Hemo Practice Test 1 Hemodialysis Practice Test July 17, 2018 You will have an hour to complete this test. You will have 3 attempts to complete this test. Good Luck! Name Email 1. A system of water treatment that removes pyrogens as well as solutes is called Sediment filtration. Reverse osmosis. Softening. Deionization.2. With regard to the evaluation of a new piece of dialysis equipment ,the LEAST helpful resource would be the manufacturer of the equipment. Unit’s technical support group. Hospital’s biomedical department. FDA Good Manufacturing Practices Act.3. What problem is commonly associated with recirculating system and central dialysate delivery system? Fungus contamination. Gram-positive contamination Excess water-soluble vitamin loss Gram-negative bacterial contamination.4. According to AAMI (not facility standards) standards, how often should the equipment be cleansed? Annually. Monthly. Daily. Bi-weekly.5. What affect will sodium modeling have on a dialysis patient during their treatment? Cause hypotension. Minimize hypotension. Decrease clotting of the kidney. Reduce the length of treatment.6. Evaluation of internal vascular access prior to treatment includes Observation for signs of infection . Auscultating a thrill. Palpating for a bruit. Disinfecting and cannulating before evaluation.7. Chloramines are MOST EFFECTIVELY removed by which of the following components of water treatment system? Ionization Ultrafiltration Activated carbon Reverse osmosis8. A patient is in the 3rd hour of a 4-hour dialysis session when the technician notices the patient yawning. The patient says he feels fine. Which of the following should be the technician’s next action? Advise the patient to take a nap. Reduce the blood flow rate. Check the blood pressure. Report this to the charge nurse.9. Patients with which of the following indicate the need for universal precautions? Hepatitis B HIV or AIDS VRE or MRSA All patients10. In which of the following ways can air enter the extracorporeal circuit? When a single needle devices is used. From air that has accumulated in the bloodstream. If the transmembrane, pressure (TMP) is high causing air to accumulate in the dialysis fluid. From cracked connectors,vented fluid containers, and loose connections.11. The total pressure in the blood circuit is a result of all of the following EXCEPT the Rate of dialysis fluid flow. Blood flow rate controlled by the blood pump. Resistance to flow in the blood circuit. Diameter of the fistula needles.12. A flushed sensation, headache, profound thirst, and vomiting are all symptoms indicating that the dialysate water is high in Aluminum. Zinc. Sodium. Magnesium.13. Which of the following descriptions best defines diffusion? Water molecules moving from an area of low concentration to an area of high concentration until equilibrium is reached. Water molecules moving from an area of high concentration to an area of low concentration until equilibrium is reached. Particles,in solution,moving from an area of high concentration to an area of low concentration until equilibrium is reached. Water movement across a membrane in response to a hydrostatic differential.14. Which of the following are some of the factors that contribute to anemia in a dialysis patients? 1.Clotting of dialyzer. 2. Excess amount of blood drawn for monthly blood work. 3. Low transferring saturation rate. 1 and 2 only. 1 and 3 only. 2 and 3 only. 1, 2 and 3.15. The action that should be taken when an air embolism has occurred during hemodialysis is to place the patient on the Left side in a Trendelenburg position. Left side in a sitting position. back in a Trendelenburg position. Right side in a sitting position.16. Which of the following is LEAST likely to be a common psychological reaction for patients beginning maintenance dialysis? Depression. Denial. Anxiety. Guilt.17. Which of the following substances is OMITTED from dialysate prescriptions? Magnesium. Chloride Phosphorus. Sodium.18. Which statement is true about diffusion: Warm molecules move slower than cold ones. A Hypertonic concentration has a lower level of solutes than in the normal blood. Smaller solutes diffuse quicker and faster than larger ones. A Hypotonic concentration has a higher level of solutes that in the normal blood.19. Commercial heparin is obtained from which of the following? 1.Beef lung. 2.Hog intestinal mucosa. 3.Urea. 4.Sheep lung 1 and 2 only. 1 and 3 only. 2 and 4 only. 3 and 4 only.20. The ultimate responsibility for maintaining water purity levels for water used for hemodialysis lies with the Head nurse. Water systems supplier. Technician. Medical director.21. Checking the bloodlines for kinks or twists as part of patient monitoring helps to prevent hemolysis. Hemolysis can result in Hypernatremia. Hyperkalemia. Hypercalcemia. Hypermagnesinemia.22. Convection is: Solutes cross the semipermeable membrane and drag the solvent. Solvent crosses the permeable membrane and drags big solutes. Solvent crosses the semipermeable membrane and drags small solutes. Solutes cross the permeable membrane and drag the solvent in small amounts. 23. Heparin is used during dialysis to Prevent clotting in the artificial kidney. Minimize intravascular clotting due to immobility. Reduce incidence of muscle cramps. Retard clotting in the limb graft.24. Which of the following are the two most important factors to consider when choosing a dialyzer? Manufacturer and membrane type. Dialyzer size and membrane pore size. Cost and its ability to be reused Durability and UFR25. A dialysis technician in the unit has contracted hepatitis B. The most probable cause would be introduction Of infective secretions into mucosal surfaces. By a contaminated needle. Of infective serum through mucosal surfaces. Of infective serum through an open cut or scratch.26. All of the following statements about hepatitis B vaccine correct EXCEPT that The vaccine provides immunity for years following effective vaccination. The most commonly reported side effects of the vaccine have been local tenderness at the injection site and slight elevation elevation in temperature. The vaccine provides passive hepatitis B immunity. Three doses of the vaccine are required for immunization.27. During the setup of a single patient machine, the conductivity has not come up to safe limits within 15 minutes. In this situation, the technician should investigate all of the following EXCEPT the