CCHT practice exam

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AAMI Chemical Analysis of water used for hemodialysis is tested
Clean the machine surface immediately
A dialysis technician observes a drop of blood on the surface of a patient's hemodialysis machine. Which of these actions should the dialysis technician take?
About one ounce (30 ml) fluid is on the floor
A dialysis technician observes all of the below on the treatment floor, which one poses an environment risk?
An artery to a vein
A fistula connects
Vitamin B12
A marker used to determine the middle molecule clearance of a dialyzer is
Cations and anions
A mixed- bed DI tank contains
A glomerulus and a tubule system
A nephron is made up of
An infiltration
A patient complains of pain at the venous needle site. The dialysis technician observes there is swelling distal to the venous needle site and that the venous pressure is rising. The dialysis technician should suspect
Dialysis Disequilibrium Syndrome
A patient who is to receive their first dialysis treatment is prone to?
bananas
A patient tells the technician that the dietician reviewed high potassium foods with her. During the conversation she states she routinely eats the following foods. Which one is highest in potassium?
It's a new Federal regulationA reason why a dialysis technician is to be certified isClotting of extracorporeal circuitA rise in transmembrane pressure in a low flux dialyzer during hemodialysis is indicative ofNever document something that someone else didA teammate asks you to document the normal saline he just gave to Mr. Smith. You would:May rupture and cause the patient to bleed profuselyA true aneurysm can be dangerous because itWas the predialysis sample drawn from the venous port?A patient's laboratory results indicate that the predialysis BUN level was lower than the post dialysis BUN level. When interpreting these findings the technician should seek the answer to which of these questions?TachycardiaA rapid pulse of 104 beats/minute would indicate that the patient has:500A patient's dry weight is 154.0 (70kg) and the patient's pre treatment weight is 158.4. (72kg). For a four- hour treatment, how many mL/ hour must the patient lose to reach dry weight?200 CFU/mLAAMI standards for the total microbial count of dialysate shall not exceed:3-5% of EDWAcceptable interdialytic weight gains areLess than two (2) EU/mLAccording to AAMI the standard level for endotoxins levels is4/15/2010According to the new Conditions for Coverage, all dialysis technicians are to be certified by a national certifying agency or state specific certification by:NutritionalAlbumin is an important test that tells about the patient'sVitamin B12All of the following are phosphate binders except:numbness and tinglingAll of the following may be signs and symptoms of an infected access except:The absence of disease producing organismsAsepsis is defined as1,385 mL/hrBased on Mrs Smith's total amount of fluid to be removed, what is the ultrafiltration rate per hour (mL/hr) for her 4 hour treatment?Discard the needleBefore a hemodialysis treatment, the technician removes the cap from the fistula needle and accidentally touches the chair with the tip of the needle. Which of these actions should the technician take first?HemolysisDialysate that is too hot will causeWeight at which the patient has no edema or fluid in the lungs and BP is normalDry weight is defined as theDisconnection of the bloodlineDuring a hemodialysis treatment the technician responds to a low venous pressure alarm. The most likely cause for this alarm is:BloodBiohazardous waste includes any material exposed to:DiffusionDecreasing the patient's prescribed blood flow rate affects the rate ofStop the pumpDuring a hemodialysis treatment, a patient's venous needle infiltrates. Which of these actions should the dialysis technician take first?Between 7.0 and 7.4Dialysate pH should be:Clamp the venous lineDuring hemodialysis, the air detector on Ms. Foster's machine alarms and foam is visible in the venous drop chamber. The immediate action of the dialysis technician should be to:How have you been since your last dialysis treatment?During predialysis data collection, it would be best for the technician to ask the patient which of these questions?Take the patient's temperatureDuring the hemodialysis treatment, a patient complains of feeling chilled. In addition to getting the patient a blanket, which of these actions should the technician take?Notify the equipment technicianDuring