2025 DAVITA FINAL EXAM | ALL QUESTIONS AND CORRECT ANSWERS | VERIFIED ANSWERS | LATEST EXAM | ALREADY GRADED A+

Explain the four transport mechanisms that play a role in hemodialysis

● Ultrafiltration​: Fluid is pushed through a semipermeable membrane.

● Convection​: Or solute drag means that solutes move with the water across the semipermeable membrane. In this way, convection adds to the clearance achieved through diffusion as solutes are dragged along with the ultrafiltrate.

● Diffusion​: Is the movement of dissolved particles across a semipermeable membrane from the side with the higher concentration to the side with the lower concentration. This difference in solute concentration on each side of the membrane is called concentration gradient. The higher the concentration gradient, the faster diffusion occurs. Once the concentration of a dissolved particle is the same on both sides of the semipermeable membrane, diffusion stops.

● Osmosis​: Is a chemical process by which dissolved chemicals will migrate from an area of high concentration to one of low

concentration. Essentially if you dissolve something in a liquid, the dissolved compounds (called solutes) will spread out until there is an equal concentration of solute everywhere.

What are the kidneys excretory functions

To normalize electrolytes, remove wastes, provide fluid and nutrient balance

What is the function of the acid concentration

Provides the concentration gradient for diffusion and helps normalize electrolytes

What is the function of bicarbonate

Buffers the acid concentrate

Signs and symptoms of hyperkalemia

> 5.5 mEq: extreme muscle weakness, abnormal heart rhythm, possible cardiac arrest

Signs and symptoms of hypokalemia

< 3.5 mEq: fatigue, muscle weakness, paralysis, respiratory failure, cardiac instability, arrhythmias, cardiac arrest

What are the kidneys endocrine functions

Renin secretion, Erythropoeitin secretion, Vit D Activation

How do we replace normal endocrine kidney functions

Provide medications

How much of normal kidney function is replaced by hemodialysis

15%

What is uremia and how does it affect the body?

Uremia is a buildup of wastes in the blood due to kidney failure and affects all body systems.

What are the most common causes of CKD in the usa?

Diabetes

Hypertension

Polycystic Kidney Disease

Outline the treatment goals for a patient with CKD

-slowing the progression of ckd

-managing comorbidities and complications

-controlling symptoms

-minimizing the effects of ckd on patients' lifestyles

-kidney replacement therapy modality education

-encouraging patients to actively participate in their healthcare

Why is it important to know what caused your patients CKD

So the nurse and PCT can inquire about possible problems during data collection and assessment

Why is sodium balance important?

Leads to volume expansion, increased cardiac output, increased peripheral vascular resistance, and increased blood pressure

Signs and symptoms of fluid imbalance

Edema, hypertension, shortness of breath

Systemic effects of CKD what would you advise for a patient who complains of: dry itchy skin, peripheral neuropathy(nerve pain in extremities) and gi problems

Use hyper-fatted soaps and lotions, monitor patient for changes in motor function and inform RN and physician of any bleeding problems/constipation/diarrhea

What is the consequences of prolonged fluid overload and hypertension

Left ventricular hypertrophy

What is Percarditis?

Inflammation of the membrane (pericardial sac) around the heart

What is a common cause of hypertension in dialysis patients

fluid overload

Left ventricular hypertrophy leads to

Ischemic heart disease, arrhythmia, myocardial infarction, and sudden death

Why are dialysis patients anemic?

1. the lifespan of their red blood cell is 60 days 1/2 of the normal 120 days.

