Final Exam DaVita (RN) questions and answers latest 2023

Final Exam DaVita (RN) questions and answers latest 2023 When dialyzing a patient with acute kidney injury, one task of the patient care teammates is to monitor blood pressure and weight closely. Why is it important? hypovolemia and hypotensive episodes can cause renal ischemia and can further damage the kidneys CKD can have its orgin pre-renal , intra-renalm or post renal. Which of the following conditions is an intra-renal cause of CKD HTN Knowing what caused your patient's CKD is important because the underlying disease could cause health complications that can impact the dialysis treatment When a PCT documents the extent of a patient's edema, for example as +3 the PCT is preforming an assessment which is not allowed legally When a patient has an irregular heartbeat, the automatic BP reading may not be accurate Which of the following is a data collection HR 72 at what time should the post treatment data collection be completed after the treatment has been completed the A in smart communication stands for actual- just report the facts which of the following events is defined as a near miss the wrong dialyzer was set up and primed for a patient, but it was caught before dialysis was initiated and the dialyzer was replaced using the __________ approach is one way to fill out an REM SBAR What is your main priority when returning a patient's blood with the hand crank during a power outage? you must be vigilant in watching for air in the blood lines what problem will cause an increase in the patient's VP a clot in the venous drip chamber Which blood test must be performed at regular intervals on patients susceptible to HPB HBsAg who is accountable for appropriate patient and teammate scheduling in the acute setting ... you are dialyzing a patient and the only available HPB surveillance test is a HBsAb of 8. What are the machine disinfection requirements after dialyzing this patient? the machine must be heat disinfected at the end of each day What is the most common factor contributing to bacteremia in dialysis patients? use of catheters for HD which infectious disease requires frequent hand washing instead of using alcohol based hand gels active clostridioides difficile infection What precautions must be used when handling lab specimens? universal precautions waiting only five seconds between lowering the blood pump speed and drawing the post treatment blood sample could cause the post treatment BUN reading to be falsely low (wait 15 seconds) which may cause a decrease in the hemoglobin of a patient with ESRD infection/inflammation fluid overload and HTN lead to LVH, this means hypotensive episodes are more likely to occur during the dialysis treatment your role in CKD-MBD management includes reminding the patient who is eating a snack during dialysis to take his phosphate binder your role in anemia management includes rinsing back as much of the patient's blood as you can at the termination of each treatment the licensed nurse has delegated a specific task to a PCT, but the PCT gets called away before performing this task. Can the PCT asek another PCT to take over? no, a task delegated by the licensed nurse to a non-licenced teammate cannot be re-delegated by this teammate the licensed nurse delegated a task to the PCT, Nicole, but Nicole has not performed this task during the last 2.5 months. What is Nicole's responsibility in the delegation communication process? Nicole is to inform the nurse that she performed the task only infrequently what is the nurse's responsibility in the delegation supervision process? to determine the level of supervision needed and to monitor the NAP's performance of the task accordingly the transport mechanism when particles move from an area of higher solute concentration to an area of lower solute concentration is called diffusion during dialysis, the movement of bicarb from the dialysate into the blood helps normalize body pH the kidneys excretory functions include normalizing electrolytes what distance should be observed between needle tips and away from each other when cannulating an internal vascular access? 1.5 inches the nephrologist has ordered 16 gauge needles and a 400 BFR for your patient. You ask the nephrologist to order a 15 gauge needles for the ordered BFR your patient prefers two places on her AVG to insert the needles because they hurt a lot less than when you cannulate different sites. You tell the patient inserting the needles into the same small area can over time damage your graft what is the appropriate intervals for total chlorine testing? prior to the first patient shift and within every 4 hours what is acceptable limit for total chlorine in the water leaving the carbon filter 0.1 or less which is the primary device for purifying the water used in dialysis the RO ICEBOAT? 