorbidities and complications
-controlling symptoms
-minimizing the effects of ckd on patients' lifestyles
-kidney replacement therapy modality education
-encouraging patients to actively participate in their healthcare
Why is it important to know what caused your patients CKD - ANSWER: So the nurse
and PCT can inquire about possible problems during data collection and assessment
Why is sodium balance important? - ANSWER: Leads to volume expansion, increased
cardiac output, increased peripheral vascular resistance, and increased blood
pressure
Signs and symptoms of fluid imbalance - ANSWER: Edema, hypertension, shortness
of breath
Systemic effects of CKD what would you advise for a patient who complains of: dry
itchy skin, peripheral neuropathy(nerve pain in extremities) and gi problems -
ANSWER: Use hyper-fatted soaps and lotions, monitor patient for changes in motor
function and inform RN and physician of any bleeding
problems/constipation/diarrhea
What is the consequences of prolonged fluid overload and hypertension - ANSWER:
Left ventricular hypertrophy
What is Percarditis? - ANSWER: Inflammation of the membrane (pericardial sac)
around the heart
What is a common cause of hypertension in dialysis patients - ANSWER: fluid
overload
Left ventricular hypertrophy leads to - ANSWER: Ischemic heart disease, arrhythmia,
myocardial infarction, and sudden death
, Why are dialysis patients anemic? - ANSWER: 1. the lifespan of their red blood cell is
60 days 1/2 of the normal 120 days.
What can you do to avoid contributing to lower hemoglobin and blood loss in dialysis
patients - ANSWER: Verify correct Erythropoietin Stimulating Agent (ESA) dose is
administered, rinse back until venous line is pink tinged, and avoid repeat lab draws
What are the 4 key elements contributing to CKD-mineral bone disorder(MBD) -
ANSWER: 1. Calcium
2. Phosphorus
3. PTH
4. Vitamin D (Calcitriol)
What are the symptoms of CKD-MBD in addition to bone disease - ANSWER: Soft
tissue calcification, itching, muscle weakness, pathological fractures, tendon
ruptures, compression of vertebrae, atherosclerosis, heart disease
What is your role in CKD-MBD management - ANSWER: *report symptoms * urge
patients to take meds (home & treatment)
*report noncompliance problems related to nonadherence
Define the term AKI - ANSWER: - Term incorporates a wide spectrum of kidney issues
- Includes acute kidney failure as well as less catastrophic kidney function changes
- May dialyze in an out-patient facility until kidney function recovers
Give 3 examples of pre-, intra- and post-renal causes of AKI - ANSWER: Pre:
Obstruction, volume depletion, impaired cardiac function.
Intra: ischemic ATN, sepsis, SIRS, septic shock, anaphylaxis drugs, Goodpasture
Syndrome, Acute Glomerulonephritis, Trauma, open heart surgery.
Post: Obstruction, Oliguric, bladder rupture, pregnancy.
Explain the difference between AKI and CKD - ANSWER: Eliminating the cause of the
AKI can often lead to the return of kidney function. You
cannot eliminate the cause of CKD which is HTN, Diabetes, genetic disorders (PKD)
Outline the treatment goals for a patient with AKI dialyzing in the out-patient facility
- ANSWER: - Find cause of AKI to restore function
- Careful to avoid catheter related infections
- Avoid substances to the kidney which may be toxic (NSAIDS, radiographic contrasts,
etc.
What do you need to consider in regards to their vascular access - ANSWER: Patients
will typically have a dialysis catheter, be careful to avoid catheter related infections
How do you protect kidneys from further injury - ANSWER: Avoid substances to the
kidney which may be toxic (radiographic contrast, amphotericin
