Davita Final Exam 2022
Per The centers for disease control prevention, which is the most common factor contributing to bacterial infections in dialysis
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- ANS-The use of catheters in hemolysis
You are assisting a patient to step on the scale by holding the patients hand such as casual contact - ANS-Does not require to wear gloves but must preform hand hygiene
Per the centers for disease control prevention, which is the most important route by pathogens are transmitted in health care setting including dialysis
- ANS-Contact transmission
The signs that numbing has taken effect and it is time to stop spraying topical anesthetic on the vascular access cannulation sites is when
- ANS-You observe blanching of the skin
which is the primary device for purifying the water used in dialysis
ANS-reverse osmosis
what complications would you expect to see if a patient is exposed to chlorine/chloramines - ANS-hemolysis
cynthia missed treatment on saturday and returns the following tuesday for her next scheduled treatment. She complains of feeling weakness in her legs. David, a PCT gets a wheelchair for her, helps her weigh in, and brings her back for the nurse to assess prior to starting her treatment. Which patient complication would you the PCT and Rn suspect Cynthia is most likely suffering from - ANS-Hyperkalemia
In the event of patient experiencing a siezure, the dialysis treatment should be
ANS-Discontinue if the seizure is severe or the patient does not respond to treatment
Per Davita Policy, fever is defined as
- ANS-Any temperature greater than 100° F or increase over baseline of 2°F with symptoms
Interventions for a patient complaining of chest pain
- ANS-Decrease blood flow rate, decrease ultrafiltration rate, administer H2O, take vital signs
What problem will cause a more positive (less negative) pre pump arterial pressure - ANS-Separation of blood tubing from arterial access
What is an important action prior to returning patients blood using the hand crank in the event of a power failure
- ANS-Remove the venous line from the clamp line
Knowing what caused your patients renal failure
ANS-is important to identify possible problems during data collection and assessment
a patient with acute kidney injury (AKI) dialysis in the out-patient facility. IN regards to the patients target weight, why is being "wet" better than being too dry?
- ANS-Being wet helps avoids hypovolemia and hypotensive episodes
Ultrafiltration is defined as
- ANS-controlled fluid removed by manipulation of hydrostatic pressure
Why is meticulous hand hygiene so important in healthcare?
- ANS-its the single most important intervention in preventing HAI's
What should be done to the heparin infusion line if a patient does not have maintenance heparin prescribed?
- ANS-Clamp & Knot the heparin line
When is a pre treatment assessment by the licensed nurse required? check all that apply
- ANS-When it is mandated by state law ( pre-treatement vs within 1 hour after start of tx) , when What are three things you should NOT include in a Risk Event Management (REM) report? - ANS-
Personal Opinons, speculation, vendettasw
The nephrologist has prescribed a 400 blood flow rate (BFR) for your patient. You would expect the physician order to also include - ANS-15 gauge needle for this prescribed BFR
You listen to you patients arteriovenous graft (AVF) and hear a whistling sound - ANS-This could be an indication of outflow stenosis
To prevent the formation of aneurysms and pseudoaneurysms the following should be practiced -
ANS-Good needle site rotation and complete needles site clotting techniques
The nephrologist has ordered the use of hemostatic sponges, such as SureSeal, for your patient. What is the correct procedure when using these sponges? - ANS-Remove the hemostatic sponge after hemostatis has been achieved and dress the needle sites with sterile gauze or band aid
The Urea Reduction Ratio calculates - ANS-The amount of urea removed during the dialysis treatment
Which of the following factors would decrease the K of the Kt/V formula ? - ANS-Inadequate anticoagulation
What steps are preformed to replace fluid removed and prevent clotting during the re circulation of blood in the extra corporeal circuit when there has been treatment interruption (i.e. patient using the restroom? - ANS-The saline infusion line is opened and if the patient is receiving an intradialytic heparin infusion via the dialysis machine: the heparin pump remains on
The waiting time after administration of the initial heparin loading does prior to initiation of hemodialysis is - ANS-3-5 minutes
