the national hemodialysis certification prep examination 2014

The National Hemodialysis Technician/Nurse Certification Prep Test By Joe Atkins (Copyright 1995-2015)

The National Hemodialysis Technician/Nurse Certification Prep Examination

By

Joseph R. Atkins, RN,MBA,CNN,CHT

Disclaimer: This examination was designed to help Hemodialysis Technicians and Nurses prepare for general certification examinations that are specific to hemodialysis therapy and general ESRD topics. It is not designed to prepare for the overall knowledge required to become a certified nephrology nurse (although it could help in providing knowledge of the specific area of hemodialysis). Regardless of the intended purpose of the test candidate, this test by no means is a guarantee that taking or passing this test will result in passing any certification test. Whether or not a candidate passes an exam, depends solely on the study habits and the abilities of said candidate. If you want to pass any exam it will require a certain amount of due diligence on your part in order to adequately prepare for the intended certification exam, regardless of the certifying body. Shortcuts or other “easy ways out” do not exist. It you truly desire to pass an examination, you will spend the time and effort necessary to accomplish your goal by studying all relevant materials recommended by your chosen certification board. If you do not pass your chosen certification test you cannot blame this test or its author. The failure will clearly lies at your door for we are all responsible for our own success or failure. This test, in and of itself, does not certify you for anything! It is only a tool to help you understand your own basic knowledge of hemodialysis. As with all of my test, it is designed to help the “test taker” learn material that will be helpful in the preparation for a certification examination.

Remember to choose the best answer. Many of the answers may appear to be similar, but there will be one clarifying word or statement that will identify the correct response. Take your time and read the questions carefully. The average time needed for each question is sixty seconds. Circle the correct answer.

Many answers may be found in the New AAMI Standards and “Review of Hemodialysis for Nurses and Dialysis Personnel” by Gutch, Stoner and Corea or other publications by NANT or ANNA.

Turn the page and begin the examination.


National Hemodialysis Certification Prep Test

Part: A

Some answers may be found in the book: Review of Hemodialysis for Nurse and Dialysis Personnel8th EditionGutch, Stoner and Corea, Mosby Pub.

Please read each question carefully and select the best answer. Print the corresponding letter of the correct answer next to the number of the question.

1. According to the ESRD federal rules and regulations, the role of the physician in a dialysis facility is:

a. To oversee the overall operations of the dialysis facility.b. To oversee and supervise the total quality of patient care, continuous quality

improvement and education and competency of the patient care staff.*c. To assure that the finances of the facility is in order.d. To supervise the ESRD interdisciplinary team.

Rational: Responsibility for the oversight of the overall medical operations of the facility lies with the physician/medical director. This individual is responsible for the overall safety and level of wellness of every patient within the facility. He/She is responsible for oversight of the QA/CQI program, which should be assuring the quality of patient care, as well as the continual improvement of patient care. This person also provides patient care leadership for the facility, setting the expectations for professionalism, as well as the attitude and demeanor of the staff. Failure of the medical director to fulfill his/her duties has the great potential to compromise the quality of patient care, as well as the morale of patients and staff. The duties of the medical director are outlined in the Federal ESRD regulations, which can be found at www.medicare.gov.

2. The role of the nurse (RN) in a dialysis facility is to:

a. Participate in the interdisciplinary team, serve as a primary nurse or case manager for a group of patients, participate in direct patient care, and supervise LPN’s and technicians. Continual education of his/her primary patients.*

b. To do patient care and assist with dialyzer reuse and supervise technicians.c. To do primary nursing and case management and social services.d. It is the responsibility of the RN to oversee patient care, but they need not participate

in patient care seeing that the level of RN functioning has increased over the years.

Rational: According to the Federal ESRD regulations, the only requirement for a registered nurse is that a professional nurse (RN) be responsible for the overall nursing care of the facility. This person only has to have twelve months of experience in nursing with an additional six months of experience in the care of


ESRD patients (with other minor stipulations mentioned). The regulation does not even require that the person be on grounds when patients are being dialyzed. However, many states, for example, Ohio, have passed licensure regulations for ESRD providers, which require that at least one RN be on sight when patients are being dialyzed. Many states who have not yet passed such legislation are looking at doing so.

The roll of the nurse in patient wellness cannot be underestimated. A nurse who carries out the nursing process with his/her primary assigned group of patients greatly adds to the overall level of wellness of those patients. In fact, wellness is what nursing is all about and what those of the profession are trained to facilitate.

As well as overseeing and providing dialysis therapy, today’s nephrology nurse has evolved into a managed care nurse, coordinating the patients overall care, managing insurance issues, outpatient testing and transplant preparation. As well, nurses provide leadership and oversight for LPN and dialysis technicians.

The American Nephrology Nurses Association is the professional organization for the nephrology nurse. ANNA sets the standards of care for nephrology nursing and has been instrumental in setting standards of care for the roles of License Practical Nurse/Licensed Vocational Nurse, as well as Dialysis Technicians as their roles pertain to all forms of renal replacement therapy.

