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PCT Practice Exam3
| Question | Answer |
|---|---|
| What are some Key Concepts of The "Reasonable & Prudent" Standard of Care for Nephrology Nursing. | Provides evidence based guidance. Meets CMS' Conditions for Coverage (CfC). Complies with state & federal laws. |
| What are the risks of performing activities your way? | Not providing safe evidence based care can lead to civil liability |
| Why do we document? | Proof care was rendered. Provides data for continuity and planning of patient care. Communication tool. Permanent Legal Record |
| What does SMART stand for? | Simple: keep message clear and simple. Meaningful: think about what and why you are sending the message. Actual: just report the facts. Read: make sure you are sending the message you intend. Teach: others about SMART communication |
| What is the difference between data collection and assessment? | Assessment: determining depth of edema. Rate, rhythm, quality of heart sounds. Respiratory rate, difficulty, identifying unusual sounds. Data collection: noting the presence of edema. Heart rate and rhythm. Respiratory rate, recognizing unusual sounds. |
| What is the role of the PCT prior to treatment initiation? | Complete data collection and PCT must notify the RN if there are any abnormal findings prior to initiation of Tx. |
| Poor or incomplete documentation may be discarded if unable to be read, True or False? | False |
| What is the normal pre-treatment blood pressure? | Systolic equal to or less than 180mm/Hg or equal to or greater than 90mm/Hg and diastolic less than 100mm/Hg |
| What is the normal heart rate range? | 60-100 |
| What is a normal temperature? | Less than 100 degrees F or 37.8 C or less than 2 degrees F over baseline (pre-treatment temperature reading) |
| The 3 words DaVita uses in order to easy recall the pre-treatment AVF/AVG access evaluation are? | Look, Listen, Feel |
| How is Target Weight determined? | Determined via Physicians order. You may not adjust the TX retroactively |
| Who determines Target Weight? | TW is the physician-prescribed weight post-dialysis that the patient can safely and reasonable achieve. |
| When can Target Weights be modified? | TW should be modified by the physician based on patient's tolerance, ongoing signs of fluid overload, and changes in fluid status. Must be adjusted in a timely manner so that the physician's most recent order is taken into account for each treatment. |
| How do you calculate interdialytic weight gain? | Pre weight-last post weight |
| How do you calculate UF goal? | Pre weight-Target weight +NS prime & rinse back + Oral intake & infusions = UF Goal |
| How do you calculate the hourly UFR? | UF Goal divide by Tx Hours = UFR/hr |
| What are the consequences if a patient is consistently fluid overloaded (hypervolemia)? | LVH Increased CVP Hypertension Increased Mortality Pulmonary Edema Increased Hospitalization rate |
| What are the consequences and risks of hypovolemia during the treatment? | Attempting to remove large amounts of fluid can lead to hypovolemia during Tx which increases mortality, Ischemia and damage to vital organs (organ stunning). Loss of residual kidney function |
| What is the difference between an AVF and an AVG? | AVF: Connection of the patient's native artery to native vein AVG: Uses artificial or biological material & requires 2 connections |
| Describe the four AVF evaluations for maturation based on the KDOQI Rule of 6's? | 600ml flow through access (on Doppler) 0.6cm in depth under the skin 0.6cm diameter (width of pencil) 6-8 weeks post-op maturation (some AVF will take longer- however notifying vascular surgeon is essential if access is not maturing) |
| Beginner Cannulator: | Less than 6 months experience or less than 10 successful cannualtions |
| Intermediate Cannulator: | 6 months experience cannulation of AVF & 10 successful cannulations |
| Advanced Cannulator | Has completed all competencies for NFACT training, expert cannulation skills documented and can determine if rule of 6's have been met. |
| Recommended needle Gauge and max BFR for a new AVF initial cannulation? | 17 gauge 250 BFR |
| When and how do you use of One needle? | As per physician order. Use arterial needle in AVF/AVG and use CVC venous limb to return blood to patient. |
| When must a tourniquet be used? | Use to help engorge fistula and stabilize vessel for cannulation-it should not impede overall blood flow to limb and take care when using on individuals with compromised or thinner skin (elderly) |
| How do we evaluate blood flow? | Determine the direction of access flow by gentle manual compression at the mid-point of the access. If unable or unsure of flow direction, do not cannulate. Notify licensed nurse of access status for follow -up. |
| What's site rotation? Healing time? | 14 days - rope ladder method Rotation of sites needed to promote healing |
| Needle insertion angles: AVF? AVG? | AVF: 25 Degrees AVG: 45 Degrees |
| Why is flipping the needles not necessary and what are the potential complications? | Flipping needles not necessary because arterial needle has back eye- flipping needles causes coring of access and can lead to increased bleeding and damage to access (scarring) |