the set up of a hemodialysis machine, the alarm test for conductivity fails. Which of these actions should the dialysis technician take?Indicators of the adequacy of the renal replacement therapyESRD specific tests such as BUN, Creatinine, and URR areUltrafiltrationExcess fluid is forced out of the blood and into the dialysate during dialysis by which principlePercent rejectionFeed conductivity- product conductivity divided by x 100 is the formula calculation ofThe ultrafiltration rateFluid to be removed divided by the treatment time tells usInadequate dialyzer primingGermicide rebound occurs due to:Anaphylaxis (severe allergic reaction)Hives, itching, tightness of the chest and respiratory distress may be signs and symptoms of:Cardiac arrestHyperkalemia can lead toHemoglobinIf the extracorporeal circuit clots and it must be discarded, it would be most important to monitor the patient's serum level of:Check dialyzer for total cell volumeIn reuse, the blood path integrity is tested toSubcutaneousLidocaine is administeredHigher hospitalization and death ratesLow albumin levels in the dialysis patient have been linked with:DigoxinMedications that dialyze easily are all exceptPsychomotorMr. Jones demonstrates how to wash his aces. This is an example of which adult learning principle?Milk of MagnesiaMr. Jones suffers from constipation. He goes to the drug store to buy a laxative. Mr Jones should avoid which medication?CognitiveMr. Roberts verbalized how to hand crank his blood pump in the event of an emergency. This is an example of which adult principle?Notify the nurse of the need for an assessmentMrs. Smith arrives for dialysis treatment complaining of shortness of breath. Her pre dialysis weight is 4.7 kilograms above the last post treatment weight. The dialysis technician reweighed and verified the weight. Which of the actions should the dialysis technician take next?5,540 mLMrs Smith dry weight is 62 kg. Her pretreatment weight when she came in for treatment on Monday was 67 kg. The priming saline amount is 240 mL, the rinseback amount is 200mL, fluid from medication is 100 mL, and she is not allowed any fluids during treatment. What is the total amount of fluid weight to be removed during her treatment?Trendelenburg position on left sideMs Foster complains of shortness of breath. While calling for the nurse the dialysis technician notices there is air in the extracorporeal circuit she/he should place Ms Foster in:AirOne reason that normal saline is used to rinse and prime the extracorporeal circuit prior to treatment is to remove:7.0-7.25Normal body pH isTime to matureOne disadvantage of a fistula is an increase inPoor rotation of sitesOne cause of aneurysms and pseudoaneurysms isBlood pump has stoppedThe air detector alarms during treatment. If the machine is working properly, the dialysis technician should expect which of these events to have occurred?Sterilant infusionPain at the venous needle site, along with respiratory difficulty and chest pain could be an indicator of:HypertensionOne sign and symptom of fluid overload isHypo-osmoleSolutions that have a higher similarity than body fluids are called?Numbness and tinglingSymptoms of hyperkalemia (high potassium) may includeBefore treatment, after treatment, and after giving heparinThe accuracy of lab results depends on adherence to proper lab draw technique. You must ensure that labs are drawn:Dialysis Disequilibrium SyndromeShort frequent hemodialysis treatments in patient's with high BUN (blood Urea Nitrogen) are performed to prevent:An infectionPrior cannulation a technician notices the skin over the patient's fistula is reddened and warm to touch. These symptoms are most likely due to:EpogenA medication used to treat anemia isTeammateThe most important monitor in the dialysis setting is:InfectionThe most frequent cause of death in the first year post transplant is:12-20 breaths per minThe normal range of resting respirations in an adult isDiabetesThe leading cause of chronic kidney disease for adults in the United States:24 hoursThe minimum dwell time to achieve sterilization with the chemical Renalin isCleansing of the handsThe most important intervention to prevent the spread of infection isOsmosisThe movement of fluid from the tissue towards a higher concentration of sodium in the blood is an example ofNephronThe functional unit of the kidney, or the structure in the kidney that does the work, is theListening with a stethoscopeThe bruit in a Av fistula or graft is detected byTemperature