What the Federal ESRD Regulations say concerning nursing personnel:

“ (d) Nurse responsible for nursing service. A person who is licensed as a registered nurse by the State in which practicing, and (1) has at least 12 months of experience in clinical nursing, and an additional 6 months of experience in nursing care of the patient with permanent kidney failure or undergoing kidney transplantation, including training in and experience with the dialysis process; or

(2) Has 18 months of experience in nursing care of the patient on maintenance dialysis, or in nursing care of the patient with a kidney transplant, including training in and experience with the dialysis process;

(3) If the nurse responsible for nursing service is in charge of self-care dialysis training, at least 3 months of the total required ESRD experience is in training patients in self-care.”

3. A patient becomes momentarily angry and begins cursing during the dialysis procedure, as a technician/LPN/LVN your first response is:

a. To tell the patient that you do not have to tolerate their behavior.b. Run directly to the nurse manager and complain about patient abuse.c. Remain calm and seek assistance from the supervising nurse.*d. Call 911.

Rational: In the absence of the physician, the nurse in charge, as well as the renal administrator, are directly responsible for the handling of such issues. Clearly, as an employee, you have the right to work in an environment that is free from hostility and violence. On the other hand, as a technician, it is not your responsibility, nor are you trained to handle such sensitive and volatile situations. If the staff of your facility has been trained to handle such issues, you would know to remain calm, excuse yourself and report the incident immediately to your nursing supervisor. This person would then try to diffuse the situation in a tactful manner. If unsuccessful, this issue would be passed onto the administrator, who would follow set written policy designed to deal with such


situations.

4. According to the Federal ESRD regulation, the head nurse or nurse manager is responsible for:

a. Coordination and supervision of all patient care staff, serves as director of nursing. Primary responsibilities are technical operations of the facility.

b. The head nurse or nurse manager works directly under the supervision of the medical director and has little responsibility for unit operations.

c. Coordination and supervision of all patient care staff, serves as director of nursing. In some instances, he/she may be responsible for the financial operation of the facility. In cooperation with the Medical Director, he/she is responsible to the overall quality of patient care administered at the facility.*

d. The nurse manager-head nurse has total responsibility for the operation of the facility.

5. The administrator of the dialysis facility is responsible for:

a. Overall responsibility of patient care and unit operations.b. Overall financial management of the facility. Assures that the facility, medical

director, physicians and staff are properly credentialed and that the federal rules and regulations, as well as all state and local regulations are being followed and adhered to.*

c. Testing and certification of all dialysis staffing, supervision of medical records and maintenance of facility contracts, ie maintains report with vendors..

d. Supervision of the practice of the Nephrologists as well as all clinical staff..

6. The dietitian of the facility is responsible for:

a. Writing dietary orders and assuring that patient’s laboratory values remain within normal limits.

b. Reviewing monthly lab results and counseling patients and their families concerning how they can maintain and improve their level of wellness by following the physician’s dietary orders. Works with interdisciplinary team and patient to develop plans of care.*

c. Advises staff on how they may assists patients in improving their laboratory results.d. Advises physician on how he/she should write their orders for the benefit of the

patient.

7. The social worker role in the dialysis facility is:

a. To solve psychosocial problems for patients and their families.b. To work with patients, their families, and the interdisciplinary team to help the patient

adjusts to End Stage Renal Disease and to help resolve financial and psychosocial issues the patient might face.*

c. To counsel patients during the difficult time of adjustment to dialysis.d. To provide crisis intervention, only, for End Stage Renal Disease patients and their

families.


8. The role of the dialysis technician/LPN/LVN varies between two major roles in the dialysis facility. Those roles are:

a. To function as an independent practitioner, without supervision.b. To be restricted to set-up, tear down and cleaning of dialysis equipment.c. To work in a machine maintenance, dialyzer reuse role or a patient care role under

the delegation and supervision of licensed physicians or registered nurses.*d. To work in machine maintenance, dialyzer reuse role or a patient care role under the

delegation and supervision of the renal administrator.

9. What are some of the knowledge and abilities that are required of the dialysis technician/LPN/LVN?

a. Patient care technicians should have good general knowledge of renal pathology and physiology.*

b. Patient care technicians need not know renal anatomy and physiology.c. Patient care technicians are only required to know the practical applications of

dialysis knowledge.d. The knowledge of a patient care technician is expected to be on par with that of a

registered nurse.

10. The national organization(s) that have set established standards of practice for hemodialysis technicians is (are):

a. The National Association of Nephrology Technologists.b. The Board of Nephrology Examiners-Nursing and Technology.c. BONENT, the ANNA and the NANT.*d. The American Association of Medical Instrumentation.

11. A new patient has arrived for his hemodialysis treatment. He has dialyzed several times. Looking in his chart, you notice that the patient has not signed his hemodialysis consent. Your response to this situation would be:

a. Initiate hemodialysis, because it is not your job to assure that the patient has a signed consent on file.

b. Take the consent to the patient and ask him to sign it in your presence and then initiate his treatment.

c. Tell the patient that he has been dialyzed illegally and should see his attorney.d. Inform the nurse in charge that consent has not been signed by the patient.*

12. Patients with End Stage Renal Disease have established rights and responsibilities. A patient arrives for his dialysis treatment. Upon checking his pre-dialysis weight, you notice that the patient has an interdialytic water weight gain of 5 Kg. The patient’s base weight is 65 Kg. Concerned for the patient, you chastise them openly in front of the staff and other patients, admonishing them for the large water weight gain. Your actions have:

a. Violated the patient’s right to privacy.b. Violated the patient’s right to privacy and has entered into the realm of abuse.*c. Helped the patient realize that they have become non-compliant and are hurting

themselves.d. Educated the patient.


