FRESENIUS PCT NEW HIRE EXAM QUESTIONS WITH CORRECT ANSWERS

What are the anatomical structures of the urinary system in order of urine flow? - (2) Kidneys, (2) ureters, (1) bladder, (1) urethra. Which of the functions of healthy kidneys are replaced by dialysis? - Removal of waste products, and Regulation of fluid balance What is the function of renin? - Renin is a hormone produced by the kidneys with important effects on the regulation of blood pressure, and on sodium and potassium balance Erythropoietin - stimulates the bone marrow to produce red blood cells (RBSc). Why must the kidney activate Vitamin D? - The kidney converts Vitamin D to Calcitriol, its activated form. This activated form of Vitamin D helps to maintain good bone health by helping absorb calcium from foods eaten What causes renal osteodystrophy (bone disease)? - No longer produce calcitriol - the active form of Vitamin D o Inadequate or lacking calcitriol causes demineralization of the bone - bone begins to break down to release the calcium needed for body functioning No longer excrete excess phosphorus (PO4) o Phosphorus is found in most foods and beverages o Increased PO4 levels cause further calcium bone loss 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 homeostasis? - Maintaining a stable internal environment uremia - build up of waste What is a semi-permeable membrane? - A membrane made from protein, with small pores or holes. Only certain molecules can fit through. At what point during the hemodialysis treatment will diffusion cease to occur? - Diffusion will continue throughout the dialysis treatment until the concentration of each electrolyte found in the patient's blood is equal to the electrolyte concentration in the dialysate. What is countercurrent flow? - Blood and dialysate flow in opposite directions What happens to diffusion when dialyzer fibers clot? - 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. What are the compartments of the dialyzer and what separates them? - The blood compartment is separated from the dialysate compartment by a semi-permeable membrane. The blood and dialysate do not mix together. What are three types of solutions? - • 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? - 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, all may be symptoms of dialyzer membrane allergy, or allergy to the sterilant used in the manufacturing process What volume should be used for fresh fill/run off? - 50 ml of saline should be drained from the arterial line and 250 ml should be drained from the venous line When dialyzing a patient, what position should the dialyzer be in during hemodialysis? - Place the dialyzer arterial end up during the treatment. What should be checked on a dialyzer before machine set up? - The dialyzer should be checked for sterility (the dialyzer should either be intact in the original packaging or if out of the package should have all open ports capped), any structural damage and be the size and brand that was ordered by the doctor. What are electrolytes? - Electrolytes are 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: - Sodium (Na+) Potassium (K+) Calcium (Ca++) Magnesium (Mg++) Fluid removed during hemodialysis comes from which body fluid compartment? - During dialysis fluid is removed from the intravascular fluid compartment or bloodstream. What is dialysate? - Dialysate is a non-sterile solution and its function is to remove waste products from the blood and balance electrolytes Dialysate is composed of - treated water, acid solution, and bicarbonate solution What electrolytes are found in the dialysate? - sodium (Na+) potassium (K+) calcium (Ca++) magnesium (Mg++) chloride (Cl-) What is conductivity? - Conductivity is the ability of a solution to transmit or "conduct" an electrical current Name four ways dialysate is checked to ensure that it is safe? - pH, conductivity, monitoring the machine temperature, and a negative residual chlorine (bleach) after routine (weekly) machine disinfection and before the first treatment after the disinfection What is Sodium Variation? - also called sodium modeling is a physician-ordered intervention to help prevent hypotension during dialysis treatment. There are three preprogrammed "profiles" that can be ordered by the physician based on several different comorbidities Why is dextrose added to the dialysate? - Dextrose, a form of glucose, is added to prevent hypoglycemia.