FRESENIUS RN STUDY GUIDE UPDATED EXAM QUESTIONS
AND ANSWERS GRADED A+
✔✔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
✔✔What to assess during patient safety checks? - ✔✔Bleeding
Arterial pressure
Venous pressure
Bloodlines for kinks
Color of the blood
Blood flow rate (BFR)
Ultrafiltration (UF) rate and fluid volume removed (FVR)
Position of the dialyzer
Access is not covered
Patients face is visible
**Venous and arterial chambers are filled to the appropriate level
,✔✔Patient assessment during pre-treatment: - ✔✔Ambulation status
Mental status
Changes in condition
Pre-weight
Blood pressure
HR
Respirations
Edema
GI status
Skin color
Access evaluation
Hospitalizations since last treatment
New complaints or life changes
Cramping
✔✔Patient assessment during treatment: - ✔✔Current time of eval/assessment
Blood pressure
BFR/DFR
Safety checks
AP/VP
Fluid removed/administered
Access check - connections and site visible
Hemosafe device attached to CVC
Patient overall status
Interventions and patient response
Change in dialysis prescription
✔✔Patient assessment post treatment: - ✔✔Ambulation status
Mental status
Changes in condition
Post weight
BP
Temp
HR
Respirations
Edema
Any new complaints
Access eval
Presence of a thrill
Condition of dressing
Escort patient to scale and waiting room
✔✔Steps for treating an infiltrated access: - ✔✔Stop dialysis, turn off blood pump and
clamp blood lines
Notify RN
, Disconnect blood lines from fistula lines and recirculate blood per procedure. Flush non
infiltrated needle with normal saline.
If infiltration happened after heparin administration, cap end of needle and secure,
remove at the end of treatment. Apply ice once secured. (if infiltration continues to
enlarge or patient is in extreme pain, pull the needle and apply pressure for 10 minutes
and notify nephrologist. If possible, next cannulation should be above the infiltrate.
Instruct patient to apply ice for 24 hours and watch for complications.
✔✔When should conductivity and pH of dialysate be checked? - ✔✔Prior to the
initiation of every treatment.
✔✔Air Embolism Treatment - COLT - ✔✔Clamp venous line - prevents additional air
from getting to the patient.
Off with the blood pump - Pressure will build in lines with the venous clamp clamped.
Turning off the blood pump stops this.
Left side positioning - Air rises, so positioning the patient on the left helps prevent air
from entering the heart.
Trendelenburg - Placing the patient in this position helps prevent air from entering the
heart, brain and lungs.
*** Additionally administer oxygen and give CPR if indicated ***
✔✔Advantages of a AV Fistula - ✔✔Uses the patients own vessels
Requires one anastomosis
Longer life span
Decreased rate of complications
Collateral circulation develops
✔✔Disadvantages of AV Fistula - ✔✔Length of time to develop - generally 1-4 month
Isometric exercises may aid in development
Lower blood flows are sometimes necessary when the fistula is immature; results in
poor clearance
Collateral circulation develops
✔✔Why would placement of an AV Fistula be difficult? - ✔✔Patients with co morbid
conditions such as diabetes, hypertension, poor circulation, and obesity make
placement more difficult.
Aneurysms can develop as a result from cannulating the same areas too often.
✔✔What is always required with a AV Fistula? - ✔✔A tourniquet
✔✔Advantages of an AV Graft - ✔✔Large surface area for cannulation
AND ANSWERS GRADED A+
✔✔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
✔✔What to assess during patient safety checks? - ✔✔Bleeding
Arterial pressure
Venous pressure
Bloodlines for kinks
Color of the blood
Blood flow rate (BFR)
Ultrafiltration (UF) rate and fluid volume removed (FVR)
Position of the dialyzer
Access is not covered
Patients face is visible
**Venous and arterial chambers are filled to the appropriate level
,✔✔Patient assessment during pre-treatment: - ✔✔Ambulation status
Mental status
Changes in condition
Pre-weight
Blood pressure
HR
Respirations
Edema
GI status
Skin color
Access evaluation
Hospitalizations since last treatment
New complaints or life changes
Cramping
✔✔Patient assessment during treatment: - ✔✔Current time of eval/assessment
Blood pressure
BFR/DFR
Safety checks
AP/VP
Fluid removed/administered
Access check - connections and site visible
Hemosafe device attached to CVC
Patient overall status
Interventions and patient response
Change in dialysis prescription
✔✔Patient assessment post treatment: - ✔✔Ambulation status
Mental status
Changes in condition
Post weight
BP
Temp
HR
Respirations
Edema
Any new complaints
Access eval
Presence of a thrill
Condition of dressing
Escort patient to scale and waiting room
✔✔Steps for treating an infiltrated access: - ✔✔Stop dialysis, turn off blood pump and
clamp blood lines
Notify RN
, Disconnect blood lines from fistula lines and recirculate blood per procedure. Flush non
infiltrated needle with normal saline.
If infiltration happened after heparin administration, cap end of needle and secure,
remove at the end of treatment. Apply ice once secured. (if infiltration continues to
enlarge or patient is in extreme pain, pull the needle and apply pressure for 10 minutes
and notify nephrologist. If possible, next cannulation should be above the infiltrate.
Instruct patient to apply ice for 24 hours and watch for complications.
✔✔When should conductivity and pH of dialysate be checked? - ✔✔Prior to the
initiation of every treatment.
✔✔Air Embolism Treatment - COLT - ✔✔Clamp venous line - prevents additional air
from getting to the patient.
Off with the blood pump - Pressure will build in lines with the venous clamp clamped.
Turning off the blood pump stops this.
Left side positioning - Air rises, so positioning the patient on the left helps prevent air
from entering the heart.
Trendelenburg - Placing the patient in this position helps prevent air from entering the
heart, brain and lungs.
*** Additionally administer oxygen and give CPR if indicated ***
✔✔Advantages of a AV Fistula - ✔✔Uses the patients own vessels
Requires one anastomosis
Longer life span
Decreased rate of complications
Collateral circulation develops
✔✔Disadvantages of AV Fistula - ✔✔Length of time to develop - generally 1-4 month
Isometric exercises may aid in development
Lower blood flows are sometimes necessary when the fistula is immature; results in
poor clearance
Collateral circulation develops
✔✔Why would placement of an AV Fistula be difficult? - ✔✔Patients with co morbid
conditions such as diabetes, hypertension, poor circulation, and obesity make
placement more difficult.
Aneurysms can develop as a result from cannulating the same areas too often.
✔✔What is always required with a AV Fistula? - ✔✔A tourniquet
✔✔Advantages of an AV Graft - ✔✔Large surface area for cannulation
