CHT PRACTICE

Practice Test Notes

Question 1-6: Fistula Assessment and Patient Care

• Tourniquet Use:

  • Helps in visualizing the fistula.

  • Prevents vessel movement.

  • Tighter skin aids in a cleaner entry into the skin.

  • Answer: d. All of the above.

• Preventing Exsanguination:

  • Secure bloodlines, access connections, and needles after cannulation.

  • Keep tubing off the floor to avoid stepping risks.

  • Ensure patient's access limb visibility.

  • Answer: d. All of the above.

• Signs of Steal Syndrome:

  • Symptoms: Pain, tingling, decreased motor skills, cold sensations.

  • Answer: d. All of the above.

• Cannulation Site Assessment:

  • Needles should be placed 1.5 inches apart mainly to decrease recirculation.

  • Answer: a. Decrease risk of recirculation.

• Preparing for Cannulation:

  • Scrub in circular motion from outside to inside, allow time for skin contact before cannulation.

  • Answer: c. Scrub in circular motion from inside to outside.

• Nephron Functions:

  • Functions include maintaining blood homeostasis, glomerular filtration, tubular reabsorption.

  • Answer: d. All of the above.

Question 7-12: Kidney Function and Disease

• Hormone for Red Blood Cell Production:

  • Answer: c. Erythropoietin.

• Slowing CKD Progression:

  • Control blood pressure and sugar, reduce risk factors like smoking.

  • Answer: d. If the patient is young, there is no need to worry about anything.

• Glomerular Filtration Rate (GFR):

  • GFR defines stages of CKD; normal GFR is around 1200 mL/min.

  • Answer: d. Both a and c.

• Common Causes of Kidney Failure in the US:

  • Answer: a. Diabetes.

• Factors Affecting Dialysis Adequacy:

  • Type of access, blood and dialysate flow rates, dialyzer.

  • Answer: d. All of the above.

• Definition of Uremia:

  • Buildup of metabolic wastes in blood.

  • Answer: a. Buildup of metabolic wastes in the blood.

Question 13-18: Anemia, Dialysis Concerns and Infection Control

• Causes of Anemia in ESRD:

  • Could arise from bleeding, inability to produce erythropoietin, chronic inflammation.

  • Answer: d. All of the above.

• Symptoms of Hypovolemia During Dialysis:

  • Symptoms include postural hypotension and tachycardia.

  • Answer: a. Postural hypotension and tachycardia.

• High Potassium Foods:

  • Tomato sauce, salt substitutes, orange juice are high in potassium.

  • Answer: a. Tomato sauce, salt substitute, orange juice.

• Transmission of Infections:

  • Hepatitis B & C, HIV transmitted via blood/body fluids.

  • Answer: d. Both a and c.

• Treatment for Infiltration:

  • Apply ice pack and consider another needle insertion.

  • Answer: b. Apply an ice pack to the site of infiltration.

• Pyrogen Reaction Causes:

  • Endotoxin levels above 2 EU/mL or greater than 200 CFU in dialysis water.

  • Answer: d. Both a and b.

Question 19-24: Patient Intervention and Active Listening

• Patient Attendance Intervention:

  • Adjusting dialysis schedule to meet patient's needs is ideal.

  • Answer: b. Change his dialysis schedule to accommodate his life needs.

• Defining Patient Outcome:

  • End result values of the care provided.

  • Answer: b. End result values of the care that was provided.

• Addressing Patient Dishonesty:

  • Weigh to verify the patient’s claims.

  • Answer: a. Politely request that the 2 of you walk over to the scale.

• Response to Patient's Eating Choices:

  • Engage in conversation about food choices.

  • Answer: a. "I would like to review what foods you can be more liberal with."

• Symptoms of Dialysis Dementia:

  • Include confusion, hallucinations, short-term memory loss.

  • Answer: d. All of the above.

• Dialysis Lifestyle Change Reactions:

  • Patients may exhibit hostility, dependency, or withdrawal.

  • Answer: d. All of the above.

Question 25-30: Effective Communication and Patient Support

• Addressing Hostility in Patients:

  • Politely ask the patient to not stand and communicate.

  • Answer: b. Politely ask Mike to sit down and share his concerns.

• Interacting with Legally Blind Patient:

  • Ensure clear communication and identify yourself.

  • Answer: c. Both a and b.

• Identifying Patients Struggling with English:

  • Upside-down papers indicate a literacy issue.

  • Answer: c. Oh yes, this paper with the pictures of the bananas.

• Responding to Hostile Conversations:

  • Acknowledge feelings while respecting the patient’s wishes.

  • Answer: c. Share with the social worker his response and your concerns.

• Active Listening Techniques:

  • Involve focusing on patient's words, using open-ended questions, and minimal talking.

  • Answer: d. Tell the patients your feelings on the matter.

• Creating Dialogue with Mr. Jones:

  • Ask more about his life to promote conversation.

  • Answer: b. “Mr. Jones, can you tell me more about what’s going on in your life?”

Question 31-40: Patient Monitoring and Documentation

• Calculating Fluid Removal During Dialysis:

  • Patient weight above dry weight matters.

  • Answer: b. Total fluids and divide by hours dialyzed.

• Ultrafiltration Factors:

  • Includes pressure and volumetric equipment influences.

  • Answer: a. Transmembrane pressure, blood side pressure and volumetric equipment.

• Considerations for Pre-Dialysis Cleaning:

  • Employing aseptic techniques and universal precautions are critical.

  • Answer: d. Both b and c.

• Needle Insertion Follow-up:

  • After insertion, maintain the angle and avoid unnecessary movement.

  • Answer: c. Level the needle, insert to the hub and rotate the needle.

• Drawing Lab Specimens Protocol:

  • Avoid samples from saline or heparin insertion points.

  • Answer: c. Shake the tube vigorously to mix.

• Effects of Inadequate Dialysis:

  • Majorly affects dialysis adequacy.

  • Answer: a. Dialysis adequacy.

Question 41-50: Equipment Usage and Emergency Protocols

• Heparin Administration Protocol:

  • Push heparin into the saline line only at treatment initiation.

  • Answer: a. Push 3000 units of heparin into the saline line as dialysis begins.

• PPE Components:

  • Gloves and gowns are included; shoe covers are not common.

  • Answer: c. Shoe covers.

• Blood Pump Stop Alarm:

  • Air detector alarm situation stops blood movement.

  • Answer: c. Air detector.

• Sodium Modeling Complication:

  • May lead to cramping and increased thirst.

  • Answer: b. Increased thirst, body weight and hypertension.

• Clotting in Hemodialysis Circuit:

  • Causes relate to anticoagulation errors or air in the circuit.

  • Answer: c. Air in the extracorporeal circuit.

Question 51-60: Treatment Parameters and Safety Measures

• Post-Dialysis Monitor Vital Signs:

  • Take immediate action upon changes in vital signs after treatment.

  • Answer: b. Check blood pressure and if low, reduce.

• Hyperthermic Dialysate Signs:

  • Signs include patient complaints and dry skin.

  • Answer: b. Chills.

• Dialysis Complications and Bleeding Risks:

  • Monitoring for prolonged bleeding or swelling at the access site is essential.

  • Answer: b. Swelling of the access site.

• Bacterial Levels in Dialysate:

  • Must monitor and maintain below 200 CFU/mL.

  • Answer: d. 200 cfu/ml.

• Components of Quality Assessment:

  • Monitor data, prioritize improvements, evaluate plans.

  • Answer: d. All of the above.

Question 61-70: Water Quality and Chemical Compliance

• Endotoxin Levels:

  • Maximum allowable is 2 EU/mL.

  • Answer: a. 2 EU/ml.

• Disinfection Frequency for RO Systems:

  • Minimum once a week is essential.

  • Answer: b. Once a week.

• Patient Risk Assessment:

  • Report out of range results immediately to responsible personnel.

  • Answer: a. Your supervisor, technical manager or Medical Director.

Question 71-80: Infection Control and Patient Management

• Patient Care Strategy:

  • Maintain high flow velocity for bacterial control.

  • Answer: a. Maintain a high flow velocity.

• Serologic Testing for Hepatitis:

  • Requires routine testing per CDC guidelines.

  • Answer: a. Annually.

• Rescue Protocol in Dialysis:

  • Priority is to return the patient’s blood then stabilize.

  • Answer: a. Return the patient’s blood, check vital signs.

Question 81-90: Communication and Emotional Support in Patient Care

• Emotional Support During Difficult Conversations:

  • Acknowledge patient's feelings and refer to appropriate personnel.

  • Answer: b. Acknowledge his feelings and refer him to the nurse.

• Active Listening Habits:

  • Engage attentively, observe tone and body language.

  • Answer: d. Both b and c.

Question 91-100: Patient Engagement and Responsibility

• Patient Education Strategies:

  • Keep patient informed during procedures to encourage involvement.

  • Answer: b. Tell him what you are doing.

• Emergency Response to Adverse Effects:

  • Understand and assess the patient's condition urgently.

  • Answer: b. Notify the nurse of his symptoms.

Question 101-110: Advocacy and Patient-Dialysis Relationships

• Maintaining Professional Boundaries:

  • It's important to not overstep personal relationships.

  • Answer: b. Recognize it would be a conflict.

• Effective Communication for Patient Concerns:

  • Openly discuss options and provide supportive listening.

  • Answer: b. "I would be happy to share more information..."