DaVita PCT Final Exam

What factor would influence the “t” of the Kt/V formula

Shortened treatment time

Poor wound healing is directly related to

Inadequate protein intake

Standing post-treatment BP reading of _____ is considered an abnormal finding

BP systolic greater than 140 or less than 90

What factor would decrease the K of the Kt/V formula

Inadequate anti coagulation

Documentation in the medical record

Provides data for the continuity and planning of patient care

Per physician order and based on individual patient needs, CKD Mineral & Bone Disorder (MBD) is treated with

Phosphate binders, Vitamin D, and Calcitriol

What is the most likely reason for a blood leak detector alarm during recirculation

Air bubbles in dialysate or a dirty sensor

The person responsible for implementation, adherence and training of the facility

The FA

Administration of normal saline

The teammate must remain with the PT to monitor the process until administration is complete and lines are secure

The dialysis team prevents additional blood loss by

Providing appropriate heparin dose per physician order using good cannulation and proper rinse back after tx.

The psychological assessment completed by the social worker

Is completed initially and annually

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

Both B and C:

Complete the emergency take off procedure

Evacuate in safe and timely manner due to impairment.

Per the CDC, which is the most important route by which pathogens are transmitted in healthcare settings including dialysis centers?

Contact transmission

A recommended intervention for muscle cramps is:

Turning the ultrafiltration (UFR) off

A patient target weight is:

Both:

Prescribed and determined by physician order

Modified by physician based on patient tolerance

What complication would you expect to see if a patient is exposed to chlorine

Hemolysis

How do you verify that the patient is stable and safe for discharge after treatment

All

Evaluate the effectiveness of the TX by comparing post and pre data

PCTs notify RN if there are any unusual findings

Nurses perform a post TX assessment as required

Why is meticulous hand hygiene so important in healthcare?

It is the single most important intervention in preventing Healthcare Associated Infections (HAI)

Which of the following may be, but doesn’t have to be a sign of hemolysis

Cherry red colored blood in the venous line

Knowing what caused your patient’s renal failure

Is important to inquire about possible problems during data collection and assessment

To assist in survey readiness you should

All

Stay current and follow policies and procedures

Assist with internal audits

Maintain a culture of safety

DaVita Quality Index (DQI) success is achieved

All of the above

Through managing individual PT first and allowing scores to follow

Through knowing each team members role in improving DQI score

Through the use of continuous quality improvement CQI process to held identity trends and makes improvements

Ultrafiltration is described as

Controlled fluid removal by manipulation of hydrostatic pressure

Water and dialysis cultures are drawn every month in a dialysis unit to monitor

Bacteria and endotoxins

Your immediate intervention for a patient experiencing an anaphylactic reaction is:

Discontinue the suspected therapy, stop the blood pump, do not return the blood

Water treatment is needed in the dialysis setting to:

Provide patient safety and prevent equipment damage.

If clotting occurs in a high flux dialyzer, the TMP will

decreaseI

The max UF rate should not exceed ___ because it may lead to hypotension episodes which increases to

13 ml/kg/hr

The excretory function of the kidneys include

Fluid balance, electrolyte balance, waste removal, acid/base balance

What type of blood/dialysate flow within the dialyzer increases the rate of diffusion providing optimal dialysis for patients

Counter current flow

The nephrologist has prescribed a 400 BFR for your patient. You would expect the physician order to also include:

15 G needles.

What is an important action prior to returning a patients blood using the hand crank in the event of a power failure?

Remove the venous line from the line clamp

Which is the primary device for purifying the water used in diaysis

Reverse osmosis

The nephrologist orders a BFR of 450 for a patient with an established AV fistula, what needle gauge would be appropriate

15 gauge WHen

when a patient is prescribed a topical anesthetic spray, the appropriate time to clean the cannulation site is

Before applying the spray

The clinical pyramid includes

The fundamentals, complex programs, and quality of life

Which statement is true regarding the “reasonable and prudent” standard of care

When supervising PCTs and other non-licensed personnel, it is responsibility of the licensed nurse to ensure these teammates also meet

Fever caused by pyrogenic reaction will most likely occur at what time during the treatment

within 45 to 75 minutesPC

PCT notices that a patient still has considerane edema in her legs when performing the post treatment data

Document the noted swelling and that the RN was informed

A surveyor asks you a question - what’s a good answer

I do not know the answer but I will find out

Patient is using CVC and has a new AV fistula present in his lower arm

Checking for the bruit and thrill every treatment

When documenting patient care, it is important to include all of these except:

Confrontation between two patients

What can be the most likely result if the surveyor sees a patient with a covered vascular access

An immediate jeopardy

For a patient with AKI, which statement is correct

A nursing assessment before treatment initiation is always required

Phosphorus binders are prescribed to prevent phosphorus in meals from being absorbed. When is the best time to take them

with a meal

The psychological assessment is completed by the social worker

initially and annually

The blood flow rate is reduced to 100 ml/min for ___ before obtaining post dialysis blood specimen for Kt/V

15 seconds The

The waiting time after administration of the initial heparin loading dose prior to initiation of hemodialysis is

3-5 minutes

What are the three things you should not include in the REM report

Personal opinions, speculation, vendetta

Dialysis replaces only ___ percent of normal kidney function

15%

What are three steps included in vascular access assessment

Look, feel, listen

A patient position used for a suspected air embolism is

Trendelenburg on left side

Flipping the arterial vascular access needle

is not necessary since all arterial needles have a back eye

Which infectious disease requires frequent handwashing instead of using alcohol based gels

C-diff

Performing a procedure “your way” rather than following DaVita’s P&Ps

can lead to civil liability in the event of an adverse patient outcome

What should be done to the heparin infusion line if a PT does not have maintenance heparin presription

Clank and knot the heparin line

Post treatment data collection and assessment is performed

After the treatment is terminated

A PCT greets a patient and the patient reports feeling short of breath. The PCT notices the patient’s lips are a blue hue. The PCT would:

Not start treatment, immediatey notify the nurse

Can you document patient vitals under another teammate already signed in the computer

No log into the computer system under your credentials and document

Which statement is true about sinks used for handwashing?

Handwashing sinks must be dedicated for handwashing purpose only and should remain clean

If you notice that a patient’s caregiver is struggling to meet the demands of the patients treatment regime you should?

Notify the social worker because he/she is there for the patient and their family

Scrubbing of each hub as part of CVC care is done for:

15 seconds

Your patient asks whether it is ok to take an over the counter cold remedy what is you appropriate response

Lets ask your nephrologist what they recommend to treat your cold symptoms

You are assessing a patient to step onto the scale by holding the patients hand. Such a casual contact

Does not require wearing gloves, but you must perform hand hygiene afterwardsT

The nephrologist has ordered the use of hemostatic sponges, such as sure seal for your patient. What is the correct procedure

Remove the hemostatic sponge after hemostasis has been achieved and dress the needle sites with sterile gauze or band aid

What could be the reason (s) for a conductivity alarm on the machine

all

Absence of concentrate or incorrect concentrate preparation

Debris or precipitate in the lines or filter

Equipment failure or machine needing calibration

Interventions for a patient complaining of chest pain include