| How far do the needle tips need to be from anastomosis? | 1.5 inches |
| How far do the needle tips need to be from one another? | 1.5 inches |
| Needle removal angle? | same angle as insertion (also follow manufacturer recommendations) |
| When to apply pressure? | When needle is completely removed |
| Use of clamps? | Need order, one clamp at a time, and must ensure blood flow |
| Use of hemostatic sponges? | Require order and must be removed prior to patient discharge |
| Complication meaning of BESTIPS? | Bleeding Erosion Stenosis Thrombosis Infection Pseudoaneruysm/Aneurysms Steal Syndrome |
| Per DaVita P&P what medication can't a PCT administer? | Oxygen |
| At what time are medications containing a preservative discarded? | 28 days , 21 for Epogen |
| What size needle with the appropriate sized syringe should be use when drawing up heparin? | 21 Gauge by 1 inch |
| How long do we wait after administering the heparin bolus prior to treatment initiation? | 3-5 mins |
| How do you verify your needle is not in the access when administering lidocaine? | Aspiration (pull back) on the syringe plunger |
| If a heparin is contraindicated during a dialysis treatment the nephrologist may order a formulary exception of Citrasate or Citra Pure dialysate to be used as part of anticoagulation therapy true or false? | True |
| What does Tramp stand for? | Time Route Amount Medication Patient |
| The two reasons for water treatment are: Patient safety Prevent equipment damage True or False? | True |
| Water Contaminant: Aluminum causes what type of patient symptoms? | Anemia, bone disease, N&V |
| Water Contaminant: Chlorine causes what type of patient symptoms? | Hemolysis |
| Water Contaminant: Calcium & Sodium causes what type of patient symptoms? | Hypertension |
| Water Contaminant: Calcium & Magnesium causes what type of patient symptoms? | Muscle Weakness |
| What is the primary purification device? What does the RO Remove? | Ro. Organic and Inorganic materials, bacteria & endotoxins |
| What are the two concerns with using DI tanks? | They exhaust quickly. When exhausted they dump/release previously removed ions back into the water. |
| What removes chlorine/Chloramines? | Primary and Secondary Carbon Tanks/Filters |
| What do you do if the total chlorine levels are too high after the Primary Carbon tank? | Repeat, check after 2nd tank |
| If post-second tank levels are within limits, how often do we monitor? | Q 30 minutes and document |
| If post-second tank levels become too high, what do we do? | Stop dialysis! |
| Water softener- Hardness Testing: | Calcium & Magnesium is removed. For RO protection. Tested at End of day. |
| Air embolism | Stop blood pump, clamp arterial/venous blood lines & access lines. Call for help. DO NOT RETURN BLOOD TO PATIENT. Place patient in Trendelenburg position on left side |
| Renin and Erythropoietin Secretion, Activation of vitamin D: Are these Excretory or Endocrine functions of the kidneys? | Endocrine Functions |
| Fluid balance, electrolyte balance, waste removal and acid base balance. Are these Excretory or Endocrine functions of the kidneys? | Excretory Functions |
| LVH leads to? | Intradialytic hypotension. Ischemic heart disease. Arrhythmias. Myocardial infarction. Sudden death |
| Sepsis, trauma, anaphylaxis, drugs & Acute Glomerulonephritis are examples of: | Intra-renal causes of AKI |
| What are some causes of a more negative pre-pump Arterial Pressure? | Clamped lines. Kink in the arterial line between the vascular access and arterial monitor. Clot. Increased blood pump speed. Needle placement |
| What is the dialysate flow pattern that increases the rate of diffusion? | Counter-Current flow |
| What % is considered an excessive IDWG? | Greater than 5% of the TW |
| Patients should be educated to take their phosphate binders when? | With all meals and snacks |
| Clotting of a high flux dialyzer will cause the TMP to? | Decrease |
| What are the symptoms of an elevated potassium? | Extreme muscle weakness and an abnormal heart rhythm |
| What is albumin (protein) needed for? | It's essential for growth, health maintenance, preventing infection, wound healing and anemia management |
| Good needle site rotation and complete needle site clotting techniques prevent which 2 vascular access complications? | Prevents the formation of aneurysms and pseudoaneurysms |
| What is the required length of time to perform scrub the hub of a CVC? | 15 seconds |
| True or False: Hypotension & Hypovolemia are associated with an increased mortality rate? | True |
| What are the interventions for a patient experiencing Chest Pain? | Decrease BFR(150ml/min) and UFR, take vital signs and administer Oxygen |
| For a patient experiencing an Anaphylactic Reaction, what should you do? | Stop the suspected therapy. Stop the blood pump. Discontinue treatment. DO NOT RETURN THE BLOOD |
| True or False: The RO (reverse osmosis) is the primary device for purifying water used in dialysis? | True |
| For a patient experiencing a seizure, why would you discontinue the dialysis treatment? | If the seizure is severe or the patient does not respond to intverstions |
