Final Version of Davita test, questions and answers with rated solutions

Final Version of Davita test, questions and answers with rated solutions what treatment factors decrease K in the Kt/v to decrease? not waiting 3-5 minutes after heparin, decreasing BFR, DFR, and BVP what factors influence "V" in Kt/v accurate data entry by nurses in snappy, sex age, weight, and amputation what are the needle gauges and prescribed blood flow rates? they are inversely related 17g 200-250 15g 250-350 15g 350-400 14 g 400 - 450 what is the procedure for post BUN lab draw? if pt wants off early, still draw the labs and educate patient about the risks. Redraw next time a pt runs full tx to show pt difference what lab draw mistakes would falsely increase Kt/V not waiting the full 15 seconds What is important when monitoring weight and BP in AKI patients? keep patients wet (hydrated) and avoid hypotensive episodes = cause renal ischemia What do you need to consider in regards to CVCs? follow P&P b/c the risk of infection is so high Why is it important to know what caused a patients chronic renal failure? we need to know about possible problems during data collection and assessment What is the role of the PCT prior to tx initiation? assessment of pt if any abnormal findings or if the pt is in an acute condition what happens in the BP cuff is the wrong size loose BP--> high reading tight BP --> low reading why is it so bad to squeeze the BP cuff if its connected to the machine? it can damage the internal BP mechanism Why is it so important that we document in the medical record? it provides data for continuity and planning of care when do pre-treatment data collection and assessment take place? collection: before tx assessment: w/in 1 hr if pt is stable when is post-treatment data collection and assessment performed? post treatment-- not before treatment or when they are disconnected what are the consequences of poor or incomplete documentation can open attack on your care What are the six items needed in charting meds? 1. med/dosage 2. date/time 3. route 4. reason (remember this!) 5. pt response 6. signature What are the 5 Ws to be used when completing an AOR? who what when where why how What are the 4 consequences of sodium loading during dialysis? 1. increased thirst 2. increased fluid intake 3. increased intradialytic weight gain = htn 4. increased UFR what is the purpose of UF profiling? change the way fluid is remodeled during the tx and allows for vascular refilling what are the consequences of hypovolemia during tx? attempting to remove a lot of fluid --> hypovolemia during tx --> loss of renal function, ischemia, and increased mortality rate what must the machine's conductivity and pH reading supposed to be? machine and manual conductivity: w/in +/-0.4 pH range: 6.9 - 7.6, measured to verify acid/base balance is in acceptable range at what temperature does hemolysis occur? 42 degrees C What do we do in a power outage? remove venous line from air detector, clamp, before starting hand crank and be diligent in watching for air in blood lines what causes a high venous pressure alarm? kink in tubing, clotting in venous drip chamber, infiltration, venous stenosis what are the risks of doing things "your way" and not the P&P way? it can lead to civil liabiliy what makes dialysis pts more susceptible to healthcare acquired infections? prolonged access to pts blood, and immunocompramised why are dialysis pts at an increased risk for acquiring HAIs at the facility? contact transmission what is the most common transmission route for HAIs contact transmission--> hands what is the most important invention you can do to prevent HAIs? handwashing what is the most common infectious complication in hemodialyisis pts? per the CDC, the most common factor contributing to bacteremia is use of CVCs What germ causes the most common infections in hemodialysis pts? MRSA which can remain on surfaces for days w/ plastic vinyl being most favorable to their survival why is wearing gloves so important? decrease risk of hand contamination and prevent transfer of organisms already on hands what is the correct procedure in regards to your hands when you have causal contact w/ a pt no gloves but must perform hand hygiene before care on pts Successful lab draw must knows follow order the lab draws to prevent specimen from being contaminated w/ other tube additives, double labeling tubes prohibits processing rules for spinning samples only spin tube of some kind of size and fill level and should be placed opposite of each other What are the symptoms of hyperkalemia? extreme muscle weakness abnormal HR, cardiac arrest what are the symptoms of hypokalemia? fatigue, muscle weakness, respiratory failure what is the primary cause of erythropoietin? primary cause how can you prevent contributing to blood loss? --adequate heperanization --ensure epo given -- completely rinse back blood --avoid repeat lab draws what is pericarditis? what is included in its treatment? w/ dialysis hold or decrease heparin systemic effects of CRF what should you do for a pt that complains of dry, itchy skin use hyperfatted soaps and lotions what should you do for a pt that complains of peripheral neuropathy? educate pt not to walk barefoot, frequent foot checks, check temp of bathwater What are the four key elements affected in CKD-MBD Ca2+ PO4 parathyroid hormone vitamin D what are the symptoms of CKD-MBD in addition to bone disease? soft-tissue calcification what is the best way to help pts successfully change behaviors? inspire behavior change through support, compassion, and empathy What does DARN stand for? desire, ability, reason, need FYI from Meghan: know the questions at the end of the motivational interviewing hand out (one of the PCTs at Red Hawk told me this_) fyi when should the communication style "directing" be used? best used when training to perform procedures what are the three core communication skills to be used w/in the communication style? asking listening informing what is the righting reflex? automatic intervention of a healthcare practitioner who observes pt doing something detrimental to his/her health What is reflective listening? includes main aspects of what the pt said during the entire communication what are the four transport mechanisms that play a role in hemodialysis? ultrafiltration convection diffusion osmosis what is important when monitoring pt weight and BP? keep patients wet and avoid hypotensive episodes b/c it can cause kidney injury what do you need to consider in regards to their vascular access? follow P&P to prevent infections why is it important to know what caused your patient's CRF? to inquire about possible problems during data collection and assessment how often do we screen for Hep C? yearly for patients and teammates tips to remember for successful lab draws 1) follow order of lab draws to prevent specimens from being contaminated with other tube additives 2) double labeling tubes prohibits processing rules for spinning samples only spin tube of same kind, size, and fill level and should be placed opposite of each other systemic effects of CRF what would you advise for