Fresenius Annual Exam Questions and Answers Latest Updated 2024 (GRADED)

Fresenius Annual Exam Questions and Answers Latest Updated 2024 (GRADED) RN's oversee and assess - ANS-The patient treatment, direct interventions, provide patient education Patient care technicians evaluate and reinforce - ANS-nursing education What are the anatomical structures of the urinary system in order of urine flow ? - ANS- (2) kidneys (2) ureters (1) bladder (1) urethra What are the functions of a healthy kidney ? remove - - ANS-Waste products - creatinine, urea and uric acid, ammonia What are the functions of a healthy kidney ? regulate / synthesis - - ANS-Fluid balance, blood volume, electrolytes and acid- base balance, synthesize calcitrol ( active vitamin D) What are the functions of a healthy kidney? Endocrine / Enzyme - - ANS-Secrete erythropoietin - stimulate bone marrow to make red blood cells Release renin - controls blood pressure What is urea ? - ANS-by-product of protein metabolism What is creatinine ? - ANS-by -product of muscle metabolism Uric acid occurs naturally in the human body as a result of ? - ANS-the metabolism of purine What is purine ? - ANS-a muscle protein that enters the body either through dietary intake ( about 30 percent) or from the breakdown of the body's own cells during cell turnover Production of renin helps to ? - ANS-regulate or control blood pressure Production of erythropoietin helps to ? - ANS-stimulate red blood cell production Synthesis of calcitrol regulates what ? - ANS-calcium / phosphorous balance. Synthesis of calcitrol enables absorbtion of what ? - ANS-dietary calcium; promoting bone health Which of the functions of healthy kidneys are replaced by dialysis ? - ANS-Removal of waste products, and regulation of fluid balance What is the function of renin ? - ANS-Renin is a hormone produced by the kidneys with important effects on the regulation of blood pressure, and on sodium and potassium balance. What is a nephron ? - ANS-The functional unit of the kidney. It is a tubular structure and filters blood to form urine. What is a glomerulus ? - ANS-A network (tuft) of capillaries that performs the first step of filtering blood. it filters water and solutes into Bowmans capsule. What does Bowmans capsule do ? - ANS-empties the filtrate into a tubule that is also part of the nephron Urinary excretion is ? - ANS-Excretion = filtration - reabsorbtion = secretion What is the function of erythropoietin? - ANS-Erythropoietin stimulates the bone marrow to produce red blood cells. What is the synthetic form of erythropoietin ? - ANS-Recombiant Epoetin Alfa ( Epogen) - or- Mircera both are drugs given by licensed nursing staff to dialysis patients to treat anemia Why must the kidney activate Vitamin D ? - ANS-The kidney converts Vitamin D to Calcitrol, its activated form. This activated form of Vitamin D helps to maintain good bone health by helping to absorb calcium from foods eaten. What are synthetic forms of activated Vitamin D ? - ANS-Calcijex, Zemplar, and Hectorol ( synthetic calcitriol) are medications used in treating bone disease for hemodialysis patients. acute renal failure - ANS-sudden onset, severe, usually reversible, Drug toxicity, motor vehicle accident, dehydration Chronic renal failure - ANS-slow onset, progressive, permanent, diabetes - diabetic nephropathy or glomerulosclerosis, Hypertension causing nephrolosclerosis, glomerulonephtitis other causes of renal failure include ? - ANS-Polycystic kidney disease, Interstitial Nephritis, Goodpasture syndrome, Wilm's tumor, Systemic Lupus Erythematosus, Alport's disease, Sickle Cell disease, Acquired Immune Deficiency (AIDS), obstructions, Scleroderma, Drug toxicity ( heroin, cocaine, non-steroidal anti-inflammatory drugs, acetaminophen) What are signs of renal failure or uremia ? - ANS-Elevated levels of - BUN / Creatinine - phosphorus - potassium, Anemia , Nerve damage, Yellow-gray appearance of the skin, fluid overload, shortness of breath and edema, hypertension, proteinuria What are symptoms of renal failure or uremia ? - ANS-Uremia, lethargy, weakness, headache, itching, fatigue, nausea, restlessness, mental status changes, loss of appetite What organ systems are affected by kidney disease ? - ANS-All organ systems are affected, musculoskeletal, integumentary, cardiovascular, gastrointestinal, respiratory, immune, neurological, hematologic, reproductive, endocrine What are the signs and symptoms of uremia ? - ANS-Yellow- gray skin tone, peripheral edema, high blood pressure, itching, loss of appetite, nausea, fatigue, restlessness, mental status changes, shortness of breath, immune system changes, proteinuria How is uremia treated ? - ANS-Dialysis, diffusion allows for uremic toxin removal, dialusate contains no urea levels, urea moves from the patient to the dialysate What is uremia ? - ANS-Caused by impaired kidney function. Build up of harmful waste products in the bloodstream What is the Glomerular Filtration Rate ( GFR) in the five stages of kidney disease ? - ANS-1- normal kidney function 2- mildly reduced kidney function 3- moderately reduced kidney function 4- severely reduced kidney function 5- very severely reduced kidney fuction ( also called chronic kidney disease ) What services are availabel from the socials services department ? - ANS-Provides emotional support, psychological counseling, patient advocate, also resource and referral services What adjustments do patients encounter when transitioning to dialysis ? - ANS-Loss of control, dietary restrictions, Loss of mobility, sexual dysfunction, financial concerns, depression, unwanted dependency on the dialysis machine and staff, altered body image concerns due to the apperarance of the access and redistribution of weight What causes renal osteodystrophy ( bone disease ) ? - ANS-patients with kidney disease no longer produce calcitriol - the active form of Vitamin D ( inadequate or lacking calcitriol causes demineralization of the bone- bone begins to break down to release calcium needed for body functioning) No longer excrete phosphorus ( phosphorus is found in most foods and beverages. Increased phosphorus levels cause further calcium bone loss) What does Calcitriol do ? - ANS-directs the gut to absorb calcium into