DAVITA R 1 UPDATED ACTUAL EXAM QUESTIONS CORRECT ANSWERS GRADED A PLUS
Question:
Angina
Answer:
Definition: Chest pain or discomfort due to Coronary Heart Disease. Occurs when heart muscle
doesn't get as much blood as it needs. May also feel discomfort in neck, jaw, shoulder, back or arm.
Uncomfortable pressure, fullness, squeezing pain in center of chest. S/S: Chest pain, difficulty
breathing, nausea Interventions: Reduce BFR to 150, reduce UFR, give O2, monitor cardiac
rhythm/VS
Question:
Dialysis Disequilibrium Syndrome (DDS)
Answer:
Definition: A condition in which rapid or drastic changes in the patient's extracellular fluid affect the
brain S/S: Headache, hypertension, nausea, restlessness, convulsions/seizures, confusion, blurred
vision Intervention: decrease BFR and DFR, shorter initial treatments,
Question:
Hypertension
Answer:
Definition: high blood pressure (Pre-Dialysis: >140/90; Post> 130/80) S/S: No symptoms,
headache, dizziness, Irritability, Blurred vision, nervousness, edema secondary to fluid retention
Intervention:Determine cause, maintain fluid balance take medications as prescribed, notify MD
Question:
hypotension
Answer:
,Definition: low blood pressure (Systolic: <90, Diastolic: <60 or drop in systolic more than 20
mm/hg S/S: flushing, yawning, dizziness, ear ringing, tachycardia, anxiousness, nausea/vomiting,
cold clammy skin, seizures, cardiac arrest Interventions: place pt in supine position, decrease UFR
to minimum, provide drinking water for less severe hypotension, give 100-200 mL saline for severe
hypotension, monitor BP, notify RN
Question:
Muscle Cramps
Answer:
Definition: painful muscle contractions in extremities or abdomen typically occurring due to
rapid/excessive fluid removal. S/S: painful cramps usually occuring later in dialysis Intervention:
massage or apply opposing force, give normal saline bolus, reduce UFR, assess dry weight
Question:
Fever & Chills
Answer:
Definition: Any temp greater than 100° F or increase over baseline of 2° F with symptoms S/S:
Temp >100°F, involuntary shaking, chills, hypotension, nausea, vomiting, headache, hypotension,
tachycardia, hot flushed skin, dry mucous membranes Interventions: nurse must assess pt for
possible cause of fever, notify treating nephrologist and obtain cultures per protocol, administer
antibiotics as ordered
Question:
Pyrogen Reaction
Answer:
Definitions: elevated temp- usually occurs 45-75 min into treatment as a result of pyrogens
(endotoxins) S/S: chills, shaking, fever, hypotension, vomiting, muscle pain Intervention: Provide
support, report pt s/s to RN, stop tx, do not return blood, notify MD.
Question:
Seizures
, Answer:
Definition: involuntary muscle spasms and loss of consciousness S/S: change in level of
consciousness, twitching/jerking movements of the extremities Intervention: protect pt and access
arm from harm, protect airway, administer O2, d/c dialysis
Question:
Blood Loss
Answer:
Definition: loss of blood typically due to dislodged needle, bleeding at access site, disconnection of
lines, system clotted and unable to return blood. S/S: hypotension, loss of consciousness, blood on
floor, chair or clothing, blood lead detector alarm, VP alarm if needle dislodged or line separate,
TMP alarm, visible clots in chamber Interventions: Manage symptoms, give saline replacement if
needed, give O2, fix cause
Question:
Clotted Dialyzer
Answer:
Definition: Dialyzer membrane clotted S/S: decrease in VP with no change in BFR, visible clots in
the venous drip chamber or line, dark blood, unable to rinse back pt's blood Intervention: ensure
proper use of heparin, monitoring pressures, maintain proper BFR. Change set up, determine cause
Question:
Hemolysis
Answer:
Definition: rupture of red blood cells S/S: cherry red blood,anxiety, restlessness, abdominal
cramping, back pain, chest tightness/dyspnea, seizures, thready pulse, hyper/hypotension
Intervention: Stop blood pump, clamp lines, do not return blood, RN assess pt, administer O2,
monitor VS and cadiac rhythm, check hemoglobin and K+
Question:
Question:
Angina
Answer:
Definition: Chest pain or discomfort due to Coronary Heart Disease. Occurs when heart muscle
doesn't get as much blood as it needs. May also feel discomfort in neck, jaw, shoulder, back or arm.