Concentrate supply. Presence of air in the concentrate line. Actual conductivity of dialysate. Temperature of the incoming water.28. The system in which fresh dialysate is delivered continuously in a counter current flow and achieves a maximum gradient throughout dialysis, is known as an Portable system. Absorbent system. Single pass system. Recirculating system.29. A patient complains of feeling dizzy. The technician notes that the patient is pale and cyanotic, the blood pressure has increased, and respiration have increased in rate and depth. Which of the following does the assessment reveal? Sepsis. Hypoxemia Allergic reaction. Hypoglycemic reaction.30. The dialysis staff should not eat or drink in the dialysis treatment area of laboratory primarily because doing so Causes unpleasant odors Is unprofessional Is upsetting to patients May spread infection31. Which of the following is the first thing that a technician should do when initiating a dialysis treatment and burning sensation occurs? Notify a charge nurse. Dial 911. Notify a physician. Discontinue the treatment immediately.32. A patient reports for dialysis with complaints of generally feeling poorly.Patient assessment reveals an elevated apical scattered railes, and 2+ jugular venous distension.Which of the following complications may be anticipated during the dialysis treatment? Cramping nausea, disequilibrium syndrome Angina,hypotension,headache Fever,itching,anaphylaxis Dyspnea,hypotension,cramping33. Which of the following is the most important to monitor to ensure safety during dialysis treatment? The dialysis technician. The temperature monitor. The pre-pump pressure alarm. The blood leak alarm.34. While performing blood procedure and monitor checks,the technician notices that a patient’s bloodlines look like “cherry soda” .The patient feels like something bad is going to happen and becomes short of breath and panicky.Which of the following should the technician suspect is happening ? Clotted blood lines High serum postassium Visual hemolysis Nervous anxiety35. The appropriate level ultra filtration rate of control in today’s high efficiency hemodialysis therapy is achieved by Calculation of the target dry weight of the patient. Using sodium modeling. Control of volumetric flow rates in and out of the hemodialyzer. Measuring uremic toxin removal.36. A patient whose serum calcium and phosphorus levels are in the low-normal range is started on IV vitamin D3 therapy (Calcijex).The technician should expect the patient’s Calcium to increase Calcium to increase and the phosphorus to decrease. Calcium and phosphorus to increase and the PTH to decrease. PTH to increase.37. When using negative pressure dialyzing systems in cold climates,what factor must be considered to prevent frothing, false-positive alarms in a blood leak detectors,and a masking of the dialyzer surface area? Adequacy of deaeration. Chloramine levels entering dialyzer Bacteria per milliliter in a dialyssate Temperature of water entering kidney machine38. Careful rinsing of reused the dialyzer prior to its being used for a patient is done primarily to remove Residual blood. Bacteria. Cellular deposits. Residual disinfectant solution.39. All of the following might improve blood flow in central venous catheter (CVC)EXCEPT Having the patient cough. Re-positioning the patient. Rotating or further inserting the catheter. Reversing the bloodlines.40. A patient complaints of a cold hand, especially the fingers.The technician should tell the patient it may be caused by Damaged nerves from fistula construction. Excessive fluid gain. Elevated sodium levels. Poor blood flow to the hand from fistula construction.41. Of the following substances is OMITTED from dialysate prescriptions? Magnesium. Chloride. Phosphorus. Sodium.42. Volume loss in a reused hollow fiber dialyzer can cause a significant reduction of the dialyzer’s efficiency. Which of the following is defined as the maximum acceptable loss? 20% 40% 60% 80%43. Whithin the first hour of treatment, a patient complains of chills, hypotension, and there is a discolored blood returning to the patient. The technician should suspect Air embolism Excessive fluid removal Pyrogen reaction. Elevated potassium levels.44. A patient complains to a technician that during his most recent dialysis he underwent a great deal of pain due to a co-worker’s venopuncture technique. The technician’s most constructive response to this patient would be to Inform the patient that he has the right to refuse venopuncture by the new technician Listen to the patient’s concerns and inform the head nurse. Tell the new co-worker of the patient’s complaint and suggest that the co-worker request to be excused from this patient’s treatment. Inform the patient that this technician is new and is sure to improve with practice.45. A practical method for determining the direction of flow in a fistula or graft segment is to Listen with a stethoscope over the fistula. Lightly palpate the vessel at two different points. Occlude the flow with one finger and determine on which side of the occlusion there is a pulsation. Insert needles in two different directions and observe the rates of blood flow.46. The most effective treatment for muscle cramping during dialysis treatment is to inject a bolus of Hypertonic saline into the injection port on the venous blood line. Hypertonic saline into the blood line through the arterial injection port. Dextrose 25% into the blood line through the venous injection port. Dextrose 25% into the blood line through the arterial injection port.47. Conductivity meter all function on the ability to Combine either iodine electrode of the meter. Pass an electrical current through the dialysate. Deflect the needle due to increased viscosity of the fluid. Change color when titrated against nitric acid.48. Recent laboratory results have been placed in the patient’s chart. The KT/V results are 1.0. Which of the following is the significance of these results? The patient is adequately dialyzed. The dietitian should be notified to review the patient’s diet. The patient treatment should be reduced. The treatment time needs to be extended.49. Using Schiff reagent,the acceptable residual formaldehyde level in a rinsed reused dialyzer is 0.0 ppm. 0.5 ppm. 1.5 ppm. 3.0 ppm.50. When cannulating a graft, the staff should use 10-15 degree angle. 20-30 degree angle. 35-45 degree angle. 46-50 degree angle.