and transmembrane pressureThe hemodialysis machine continuously monitors many parameters. Which of these parameters must be verified by an external measuring device?65%The National standard, based on the KDOQI (kidney Disease Outcomes Quality Initiative) guidelines, for the Urea Reduction Rate (URR) is a ratio greater than:PeritonitisThe most common complication in Peritoneal dialysis is:PatientThe most important member of the patient care team is theZemplarThe medication used to improve calcium absorption is:6 monthsThe minimum amount of experience required to take the NNCC certifying exam is:1.0 to 1.5 liters per dayThe usual fluid allowance for a person with kidney failure isAAMIThe organization that sets the standards for dialysis water quality is calledPerformance of the dialyzerTotal cell volume (TCV) is an indirect measure of the:Before each patient shift or every four hoursTotal chlorine levels in the water are testedIncrease the rate of waste removalThe purpose of using counter-current flow is toOsmosisWater moves across a membrane from an area of lower solute concentration to an area of higher solute concentration by which principleOperates on the principle of ion exchangeThe water softener80%The TCV should be no less thanEdema and shortness of breathWhat are the typical signs of fluid overloadA thrillTo determine the latency of an arteriovenous vascular access, the dialysis technician should initially feel for the presence ofTransmembrane pressureUltrafiltration is influenced byDiffusionWaste products are removed during dialysis by which principleCalcium and magnesiumThe water softener removesResidual SterilantThe reprocessed dialyzer is carefully rinsed prior to patient use to removeEndotoxinThe part of the cell wall of bacteria that, when released, can cause fever in hemodialysis patient's is:Should point in the direction of the blood flowThe venous needle in an AV fistulaTransmembrane pressureThe total pressure that exists across the dialyzer membrane is calledAluminumThe substance that may be added to the municipal drinking water to make it clearer is:Kt/VWhich of the following is the most accurate measure of dialysis adequacy?BicarbonateWhich of the following component in dialysate is used to correct metabolic acidosis?Kinking of the venous blood lineWhich of the following is most likely to cause a high venous pressure alarm?Hemoglobin/HematocritWhat lab tests are used to monitor anemia in the ESRD patient?CognitiveWhich learning domain is knowledge based?Cranberry juice colored blood in the venous lineWhich of the following is the classic sign of hemolysis?Ice CreamWhich food below is highest in phosphorus?O.9% normal salineWhen fluid replacement is necessary during the hemodialysis treatment, which of the following solutions is used?Elevated hematocritWhich of the following is not a symptom of uremia?Removing too much fluidWhich of the following is a cause of hypotension during and after dialysis treatments?Dialysis quality waterWhich of the following is considered to be safe water for dialysis?18 gaugeWhich of the following is the largest needle?Using a bath that will provide a greater concentration gradientWhich of the following actions would increase diffusion during dialysis?UreaWhich of the following diffuses from the patient's blood during dialysis?HandwashingWhat is the most important activity that the dialysis technician can perform to prevent the spread of infectious disease in the dialysis clinic?2.0 inches apartWhen cannulating. The tips of the needles should be at leastHypotension and crampingWhich of the following symptoms would indicate a need to increase the estimated dry weight (EDW)?2.0Your patient is to receive 2000 units of heparin. The vial you are using is 1000 u/ml heparin. How many mls will you draw up for this patient?An arteriovenous fistulaWhich of these types of vascular accesses has the fewest complications?Tighten all connectionsWhich of the following is used to prevent air in the bloodlines?AAMIWhich organization set the standards and recommendations for dialyzer reprocessing?Venous needle is against the wall of the vesselWhich of the following would cause a high venous pressure alarm?Clotting in the extracorporeal circuitWhich of the following might indicate a need to increase heparin?The patient just had surgery yesterdayWhich of the following might indicate a need to decrease the heparin dose?Ensuring accurate documentationWhich of these technician activities contributes to data collection used