Uncomfortable pressure, fullness, squeezing pain in center of chest. S/S: Chest pain, difficulty
breathing, nausea Interventions: Reduce BFR to 150, reduce UFR, give O2, monitor cardiac
rhythm/VS
Question:
Dialysis Disequilibrium Syndrome (DDS)
Answer:
Definition: A condition in which rapid or drastic changes in the patient's extracellular fluid affect the
brain S/S: Headache, hypertension, nausea, restlessness, convulsions/seizures, confusion, blurred
vision Intervention: decrease BFR and DFR, shorter initial treatments,
Question:
Hypertension
Answer:
Definition: high blood pressure (Pre-Dialysis: >140/90; Post> 130/80) S/S: No symptoms,
headache, dizziness, Irritability, Blurred vision, nervousness, edema secondary to fluid retention
Intervention:Determine cause, maintain fluid balance take medications as prescribed, notify MD
Question:
hypotension
Answer:
,Definition: low blood pressure (Systolic: <90, Diastolic: <60 or drop in systolic more than 20
mm/hg S/S: flushing, yawning, dizziness, ear ringing, tachycardia, anxiousness, nausea/vomiting,
cold clammy skin, seizures, cardiac arrest Interventions: place pt in supine position, decrease UFR
to minimum, provide drinking water for less severe hypotension, give 100-200 mL saline for severe
hypotension, monitor BP, notify RN
Question:
Muscle Cramps
Answer:
Definition: painful muscle contractions in extremities or abdomen typically occurring due to
rapid/excessive fluid removal. S/S: painful cramps usually occuring later in dialysis Intervention:
massage or apply opposing force, give normal saline bolus, reduce UFR, assess dry weight
Question:
Fever & Chills
Answer:
Definition: Any temp greater than 100° F or increase over baseline of 2° F with symptoms S/S:
Temp >100°F, involuntary shaking, chills, hypotension, nausea, vomiting, headache, hypotension,
tachycardia, hot flushed skin, dry mucous membranes Interventions: nurse must assess pt for
possible cause of fever, notify treating nephrologist and obtain cultures per protocol, administer
antibiotics as ordered
Question:
Pyrogen Reaction
Answer:
Definitions: elevated temp- usually occurs 45-75 min into treatment as a result of pyrogens
(endotoxins) S/S: chills, shaking, fever, hypotension, vomiting, muscle pain Intervention: Provide
support, report pt s/s to RN, stop tx, do not return blood, notify MD.
Question:
Seizures
, Answer:
Definition: involuntary muscle spasms and loss of consciousness S/S: change in level of
consciousness, twitching/jerking movements of the extremities Intervention: protect pt and access
arm from harm, protect airway, administer O2, d/c dialysis
Question:
Blood Loss
Answer:
Definition: loss of blood typically due to dislodged needle, bleeding at access site, disconnection of
lines, system clotted and unable to return blood. S/S: hypotension, loss of consciousness, blood on
floor, chair or clothing, blood lead detector alarm, VP alarm if needle dislodged or line separate,
TMP alarm, visible clots in chamber Interventions: Manage symptoms, give saline replacement if
needed, give O2, fix cause
Question:
Clotted Dialyzer
Answer:
Definition: Dialyzer membrane clotted S/S: decrease in VP with no change in BFR, visible clots in
the venous drip chamber or line, dark blood, unable to rinse back pt's blood Intervention: ensure
proper use of heparin, monitoring pressures, maintain proper BFR. Change set up, determine cause
Question:
Hemolysis
Answer:
Definition: rupture of red blood cells S/S: cherry red blood,anxiety, restlessness, abdominal
cramping, back pain, chest tightness/dyspnea, seizures, thready pulse, hyper/hypotension
Intervention: Stop blood pump, clamp lines, do not return blood, RN assess pt, administer O2,
monitor VS and cadiac rhythm, check hemoglobin and K+
Question:
