{"id":110018,"date":"2023-07-25T21:23:37","date_gmt":"2023-07-25T21:23:37","guid":{"rendered":"https:\/\/learnexams.com\/blog\/?p=110018"},"modified":"2023-07-25T21:23:40","modified_gmt":"2023-07-25T21:23:40","slug":"clinical-annual-competency-exam-fresenius-complete-answered-2022-2023-guide","status":"publish","type":"post","link":"https:\/\/www.learnexams.com\/blog\/2023\/07\/25\/clinical-annual-competency-exam-fresenius-complete-answered-2022-2023-guide\/","title":{"rendered":"Clinical Annual Competency Exam &#8211; Fresenius (Complete Answered 2022\/2023 guide)"},"content":{"rendered":"\n<p>Inadequate Heparinization<br>The adequacy of a dialysis treatment may be compromised by<\/p>\n\n\n\n<p>Post reinfusion and prior to disconnection<br>Routine post dialysis treatment documentation on the patients dialysis treatment record should include patients blood pressure and temperature both<\/p>\n\n\n\n<p>Chemical content<br>Individual acid containers should be labeled with<\/p>\n\n\n\n<p>Notify the RN<br>The patient complains of pain at the catheter exit site. What would the PCT do first?<\/p>\n\n\n\n<p>Hemosafe is in place and secure on the arterial line (hemosafe clamp should be secured on the venous line)<br>Which of these findings noted on a safety check would indicate that an intervention is needed.<\/p>\n\n\n\n<p>Notify the RN<br>The patient presents to the dialysis center with a pulse rate of 44\/bpm but doesn&#8217;t appear to be in distress. What should be the dialysis technicians immediate action?<\/p>\n\n\n\n<p>Assessment for possible clotting in the dialyzer<br>Documentation and interpretation of the KECN (clearance effective by conductivity) results can assist the staff member in<\/p>\n\n\n\n<p>Circulation of water during the day only<br>Which of the following would minimize bacterial growth in the water treatment system?<\/p>\n\n\n\n<p>Pressure<br>A major factor affecting ultrafiltration is<\/p>\n\n\n\n<p>Palpating for a thrill<br>Pre-treatment evaluation of an internal vascular access includes<\/p>\n\n\n\n<p>Hypotension<br>A patient having a dialysis treatment complains of feeling dizzy, and begins to yawn. These symptoms are most likely to indicate that the patient has<\/p>\n\n\n\n<p>Check the dialysate effluent with a blood leak test indicator<br>If a blood leak detector alarms a second time and no visible blood is noted, what should the PCT do next?<\/p>\n\n\n\n<p>Surface area of the dialyzer<br>Which has the most impact on dialyzer clearance?<\/p>\n\n\n\n<p>Turn the blood pump off, clamp the venous line.<br>The patient exhibits signs of hemolysis. What is the appropriate action to take?<\/p>\n\n\n\n<p>Calcium and magnesium<br>Softener tanks remove<\/p>\n\n\n\n<p>Technical must perform a functional test on the machine.<br>During dialysis a patient has a cardiac arrest. Which action should be completed on the dialysis machine before the machine is used by another patient?<\/p>\n\n\n\n<p>Low clearance, hold heparin dose<br>The following KECN&#8217;s are noted: the results indicate a<br>Time KECN. TIME KECN<br>00:15. 268. 01:45. 243<br>00:45. 254. 02:15. 240<br>01:15. 242. 02:45. 