to measure quality outcomes?Draw one line through it, date, time, signature/credentials, with the words "error"You have documented incorrectly on a patient's chart. How do you correct this?Phosphorus, potassium, and calciumWhat's the normal lab value?The movement of particles across a semipermeable membrane from an area of higher solute concentration to an area of lower solute concentration, until the concentration on both sides of the membrane is equalWhat is diffusion?The process of passing fluid through a filter or semipermeable membraneWhat is filtration?A medication(synthetic erythropoietin) used to stimulate production of red blood cellsWhat is epogen?2 hoursHow long can a used dialyzer sit out before reprocessing?11 hoursHow long can a reprocessed dialyzer sit out to dry before use?14 daysWhat is a reused dialyzer shelf life?80%What is a reuse dialyzer (TCV) percentageAssociation for the Advancement of Medical InstrumentationWhat does AAMI stand for?BicarbonateThe base used to maintain an acceptable dialysate pH(acid/base balance). A bufferBlood urea nitrogen, the end product of protein metabolismWhat is BUN?A ballooning of the AV fistula, sometimes caused by improper rotation of needle sitesWhat is a aneurysm?dysrhythmiaAn irregular heart beatDyspneaDifficulty breathingEdemaAbnormal accumulation of fluid in the body tissues causing swelling. Fluid accumulated in the interstitial spaceA medication (synthetic erythropoietin) used to stimulate production of red blood cellsWhat is Epogen given for?The circuit "outside body" that carries blood from the patient through dialyzer and back to the patient. The dialyzer and blood lines make up the circuitWhat is extracorporeal circuit?The process of passing fluid through a filter or semipermeable membrane.What is filtration?A tuft of capillaries in the nephron that act as filters to remove waste products, fluid and excess electrolytes from the blood as it passes through the kidney.What is glomerulus?Hematocrit (HCT)The measurement of the percentage of red blood cells in a sample of whole blood. This measure is affected by vascular volume.HematomaA localized mass of clotted or partially clotted blood confined within an organ or tissue, which may be discolored (bruised).Hemoglobin (HB)A protein that carries oxygen from the lung to the body tissue and transports carbon dioxide from the tissues to the lungs.HemolysisWhat is the rupture of red blood cells? ( lysis is cell rupture)HemostasisThe cessation of bleeding due to clotting. In dialysis, hemostasis refers to the cessation of bleeding from a needle site.hyperkalemiaAn excess of potassium in the blood caused by dietary indiscretion, certain medications, internal bleeding, cellular injury or blood transfusion.Muscle weakness, nausea, and vomitingWhat are symptoms of hyperkalemia?HypertensionHigh blood pressure is signs of?Movement of blood from a needle site into the surrounding tissue that occurs when the needle pierces the vessel wall.What is infiltration?Swelling around the insertion site and painSymptoms of infiltration?A mathematical measurement of the adequacy or dialysis treatment, which considers protein intake and the amount of urea removed from the patient.What is kt/v?NephronThe functional unit of the kidneyOsmosisThe movement of fluid across a semipermeable membrane from an area of lower solute concentration to an area of higher solute concentration. Movement occurs until equilibrium is reached:pHThe measure of the acid-base status of a solution. PH stands for potential of hydrogenAn electrolyte necessary for bone formation, energy transfer, andneuromuscular functionWhat is phosphorus?Very thin flexible sheets of material, such as cellophane, with pores that allow smaller particles or molecules to pass through while blocking larger ones.What is semipermeable membrane?A condition caused when the surgical diversion of the arterial blood supply through the vascular access deprives the distal portion of the access extremity of oxygenated blood.What is steal syndrome?A narrowing of blood vessels due to the build up of hypertrophic tissue, anatomical narrowing if the vessels, or surgical technique problems.What is stenosis?Rapid heart beatWhat is Tachycardia?Controlled fluid removal achieved by increasing or decreasing the amount of fluid moves across a semipermeable membrane by controlling hydrostatic pressureWhat is ultrafiltration?A waste product of protein metabolism affected by dietary intake.What is urea?A vitamin that helps the body produce