FRESENIUS RN TEST PAPER UPDATED EXAM QUESTIONS
AND ANSWERS GRADED A+
✔✔Where HD vs PD is done? - ✔✔HD is done usually outpatient or home HD is done in
home.
PD is done in the patient's home.
✔✔What filters waste in HD vs PD? - ✔✔A dialyzer (artificial kidney) filters the waste
from blood in HD.
The patient's peritoneal membrane acts as the semi-permeable membrane and filters
waste in PD.
✔✔How long does HD vs PD take? - ✔✔HD usually lasts 3-4 hours, 3 times a week.
PD is performed daily with several exchanges during the day, or done during sleeping
hours with a cycler.
✔✔How is fluid removed in HD vs PD? - ✔✔Fluid removal is done through ultrafiltration
in HD.
Fluid removal occurs via osmotic pressure and concentration gradients caused by
dextrose solution and dwell times in PD.
✔✔What are the body fluid compartments? - ✔✔Intracellular - inside the cells.
Extracellular - outside the cells.
Intravascular - inside the blood vessels.
Interstitial - between the cells.
✔✔What is diffusion? - ✔✔Movement of solutes across a semi-permeable membrane
from higher to lower concentration.
✔✔What is osmosis? - ✔✔Movement of fluid from a lower concentration of solutes to a
higher concentration.
✔✔What is ultrafiltration? - ✔✔Uses both negative and positive pressure to remove
excess fluid from the patient.
✔✔Why is water used for dialysis treated? - ✔✔Water contains contaminants,
electrolytes, and impurities. Because dialysis patients are exposed to large amounts of
water each treatment, these impurities must be removed to protect the patient form
harm.
✔✔What is chloramine and how is it different from chlorine? - ✔✔Some water treatment
facilities use a combination of chlorine and chloramine to treat water. Chloramine is a
combination of bleach and ammonia, whereas chlorine is bleach alone.
,✔✔What is the diasafe filter? - ✔✔It is found on the back of the hemodialysis machine
and allows for the delivery of ultrapure dialysate.
✔✔What factors impact the rate of diffusion? - ✔✔Concentration gradient
Temperature
Molecular weight of solutes
Nature of the solution
Membrane permeability
Surface area
Flow geometry convection
✔✔What happens to diffusion when dialyzer fibers clot? - ✔✔Diffusion is decreased.
Clotted fibers cause the permeability of the fiber to be reduced or eliminated, causing a
decrease in treatment adequacy. As a result, diffusion does not occur as particles
cannot diffuse across the membrane.
✔✔At what point during the hemodialysis treatment will diffusion cease to occur? -
✔✔Diffusion will continue throughout the dialysis treatment until the concentration
gradient of each electrolyte found in the patient's blood is equal to the electrolyte
concentration in the dialysate.
✔✔What is the largest factor that impacts ultrafiltration? - ✔✔Pressure.
✔✔What happens when the dialysate flow is turned off during the treatment? - ✔✔The
patient's blood is not cleaned and adequacy will decrease.
✔✔What are the compartments of the dialyzer and what separates them? - ✔✔There
are two compartments, the blood and dialysate compartment. The two are separated by
a semipermeable membrane.
✔✔What is a semi-permeable membrane? - ✔✔A membrane made from protein, with
small pores or holes. Only certain molecules can fit through.
✔✔What is countercurrent flow? - ✔✔Blood and dialysate flow in opposite directions-
called countercurrent flow, which means as blood flows down into the dialyzer (arterial
to venous), dialysate flows up (venous to arterial)
✔✔What are 3 types of solutions? - ✔✔Hypotonic - containing less particles
Isotonic - containing equal particles
Hypertonic - containing more particles
✔✔pH scale - ✔✔Less than 7 = acidic
Greater than 7 = alkaline
Equal to 7 = acid and base ions are equal
,✔✔Normal blood pH - ✔✔7.35-7.45
✔✔What is bicarbonate? - ✔✔(HCO3) is a buffer that helps to maintain a constant pH in
a solution even if an acid or base is added.
✔✔What is conductivity? - ✔✔The ability of a solution to transmit or conduct an
electrical current. In dialysis, it is used to calculate the electrolyte concentration in the
final dialysate.
✔✔What is the safe conductivity from the theoretical conductivity reading from the
machine? - ✔✔+ or - 0.5
✔✔What is dialysate? - ✔✔A non-sterile solution and its function is to remove waste
products from the blood and balance electrolytes.
✔✔What is dialysate composed of? - ✔✔Purified water
Acid solution
Bicarbonate solution
✔✔Why is dextrose added to dialysate? - ✔✔Dextrose is a form of glucose and is
added to prevent hypoglycemia.