What must be completed prior to medication preparation ? - ANS-Put on PPE and perform hand hygiene, visually inspect ampules and vials for cracks, leaks, discoloration, or particulate matter including checking the expiration date
Water and dialysate cultures are drawn every month in the dialysis unit to monitor - ANS-bacteria & endotoxins
Intra-renal causes of Acute Kidney Injury - ANS-Sepsis, trauma, anaphylaxis, drugs, acute glomerulonephritis
The excretory functions of the kidneys include - ANS-fluid balance,electrolyte balance, waste removal and acid base balance
Acid concentrate replaces the excretory function of normal kidney function by - ANS-normalizing electrolytes
The endocrine functions of the kidneys are - ANS-Renin and erythropoietin secretion, activation of vitamin D
The dialysis prescription, nursing assessments, interventions and follow ups help us to provide the highest quality treatment for every patient, every time. Despite our efforts, dialysis replaces only ___ percent of normal kidney function - ANS-15%
Which statement is true about sinks used for hand washing? - ANS-handwashing sinks must be dedicated for handwashing purposes only and should remain clean
The most common infectious complication for hemodialysis patients is - ANS-vascular access infection
What is one method surveyors use to verify infection control training and education ? - ANS-
Documentation of infection control training in teammates file or transcript
Which infectious disease requires frequent hand washing instead of using alcohol based hand gels? - ANS-active clostridioides difficile infection (c-diff)
Per the centers for disease contorl and prevention (CDC), which is the most important route by which pathogens are transmitted in health-care settings including dialysis centers? - ANS-contact transmisson
V-tags for centers for medicare & medicaid services (CMS) surveys state specific regulations to be met within a condition such as infection control, provide interpretive guidance for each regulation, and cite deficiencies by tag number. How can knowledge of these V-tags affect the practice of patient are providers - ANS-provide patient care within CMS conditions for coverage, understand rationales for specific regulations as outlined in the interpretive guidance , assist in the development of policies and procedures
If your facility dialyzers Hepatits B positive patients, which assignment would NOT be an appropriate patient care assignment? - ANS-caring for HBsAG positive & Hepatitis B susceptible patients at the same time
Upon completing machine set up and before treatment initiation it is important to verify the prescription and machine settings: - ANS-To confirm patients unique prescription parameters are programmed correctly into the dialysis delivery system, To validate that all safety features are enable, functioning correctly, and within acceptable limits
What type of blood/dialysate flow within the dialyzer increases the rate of diffusion providing optimal dialysis for patients? - ANS-counter-current flow
A PCT greets a patient and the patient reports feeling short of breath. The PCT notices that the patient's lips are a blue hue. The PCT would: - ANS-not start treatment, immediatly notify the nurse
In those states that do not require a nursing assessment to be completed prior to treatment initiation, the PCT would be required to report abnormal patient data collection findings - ANS-to the nurse before treatment initiation
For patients with Acute Kidney Injury (AKI) which statement is correct? - ANS-a nursing assessment prior to treatment initiation is always required
How do you verify that the patient is stable and safe for discharge after the dialysis treatment? - ANS-PCTS notify the nurse if there are any unusual findings, nurses perform a post treatment assessment as required, evaluate the effectiveness of the treatment by comparing data to predialysis findings
The patient is using a central venous catheter (CVC) for dialysis and has a new arteriovenous fistula
(AVF) present in his lower arm. What observation/assessment should you perform for the AVF? -
ANS-checking for the bruit and thrill every treatment day
Can you document patient vital signs under another teammate already signed into the computer? - ANS-No- Log into the computer system under you credentials and document
Per DaVita policy for a patient that can stand a post treatment blood pressure reading of _______ is considered an abnormal finding and should be reported to a licensed nurse. - ANS-Standing systolic BP greater than 140mm/hg or less than 90 mm/Hg, Standing diastolic BP greater than 90 mm/Hg or less than 50 mm/Hg