normal size cells with strong cell walls.What is vitamin B-12?A vitamin that, in its active form helps maintain the balance of blood calcium and phosphorus with calcium and phosphorus stored in the bones.What is vitamin D?A slow heart rateWhat is bradycardia?HypertensionOne sign and symptom of fluid overload?OsmosisWater moves across a membrane from an area of lower solute concentration to an area of higher solute concentration by which principle?DiffusionWaste products are removed during dialysis by which principle?UltrafiltrationExcess fluid is forced out of the blood and into the dialysate during dialysis by which principle?OsmosisThe movement of fluid from the tissue towards higher concentration of sodium in the blood is an example ofDiffusionDecreasing the patient's prescribed blood flow rate affects the rate of?Transmembrane pressureUltrafiltration is influenced by11 hoursThe minimum dwell time to achieve sterilization with the chemical renalin is?Residual SterilantThe reprocessed dialyzer is carefully rinsed prior to patient use to remove:Box port behind the machineThe patient's machine alarms blood leak, where would you draw the sample from to determine if there is a blood leak?Pyrogen ReactionWhat causes symptoms of fever and chills?arteriovenous (AV) fistulaWhich of the following types of vascular access has the lowest incidence of infection?HypotentionDuring Mrs. King's hemodialysis treatment, she starts actively yawning. The technician suspects she may be experiencingSalt level in brine tankWhile performing the end-of-day water hardness check, the technician notes that the hardness exceeds the allowable limit. In addition to notifying the equipment technician, the technician should check which component of the water system?A life-threatening conditionChloramine levels in treated water that are in excess of the standards of the Association for the Advancement of Medical Instrumentation (AAMI) could result inSaltA patient is experiencing large weight gains between hemodialysis treatments. The technician should remind the patient that the best dietary measure to control weight gain is to decrease the intake ofNotify the equipment technicianWhen doing a routine patient check, the technician notices a puddle of clear liquid underneath a dialysis machine. After wiping it up, which of these actions, if any, should the technician take?Rope and ladder techniqueA patient has an arteriovenous (AV) fistula in his lower left arm. When choosing a cannulation site, the technician observes where previous needles were placed and chooses to use alternate sites for arterial and venous needle insertion. This practice is an example ofHypertonicA solution with higher osmolarity than body fluid?Call the bio-medIf during a set up, a machine test fails what would be the next step after re-testing?Operates in the principle of ion exchangeWhat does the water softener do?Dialysis Equilibrium SyndromeShortened frequent treatments in patient's with high BUN prevent?1:100What is the ratio for bleach wipes?1:10What is the ratio for bleach clamps?1:10What ratio do you use for blood spills?1:10What is the ratio for bleach water?Numbness and tinglingSymptoms of hyperkalemia?EndotoxinsWhat part of the cell wall when released can cause fever in hemodialysis patients?HemoglobinIf the extracorporeal circuit clots we must monitor the patient's serum level of?Using a bath with a greater concentrationWhich action increases diffusion during dialysis?Residual SterilantDialyzers are carefully rinsed prior to use to remove:HecterolVitamin given to patients by the nurse?Blood electrolyte levelsChanging the composition of the dialysis solution can influence the patient'sRemove the line from the venous line clampBlood flow is manually maintained during power outage. The technician must take which of the following actions?Countercurrent flowThe technician observes that a patient's dialysate lines were incorrectly placed on the dialyzer. The technician corrects the line placement. The principle underlying the technicians' actions is that the clearance is maximized byTreatment timeMrs. Miller's calculated kt/V urea is 0.9 one of the factors that affects her kt/V urea is her?As far apart as possibleIn order to maximize access recirculation. The technician should place Mrs. Miller's fistula needle:Clot formationHeparin is given during Mrs. Miller's dialysis treatment to lower risk forWe need to ensure early detection of needle dislodgementMrs. Miller asks the technician"why can't I completely