238<\/p>\n\n\n\n<p>Either with or against the flow of blood<br>The arterial needle is placed<\/p>\n\n\n\n<p>Priming the dialyzer venous end up<br>An important factor in achieving adequacy during machine set up is<\/p>\n\n\n\n<p>Ultra Care<br>The FMC program that utilizes technology to improve our patient care is<\/p>\n\n\n\n<p>Bicarbonate<br>The component of the dialysate that helps treat acidosis is<\/p>\n\n\n\n<p>Check the patient blood pressure<br>The PCT notices the patient yawning toward the end of treatment. The PCT should take which action immediately<\/p>\n\n\n\n<p>Presence of endotoxins in the dialysate<br>Several patients with normal pre-dialysis temperatures develop sudden chills and a spike in temperature. This situation is most likely caused by<\/p>\n\n\n\n<p>150 ml\/min<br>What is the correct blood flow rate for priming the dialyzer<\/p>\n\n\n\n<p>Use of a tourniquet is optional when cannulating a new AVF<br>What is NOT true when cannulating a new AVF?<\/p>\n\n\n\n<p>Weekly<br>If bicarbonate concentrate jugs are used, the frequency for disinfecting jugs is<\/p>\n\n\n\n<p>Aid in fluid removal<br>Using the sodium variation module during the dialysis treatment will<\/p>\n\n\n\n<p>To improve nutritional status and ensure compliance with oral intake and reduce the risk of morbidity and mortality<br>Oral nutrition supplements are given to FMS in-center dialysis patients who are malnourished while they are at the dialysis facility for what reason?<\/p>\n\n\n\n<p>Elevated potassium levels may cause changes in heart rhythm<br>When instructing patients with CKD, who are receiving dialysis, the RN should include the fact that<\/p>\n\n\n\n<p>Sitting blood pressure followed by the standing blood pressure<br>One way to establish a patient has orthostatic hypotension is to obtain a patients<\/p>\n\n\n\n<p>Albumin, Hgb, Phosphorous, Adequacy, Catheter Rate<br>The QSR is a monthly report detailing quality outcomes as primary or secondary. Primary quality outcomes are those that have the highest impact on patient survival. These include<\/p>\n\n\n\n<p>Clamp the venous line<br>Dialysis has been initiated on a patient using a right internal jugular catheter, as the blood pump is turned up to 200 ml\/min, foam begins to accumulate in the lines. The patient begins to wheeze, and becomes short of breath. The care givers FIRST action would be to<\/p>\n\n\n\n<p>Disinfect with 1:100 bleach water and rinse with RO water until negative for bleach<br>If the bicarbonate jugs have been in storage and are needed for emergency use, what action must be taken prior to use?<\/p>\n\n\n\n<p>Less than 0.10 ppm<br>According to FMS policy, the safe level for total chlorine is<\/p>\n\n\n\n<p>Bananas, orange juice, and salt substitute<br>What has the highest potassium content<\/p>\n\n\n\n<p>Remote Total Dissolved Solids (TDS) alarms in treatment room<br>What notification process would alert the staff of poor water quality during the dialysis treatment<\/p>\n\n\n\n<p>After the completion of the last patient treatment<br>Following FMC policy, when should the second hardness test be completed<\/p>\n\n\n\n<p>10 minutes<br>According to AAMI standards the required exposure time of water to the carbon filters to effectively remove chlorine and chloramine is<\/p>\n\n\n\n<p>Notify the RN in charge to stop treatment<br>If the second GAC (carbon) filter exceeds the acceptable limit for total chlorine, what is the next step?<\/p>\n\n\n\n<p>Hypotension<br>Excessive fluid removal during dialysis, combined with the patients taking an anti hypertension medication may result in the patient having<\/p>\n\n\n\n<p>Should be engaged before removing the needle from the patient access<br>When removing needles from an internal access the needles safety device<\/p>\n\n\n\n<p>Turn off ultrafiltration rate<br>To properly collect a post BUN sample, it is necessary to<\/p>\n\n\n\n<p>Gloves, full face shield or mask and protective eyewear with side shield and fluid resistant gown<br>What PPE is required when performing venipuncture?