✔✔What electrolytes are found in dialysate? - ✔✔Sodium
Potassium
Calcium
Magnesium
Chloride
✔✔What are 4 ways dialysate is checked to ensure that it is safe? - ✔✔pH
Conductivity
Monitoring the machine temp
A negative residual bleach strip test after weekly disinfection
✔✔What causes increased arterial pressures? - ✔✔Kinks, clamp or occlusion on the
arterial line
BFR exceeds vascular access flow
Needle gauge size selected compared to BFR
Needle placement
Clotting, stenosis, vasoconstriction or vasospasms
Malposition of catheter tip, constricting sutures at insertion site or CVC thrombus
Hypotension
Poor cardiac output
Increased blood viscosity due to high hgb or ultrafiltration
, ✔✔What causes increased venous pressure? - ✔✔Kinks, clamp or occlusion on venous
line
Infiltration or poor needle placement
Clotting in: needle, CVC, venous chamber lines or dialyzer
Machine malfunction
Wet or bloody transducer protectors
Venous infiltration
✔✔What is the meaning of a blood leak alarm? - ✔✔Fibers have broken inside the
dialyzer. Blood and dialysate have entered each others compartments. Inspect dialysate
for pink-tinged color. Confirm this by checking effluent dialysate fluid (red hanson) with a
blood leak strip.
If positive, DO NOT return blood.
✔✔What is the meaning of an air detector alarm? - ✔✔Air or foam has been detected
by the machine. The machine automatically clamps off line below venous chamber.
Blood pump stops to assure that no air gets to patient.
DO NOT disarm.
✔✔What is the meaning of a venous pressure alarm? - ✔✔Something is blocking the
return of the blood to the access.
This alarm may indicate a kink on the venous bloodline, an infiltrated venous needle, a
clotted access, any clotting from the venous chamber to the patient's access.
✔✔What is the meaning of an arterial pressure alarm? - ✔✔AP is the amount of
pressure it takes to "pull" the blood from the access to get it to the dialyzer. Since it is a
pull, it is a negative pressure. Anything that blocks the pull of the blood from the access
to the blood pump will create an increased negative AP and will cause a low AP alarm.
TOO much pressure will cause RBC's to hemolyze and release potassium into the
blood stream, therefore when the pressure is too high, a high AP alarm will sound.
✔✔What is the meaning of a TMP alarm? - ✔✔TMP measures the transmembrane or
total membrane pressure - the pressure difference across the membrane fibers inside
the dialyzer. It reflects the total pressure across the membrane used to achieve the
desired fluid loss. As fibers clot off in the dialyzer, TMP rises.
✔✔What does the blood pressure alarm mean? - ✔✔BP is under or above normal
limits. Blood pump does not stop.
✔✔What is the meaning on the conductivity alarm? - ✔✔When conductivity exceeds or
drops below the preset parameters the dialysate will go into bypass to prevent the
possibility of hemolysis or crenation.
✔✔Patient safety checks are performed every _______. - ✔✔30 minutes
AND ANSWERS GRADED A+
✔✔Where HD vs PD is done? - ✔✔HD is done usually outpatient or home HD is done in
home.
PD is done in the patient's home.
✔✔What filters waste in HD vs PD? - ✔✔A dialyzer (artificial kidney) filters the waste
from blood in HD.
The patient's peritoneal membrane acts as the semi-permeable membrane and filters
waste in PD.
✔✔How long does HD vs PD take? - ✔✔HD usually lasts 3-4 hours, 3 times a week.
PD is performed daily with several exchanges during the day, or done during sleeping
hours with a cycler.
✔✔How is fluid removed in HD vs PD? - ✔✔Fluid removal is done through ultrafiltration
in HD.
Fluid removal occurs via osmotic pressure and concentration gradients caused by
dextrose solution and dwell times in PD.
✔✔What are the body fluid compartments? - ✔✔Intracellular - inside the cells.
Extracellular - outside the cells.
Intravascular - inside the blood vessels.
Interstitial - between the cells.
✔✔What is diffusion? - ✔✔Movement of solutes across a semi-permeable membrane
from higher to lower concentration.
✔✔What is osmosis? - ✔✔Movement of fluid from a lower concentration of solutes to a
higher concentration.
✔✔What is ultrafiltration? - ✔✔Uses both negative and positive pressure to remove
excess fluid from the patient.
✔✔Why is water used for dialysis treated? - ✔✔Water contains contaminants,
electrolytes, and impurities. Because dialysis patients are exposed to large amounts of
water each treatment, these impurities must be removed to protect the patient form
harm.
✔✔What is chloramine and how is it different from chlorine? - ✔✔Some water treatment
facilities use a combination of chlorine and chloramine to treat water. Chloramine is a
combination of bleach and ammonia, whereas chlorine is bleach alone.
,✔✔What is the diasafe filter? - ✔✔It is found on the back of the hemodialysis machine
and allows for the delivery of ultrapure dialysate.
✔✔What factors impact the rate of diffusion? - ✔✔Concentration gradient
Temperature
Molecular weight of solutes
Nature of the solution
Membrane permeability
Surface area
Flow geometry convection
✔✔What happens to diffusion when dialyzer fibers clot? - ✔✔Diffusion is decreased.
Clotted fibers cause the permeability of the fiber to be reduced or eliminated, causing a
decrease in treatment adequacy. As a result, diffusion does not occur as particles
cannot diffuse across the membrane.