What can you do to avoid contributing to lower hemoglobin and blood loss in dialysis patients

Verify correct Erythropoietin Stimulating Agent (ESA) dose is administered, rinse back until venous line is pink tinged, and avoid repeat lab draws

What are the 4 key elements contributing to CKD-mineral bone disorder(MBD)

1. Calcium

2. Phosphorus

3. PTH

4. Vitamin D (Calcitriol)

What are the symptoms of CKD-MBD in addition to bone disease

Soft tissue calcification, itching, muscle weakness, pathological fractures, tendon ruptures, compression of vertebrae, atherosclerosis, heart disease

What is your role in CKD-MBD management

*report symptoms * urge patients to take meds (home & treatment)

*report noncompliance problems related to nonadherence

Define the term AKI

- Term incorporates a wide spectrum of kidney issues

- Includes acute kidney failure as well as less catastrophic kidney function changes

- May dialyze in an out-patient facility until kidney function recovers

Give 3 examples of pre-, intra- and post-renal causes of AKI

Pre: Obstruction, volume depletion, impaired cardiac function.

Intra: ischemic ATN, sepsis, SIRS, septic shock, anaphylaxis drugs, Goodpasture Syndrome, Acute Glomerulonephritis, Trauma, open heart surgery.

Post: Obstruction, Oliguric, bladder rupture, pregnancy.

Explain the difference between AKI and CKD

Eliminating the cause of the AKI can often lead to the return of kidney function. You

cannot eliminate the cause of CKD which is HTN, Diabetes, genetic disorders (PKD)

Outline the treatment goals for a patient with AKI dialyzing in the out-patient facility

- Find cause of AKI to restore function

- Careful to avoid catheter related infections

- Avoid substances to the kidney which may be toxic (NSAIDS, radiographic contrasts, etc.

What do you need to consider in regards to their vascular access

Patients will typically have a dialysis catheter, be careful to avoid catheter related infections

How do you protect kidneys from further injury

Avoid substances to the kidney which may be toxic (radiographic contrast, amphotericin

B, low dose aspirin, NSAIDS)

What is important when monitoring weight and BP

keep a little extra fluid on them so it is available to the kidneys when they start filtering/ultra-filtrating on their own

AKI patients are at increased risk for which complications

hypovolemia and hypotension

What is the difference between OSHA and CMS infection control requirements

OSHA: Requires employers to provide workers with a safe workplace

CMS: Concerned with patient care and patient safety

What are V-tags and why are they important

They state specific regulations to be met within a condition such as infection control, providing interpretive guidance for each regulation and citing deficiencies by tag #

Explain the acceptable hand hygiene technique when caring for a patient with active clostridioides difficile infection (C diff)

Handwashing with soap and water per policy is the only acceptable hand hygiene

What is the most common infectious complication in hemodialysis patients

Bacterial vascular access infections

What organism causes the most common infections in hemodialysis patients

Methicillin-resistant Staphylococcus aureus (MRSA) - Must pay attention to Infection control! Proper hand hygiene, cleaning &

disinfecting procedures to prevent spread of infection (Viable on surfaces for days)

What is the importance of wearing gloves

Reduces the risk of hand contamination and prevents the transfer of organisms already on hands

Why do you need to perform hand hygiene before and after wearing gloves

gloves are not impervious and have microscopic pores

Who can use clean sinks for hand washing

Teammates and patients

Is a cleaned dialysis machine considered a 'clean' area?

no

How can you tell when an area or sink is clean or dirty in your facility

It is clearly labeled with a 'clean' or 'dirty' sign

What is "strikethrough" of an external pressure transducer and why is it of concern?

It is when fluid could have entered the machine and contaminated the internal pressure transducer protector providing a reservoir for microorganisms and causing subsequent patient blood infections

When should a sharps container be removed from the floor

When they are 3/4 full

Explain the HBV classification and state which test is performed monthly on HBV susceptible patients.

HBsAg: Hepatitis B surface antigen - tested monthly for susceptible its and non-responders

Anti-HBs: Hepatitis B surface antibody

Anti-HBclgM: Hepatitis B Core AB-IGM

How do surveyors verify teammates have completed infection control training and education?

