Dialysis Technician Exam Study Guide – Flashcards
180 test answers
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What are the hemodialysis treatment options?
answer
In-Center, Nocturnal, Short Daily
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What development in dialysis came first?
answer
Dr. Kolff's rotating drum
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What is the definition for dry-weight?
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Post-dialysis weight at which all or most excess fluid has been removed
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How are clinics paid by Medicare for dialysis?
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Composite Rate
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The primary cause of the anemia of ESRD is:
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Erythropoietin Deficiency
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What isn't a component of the Extracorpeal Circuit?
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Blood Leak Detector
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What waste product of muscle metabolism is removed by healthy kidneys?
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Creatinine
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What line is a negative pressure?
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Arterial
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What is the leading cause of chronic kidney disease for adults in the U.S.?
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Diabetes
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What are the symptoms of puritis?
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Itching
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Why must water used for dialysate be treated?
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Dialysis patients are exposed to large volumes of water during dialysis
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What is the U.V. light and what does it do?
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Invisible radiation that destroys microorganisms
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Which patients may benefit from an increased bicarbonate concentration?
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Poorly compliant with regards to fluid intake
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If an air embolism occurs, how should a patient be placed?
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Trendelenberg on the left side
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What symptom is "cherry pop" colored blood?
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Hemolysis
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When does first-use syndrome usually appear?
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15-30 minutes of starting treatment
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What are the two main types of dialysis?
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Hemodialysis & Peritoneal Dialysis
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What is the functional unit of the kidney, or the structure in the kidney that does the work?
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Nephron
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Severe chest pain and dyspnea are symptoms of what?
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Air Embolism
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What are the symptoms of first use syndrome?
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Back pain 15 minutes into treatment
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What are symptoms of anemia?
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Weak, Syanotic, Dizzy
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What are three signs or symptoms of an access infection?
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Drainage, Fever, Swelling
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What is the pressure across the dialyzer membrane?
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TMP -Transmembrane Pressure
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What are the symptoms of an air embolism?
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Shortness of breath, Coughing, Confusion
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What is a long-term complications of a fistulae?
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Thrombosis
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What are the symptoms of a pyrogen reaction?
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Fever, Chills
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What are the symptoms of disequilibrium syndrome?
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Headache
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What would a rapid pulse of 104 beats per minute indicate?
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Tachycardia
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What does infiltration mean?
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A needle tip that punctures a vessel and goes out the other side, so blood escapes into the tissues
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According to AAMI standards, when should bacteriologic testing for water and dialysate take place?
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Monthly
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What is the first step in the port/catheter pre-dialysis assessment?
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Assessing the ease of heparin removal and saline flushing before connecting bloodlines
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What would be a cause of hypotension during and after dialysis?
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Removing too much fluid
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How frequently should the carbon tanks be checked for chlorine and chloramines?
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Each shift
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What complication can happen to grafts if the needle sites are not rotated?
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Pseudoaneurysm
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What can cause a dialyzer membrane leak?
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Any damage to the dialyzer
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What is included in the dialysate delivery system monitors?
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Conductivity, pH, Flow Rate
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What is the measurement of ions or particles that carry an electrical charge known as?
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Conductivity
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Who must check the dialyzer to verify quality control information?
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Two people, one of whom should be the charge nurse
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What symptom occurs due to dialysate that is too hot?
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Hemolysis
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What activity does the water softener perform?
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Removes calcium and magnesium from water
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What is a way to prevent infection in catheters?
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Wash hands and change gloves prior to touching the catheter
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Which organization sets the standards and recommendations for dialyzer reprocessing?
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AAMI
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What substance may be added to municipal drinking water supplied to make the water cleaner?
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Bleach
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What is dialysate a mixture of?
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Acid, Bicarbonate, Water
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Why should you rotate needle sites on a fistula?
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To prevent aneurysms
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What is the most likely source of staphylococcus aureus?
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Nasal drainage or Discharge
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What could large amounts of aluminum in water used for dialysate cause?
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Bone Disease
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What are sign and symptoms of Steal Syndrome?
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Pale, Bluish nail beds of the access hand. Cold feeling in access limb. Pain in access limb (hand or fingers)
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What are symptoms of hemolysis?
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Bright red colored blood
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What are some complications of "flipping" the needle in AVF cannulation?
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Infiltration, Stretching the needle hole, Tearing the lining of the vessel
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What is the condition that can develop from using the subclavian vein for catheter placement?
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Central Venous Stenosis
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When assessing a fistula or graft, what needs to be felt prior to starting dialysis?
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Pulse and Thrill
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Contamination of water by bacteria endotoxins may cause what reaction?
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Pyrogenic
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When drawing a blood specimen from a double lumen catheter, what should the clinician always do?
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Discard the first 4-5 ml of blood before obtaining the sample
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What medication is used to prevent blood from clotting in the extracorporeal circuit?
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Heparin
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What is oxygen carrying red pigment of red blood cells?
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Hemoglobin
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What is a severe loss of blood?
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Exsanguination
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What is low blood sugar?
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Hypoglycemia
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What can misuse of mishandling result in?
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Illness, Injury, Death
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What is a symptom of Hypotension?
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Yawning
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How far should needle insertion be done from the anastomosis in a fistula or graft?
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One inch
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What is high phosphorous?
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Hyperphosphatemia
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To determine the amount of urea removed from a patient during a specific dialysis treatment, what tests are needed?
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Pre-BUN, Post-BUN, URR
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What is a symptom of Disequilibrium Syndrome?
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Headache, Restlessness
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What can the development of bacteria in bicarbonate concentrate lead to?
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Pyrogen Reactions and Innfections
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What is the normal range of resting respirations in an adult?
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12-20 breaths per minute
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What happens when molecules of dissolved solute are dragged along?
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Convection
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What is high potassium?
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Hyperkalemia
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What is the breakdown of red blood cells with a concurrent loss or liberation of hemoglobin and large amounts of potassium?
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Hemolysis
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When assessing a fistula or graft, what needs to be listened for prior to starting?
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Bruit
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What is Hypoglycemia?
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High Blood Sugar
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How long can Hepatitis B Virus survive on surfaces?
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One Week
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What should be done to prevent needle sticks?
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Throwing used needles into puncture-resistant, color coded containers
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If the dialysate conductivity moves outside the pre-set limits, what will occur within the dialysate delivery system?
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Dialysate will bypass to drain. Audio and visual alarms
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How often should the RO operating parameters be checked?
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Daily
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What is low calcium?
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Hyocalcemia
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What is the most common way that water treatment systems are disinfected?
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Chemical
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What is the most important activity that you can perform to prevent the spread of infectious diseases?
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Hand Washing
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What is Hyponatremia?
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Low Sodium
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What method kills bacteria, but will not destroy all of them completely?
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Dissinfection
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Why are dialyzers mainly reprocessed?
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Reprocessing reduces the cost of dialysis treatments
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What is the empty bed contact time of chlorine tanks?
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5 minute/tank
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What is low phosphorous?
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Hypophospatemia
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What is molecular weight?
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How big the holes are
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Blending valve keeps water at what temperature?
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77 Degrees
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What is Hypercalcemia?
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High Calcium
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What prevents water from going back out?
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Backflow Prevention Valve
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What is dialysate buffered to?
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Helps regulate the patients pH
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What is a step of the CQI process?
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Implement the PDCA Style
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What is high sodium?
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Hypernatremia
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What is the most common cause of pruritus in patients?
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Hyperphosphatemia or Uremia
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What is a transducer protector?
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A device inside the machine that converts air pressure into an electronic signal
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T or F: Double acid hook-ups for a dialysis treatment is potentially lethal.
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True
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T or F: Steal Syndrome may occur with AV fistulas or AV Grafts.
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True
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What is low potassium?
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Hypokalemia
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Which ion doesn't dialyze easy?
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Protein, Phosphorous
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Higher bicarbonate concentration in dialysate are needed when plasma bicarbonate levels drop below:
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22 mEq/L
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Where is the heparin pump infusion line located?
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On the arterial tubing before the dialyzer
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Muscle cramps are primarily caused by the shifting of what ion during treatment?
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Sodium
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What is the Health Insurance Portability & Accountability?
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A law that created national rules about the security and privacy of health data
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What does intravascular mean?
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Inside the blood vessels
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During dialysis, levels of waste in the blood should:
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Decrease
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What is one way to remove solutes?
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Convection
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What is not a dialyzer characteristic?
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Capacity
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A nephron is made up of:
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Glomerulus, Tubule
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What isa solution a mixture of?
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A Solvent and a Solute
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A semipermeable is a filter that:
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Allows only certain sized particles to cross
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Diffusion is movement of particles .....
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From an area of higher concentration to an area of lower concentration
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What does AAMI stand for?
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Association for the Advancement of Medical Instrumentation
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What is covered by the standardsof AAMI?
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Dialyzer Reprocessing
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Whatare symptoms of pericarditis?
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Chest pain relieved after sitting upright
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What is a Chief iron-storage protein in the body?
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Serum Ferritin
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How can you prevent a patient from having a dialyzer reaction?
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Use cellulose acetate dialyzer membrane
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What does the conductivity of dialysate reflect?
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Electrolyte levels of the dialysate bath
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What is the syndrome that cerebral edema can cause by the too rapid removal of urea nitrogen from the blood?
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Dialysis Disequilibrium Syndrome
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How much blood is outside the patients body at any time during dialysis?
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150-250 ml
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What factor affects the rate of diffusion?
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Surface area of the membrane
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What are symptoms of a dialyzer reaction?
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Back Pain
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What are the steps for dialyzer reprocessing after a dialysis treatment?