<\/p>\n\n\n\n<p>Solution to conduct an electrical current<br>Conductivity is best described as the ability of a (n)<\/p>\n\n\n\n<p>Inspect the dialysate effluent for pink or red tinged color<br>The patients blood leak detector alarms. After verifying the blood pump has stopped, what should the PCT do next?<\/p>\n\n\n\n<p>Total Dissolved Solids (TDS)<br>What reading on the reverse osmosis (RO) machine indicates the level of water quality?<\/p>\n\n\n\n<p>0.10 ppm<br>Which total chlorine reading is UNACCEPTABLE?<\/p>\n\n\n\n<p>The patient does not respond to verbal questioning and vital signs are trending down.<br>The PCT observes a patient at the 30 minute safety check. What signs or symptoms will prompt the tech to wake the patient for further evaluation?<\/p>\n\n\n\n<p>Hemolysis<br>A patient begins to experience shortness of breath, chest pain, and sudden hypotension, the blood is bright red and translucent. The complication most likely occurring is<\/p>\n\n\n\n<p>The top level of the salt pellets in the brine tank must be maintained above the level of the brine solution in the tank<br>What is the correct level for salt in the brine tank?<\/p>\n\n\n\n<p>Examine both patient arms for the presence of an access<br>Prior to applying the blood pressure cuff on a new patient, the PCT should<\/p>\n\n\n\n<p>Chlorine and chloramines<br>The carbon tank removes<\/p>\n\n\n\n<p>Hazardous materials identification system (HMIS) labels<br>Individual bicarbonate containers must be labeled with<\/p>\n\n\n\n<p>Received from the water supplier to make product water for dialysis<br>Source water is<\/p>\n\n\n\n<p>Dialyzer primed at 300 ml\/min<br>What factor is most likely to affect dialysis adequacy<\/p>\n\n\n\n<p>Kink or obstruction after the dialyzer<br>If the arterial pressure changes from -200 mmHg to -250 mmHg from the initiation of treatment, what would be a possible cause?<\/p>\n\n\n\n<p>15 minutes<br>How long must the reverse osmosis machine (RO) run prior to collecting samples for water testing?<\/p>\n\n\n\n<p>Hemolysis<br>Blood pump occlusion and kinked lines would most likely cause which complication during hemodialysis?<\/p>\n\n\n\n<p>1:10 bleach water solution<br>What solution should be used to disinfect a large blood spill area (greater than 10 mLs)<\/p>\n\n\n\n<p>Which letters in the acronym COLT<\/p>\n\n\n\n<p>List three blood borne pathogens<br>HIV<br>Hepatitis B<br>Hepatitis C<\/p>\n\n\n\n<p>What is hepatitis?<br>Inflammation of the liver<\/p>\n\n\n\n<p>How is hep a transmitted?<br>Contaminated food and oral-fecal route<\/p>\n\n\n\n<p>How is hep B and C transmitted?<br>Exposure to blood and body fluids of an infected person<\/p>\n\n\n\n<p>How long can hep b live on surfaces for?<br>Seven days<\/p>\n\n\n\n<p>When caring for HBV patients staff should NOT<br>Take care of hepatitis susceptible patients on the same shift at the same time<\/p>\n\n\n\n<p>Why do we dialyze hep c in the clinical area and not in isolation?<br>Not as contagious as hep B<\/p>\n\n\n\n<p>What blood test indicates infection with Hep B?<br>HbsAg<br>Indicates viral presence<br>Tests for the antigen<\/p>\n\n\n\n<p>What blood test indicates immunity against hep b?<br>HbsAb<br>Indicates presence of immunity<\/p>\n\n\n\n<p>What vaccine provides long term immunity to hep b?<br>Recombivax<br>Engerix<\/p>\n\n\n\n<p>S\/S of TB<br>Night sweats<br>Productive, persistent cought<br>Unexplained weight loss<br>Chills<br>Fever<br>Blood tinged sputum<\/p>\n\n\n\n<p>How is TB spread?<br>Droplet<\/p>\n\n\n\n<p>What can live outside of the body for seven days? How are they spread?