✔✔At what point during the hemodialysis treatment will diffusion cease to occur? -
✔✔Diffusion will continue throughout the dialysis treatment until the concentration
gradient of each electrolyte found in the patient's blood is equal to the electrolyte
concentration in the dialysate.
✔✔What is the largest factor that impacts ultrafiltration? - ✔✔Pressure.
✔✔What happens when the dialysate flow is turned off during the treatment? - ✔✔The
patient's blood is not cleaned and adequacy will decrease.
✔✔What are the compartments of the dialyzer and what separates them? - ✔✔There
are two compartments, the blood and dialysate compartment. The two are separated by
a semipermeable membrane.
✔✔What is a semi-permeable membrane? - ✔✔A membrane made from protein, with
small pores or holes. Only certain molecules can fit through.
✔✔What is countercurrent flow? - ✔✔Blood and dialysate flow in opposite directions-
called countercurrent flow, which means as blood flows down into the dialyzer (arterial
to venous), dialysate flows up (venous to arterial)
✔✔What are 3 types of solutions? - ✔✔Hypotonic - containing less particles
Isotonic - containing equal particles
Hypertonic - containing more particles
✔✔pH scale - ✔✔Less than 7 = acidic
Greater than 7 = alkaline
Equal to 7 = acid and base ions are equal
,✔✔Normal blood pH - ✔✔7.35-7.45
✔✔What is bicarbonate? - ✔✔(HCO3) is a buffer that helps to maintain a constant pH in
a solution even if an acid or base is added.
✔✔What is conductivity? - ✔✔The ability of a solution to transmit or conduct an
electrical current. In dialysis, it is used to calculate the electrolyte concentration in the
final dialysate.
✔✔What is the safe conductivity from the theoretical conductivity reading from the
machine? - ✔✔+ or - 0.5
✔✔What is dialysate? - ✔✔A non-sterile solution and its function is to remove waste
products from the blood and balance electrolytes.
✔✔What is dialysate composed of? - ✔✔Purified water
Acid solution
Bicarbonate solution
✔✔Why is dextrose added to dialysate? - ✔✔Dextrose is a form of glucose and is
added to prevent hypoglycemia.
✔✔What electrolytes are found in dialysate? - ✔✔Sodium
Potassium
Calcium
Magnesium
Chloride
✔✔What are 4 ways dialysate is checked to ensure that it is safe? - ✔✔pH
Conductivity
Monitoring the machine temp
A negative residual bleach strip test after weekly disinfection
✔✔What causes increased arterial pressures? - ✔✔Kinks, clamp or occlusion on the
arterial line
BFR exceeds vascular access flow
Needle gauge size selected compared to BFR
Needle placement
Clotting, stenosis, vasoconstriction or vasospasms
Malposition of catheter tip, constricting sutures at insertion site or CVC thrombus
Hypotension
Poor cardiac output
Increased blood viscosity due to high hgb or ultrafiltration
, ✔✔What causes increased venous pressure? - ✔✔Kinks, clamp or occlusion on venous
line
Infiltration or poor needle placement
Clotting in: needle, CVC, venous chamber lines or dialyzer
Machine malfunction
Wet or bloody transducer protectors
Venous infiltration
✔✔What is the meaning of a blood leak alarm? - ✔✔Fibers have broken inside the
dialyzer. Blood and dialysate have entered each others compartments. Inspect dialysate
for pink-tinged color. Confirm this by checking effluent dialysate fluid (red hanson) with a
blood leak strip.
If positive, DO NOT return blood.
✔✔What is the meaning of an air detector alarm? - ✔✔Air or foam has been detected
by the machine. The machine automatically clamps off line below venous chamber.
Blood pump stops to assure that no air gets to patient.
DO NOT disarm.
✔✔What is the meaning of a venous pressure alarm? - ✔✔Something is blocking the
return of the blood to the access.
This alarm may indicate a kink on the venous bloodline, an infiltrated venous needle, a
clotted access, any clotting from the venous chamber to the patient's access.
✔✔What is the meaning of an arterial pressure alarm? - ✔✔AP is the amount of
pressure it takes to "pull" the blood from the access to get it to the dialyzer. Since it is a
pull, it is a negative pressure. Anything that blocks the pull of the blood from the access
to the blood pump will create an increased negative AP and will cause a low AP alarm.
TOO much pressure will cause RBC's to hemolyze and release potassium into the
blood stream, therefore when the pressure is too high, a high AP alarm will sound.
✔✔What is the meaning of a TMP alarm? - ✔✔TMP measures the transmembrane or
total membrane pressure - the pressure difference across the membrane fibers inside
the dialyzer. It reflects the total pressure across the membrane used to achieve the
desired fluid loss. As fibers clot off in the dialyzer, TMP rises.
✔✔What does the blood pressure alarm mean? - ✔✔BP is under or above normal
limits. Blood pump does not stop.
✔✔What is the meaning on the conductivity alarm? - ✔✔When conductivity exceeds or
drops below the preset parameters the dialysate will go into bypass to prevent the
possibility of hemolysis or crenation.
✔✔Patient safety checks are performed every _______. - ✔✔30 minutes