cover up with a blanket during my hemodialysis"? "I'm cold" which of these responses by the technician would be best?Make sure the blood pump stoppedDuring a treatment, Mrs. Miller's venous needle infiltrates. Which of the actions should the technician take first?It is not permitted by the current ESRD regulationsA patient is busy with a patient when a machine across the room alarms. The dietician standing nearby mutes the alarm. The technician should have which of these understandings concerning this action?StealA patient who recently had an Av fistula placed in the left forearm is experiencing numbness and tingling of the left hand. The patient's left is cold and fingernail beds are blue. The patient most likely had which of of these symptoms?ThrombosisHolding needle puncture sites instead of using spring loaded clamps fistula clamps is recommended to avoid accessDisinfectingThe greatest reduction in microorganism in the dialysis machine is accomplished byTeaching patients how to meet nutrition needsThe role of the renal dietician includesHypotensionDuring Mrs. King's hemodialysis treatment, she starts actively yawning. The technician suspects she may be experiencingFirst- use syndromeA patient who is receiving an initial hemodialysis treatment on a non- reusable dialyzer should be observed for signs ofCreatinineA substance that is cleared from the body by healthy kidney is?Whether other patients are having similar symptomsDuring a dialysis treatment, a patient suddenly develops fever and chills. The initial action that should be taken is to determineAir detectorWhich of the following components of the dialysis machine is designed to protect the patient from bubble/foam?Remove disinfectantOne purpose of priming the bloodlines and extracorporeal circuit pre-dialysis is to?Adequately rinseback as much of the patient's blood as possible at each treatmentWhich of the following actions can the dialysis technician take to help minimize anemia?7 daysThe hepatitis B virus is able to survive on environmental surfaces for as long as:Change the DNA of microbes so they die or cannot multiplyA new technician is being oriented to the water treatment system. The equipment technician explains that the purpose of the ultraviolet (UV) light is to?FallsFor pain management, Mr Rivera is taking narcotic pills as prescribed by his doctor. The dialysis technician knows that taking this medication puts Mr Rivera at increases risk forTime required to matureWhat is a disadvantage of an AV fistula as hemodialysis access compared to other types of access?Prevent prolonged bleedingA patient who has an arteriovenous fistula receives a bonus dose of heparin at the beginning of a hemodialysis treatment and a continuous heparin infusion during the treatment. The patient's heparin administration should be terminated 30-60 minutes before the end of treatment in order toVascular surgeonA patient with a right Av fistula arrives at the dialysis facility complaining of pain, tingling, and cold fingers in his right hand. The technician would expect the nurse will notify which of the following physicians for possible corrective action?No additional precautions are necessary for the patientA patient is diagnosed with hepatitis C beyond standard precautions. What additional measures. If any, should be taken for the patient?You don't have enough red blood cells to carry oxygenA patient tells the technician. "The doctor told me I'm anemic what does that mean"? Which response by the technician would be correct?Two red blood cellsIn hemodialysis, the term anastomosis refers to the connection of?Blood returning to the patientVenous pressure is a result of resistance created by theBefore each patient shiftAccording to the standards of the Association for the Advancement of Medical Instrumentation (AAMI), pre treatment water should be checked for chloramines at which of these times?The patient must receive dialysis in a hospital in a special isolation roomA patient on hemodialysis goes to the emergency department for persistent coughing and fever. He is diagnosed with active tuberculosis (TB) which of the following actions would the technician expect to be taken in regard to the patient's dialysis treatment?Anaphylaxis (severe allergic reaction)Hives, itching, tightness of the chest and respiratory distress may be signs and symptoms of:UltrafiltrationExcess fluid is forced out of the blood and into the dialysate during dialysis by which principle6-8 weeksHow long does it take a Fistula to mature