| When listening to your patient's access a whistling sound could indicate what type of stenosis? | An outflow stenosis |
| What is health literacy? | Knowledge of basic medical info |
| On a survey, a covered access can result in which type of deficiency? | Immediate Jeopardy |
| If your patient does not receive a Intradialytic Heparin infusion, what should be done with the Heparin Line? | Clamp and knot the line |
| What is considered an abnormal post treatment BP for a patient who can stand? | Standing systolic BP greater than 140mm/Hg or less 90mm/Hg Standing diastolic BP greater than 90mm/Hg or less than 50mm/Hg |
| In a dialysis patient, this is the most common type of infectious complication: | Vascular Access Infections |
| Of the 3 different types of Vascular access (AVF, AVG & CVC), which one is the most common factor contributing to bacterial infections in the dialysis patients? | Central Venous Catheters (CVCs) |
| The most common route by which pathogens are transmitted in a healthcare setting? | Contact Transmission |
| What is the single most important intervention in preventing HAIs? | Hand Hygiene |
| What are the 2 times you must use soap and H20 to perform hand hygiene and not use hand sanitizer? | When hands/gloves are visibly soiled. When caring for a patient with an active C-Diff infection |
| This test is performed monthly on Hepatitis B susceptible patients. | HbsAg-Hepatitis B surface Antigen |
| What is the recommended maximum UFR/hr? | 13ml/kg/hr |
| How long does the RO need to run before performing a chlorine/Chloramine test? | 15 mins |
| What is the 1st response to a final water quality alarm? | Place all machines into bypass |
| What are some reasons for a machine conductivity alarm? | Equipment failure. Debris or precipitate in the lines or filter. Absence of concentrate or incorrect concentrate preparation. |
| What is the acceptable Total Chlorine testing limits? | 0.1 ppm |
| Cherry red colored blood in the venous line is a sign of which patient complication? | Hemolysis |
| What does the Urea Reduction Ratio (URR) calculate? | The amount of urea removed during the dialysis treatment |
| Osmosis: | Fluid moves form lower solute concentration to higher solute concentration |
| Diffusion: | Particles move from an area of higher solute concentration to an area of lower solute concentration |
| Convection: | Solutes dragged across the semipermeable membrane along with fluid |
| For an AKI patient- Why is being "wet" better than being too dry? | Being wet helps avoid hypovolemia and hypotensive episodes |
| How long do you wait after lowering the blood pump speed before drawing the post treatment Kt/V | 15 seconds |
| What are the kidney's excretory functions? | To normalize electrolytes, remove wastes, provide fluid and nutrient balance |
| How do we replace normal excretory kidney functions? | by normalizing electrolytes and providing fluid balance through ultrafiltration |
| What is the function of the acid concentrate? | Provides the concentration gradient for diffusion |
| The function of the bicarbonate in the dialysate solution is to buffer the acid concentrate: True or False? | True |
| What is the function of the bicarbonate when it diffuses into the patient's blood? | Normalizes body pH |
| Signs and symptoms of Hyperkalemia: | Extreme muscle weakness, abnormal heart rhythm and possible cardiac arrest. |
| Signs and symptoms of Hypokalemia: | fatigue, muscle weakness, paralysis, respiratory failure, cardiac instability, arrhythmias and cardiac arrest |
| What is the normal blood pH range? | 7.35-7.45 |
| What are the kidney's endocrine functions? | Renin secretion, Erythropoietin secretion, vitamin D activation |
| How do we replace normal endocrine kidney functions? | Provide Medications |
| How much of normal kidney functions is replaced by HD? | 15% |
| What is Uremia and what does it affect? | Uremia is the buildup of wastes in the blood due to kidney failure and it affects all body systems |
| What are the most common causes for CKD in the USA? | Diabetes. Hypertension. Polycystic Kidney Disease |
| Signs and symptoms of Fluid imablance? | Hypertension. Edema. Shortness of Breath |
| Why is sodium balance important? | Leads to Volume Expansion-Increased CO-Increased peripheral vascular resistance increased BP |
| What does hypertension lead to? | Left Ventricular Hypertrophy (LVH) |
| What is the condition that is an inflammation of the membrane (Pericardial Sac) around the heart called? | Pericarditis |
| How is Pericarditis treated? | Treatment is to hold the heparin or reduce the dose, based upon physician orders. Give more frequent dialysis |
| List some ways you can prevent contributing to blood loss. | Ensure Epogen dose is correct and administered, rinse back until venous line is pink tinged, and avoid repeat lab draws |
| How often are machine alarm test performed? | Before initiation of each patient treatment |
| How long can dialyzer be set up for once recirculation is complete? Why can't it remain set up longer? | 2 hours. It can grow bacteria |
| The manual conductivity value must match +/-_ _ _on the Fresenius (FMC) dialysis delivery system displayed conductivity | 0.4 mS |
| What is the safe dialysate pH range? | 6.9-7.6 |
Created by:
Villaneday