<br>MRSA<br>VRE<br>Spread through contaminated hands of health care workers<\/p>\n\n\n\n<p>What assures that MRSA patients are no longer actively infected?<br>Three consecutive cultures come back negative<\/p>\n\n\n\n<p>Precautions to take when caring for MRSA\/VRE?<br>Contact<\/p>\n\n\n\n<p>How to seat VRE patients<br>In the same cohort as people with the same bacteria<\/p>\n\n\n\n<p>How long should you wash your hands for? With alcohol?<br>40-60 seconds soap and water<br>20-30 seconds alcohol<\/p>\n\n\n\n<p>What is urea?<br>A by product of protein metabolism<\/p>\n\n\n\n<p>What is creatine?<br>A by product of muscle metabolism<\/p>\n\n\n\n<p>What is uric acid?<br>Occurs naturally in the human body as a result of the metabolism of purine<br>Purine is from dietary intake or the breakdown of the bodies own cells<\/p>\n\n\n\n<p>What does the nephron do?<br>Filters blood to form urine<\/p>\n\n\n\n<p>What performs the first step in filtering blood?<br>The glomerulus<\/p>\n\n\n\n<p>Which of the functions of healthy kidneys can be replaced by dialysis?<br>Removal of waste products<br>Regulation of fluid balance<\/p>\n\n\n\n<p>What is renin?<br>Regulates blood pressure<br>Sodium and potassium balance<\/p>\n\n\n\n<p>Three common causes of renal failure<br>Diabetic neuropathy or glomerulosclerosis<br>HTN causing nephrosclerosis<br>Glomerulonephritis<\/p>\n\n\n\n<p>S\/S of uremia<br>Yellow-gray appearance<br>Headache<br>weakness<br>fluid overload<br>anemia<br>Elevated BUN and creatinine<br>Itching<br>Changes in mental status<\/p>\n\n\n\n<p>Normal GFR<br>90+<\/p>\n\n\n\n<p>Mildly reduced GFR<br>60-89<\/p>\n\n\n\n<p>Moderately reduced kidney function<br>30-59<\/p>\n\n\n\n<p>Severely reduced kidney function<br>15-29<\/p>\n\n\n\n<p>Very severely reduced kidney function<br>less than 15<\/p>\n\n\n\n<p>Why are renal patients acidotic?<br>Kidneys control acid\/base balance<br>Hydrogen builds up due to lack of bicarb<\/p>\n\n\n\n<p>What needs to be considered when giving meds?<br>Decrease elimination due to loss of kidney function<br>Potential toxicity<br>Increased potency\/duration<br>Increased frequency<\/p>\n\n\n\n<p>Phosphate binders<br>Tums<br>Amphojel<br>Alucaps<br>Renagel<br>Renvela<br>Phoslo<\/p>\n\n\n\n<p>What is hectoral, calcijex, and zemplar?<br>Help absorb calcium<br>Reduce PTH<\/p>\n\n\n\n<p>What is the desired hemoglobin level for hemodialysis patients<br>10-11<\/p>\n\n\n\n<p>What med is seen to slow progression of kidney disease?<br>Lisinopril<br>beta blocker<\/p>\n\n\n\n<p>How do you check blood sugar levels?<br>From the arterial port<\/p>\n\n\n\n<p>What controls the bodies homeostasis?<br>Electrolytes<\/p>\n\n\n\n<p>What are the most important electrolytes to consider in uremic patients?<br>Sodium<br>Potassium<br>Calcium<br>Phosphate<br>Magnesium<br>Bicarb<\/p>\n\n\n\n<p>What is normal blood pH?<br>7.35 to 7.45<\/p>\n\n\n\n<p>What is added to dialysate to maintain a patients ph?<br>Bicarb<\/p>\n\n\n\n<p>Hypertonic<br>Contains more particles<\/p>\n\n\n\n<p>Hypotonic<br>Contains less particles<\/p>\n\n\n\n<p>When does diffusion cease to occur?<br>Until the concentration of each electrolyte found in the patients blood is equal to the electrolyte concentration in the dialysate<\/p>\n\n\n\n<p>Why is dextrose added to the dialysate?<br>To prevent hypoglycemia<\/p>\n\n\n\n<p>What is the purpose of checking the dialysate?<br>That it is compatible with human pH<br>Conductivity and temp to prevent hemolysis and crenation<\/p>\n\n\n\n<p>Name four ways dialysate is checked<br>pH<br>conductivity<br>temp<br>check for chlorine after weekly disinfectant<\/p>\n\n\n\n<p>What should the temp be?