13. You are about to initiate hemodialysis on an 87-year-old white female who is telling you that she no longer wishes to receive hemodialysis. Your first response would be:

a. To plead with the patient to stay on hemodialysis, informing them that they will die if they do not receive treatment.

b. Inform them that they are doing the right thing and that they will soon be in heaven with God.

c. Tell them that stopping hemodialysis is paramount to committing suicide.d. Inform the patient that you respect their request and then take the patient’s request

directly to the nurse in charge.*

14. A friend of a patient is one of your good personal friends. During casual conversation on off duty hours, the friend asks how a patient is doing on hemodialysis. She is very concerned about the patient’s large water weight gains. You inform her that the water weight gains have slightly improved. Your action has:

a. Helped to educate the patient’s friend.b. Helped the patient gain an ally in their struggle to control their interdialytic water

weight gains.c. Not hurt anyone.d. Violated the patient’s right to privacy.*

15. In any work situation, it is vital that there be a person who is ultimately, responsible for decision-making. In the dialysis clinic, in the absence of the physician, the following person is responsible for making nursing decisions in patient care:

a. The Chief Technician.b. The Nurse Administrator.*c. The Education Coordinator.d. The Administrator.

16. Of the following descriptions, which one best describes, the normal functions of the kidneys:

a. They maintain the balance between body water and the substances dissolved in it within the narrow limits necessary for life, control metabolic acid-base balance, excrete waste by-products of protein metabolism and provide certain hormones that assist in the balance blood pressure and bone marrow activity.*

b. They rid the body of waste by product and salts, as well as excess water.c. They simply filter the blood of excess calcium, magnesium, sodium and water.d. They filter the blood of excess chemistries, assist in the balance of blood pressure

and provide erythropoietin to build red blood cells.


The metric system is used in the chemical and physical measurements that relate to everyday life, as well as dialysis. The following questions will test the student’s understanding of this system.

17. In the metric system, a meter equals:

a. 36 inches, the same as the yard.b. 39.37 inches, a little over a yard.*c. 29 inches, a little less than a yard.d. 4 feet, a little over a yard.

18. In the metric system, ____ centimeters are equal to one inch.

a. 3 cmb. 2 cmc. 2.54 cm*d. 2 cm

19. In the metric system, ____ quarts are equal to 1 Liter.

a. 1.057 quarts*b. 1.5 quartsc. 2 quartsd. 0.9 quarts

20. In the metric system, _____ liters are equal to one gallon.

a. 6 litersb. 2.5 litersc. 3.9 litersd. 3.785 liters*

21. In the metric system a Kilogram is equal to _____ pounds.

a. 2.2 lbs.*b. 2.4 lbs.c. 3 lbs.d. 2.79 lbs.

22. In the metric system ______ mls is equal to 1 ounce.

a. 42 mlsb. 20 mlsc. 29.57 mls*d. 15 mls

Temperature is expressed in degrees centigrade, which is also known as degrees Celsius. In this measurement, zero degrees is the freezing point of water and 100 degrees is the boiling point of water. Temperature can also be expressed in degrees Fahrenheit. The formula for conversion between the two systems of temperature measurement is:

Centigrade to Fahrenheit: 1.8 X degrees C + 32= degrees FFahrenheit to Centigrade: degrees F - 32 X .5556=degrees C

Example: C to F


37 degree C X 1.8 + 32 = 98.6

Example: F to C

98.6 - 32 X .5556 = 37.0

23. Using the examples given convert the boiling point of water, which is 100 degrees Celsius to the boiling point of water in degrees Fahrenheit. The answer is:

a. 180 degrees Fb. 212 degrees F*c. 360 degrees Fd. 120 degrees F

24. Matter is anything that:

a. Has mass, weight and occupies space.*b. Has mass.c. Has is composed of a complex chemical structure.d. Appears on the Periodic chart.

25. The smallest particle of an element that retains the properties of the element is:

a. A proton.b. A neutron.c. An electron.d. An Atom.*

26. All atoms are made up of:

a. Tachyons and Quantum masses.b. Protons, Neutrons and Electrons.*c. Mass particles.d. Elements.

27. Ionic bonding means that there is an attraction between positive and negative ions. An example of this would be:

a. Sodium Chloride (NaCl)*b. Water (H2O)c. Sugar and water.d. Wine and vinegar.

28. With a covalent bond (which is stronger than an ionic bond), some atoms cannot easily fill their outer most orbitals, because they have several electrons to gain or lose. An example of a compound created by a covalent bond is:

a. Sodium Chloride (NaCl)b. Potassium Chloride (KCl)c. Dextrose and waterd. Water (H2O)*


29. A solution is a homogenous mixture of dissolved particles (solute) and a liquid (solvent). A simple example of a solution would be:

a. Dialysate*b. Waterc. Alcohold. Air

30. Renin is a hormone, which is produced by the kidneys. Its primary function is:

a. The manufacture of red blood cells.b. Blood pressure control and sodium and fluid volumes.*c. The control and distribution of calcium.d. The control and distribution of vitamin D.