the bloodstream. If calcitriol levels drop too low, parathyroid hormone (PTH) is increased. Increased PTH levels direct osteoclast activity - bone breakdown to increase serum calcium levels. Calcitriol and PTH work together to maintain serum calcium levels. Diminished or lacking calcitriol levels decrease gut absorption of calcium, so the body takes the needed calcium from bones. Treatments options - what is Hemodialysis ? - ANS-uses a vascular access to draw blood from the access to the dialyzer and into the semipermeable membranes where the process of diffusion removes the waste products and ultrafiltration removes the fluid. The process of hemodialysis provides approximately 15% of the function of the normal kidney. Treatments options - what is peritoneal dialysis ? - ANS-uses a permanently placed catheter in the patients higly vascularized peritoneal cavity. The peritoneum is the membrane surrounding the abdominal organs. Dialysate fluid is infused into the cavity and is allowed to dwell there for a period of time. Then the fluid is drained. Through osmosis and diffusion, excess fluid and waste products are removed. Treatments options - What is transplantation ? - ANS-surgically implanting a working kidney from a living or cadaver donor and involves anti- rejection medications. intracellular - ANS-inside the cells extracellular - ANS-outside the cells intravascular - ANS-inside the blood vessels interstitial - ANS-between the cells What is homeostasis ? - ANS-the steady internal state of equilibrium in the body. A naturally occurring constant balance within the internal environment of the body. - the steady state of being - the kidneys conserve or excrete excess fluid as needed to keep the internal environment in balance. What is diffusion ? - ANS-The scientific principle that causes the sodium to move across the semipermeable membrane . What is a semi- permeable membrane ? - ANS-A membrane made from protein, with small pores or holes. Only certain molecules can fit through the pores depending on the pore size. Molecules larger than the pore size will not pass through the semi-permeable membrane. Red blood cells and proteins are too large to pass through the semipermeable membrane pores of the dialyzer. Urea, sodium, potassium and water for example can pass through the pores of the membranes. What factors impact the rate of diffusion ? - ANS-Concentration gradient, temperature, molecular weight of solutes, nature of the solution, membrane permeablilty, surface area, flow geometry convection ( solvent drag) At what point during the hemodialysis treatment will diffusion cease to occur ? - ANSDiffusion will continue throughout the dialysis treatment until the concentration of each electrolyte found in the patients blood is equal to the electrolyte concentration in the dialysate. What is countercurrent flow ? - ANS-Blood and dialysate flow in opposite directions - called countercurrent flow. Blood flows down into the dialyzer (areterial to Venous) dialasate flows up (venous to arterial). This opposite flow allows for better clearance and diffusion. What happens to diffusion when dialyzer fibers clot ? - ANS-When dialyzer fibers clot - either from inadequate heperanization or an improperly primed dialyzer, diffusion is decreased. Clotted fibers cause the permeability of the fiber to be reduced or eliminated causing a decrease in treatment adequacy. What are the compartments of the dialyzer and what seperates them ? - ANS-The dialyzer is composed of two compartments housed inside a plastic casing. The blood compartment is seperated from the dialysate compartment by a semi- permeable membrane. The blood and dialysate do not mix together. There is a potting material on both ends of the dialyzer to assure seperation of blood and dialysate. What are three types of solutions ? - ANS-Hypotonic - containing less particles Isotonic - containing equal particles Hypertonic - containing more particles When is it known that a patient has developed sensitivity to a dialyzer? - ANS-Patients develop mild to severe reactions in some cases, usually seen the first half hour of treatment. Sneezing, itching, pain at the access site, chest pain, rashing, hives, fever How ling can a dialyzer recirculate with saline before it is considered unsafe to use ? - ANS-4 hours after 2 hours recirculate What volume should be used for fresh fill/ run off ? - ANS-Fresh fill / run off must be performed prior to the initiation of every treatment. 50 ml of saline should be drained from the arterial line and 250 ml should be drained from the venous line before lines are connected to the patient. When dialyzing a patient what position should the dialyzer be in during hemodialysis ? - ANS-place the dialyzer arterial end up What should be checked on a dialyzer before machine set up ? - ANS-the dialyzer should be checked for sterility I the dialyzer should be intact in the original packaging or if out of the package should have all the ports capped), in the structural damage and be the size and brand that was ordered by the doctor. What are electrolytes ? - ANS-charged particles that can conduct an electrical current. Electrolytes in the body control motor, muscle and nerve function, and maintain the body's homeostasis. The most important electrolytes to consider in uremic patients are ? - ANS-sodium ( Na+) Potassium (K+) Calcium ( Ca++) Magnesium ( Mg++) Fluid removed during hemodialysis comes from which body fluid compartment ? - ANSDuring dialysis fluid is removed from the intravascular fluid compartment or bloodstream. Intravascular = inside the blood vessels What is PH ? - ANS-ph less than 7 = acidic ph greater than 7 = alkaline normal blood ph is 7.35 to 7.45 What is dialysate ? - ANS-Dialysate is a non-sterile solution and its function is to remove waste products from the blood and balance electrolytes. Dialysate is composed of purified water, acid solution, and bicarbonate solution. The bicarbonate solution helps treat metabolic acidosis ( too much acid in the body fluids) What electrolytes are found in the diaysate ? - ANS-Electrolytes in the dialysate must be in similar amounts to what is normally in the body's electrolyte count. these electrolytes are sodium, potassium, calcium, magnesium, chloride