<br>36-39<br>Set by an MD<\/p>\n\n\n\n<p>Why do we use a biocompatible membranes in the dialyzer?<br>Closer to human cells and tissues<br>less of an immue response<\/p>\n\n\n\n<p>How to select a dialyzer for a patient<br>Size<br>Clearance needs<br>UF needs<br>Membrane biocompatibilty<\/p>\n\n\n\n<p>Dialyzer sensitivity<br>Sneezing<br>Itching<br>Rash<br>Hives<br>Fever<br>Pain at the access site<br>Chest pain<br>Usually within the first half hour<br>Using one sterilized with an electron beam<\/p>\n\n\n\n<p>How is the blood compartment separated from the dialysate?<br>Semi-permeable membrane<\/p>\n\n\n\n<p>What is a semi-permeable membrane?<br>Only certain molecules can fit through the pores<br>Molecules larger than the pore size will not fit<br>Red blood cells and proteins are too large to pass through<\/p>\n\n\n\n<p>What can pass through the semi permeable membrane<br>Urea<br>Sodium<br>Potassium<br>Water<\/p>\n\n\n\n<p>What should be checked before machine set up?<br>Dialyzer for sterility<\/p>\n\n\n\n<p>Why does the dialysate flow bypass the dialyzer?<br>Temperature<br>Conductivity<br>Dialysis flow rate<br>TMP<br>Blood leaks in the dialyzer<br>pH measure<\/p>\n\n\n\n<p>What happens if you prime the machine higher than 150 ml\/min<br>Gas vapor lock<br>Not all the fibers open<\/p>\n\n\n\n<p>How long can a dialyzer recirculate with saline before it is considered unsafe to use?<br>Four hours<\/p>\n\n\n\n<p>What three processes occur in the dialyzer simultaneously?<br>Osmosis<br>Diffusion<br>Ultrafiltration<\/p>\n\n\n\n<p>What is ultrafiltration in dialysis?<br>The use of more than one type of pressure, positive and negative, to remove fluid<\/p>\n\n\n\n<p>How do blood and dialysate flow travel through the dialyzer<br>Countercurrent flow<br>Blood flows down (arterial to venous)<br>Dialysate flows up (venous to arterial)<\/p>\n\n\n\n<p>How to tell if your dialyzer is clotting<br>Rising TMP<br>Rising venous pressure<br>Dark blood in dialyzer<br>Air detector alarms<\/p>\n\n\n\n<p>Heparin<br>Heparin does not dissolve clots<br>Anticoagulant effect 5-10 minutes after injection<br>90 minute half life<\/p>\n\n\n\n<p>After heparin is given, how long must you wait before starting the treatment?<br>3-5 minutes<\/p>\n\n\n\n<p>When might the heparin dose be decreased?<br>Treatment time and dialzyer size is reduced<\/p>\n\n\n\n<p>When might the heparin dose be increased?<br>When a patients KECN is decreasing<br>Signs of clotting<br>Infection or fever<\/p>\n\n\n\n<p>What circumstances would contraindicate the use of heparin?<br>Actively bleeding<br>Post-surgery or dental procedure<br>Allergy\/sensitivity<br>Scheduled for surgery<\/p>\n\n\n\n<p>How long can a patients blood be recirculated during treatment interuption?<br>May lose oxygen after 15 minutes<\/p>\n\n\n\n<p>Why do transducers have to be blood and fluid free?<br>To get accurate arterial and venous pressure readings<\/p>\n\n\n\n<p>What does pre pump arterial blood flow measure?<br>The amount of pressure and the quality of blood flow from the access to the blood pump<\/p>\n\n\n\n<p>What must be removed when hand cranking?<br>The venous tubing<\/p>\n\n\n\n<p>Renal patient temperature<br>96.4-98.9<br>Many patients have below normal body temp<br>Elevated pre temp could mean infection<\/p>\n\n\n\n<p>1 kg =<br>1000 cc<br>2.2 lbs<\/p>\n\n\n\n<p>1 oz =<br>30cc<\/p>\n\n\n\n<p>I liter =<br>1000 cc<\/p>\n\n\n\n<p>What tells us the EDW is too low? Pulling off too much?<br>N\/V<br>Dizziness until next treatment<\/p>\n\n\n\n<p>What tells us the EDW is too high? Not pulling off enough?