31. The functional unit of the kidney is the:

a. Nephron*b. Papillac. Minor and Major Calyxd. Pyramids

32. Each nephron is made up of two parts:

a. The renal cortex and medulla.b. The glomerulus and the tubule.*c. The Major and Minor Calyx.d. The Cortex and Hilum.

33. The primary function of the glomerulus is to filter water and solutes of a size less than ___________ Daltons.

a. 200,000b. 150,000c. 68,000*d. 23,000

34. _____% of the filtrate removed from the glomerulus is reabsorbed in the tubules.

a. 50%b. 99%*c. 65%d. 75%

35. The GFR or glomerular filtration rate of the average man, per day is:

a. 3 litersb. 400 litersc. 180 liters*d. 50 liters


36. The GFR or glomerular filtration rate of the average man, per minute is:

a. 1,500 mlb. 125 ml*c. 200 mld. 500ml

37. The main function of the renal tubules is:

a. Reabsorbtion and secretion of filtrate.*b. Secondary filtering.c. Homogenization of filtrate.d. Secretion of filtrate.

38. Acute renal failure is defined as:

a. The sudden inability to urinate in a 24 hour period.b. The severe and sudden impairment of kidney function.*c. Any sudden condition that requires dialysis therapy.d. Any condition causing a person to hold water.

39. Oliguria is a condition of renal failure during which there is a drop in volume of urine output. In acute renal failure there is less than ____ ml of urine produced in a 24 hour period.

a. 100mlb. 1,000mlc. 250mld. 400ml*

40. There are three categories of causes of renal failure, which are:

a. Pre-Renal, intra-renal and post renal.*b. Chemical, non-chemical and traumatic.c. Acid, Base and Ionic.d. Arterial, vascular and interstitial.

41. ATN or acute tubular necrosis is caused by a severe reduction in blood flow or direct toxic injury to the tubular cells of the nephron. In oleguric ATN the urine output falls to about ____ ml/hr and serum urea, creatinine, phosphate and potassium begin to rise.

a. 10 mlb. 70 mlc. 150 mld. 20 ml*

42. Conductivity is:

a. The property or ability of a solution to conduct electric current.*b. The electrical resistance of a solution.c. A measurement of electrical current of a solution.d. Particles moving from an area of higher to lower concentration.


43. Urea and Creatinine are soluble in water. Which of the following statements are true concerning the urea and creatinine and charged particles?

a. Urea and creatinine add to the conductivity of a solution.b. Urea and creatinine do not form charged particles.*c. Urea and creatinine are electrolytes.d. Urea and creatinine are mildly electrically conductive.

44. Osmosis is:

a. Fluid moving from an area of greater particle concentration to an area of lower particle concentration.

b. Fluid moving across a semipermeable membrane.c. Fluid moving from an area of lower particle concentration to an area of higher particle

concentration.*d. Particles moving from an area of higher concentration to an area of lower

concentration.

45. Osmolality works by:

a. Fluid being drawn from an area of lower particle concentration to an area of higher particle concentration.*

b. The active force of transmembrane pressure.c. Lowering particle concentration in the area where you want fluid to move to.d. Increasing ultrafiltration.

46. A patient comes in for hemodialysis with a large fluid weight gain (5 Kg.). This patient consistently has difficulty with low blood pressure, which is related to the removal of fluid during hemodialysis. One way of helping to remove the fluid without compromising the patient’s blood pressure would be to:

a. Put the patient on a normal saline drip during his dialysis treatment.b. Suggest that the nurse administer 50 ml of 25% Mannitol at the beginning of the

dialysis treatment.*c. Do nothing and hope that the patient’s blood pressure will not drop.d. Never remove more than 3 Kg from this patient.

47. The human body contains ______ % to _____ % water, averaging about ___%. The percentage varies simply because of body fat. As a result, adult females have less water than adult males, with children, especially infant, having the highest percentage of body water.

a. 20% to 30% averaging 35%b. 45% to 75% averaging 60%*c. 80% to 90% averaging 85%d. 35% to 50% averaging 42%

48. _____% of the total body water is intracellular.

a. 25%b. 45%c. 70%d. 55%*


49. _____% of the total body water is extracellular.

a. 25%b. 45%*c. 70%d. 55%

50. The major electrolyte in extracellular fluid is:

a. Potassiumb. Calciumc. Glucosed. Sodium*

51. The major intracellular electrolyte is:

a. Potassium*b. Calciumc. Glucosed. Sodium

52. In the sodium potassium pump, when a muscle cell is being activated, the electrolyte ________ moves from the inside of the muscle cell to the outside of the muscle cell.

a. Sodiumb. Calciumc. Potassium*d. Magnesium

53. In relationship to the question above, when the muscle cell is being activated the electrolyte _______ shifts from the outside of the muscle cell to the inside of the muscle cell.

a. Sodium*b. Calciumc. Potassiumd. Magnesium

54. Dialysis patients should not use magnesium-based laxatives because:

a. It will severely depress their central nervous system.* b. It causes hypersensitivity in patients with renal failure.c. It causes severe constipation in patients with renal disease.d. It causes renal osteodystrophy.