2 Identifiers Consent valid Equipment is functioning Hep B status Orders are complete Access is patent Documentation is timely ? any questions/concerns Your patient complains of ringing in the ears, being nauseated and having cold clammy skin. The most likely causes is Hypotension What is a likely cause for dysrhythmias? Hypotension, heart disease, or rapid changes in K In what position should you place a patient who experiences intradialytic hypotension? Supine What do you do for a patient with an air emblolism? Clamp lines, put patient on left side, Trendelenburg, attempt to aspirate the air, administer O2 per MD, monitor VS closely, initiate CPR if needed, notify code team Why is thirst control and limiting interdialytic weight gains a shared responsibilyt between the healthcare team and the patient? Caregivers can contribute to Na loading during dialysis causing an increased thirst and fluid intake between treatments Preventing hypotensive episodes during dialysis treatment is important because they are associated with a higher mortality rate The mortality risk for patient who experience two or more episodes of intradialytic hypotension per week increases to 70% which condition may impair a patient's increase in pulse rate as a response to hypovoilemia autonomic neuropathy a patient's protein status is affected by nutritional and non-nutritional factors. what can you do to prevent a drop in your patient's albumin? prevent HAIs Calciphylaxis (soft tissue calcification) is a consequence of which out or range labs? Ca, PTH, Phosphorus How do phosphate binders work? they prevent the phosphorus in food from being absorbed when taken with meals The method to protect against infection by pathogenic microorganisms when preparing and administering medications is called aseptic technique Why must you wait 3-5 minutes after administering the initial heparin bolus before initiating treatment? takes 3-5 minutes for heparin to become systemic When do you take PO4 binders? with meals and snacks #1 thing we do patient safety Conductivity acceptable rrange 13-15.5 and +/- 0.4 of the machine pH of dialysate 6.9-7.6 blood pH 7.35-7.45 When is the RO checked? before the first patient and every 4 hours afterwards Bicarb lasts for how long once opened? 24 hours Acid lasts for how long when opened? 30 days if additives discard after treatment lifespan of a RBC for dialysis patient 60 days Ultrafiltration fluid passing thru a membrane Convetion solute being dragged across the semipermeable membrane Diffusion particles from high to low concentrations Osmosis fluid from lower to higher concentration How much air can cause a patient harm? 10mL What is the solution of bleach to clean up a spill? 1:10 2 independent nursing functions patient care and technical skills 2 common routes for CVC infection into cath via contact of the insertion site and via cath lumen- scrub the hub for 60 seconds each limb Most common cause for CKD in USA DM What is the percent of kidney function lost before going on dialysis 75% HD replaces what percent of kidney function 15% What is the direct result of intravascular fluid overload HTN Patient with cardiac disease are 10x more likely to develop intra HTN LVH Offer a patient of this is an example of oral sodium loading broth this electrolyte is often elevated with patients with severe itching phosphorus kidneys regulate BO by realeasing renin hormone stimulated in bone marrow production erythropoeitin Excess of this electrolyte causes slowing of the hearts electrical system k mucosal alteration in the stomach of patients with AKI can lead to this anorexia what is the inflammation aroudn the heart called pericarditis restless leg syndrome is a complication of peripheral neropathy measures the RBC by weight HgB what is the diminished quality and quality of RBC anemia what is classified as bone disease associated with renal failure CKD-MBD the vitamin converts vit d into which hormone Calictrol these procedures can causes significant blood loss in our patients access procedures maintaining a normal serum Ca levels are the primary function of this hormone PTH this disease is the leading cause of death at all stages in CKD cardiac this skin color is associated with the decrease circulation of RBC from secondary anemia pale it is important to use this team approach when dealing with psychological patients multidisplinary What is the reason for a meerCAT audit to prepare for survey readiness one thing to improve CAT audit scores practice good hand hygiene one thing to improve meerCAT score store look-a-like, sound-a-like products appropriately Why is the order of lab draw important samples in subsequent tubes are not contaminated with additives from the previous what do you want the level of albumin to be >4 if drawing labs during dialysis how do you label them? DRAWING DURING DIALYSIS BUN lab draws post dialysis turn off or decrease UR to 50 decrease DFR to 300 or place machine in bypass reduce BFR to 100 wait 15 seconds for AVG/AVF and CVC (WAIT 15 seconds!!) Obtain from A Line Why is drawing the correct amount for blood cultures improtant too much blood may create a false positive When do we test Hep B need to have it every 28 days drawn for negative and susceptible, if negative and immune every 365 days. if unknown draw patient Rule of 6 is good for? new AVF to guide what is LOOK LISTEN AND FEEL? assessment without needles inflow stenosis is with AVF, venous stenosis, water hammer pulse outflow stenosis with AVG, whistling sound How do you identify disinfectant infusion is happening burning or pain at that access site What do you do for disinfectant infusion? stop pump, clamp lines, DO NOT RETURN blood, O2, NS via A Line and collect blood specimens what is hemolysis destruction of RBC what is S/S of hemolysis anxiety, restlessness, n/v, dyspenea, chest tightness, hyperkalemia, blood will look cranberry what do we do for hemolysis stop treatment, clamp lines, DO NOT RETURN BLOOD, assess patient, draw labs, obtain samples for hypotonic dialysate, check dialysate temp, give o2 what are s/s of air embolism dyspnea, coughing, chest tightness/pain, cyanosis, confusion, visual disturbances hypotension a drop in BP by 20 decrease in MAP by 10 if pre SBP less than 90 drop of 10 with symptoms