When documenting patient care, it is important to include all of these except - ANS-a confrontation between two patients
Documentation in the medical record - ANS-provides data from continuity and planning of patient care
All documentation on machine setup and pre-treatment patient information - ANS-must be entered into the computer before the treatment is initiated
Post treatment data collection and assessment is performed - ANS-after the treatment is terminated
The PCT notes that a patient still has considerable edema in her legs when performing the post treatment data collection. IN addition to informing the nurse, what should the PCT document? - ANS-Document the noted swelling and that the RN was informed
What statement is true regarding the "Reasonable and Prudent" standard of care? - ANS-when supervising patient care technicians and other non-licensed personnel,it is the responsibility of the licensed nurse to ensure these teammates also meet the standards
Performing a procedure "your way" rather than following the dialysis facility's policies and procedures (P&P) - ANS-can lead to personal and/or organization liability in the event of an adverse patient outcome, inaddition to survey citations and risk regardless of whether an adverse
The maximum ultra-filtration (UF) rate should not exceed _____ because it may lead to hypotension episode which increases the risk of organ stunning or mortality. - ANS-13mL/k/hr
To assist in survey readiness you should - ANS-know and follow policies and procedures, be accountable and take initiative, live out our mission and core values
A surveyor asks you a question. Which of the following statements would be a good answer? - ANS-i do not know the answer but i will find out
Teammates MUST be able to readily identify patients who may require additional assistance in the event of an emergency evacuation. This will include patients who need help with or are unable to - ANS-complete the emergency take off procedure, evalute in safe and timely manner due to impairment
Per physician order and based on indivuals patients needs, Chronic Kidney Disease Mineral & Bone
Disorder (MBD) is treated with - ANS-phosphate binders, vitamin D and cinacalcet
Poor wound healing is directly related to - ANS-inadequate protein intake
Phosphate binders are prescribed to prevent phosphorus in meals from being absorbed. When is the best time to take them ? - ANS-with a meal
The definition of Health Literacy is - ANS-The degree to which individuals understand basic health information
If you notice that a patient's caretaker is struggling to meet the demands of the patient's treatment regime you should - ANS-Notify the social worker because he/she is there for patients and their familes
The Psychosocial Assessment completed by the social worker: - ANS-is completed initially and annually
The Clinical Pyramind includes: - ANS-The fundamentals, complex programs and quality of life
DaVita Quality Index (DQI) success is achieved - ANS-managing individual patients first & allowing scores to follow, knowing each team members role is improving DQI scores, use of the continous quality improvement process to help identify trends and makes improvements
What can be the most likely result if the surveyor sees a patient with a covered vascular access? - ANS-an immediate jeopardy
Which of the following is a sign of hemolysis - ANS-cherry red colored blood in venous line
A recommended intervention for muscle cramps is - ANS-turning the ultrafiltration rate (UFR) off
The patient position used for a suspected air embolism is - ANS-trendelenburg, on left side
Your immediate intervention for a patient experiencing an anaphylactic reaction is - ANS-stop the blood pump, discontinue the suspected therapy, do not return the blood
What is the most likely reason for a blood leak detector alarm during re circulation? - ANS-air bubbles in the dialysate or a dirty sensor
What is an appropriate intervention's with an air/foam detector alarm? - ANS-Look at the circuit, do not return blood with air in system,fix problem
What will cause a more negative pre-pump arterial pressure? - ANS-kinking of the arterial blood line between the vascular access and arterial monitor
If clotting occurs in a high flux dialyzer, the transmembrane pressure (TMP) will - ANS-decrease
What could be the reasons for a conductivity alarm on the dialysis machine? - ANS-absense of concentrate or incorrect concentrate preparation , debris or precipitate in the lines or filter, equipment failure or machine needing calibration [Show Less]