55. Non-electrolytes in body fluid are:

a. Potassium, calcium and magnesium.b. Sodium, calcium and glucose.c. Glucose, protein and Sodium.d. Glucose, amino acids, other nutrients and metabolic waste.*


56. Depending upon the ambient temperature and humidity of room and outside air, a patient can lose as much between ______ ml to ______ ml of body fluid per day through perspiration and respiration.

a. 700 ml to 1000 ml*b. 1000 ml to 1500 mlc. 1500 ml to 2000 mld. 2000 ml to 2500 ml

57. End Stage Renal Disease occurs when the patient’s renal function falls to ____% to _____% of normal. This is the point at which renal replacement therapy needs to be begun in order for the patient to survive.

a. 45% to 50%b. 35% to 45%c. 5% to 8%d. 10% to 15%*

58. Glomerulonephritis is responsible for about ___ % of the End Stage Renal Disease in the United States.

a. 40%b. 15%*c. 25%d. 75%

59. Cystic Disease accounts for approximately ___ % of the ESRD in the United State.

a. 28%b. 4%*c. 15%d. 80%

60. Diabetes Mellitus is responsible for ____ % of the ESRD in the United States.

a. 33%*b. 70%c. 85%d. 7%

61. Hypertension is responsible for approximately ____% of the ESRD in the United States.

a. 28%*b. 44%c. 90%d. 14%


62. Erythropoeitin is a hormone produced in the kidneys that stimulate the bone marrow to produce red blood cells. In renal failure the production of this hormone is greatly decreased due to End Stage Renal Disease. The replacement hormone for this deficit is:

a. Decadurobolinb. Calcitriolc. Phoslo (Calcium Acetate)d. Epogen Alpha*

63. Non-diabetics with ESRD develop abnormal glucose metabolism, which results in:

a. Obesityb. Severe weight loss*c. Anorexiad. Bolemia

64. Based on the previous question, the identified problem occurs due to the ESRD patient’s lack of sensitivity to:

a. Reninb. Angiotensin IIc. Insulin*d. Glucose

65. It is characteristic for patients with insulin dependent diabetes to be able to reduce their need for insulin. The reason for this change is:

a. The dialysis machine washes glucose out of the body.b. Since dialysis therapy helps correct metabolic acidosis, the patient’s peripheral

cellular resistance to insulin is reduced.*c. Patients on dialysis tend to consume less sugar in their diets.d. Dialysis patients are routinely switched to Humalin insulin once dialysis is initiated.

66. When adjusting a patients Epogen dose, it is desirable to maintain the patient’s hematocrit between:

a. 20 to 25%b. 33 to 36.5%*c. 40 to 50%d. 50 to 60%

67. A patient who has been on dialysis two years suddenly tells you that he is having difficulty sleeping, nightmares and restless leg syndrome at night. He is probably in need of:

a. A sleeping pill.b. A more efficient or longer hemodialysis treatment.*c. A higher protein restricted diet.d. A restricted phosphate diet.


68. The primary cause of death in patients with ESRD is:

a. Cardiovascular disease*b. Cancerc. Infectiond. Suicide

69. ESRD patients are usually very malnourished and suffer from poor appetite. Another explanation for this, besides insulin resistance is:

a. Due to uremia, food, especially proteins, taste repugnant.*b. ESRD patients suffer from anorexia.c. ESRD causes patients to produce too much insulin.d. ESRD patients suffer from severe diarrhea.

70. ESRD patients should avoid taking aspirin products, unless a nephrologist specifically prescribes it because:

a. ESRD patients all take coumadin.b. ESRD patients have platelet defects and maybe more prone to GI bleeding.*c. ESRD patients are more prone to falling injuries.d. ESRD patients eventually develop hemophilia.

71. ESRD patients, even those being well dialyzed, may have difficulty controlling the intake of phosphorus. The PO medication(s) to control the absorption of phosphorus in the patient’s diet is (are):

a. Calcium Carbonate, Calcium Acetate, Aluminum Hydroxide or Renagel (a plastic resin derivative).*

b. Magnesium and Calcium based anti-acids.c. Calcijex.d. Rocaltrol.

72. In relation to the previous question, the medications, which control the absorption of phosphorus, does so by:

a. Promoting the adsorbtion of phosphorus.b. Binding phosphorus in the medication so that it will not be absorbed, but removed

from the body in the patient’s stool.*c. By binding up PTH in the patient’s stool.d. By making the patient nauseated at the thought of consuming phosphorus.

73. When phosphorus is high, the patient’s parathyroid hormone (PTH) rises in the blood stream. The increased PTH:

a. Causes the patient to eat more phosphorus.b. Causes the patient to lose calcium in their stool.c. Causes the patient to consume more calcium based foods.d. Moves calcium from the bones to the blood stream.*


74. In relation to the above questions, the increased PTH and the result of that increase, if left untreated, will cause:

a. Renal calculi.b. Soft bone syndrome.c. Renal osteodystrophy secondary to hyperparathyroidism.*d. Soft tissue calculi deposit syndrome.

75. ESRD patients have skin changes, which affect the skins ability to assists in the process of vitamin D. This inability to complete the change of vitamin D to vitamin D3 is due to the skins inability to:

a. Absorb vitamin D through the skin.b. Complete the change of vitamin D to vitamin D3 through photosynthesis.*c. Produce vitamin D.d. The skin is not involved in the process of vitamin D.