a pt who complains of dry, itchy, skin hyperfatty soaps and lotions systemic effects of CRF- what would you advise for a patient who complains of peripheral neuropathy? no walking barefoot, check water temp before baths what would you advise for a patient who complains of psychological problems? depression, brain fogginess what are the foru key elements affected in CKD-MBD Ca2+ Phosphorus Calcitrol Parathyroid what are symptoms of CKD-MBD in addition to bone disease? soft tissue classification what is your role in CKD-MBD in addition to bone disease? soft tissue calcification what is your role in CKD-MBD management? pt education how much normal kidney function is replaced by HD? 15% What does DARN stand for? D-- desire A-- ability R-- reason N--need One component of the directing style is: a) being in charge b) seeing through the other person's eyes c) understanding through listening a) being in charge One component of the following style is a) eliciting behavior through patient's own insights and motivations b) giving instructions c) understanding through listening c) understanding through listening One component of the guiding style is a) allowing to sort things out in one's own time b) being a knowledgeable resource c) expecting compliance b) being a knowledgeable resource The three core communication skills used in motivational interviewing are? a) monitoring, persuading, advising b) explaining, comprehending, adapting c) inquiring, directing, following d) asking, listening, informing d) asking, listening, informing The four guiding principles in motivational interviewing can be remembered by the acronym a) GUIDe b) RULE c) PRINce d) MOTIv b) RULE The righting reflex is defined as the automatic intervention of a healthcare practitioner who observes a patient doing something detrimental to his/her health The EPE (elicit-provide-elicit) approach allows the healthcare professional to work with the patient and emphasizes patient's active involvement in his/her own healthcare Summarizing during reflective listening a) recalls the patient's resistance statements to change and summarizes reasons for change b) summarizes strategies for change based on the practitioners expertise c) includes main aspects of what the patient said during the entire communication d) includes the practitioners opinion of what the patient said during the entire conversation a--> not 100% sure but pretty sure The best way to help patients successfully change behaviors is to a) scare them through describing serious health risks of the current behavior b) inspire behavior change through support, compassion, and empathy c) tell them how to accomplish the desired change d) list medically sound reasons why change is necessary b) inspire behavior change through support, compassion, and empathy Which of the following statements is NOT an underlying assumption of self management? a) regardless of the chronic condition, people have similar challenges with self-management b) people can learn the skills needed to better manage their diseases day to day c) people with complex chronic conditions such as ESRD have more difficulties with successful self-management d) people who understand and take control of their condition will be healthier and happier c) people with complex chronic conditions such as ESRD have more difficulties with successful self-management Which of the following is a basic principle of patient self-management? a) focusing primarily on dialysis prescription and adherence to treatment b) dealing with the consequences of illness, rather than just the physical disease c) taking on responsibility of the medical management of the illness d) allowing care providers to help with the day-to-day management of the disease b) dealing with the consequences of the illness, rather than just the physical disease Andragogy takes into account a) that adults desire to take responsibility for what they learn b) that adults are more set in their ways and need more direction than children c) the adults recognize the instructor's expertise and responsibility for the curriculum d) that adults depend on the instructor's instructions when learning complex skills a) that adults desire to take responsibility for what they learn Motivational Interviewing a) is based on the healthcare provider's motives to assist patients in making good healthcare decisions b) allows healthcare providers to motivate patient's to making better healthcare decisions c) assists healthcare providers in confronting patients harmful beliefs d) helps healthcare providers understand the patient's concerns and perceptions about living with ESRD d) helps healthcare providers understand the patient's concerns and perception about living with ESRD The definition of health literacy includes a) the degree to which individuals understand basic health information b) the degree to which individuals are knowledgeable in healthcare terminology c) the degree to which individuals an perform appropriate self-care d) the degree to which individuals understand their rights and healthcare consumers a) the degree to which individuals understand basic health information healthcare professionals can help patients with low health literacy by: a) asking patients if they can read before giving them written instructions b) organizing information so that the most important points stand out and repeating this information c) asking simple questions that a patient can answer with a "yes" or "no" b) organizing information so that the most important points stand out and repeating this information Educational tips for visual learners include: a) providing soft background music b) using lively hand gestures when delivering long lectures c) allowing plenty of time for the patients to talk d) selecting quiet surroundings d) selecting quiet surrounding Educational tips for auditory learners include: a) providing background music of the patient's choice b) incorporating the patient's secondary learning style c) using word associations and mnemonics d) minimizing use of written materials c) use word association and mnemonics educational tips for kinesthetic learners include: a) taking short breaks allowing your patient to get up and walk around b) allowing the patient to doodle during long lectures c) using outlines, pictures, graphs, charts, and diagrams whenever possible d) letting the patient watch videos a) take short breaks and allow your patients to get up and walk around What is the 2-4-8 rule for teaching patients complex skills? 2 hours: maximum length of uninterrupted training 4 hours-- maximum total of training per day 8 days-- minimum number of training days Organ donation in the US adheres to a) the "opt-in" principle b) presumed consent a) the "opt-in" principle Which of the following is NOT a task of organ procurement organizations a) recover the organ from deceased organs for transplantation b) collaborate w/ health care professionals to approach families of potential organ donors c) manage the national transplant waiting list, matching donors to recipients d) educate the public about organ donation I think it's b, but I'm not completely sure