DaVita Final Exam – Hemodialysis Transport Mechanisms and Core Concepts Review
Explain the four transport mechanisms that play a role in hemodialysis - correct 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 - correct answer To normalize electrolytes, remove
wastes, provide fluid and nutrient balance
What is the function of the acid concentration - correct answer Provides the concentration
gradient for diffusion and helps normalize electrolytes
What is the function of bicarbonate - correct answer Buffers the acid concentrate
Signs and symptoms of hyperkalemia - correct answer > 5.5 mEq: extreme muscle weakness,
abnormal heart rhythm, possible cardiac arrest
Signs and symptoms of hypokalemia - correct answer < 3.5 mEq: fatigue, muscle weakness,
paralysis, respiratory failure, cardiac instability, arrhythmias, cardiac arrest
What are the kidneys endocrine functions - correct answer Renin secretion, Erythropoeitin
secretion, Vit D Activation
How do we replace normal endocrine kidney functions - correct answer Provide medications
How much of normal kidney function is replaced by hemodialysis - correct answer 15%
What is uremia and how does it affect the body? - correct 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? - correct answer Diabetes
Hypertension
Polycystic Kidney Disease
,DaVita Final Exam – Hemodialysis Transport Mechanisms and Core Concepts Review
Outline the treatment goals for a patient with CKD - correct 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 - correct answer So the nurse and
PCT can inquire about possible problems during data collection and assessment
Why is sodium balance important? - correct answer Leads to volume expansion, increased
cardiac output, increased peripheral vascular resistance, and increased blood pressure
Signs and symptoms of fluid imbalance - correct 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 - correct 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 - correct answer Left
ventricular hypertrophy
What is Percarditis? - correct answer Inflammation of the membrane (pericardial sac) around
the heart
What is a common cause of hypertension in dialysis patients - correct answer fluid overload
Left ventricular hypertrophy leads to - correct answer Ischemic heart disease, arrhythmia,
myocardial infarction, and sudden death
Why are dialysis patients anemic? - correct 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 -
correct 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) - correct answer
1. Calcium
2. Phosphorus
, DaVita Final Exam – Hemodialysis Transport Mechanisms and Core Concepts Review
3. PTH
4. Vitamin D (Calcitriol)
What are the symptoms of CKD-MBD in addition to bone disease - correct 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 - correct answer *report symptoms * urge patients
to take meds (home & treatment)
*report noncompliance problems related to nonadherence
Define the term AKI - correct 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 - correct 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 - correct 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 - correct
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 - correct answer Patients will
typically have a dialysis catheter, be careful to avoid catheter related infections
How do you protect kidneys from further injury - correct answer Avoid substances to the
kidney which may be toxic (radiographic contrast, amphotericin
B, low dose aspirin, NSAIDS)
Explain the four transport mechanisms that play a role in hemodialysis - correct 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 - correct answer To normalize electrolytes, remove
wastes, provide fluid and nutrient balance
What is the function of the acid concentration - correct answer Provides the concentration
gradient for diffusion and helps normalize electrolytes
What is the function of bicarbonate - correct answer Buffers the acid concentrate
Signs and symptoms of hyperkalemia - correct answer > 5.5 mEq: extreme muscle weakness,
abnormal heart rhythm, possible cardiac arrest
Signs and symptoms of hypokalemia - correct answer < 3.5 mEq: fatigue, muscle weakness,
paralysis, respiratory failure, cardiac instability, arrhythmias, cardiac arrest
What are the kidneys endocrine functions - correct answer Renin secretion, Erythropoeitin
secretion, Vit D Activation
How do we replace normal endocrine kidney functions - correct answer Provide medications
How much of normal kidney function is replaced by hemodialysis - correct answer 15%
What is uremia and how does it affect the body? - correct 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? - correct answer Diabetes
Hypertension
Polycystic Kidney Disease
,DaVita Final Exam – Hemodialysis Transport Mechanisms and Core Concepts Review
Outline the treatment goals for a patient with CKD - correct 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 - correct answer So the nurse and
PCT can inquire about possible problems during data collection and assessment
Why is sodium balance important? - correct answer Leads to volume expansion, increased
cardiac output, increased peripheral vascular resistance, and increased blood pressure
Signs and symptoms of fluid imbalance - correct 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 - correct 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 - correct answer Left
ventricular hypertrophy
What is Percarditis? - correct answer Inflammation of the membrane (pericardial sac) around
the heart
What is a common cause of hypertension in dialysis patients - correct answer fluid overload
Left ventricular hypertrophy leads to - correct answer Ischemic heart disease, arrhythmia,
myocardial infarction, and sudden death
Why are dialysis patients anemic? - correct 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 -
correct 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) - correct answer
1. Calcium
2. Phosphorus
, DaVita Final Exam – Hemodialysis Transport Mechanisms and Core Concepts Review
3. PTH
4. Vitamin D (Calcitriol)
What are the symptoms of CKD-MBD in addition to bone disease - correct 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 - correct answer *report symptoms * urge patients
to take meds (home & treatment)
*report noncompliance problems related to nonadherence
Define the term AKI - correct 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 - correct 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 - correct 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 - correct
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 - correct answer Patients will
typically have a dialysis catheter, be careful to avoid catheter related infections
How do you protect kidneys from further injury - correct answer Avoid substances to the
kidney which may be toxic (radiographic contrast, amphotericin
B, low dose aspirin, NSAIDS)