76. Examples of medication(s) used to replace vitamin D3 in the ESRD patient is (are):

a. Phoslo and Tumsb. Decadurobolinc. Rocaltrol (PO), Zemplar (IV) and Calcijex (IV)*d. Over the counter vitamin D supplements

77. Estrogen levels in women and testosterone level in men decrease in patients with ESRD. As a result the following occurs.

a. Low sperm count and impotence in men. Irregular or absence of menstruation in women.*

b. Increased libido in women with a decreased libido in men.c. All ESRD patients must take testosterone or estrogen replacement therapy.d. Females usually need to have hysterectomies.

78. The inventor of the concept of dialysis was:

a. Alexander Graham Bellb. Thomas Edisonc. Thomas Graham*d. Dr. Wilhelm Graham

79. The first artificial kidney was invented in 1913 by:

a. Thomas Grahamb. Abel, Rowndtree and Turner*c. Michael Monroed. Dr. William Morris

80. The first successful artificial kidney was a rotating drum device developed by Dr. Willem Kolff, MD, PhD and Hendrik Berk in 1943, but the first patient to survive a dialysis treatment did not occur until:

a. 1962


b. 1971c. 1954d. 1945*

81. A semipermeable membrane can best be described as:

a. Any material with pores.b. A selective membrane with microscopic pores.*c. A membrane with various sizes of pores.d. A membrane with standard sizes of pores.

82. In hemodialysis, the semipermeable membrane functions by:

a. Providing a semipermeable barrier, which separates the blood and the dialysate in the hemodialyzer allowing the passage of excess water and solutes to pass from the blood into the dialysate.*

b. Providing a semipermeable barrier, which permits the passage of albumin, urea, chemistries and water through the membrane.

c. Filtering proteins, glucose, waste by-products and chemistries from the body.d. Allowing the dialysis machine to wash the blood.

83. Diffusion is:

a. The movement of water across a semipermeable membrane from an area of low particle concentration to an area of high particle concentration.

b. The movement of particles from an area of low concentration to an area of high concentration.

c. The movement of solutes from an area of low concentration to an area of high concentration.

d. The movement of particles from an area of high concentration across a semipermeable membrane to an area of low concentration.*

84. In order to dialyze the patient’s blood effectively and safely, without the destruction of a patient’s blood cells, the dialysate solution should be:

a. Hypertonic.b. Isotonic*c. Hypotonicd. Platonic

85. The destruction of red blood cells that occurs when there is accidental exposure of blood to a hypertonic solution is call:

a. Hemolysisb. Coombs syndromec. Cell deathd. Crenation*

86. A hypertonic solution is best described as a solution in which:

a. The particle concentration is lower inside the cell and higher on the outside of the cell.*

b. The particle concentration is higher inside the cell and lower on the outside of the cell.

c. The particle concentration is equal on the outside and inside of the cell.d. The particle concentration is high on both sides of the cellular membrane.


87. A hypotonic solution is best described as a solution in which:

a. The particle concentration is lower inside the cell and higher on the outside of the cell.

b. The particle concentration is higher inside the cell and lower on the outside of the cell.*

c. The particle concentration is equal on the outside and inside of the cell.d. The particle concentration is high on both sides of the cellular membrane.

88. An isotonic solution is one in which:

a. The particle concentration is lower inside the cell and higher on the outside of the cell.

b. The particle concentration is higher inside the cell and lower on the outside of the cell.

c. The particle concentration is equal on the outside and inside of the cell.*d. The particle concentration is high on both sides of the cellular membrane.

89. A large number of molecules diffuse across the semipermeable membrane of a dialyzer. Middle molecules range in size between:

a. 100 to 200 d (Daltons)b. 150 to 250 d (Daltons)c. 300 to 2000 d (Daltons)*d. 5,000 to 15,000 d (Daltons)

90. Beta 2-Microglobulin is about 11,800 d (Daltons), has been identified to cause the following problems in ESRD patients:

a. Amyliod, carpal tunnel syndrome, bone disease and anemia.*b. Severe itching.c. Anorexia.d. Hair loss.

CEU4U programmer. The ( * ) denotes the correct answer to each question.


National Hemodialysis Certification Prep Test

Part: B

Most answers may be found in the book: Review of Hemodialysis for Nurses andDialysis Personnel5th or 6th EditionCutch, Stoner and Corea, Mosby Pub.


1. The dialysis process involves the transport of unwanted or excess solutes and excess water from the blood across a semipermeable membrane. This phenomenon is also known as:

a. Mass Transport*b. Diffusionc. Ultrafiltrationd. Osmosis

2. In discussing the process above another term for it is:

a. Solute Flux*b. Diffusionc. Ultrafiltrationd. Osmosis

3. What factors affect mass transfer rate:

a. Ultrafiltration rate.b. Temperature and dialyzer size and membrane characteristics.*c. Manipulation of the dialysis machine.d. The Co-efficient of the dialyzer.