Documentation of infection control training in teammate's file or transcript

Which patient case assignments are appropriate when caring for hepatitis b patients

Caring for HBsAg positive and hepatitis b immune patients at the same time

Caring for hepatitis b susceptible patients and those in the process of receiving the vaccination at the same time

Caring for hepatitis b immune and susceptible patients at the same time

State the 3 strategies recommended to decrease the risk of infection when working with a CVC

- Using facemasks when lumens or exit site is exposed

- Wearing clean gloves and avoid touching exposed surfaces

- Minimizing catheter lumen or exit sites from being exposed

What is the most common transmission route for HAIs

contact transmission

What is the reason the dialysis patients are at increased risk for acquiring a HAI at the facility

Chronic kidney disease patients are immunosuppressed and more vulnerable to infection

What contributes to hemodialysis patients being places at increased risk for acquiring a HAI at the facility

Kidney failure weakens the immune system making the patients more vulnerable. Dialysis patients oftentimes have multiple comorbid conditions which further weakens the immune system

What is the correct procedure in regards to your hands when you have casual contact with a patient

don't need to have gloves but must perform hand hygiene before caring for patients

What is the total proportion of dialysate used at davita( mixture of specific proportions of acid, bicarbonate, and dialysis quality water)

45X

What are the two most frequent physician prescribed potassium strengths of dialysate concentrate used at davita

2.0 K+ and 3.0 K+

What part of the kidney functions similarly to the dialyzers semi-permeable membrane to provide filtration and removal of fluids and toxins

glomerulus

What are the two waste products removed by the dialysis that we monitor with monthly labs

Blood urea nitrogen (BUN) and creatinine

How often are dialysis machine alarm tests performed

Before the initiation of each patient treatment

What is the safe dialysate pH range?

Between 6.9 and 7.6

Why is it important for patient care teammates to know when the water treatment system disinfection was performed

Because the end-to-end disinfection process will also introduce the disinfectant solution to the dialysis delivery systems through their water inlet lines

Following recirculation, how long can a dialyzer and blood lines be set up?

2 hours

Why are the dialyzer and blood lines not used for a dialysis treatment once recirculating for longer than two hours?

Because of the potential for bacterial growth

What is the correct procedure for residual bleach testing after the chemical disinfection of loops and equipment fluid pathways

Residual bleach testing should be performed after bleach disinfection and prior to equipment use

What are the key concepts related to "reasonable and prudent" care?

The standard of care is care which a reasonable and prudent nephrology nurse would give under the same or similar circumstances

Actions a reasonable and prudent nephrology nurse would do as well as actions the nurse would avoid doing

Who established the standards of care for nephrology nursing and for what purpose

- American Nephrology Nurses Association (ANNA) establish the standards of care and scope of practice for Nephrology nursing

- Standards of Care can serve as a basis for many areas including policy and procedures, protocols, educational offerings, regulatory systems, and more

What are three considerations when delegating nursing care activities

Must be within the nurses scope of practice, Must be delegable by State Board of Nursing, Personnel must be adequately trained to perform activity

What role does davitas P&P play?

-Provides evidenced-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

What are the four reasons that we document in the medical record

- Proof that care was rendered

- Provides data continuity

- Communication tool

- Permanent legal record

List six occurrences when to document

Baseline assessment • change from baseline assessment • change in patient's condition • procedure or treatment •medication given and patient response •patient teaching

What does SMART communication stand for?

S: simple-keep message clear and simple

M: meaningful-think about what and why you are sending the message

A: actual-just report the facts

R: read-make sure you are sending the message you intend

T: teach-others about SMART communication

What are the possible consequences of not using SMART communication?

- Exposes you and Davita to liability

- Reputational injury

- Jeopardizes the recipient

- Potentially career threatening

How do you document late entries

* From policy 3-02-02: MEDICAL RECORD PREPARATION AND CHARTING GUIDELINES

* late entries:

If unable to chart immediately after rendering a service or at the time of an observation the teammate is to make the appropriate entry as soon as possible.

Electronic:

-if documenting within the electronic medical record, the notation will automatically contain your electronic signature date and time.

Paper chart:

- The late entry must be signed by the person making the late entry.

-The late entry must be timed and dated at the time it is entered.