<br>HTN<br>Headaches<br>SOB<br>Edema<\/p>\n\n\n\n<p>What should the TW include?<br>Available weight plus prime, rinse back, blouses, and other fluids given during treatment<\/p>\n\n\n\n<p>What is considered the best adequacy monitoring method?<br>Urea kinetic modeling<\/p>\n\n\n\n<p>What is double pool or eKt\/V?<br>Volume of urea in both the intracellular and extra cellular compartments<br>Entire body accounting for all body fluid compartments<br>Minimum of 1.2<\/p>\n\n\n\n<p>What is the molecular weight of sodium and urea?<br>58-60 daltons<\/p>\n\n\n\n<p>What does KECN stand for?<br>Clearance effective by conductivity sodium<\/p>\n\n\n\n<p>What is the normal KECN range?<br>200-300<\/p>\n\n\n\n<p>What should the KECN be less than?<br>The blood flow rate<\/p>\n\n\n\n<p>What is the KECN is less than 150?<br>Poor clearance<br>Will not be used to generate an OLC volume<\/p>\n\n\n\n<p>What if the KECN is greater than 350?<br>May need temp change and conductivity recalibrate<\/p>\n\n\n\n<p>How long should blood tubes spin for?<br>10 minutes<\/p>\n\n\n\n<p>When is lab work drawn and from where?<br>Before giving heparin<br>From the arterial line<\/p>\n\n\n\n<p>Disadvantage of an AV fistula?<br>Takes longer to mature 1-4 months<\/p>\n\n\n\n<p>Disadvantages of a graft<br>Bleed more<br>More prone to infection<\/p>\n\n\n\n<p>Why is it better to conduct access flow testing at the start of treatment?<br>Patients are more hemodynamically stable<br>Not affected by ultrafiltration<\/p>\n\n\n\n<p>What can cause an access to clot?<br>Hypotension post treatment<\/p>\n\n\n\n<p>What to look for in an internal access pre and post treatment?<br>Bleeding<br>Swelling<br>Bruising<br>Redness<br>Drainage<br>Thrill and bruit<\/p>\n\n\n\n<p>What direction should needles be placed for optimal flow?<br>Venous in the direction of blood flow<br>Arterial can go either way<\/p>\n\n\n\n<p>What is steal syndrome?<br>Arterial blood being shunted into the venous circulation through the anastomosis<br>Reduction of blood flow (ischemia) to the extremity<br>Distal to the access<br>pain, tingling, numbness, cold, cyanotic hands or nails<\/p>\n\n\n\n<p>Where do catheters sit?<br>In the right atrium of the heart<\/p>\n\n\n\n<p>How can you manage poor catheter flow during treatment?<br>Lower the patients head<br>Have the patient cough<\/p>\n\n\n\n<p>When is cramping seen?<br>Middle to end of treatment<\/p>\n\n\n\n<p>What do you NOT do for cramping?<br>MASSAGE<\/p>\n\n\n\n<p>How to test for hemolysis<br>Take blood from the venous port<br>If blood is red or pink after the centrifuge it is positive<\/p>\n\n\n\n<p>S\/S of crenation<br>Dark opaque blood<br>SOB<br>Chest pain<\/p>\n\n\n\n<p>What is pericarditis? S\/S?<br>Inflammation that surrounds the heart due to fluid and waste build up<br>Fever<br>Chest pain<br>Pericardial friction rub<\/p>\n\n\n\n<p>What is a pyrogenic reaction? S\/S?<br>Reaction to pyrogens (foreign bodies, endotoxins) that cause a reaction<br>Subside suddenly one hour intro treatment or after treatment ends<br>Fever, chills, low BP<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Inadequate HeparinizationThe adequacy of a dialysis treatment may be compromised by Post reinfusion and prior to disconnectionRoutine post dialysis treatment documentation on the patients dialysis treatment record should include patients blood pressure and temperature both Chemical contentIndividual acid containers should be labeled with Notify the RNThe patient complains of pain at the catheter exit site. 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