4. Conductive Transport and Diffusive Transport are:

a. Identical terms that describe the diffusion of particles across a semipermeable membrane from a high to a lower side.*

b. Movement of water from one side of a dialysis membrane to the other side.c. The movement of water from a lower concentration to a higher concentration.d. The movement of particles from a lower to a higher concentration.


5. The following determines the rate of diffusive transport:

a. Overall dialyzer characteristics.b. Overall dialysis machine characteristics and capabilities. c. Concentration gradient across the dialyzer membrane.d. The concentration gradient across the membrane, membrane surface area,

membrane coefficient, Qb and Qd.*

6. Convective transport is:

a. Solvent drag, which leads to Solute drag.*b. The movement of water with the aide of ultrafiltration.c. The movement of water with the aide of osmosis.d. Diffusion due to the force of Osmosis.

7. The amount of solutes convected across a membrane in proportion to the fluid ultrafiltrated is called the:

a. Mass transfer rate.b. Convective rate.c. Sieving coefficient.*d. Flux rate.

8. What statement best describes “clearance”?

a. It’s a fixed and known value.b. It is a direct result of the TMP.c. It’s an absolute volume.d. It’s a theoretical volume, not a real volume, which empirically calculates the cleared

substance (x) in one minute.*

9. Urea clearances in any dialysis treatment may be improved by manipulation of the following:

a. Dialyzer membrane size and permeability, Qb, Qd and time on dialysis.*b. Selecting the best dialysis machine.c. Using only high flux dialyzers.d. Increasing the patients blood flow rate and dialysate flow rate.

10. Ultrafiltration is:

a. A passive force that removes solutes.b. An applied force of pressure used to move fluid across a semipermeable

membrane.*c. A by product of osmosis.d. The result of diffusion.

11. Ultrafiltration is accomplished through the combined forces of:

a. Osmosis and diffusion.b. The combined forced of positive and negative pressures.*c. The dialysis machine negative pressure pumps.d. Trans Metric Pressure.


12. Transmembrane pressure is the combined force of:

a. Osmosis and diffusion.b. Positive and negative pressures.*c. The dialysis machines negative pressure pumps.d. Trans Metric Pressure.

13. You are using a high flux dialyzer on a patient who has had a modest interdialytic water weight gain. As a result of the low weight gain it is possible that the TMP of the dialysis machine may be:

a. Positive.b. Zero.c. Minus zero.*d. Extremely high

14. In relationship to the previous question and water quality, the pressures exerted upon the dialyzer membrane could:

a. Cause the patient to have episodes of cramping.b. Could result in endotoxins being moved from the dialysate into the patient.*c. Would not make any difference in the patient’s well being.d. Would result in excess fluid being removed from the patient.

15. In relationship to the last two questions, a negative TMP produces:

a. Negative pressure moving fluid from the blood side of the dialyzer.b. Positive pressure moving fluid into the blood side of the dialyzer.*c. No pressure changes on the dialyzer membrane.d. Positive pressure moving fluid into the dialyzer side of the membrane.

16. In counter current dialysis therapy, the dialysate and the blood within the dialyzer are moving:

a. In the same directions.b. In opposite directions.*c. They intermittently move in the same and then opposite directions.d. There is no such thing as cross current dialysis therapy.

17. Co-current dialysis therapy is sometimes used:

a. When dialyzing some new ESRD patients.b. For patients prone to nausea and vomiting during dialysis.c. For acutely ill dialysis patients that must be gently dialyzed.d. All of the above.*

18. The Qd or dialysate flow rate should be _____ X the Qb for the most effective dialysis treatment.

a. 6Xb. 2X*c. 5Xd. 1.5X


19. The primary advantage of counter current hemodialysis therapy is:

a. A hydrostatic vortex enhances the removal of chemistries and waste by-products.*b. Patients are dialyzed more gently because fewer particles are removed from their

blood.c. There is no advantage to cross current dialysis therapy.d. There is no such thing as cross current dialysis therapy.

20. The two major components of resistance in the hemodialysis blood circuit are:

a. Venous pressure and arterial pressure.b. Viscosity and geometry*.c. Venous resistance and patient blood pressure.d. Blood pump occlusion.

21. The viscosity of a patient’s blood is related to:

a. Pt.b. PTT.c. Clotting times.e. Hematocrit*.

22. The geometry of a hemodialysis blood tubing set is affected by:

a. The blood pump segment.b. The dialysis machines blood tubing schematic.c. Length, Diameter size and number of pathways*.d. The type of plastic used in the manufacture of the blood tubing.

23. In some types of dialyzers, there is a possibility of variance in the blood volume or compliance. A primary characteristic of hollow fiber dialyzers is that they:

a. Are generally non-compliant.*b. Have flexible compliance.c. Vary greatly in compliance.d. Increase in compliance as TMP is increased.

24. Presently, there are two methods of ultrafiltration control built into hemodialysis machines, which are:

a. The Fresenius method and the Cobe method.b. The negative and positive pressure method.c. The volumetric-balance chamber and the servo-feedback-flow sensor type.*d. The ultrafiltration method and the negative pressure method.