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Pre-Cleaning, Performance Tests, Dialyzer Rejection, Disinfection
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What are symptoms of anaphylaxis?
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Hives, Trouble Breathing, Hypotension, Anxiety
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What is the length of dialysis treatments based on?
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Clearance, Blood Flow Rate, Fluid Gains, Patients Health
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What is Pressure Gradient or TMP?
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Difference between blood and dialysate pressure
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A patient who is fluid overloaded will probably have which symptoms?
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Tachycardia, Hypertension, Dyspnea
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What conditions could alter or affect dialysate flow rates?
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Low water pressure, Dialysate pump failure, Obstruction in dialysate flow path
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What are the symptoms of Hypotension?
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Dizziness, Tachycardia
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What level of calcium concentration usually at?
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2.5-3.5 mEq
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What medical problems may occur due to chronic kidney disease?
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Anemia, Sleeping Problems, Pericarditis
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What are the steps for reprocessing the first time?
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Dialyzer labeling, Total Cell Volume, Reprocessing
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What will increase the amount of solutes that will diffuse across the semi-permeable membrane?
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High Concentration Gradient
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What are symptoms to Hyperkalemia?
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Muscle Weakness
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What is ETD?
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Germicide in dialyzer
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How much iron is in the body?
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Transferrin Saturation (TSAT)
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What is the condition that renal patient develop due to kidney inability to reabsorb enough bicarbonate?
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Metabolic Acidosis
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An AV Fistula can routinely be used for cannulation within how many weeks of being created?
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2 Weeks
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What is the target lab value for Serum Ferritin?
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>200 ng/mL
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What is the target lab value for BUN?
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5-25 mg/dL
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What is the target lab for Magnesium?
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1.7-2.5 mg/dL
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What is the target lab for Sodium?
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135-146 mEq/L
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What is the target lab for Creatinine?
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10-18 mg/dL .4-1.4
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What is the lab value for Albumin?
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>4.0 g/dL
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What is the target lab value for Phosphorous?
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3.5-5.5 mg/dL
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What is the target lab value for Calcium?
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8.4-9.5 mg/dL
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The endocrine functions of the kidney include what?
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Making erythropoietin and the active form of Vitamin D
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What is the target lab value for Potassium?
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3.5-5.5 mEq/L
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Negative pressure is pressure created when...
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Fluid is pulled through a restriction
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What is the definition of contact time?
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Amount of time the germicide remains in the dialyzer
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What is the purpose of a proportioning system?
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Make dialysate by mixing fresh concentrate with fixed amounts of treated water
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What is an acceptable level of post softner hardness?
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0.8 grain/gallon
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A dialysate that contains too much potassium causes hyperkalemia. What are the signs and symptoms?
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Muscle weakness, Cardiac Arrhythmia, Cardiac Arrest
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What is the instrument used for measuring blood pressure called?
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Sphygomanometer
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What is the build-up of waxy proteins in soft tissues, bones, and joints?
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Amyloidosis
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Which direction should the venous be placed?
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Antegrade
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What does ETO stand for?
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Ethylene Oxide
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What is the normal pH for a patient?
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7.35-7.45
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What test must be performed on new dialyzers?
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TCV (Total Cell Volume)
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According to AAMI standards, the total endotoxin count of dialysate shall not exceed what ?
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2 EU/ml
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What does dialysate conductivity measure?
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the total electrical charge of a solution
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What are two criteria for rejecting a reprocessed dialyzer?
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Less than 80% of original fiber bundle volume aesthetic apperance
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What is a problem in dialyzer reprocessing that may cause bacteria or endotoxin contamination of the dialyzer?
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Improperly prepared germicide
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What germicide is used for dialyzer reprocessing?
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Peracetic Acid
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What is the target lab value for Transferrin Saturation?
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20%
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What is the target lab value for Hemoglobin?
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>11 g/dL
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What is a limitation of a reverse osmosis system?
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Thin film composite membranes break down when exposed to chlorine and chloramines
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What is the normal GFR?
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125 mL/min
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Stage 1 kidney disease is at what GFR?
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>90
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Stage 5 kidney disease is at what GFR?
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<14
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Stage 3 kidney disease is at what GFR?
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30-59
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What labeling must be on reuse dialyzers?
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Patient Name, Color Code, Medical Record #, Warning if 2 Patients have same name, Must say re-use on dialyzer
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What means you have had the vaccine. You want this to be positive.
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Antibody
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What means you have the actual disease. You want this to be negative.
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Antigen
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Stage 4 kidney disease is what GFR?
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15-29
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Name 2 compartment of the dialyzer.
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Blood Dialysate
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According to AAMI standards, the total microbial count of dialysate shall not exceed...
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200 CFU/mL
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What are 2 types of ultrafiltration systems?
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Volumetric UF control and flow control
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What are the 3 main ways to remove solutes?
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Diffusion, Convection, Absorption
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Shriveling of red blood cells and may be caused by hypertonic
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Crenation
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