DAVITA FINAL EXAM NEWEST 2025 ACTUAL EXAM COMPLETE 200 QUESTIONS AND CORRECT DETAILED
ANSWERS
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
B, low dose aspirin, NSAIDS)
What is important when monitoring weight and BP - (ANSWER)keep a little extra fluid on them so it is
available to the kidneys when they start filtering/ultra-filtrating on their own
AKI patients are at increased risk for which complications - (ANSWER)hypovolemia and hypotension
ANSWERS
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
B, low dose aspirin, NSAIDS)
What is important when monitoring weight and BP - (ANSWER)keep a little extra fluid on them so it is
available to the kidneys when they start filtering/ultra-filtrating on their own
AKI patients are at increased risk for which complications - (ANSWER)hypovolemia and hypotension