How do you document charting errors

when documenting on paper draw a single line through the entry, date/signature/teammate credentials, chart the correct information. if documenting in an electronic health record system follow facility procedure for that system

What is the difference between data collection and assessment and who is responsible for which?

Assessment- Nurse: determining depth of edema; heart rate, rhythm, quality of heart sounds; respiration rate, rhythm, effort being put into breathing, identifying unusual lung sounds

Data collection- PCT: noting presence of edema, counting the patients heart rate; respiration rate, recognizing unusual breath sounds; machine parameters, safety checks

Data collection-PCT

Noting presence of edema; Heart rate and rhythm; Respiration rate, rhythm, recognizing unusual breath sounds; Machine parameters, safety checks

What is the role of the licensed nurse prior to treatment initiation?

Assess abnormal findings from data collection, determine appropriate interventions (based on physician orders) and contact physician if needed

When is a pre-treatment assessment by the licensed nurse required?

For patients with AKI-a pre-treatment assessment is always required

What is the role of the PCT prior to treatment initation

Complete data collection and PCT must notify the RN if there are any abnormal findings prior to the initiation of treatment

What are the appropriate times for documentation

Pre-treatment safety checks prior to start of treatment

Pre-treatment data collection assessment prior to treatment

Observations during treatment every 30 minutes

Post treatment data collection assessment after treatment has ended

What is the preferred location for taking a blood pressure?

Upper, non-vascular access arm

What BP reading error can be caused by an incorrect cuff size?

Cuff too small: reading may be higher than actual BP

Cuff too large: reading may be lower than actual BP

What is a normal pre-treatment blood pressure?

Systolic equal to or less than 180 mm/Hg or equal to or greater than 90 mm/Hg and diastolic less than 100 mm/Hg

What is a normal respiratory range

12-20 breaths/min

What is a normal temperature

Less than 100ﾟF or 37.8ﾟC or less than 2ﾟF 1ﾟC of baseline

The three words davita uses in order to easily recall the pre-treatment AVF/AVG access evaluation are?

look, listen, feel

When is post treatment by a licensed nurse required?

If required by law

If there are abnormal findings

What are the 6 "W"s to be used when completing a REM

What, when, where, why, witness, who

What are the 3 things you should not include in a REM?

Personal opinions, Speculation or Theories, Vendettas - Remember include only the facts!!!

target weight

-Is determined via physician order

-TW is the physician prescribed weight post-dialysis that the patient can safely and reasonably achieve 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. You may not adjust the TW retroactively

Interdialytic Weight Gain (IDWG) Calculation:

Pre weight - (minus) Last post weight

UF goal calculation

pre weight - target weight + prime and rinseback + oral intake / information

UFR calculation

UF Goal / Tx hours = UFR

The maximum ultra-filtration (UF) rate should not exceed (unless ordered by the physician)?

13 mL/kg/hr

What are the four consequences of sodium loading during dialysis

- Increased thirst

- Large fluid gains

- More hypotension

- Ischemic events during the hemodialysis treatment

State 3 ways we can contribute to sodium loading during dialysis

1. Broth

2. Normal saline, hypertonic saline

3. Increased sodium in dialysate (high setting in machine or sodium modeling)

What are the consequences if a patient is consistently fluid overload

Lvh increased central venous pressure, hypertension, increased mortality, pulmonary edema, increased hospitalization rate

What is the difference between an arteriovenius fistula(AVF) and an arteriovenius graft (AVG)

AVF-connection of the patients native artery to native vein

AVG-uses artificial or biological material and requires 2 connections

What is the point where an artery and a vein are connected to create an AVF?

anastomosis

Describe the four AVF evaluations for maturation based on the KDOQI Rule of 6's

• 600 ml flow through access (on Doppler)

• 0.6 cm in depth under the skin

• 0.6 cm diameter (width of pencil eraser)

• 6-8 weeks post op maturation (some AVF will take longer- however notifying vascular surgeon is

essential if access in not maturing)