25. During fluid removal, hypovolemia and resultant hypotension occurs when:

a. When fluid is removed to quickly.b. When a patient has too large of an interdialytic water weight gain.c. If the patient eats a large meal during the dialysis treatment.d. Fluid is removed from the vascular compartment of the patient faster than fluid can

move from the extracellular compartment (interstitial space).*


26. Reverse ultrafiltration occurs when a negative TMP (note: not negative pressure) produces positive pressure on the dialysate side of the semipermeable membrane. The most important significance of this is:

a. Patients may take on water weight during the treatment.b. Patients could be exposed to endotoxins and viruses in the water treatment

system.*c. That it produces no negative affects.d. Patients will receive a better dialysis treatment.

27. Middle molecules are those that range between the sizes of (d=Daltons):

a. 1500d to 60,000db. 500d to 2000d*c. 3000d to 10,000dd. 20d to 500d

28. The ideal Kt/V ranges between:

a. 1.9 and 2.0b. 4.6 and 9c. 1.2 and 1.4*d. There is no accepted ideal Kt/V.

29. The expected Urea Reduction Rate (URR) for a hemodialysis treatment is:

a. 95%b. 25%c. 65%*d. 14%

30. The four basic functional components of a hollow fiber dialyzer is/are:

a. Dialysate connectors, blood connectors, headers and blood fibers.b. Blood compartment, dialysate compartment, semipermeable membrane and

membrane support structures (epoxy).*c. Arterial header, venous header, dialysate inlet and dialysate outlet.d. The headers, dialyzer body, FDA approved label, and blood fibers.

31. There are two types of dialyzer geometry’s used today:

a. High Flux and high efficiency.b. A69 and Polysulfone.c. Rectangular cross section (plate) and circular cross section (hollow fiber).*d. Coil and Plate.

32. Many hollow fiber dialyzers are made of cellulose or regenerated cellulose acetate or Cuprophan. Although these dialyzers are inexpensive to manufacture, they have one major drawback, which is:

a. Bio-incompatibility.*b. They clot easily.c. They produce endotoxins.d. They rupture easily.


33. Dialyzers (artificial kidneys) with synthetic membranes, such as the AN69 and Polysulfone have the tremendous advantage of:

a. Biocompatibility*b. Low costc. Improved reused. Reduced clotting

34. The primary material used in the production of synthetic membranes is:

a. Natural fiberb. Crude oilc. Vegetablesd. Plastic*

35. Synthetic membrane dialyzers have a primary advantage over cellulose based membranes, which is (are):

a. They are biocompatable and have high flux dialysis capabilities.*b. They do not clot as easily as cellulose-based membranes.c. They are less expensive than cellulose based membranes.d. They remove more fluid than cellulose based membranes.

36. A tremendous concern about synthetic membranes is that they:

a. Have a high coefficient, requiring exact volumetric control in order to be used.*b. They are not as biocompatible as cellulose membranes.c. They clot easily.d. They are too expensive to be used.

37. One of the largest concerns about the use of synthetic membranes is:

a. Blood leaks.b. Overfiltration.c. Risk of exposure to endotoxins (LAL) and pyrogens.*d. Bio-incompatibility.

38. The chemical that determines the bio-computability of a dialyzer membrane is (are):

a. Renalin or Peracidin.b. Free hydroxyl radicals.*c. Glycerin.d. Microscopic cellulose fibers.

39. The worst offender of dialyzer membrane bio-incompatibility is (are):

a. Polysulfoneb. Cellulose Acetatec. AN69d. Cupophan*


40. The worst scenario of bio-incompatability is (are):

a. Of no concern in the long term.b. Mild allergic reaction.c. Mild allergic reaction or anaphylactic shock.*d. Pulmonary emboli.

41. A chronic problem with cellulose-based membranes is:

a. Clotting.b. First use syndrome.*c. Blood leaks.d. Membrane deterioration.

42. First use syndrome is caused by:

a. Improper set-up of the dialyzer.b. The release of histamine, thromboxane and monokines.*c. LAL’s in the water treatment system.d. Microscopic cellulose fibers.

43. The advantage(s) of dialyzer reuse is (are):

a. Direct savings to Medicare.b. Reduced compliment factor.c. Increased biocompatibility of the dialyzer and reduced cost of treatment.*d. Improved Kt/V and URR.

44. The disadvantages of dialyzer reuse is (are):

a. Decreased biocompatibility of the dialyzer membrane.b. Over filtration of fluid.c. Processing, testing, identification, storage, documentation, exposure risks to

sterilizing agents, additional risk management-QA and performance improvement requirements and the possibility of patients developing anti-N antibodies (formaldehyde only).*

d. Particles moving from an area of higher concentration to an area of lower concentration.

45. Osmolality works by:

a. Fluid being drawn from an area of lower particle concentration to an area of higher particle concentration.*

b. The active force of transmembrane pressure.c. Lowering particle concentration in the area where you want fluid to move to.d. Increasing ultrafiltration.


46. A patient comes in for hemodialysis with a large fluid weight gain (5 Kg.). This patient consistently has difficulty with low blood pressure, which is related to the removal of fluid during hemodialysis. One way of helping to remove the fluid without compromising the patient’s blood pressure would be to:

a. Put the patient on a normal saline drip during his dialysis treatment.b. Suggest that the nurse administer 50 ml of 25% Mannitol at the beginning of the

dialysis treatment.*c. Do nothing and hope that the patient’s blood pressure will not drop.d. Never remove more than 3 Kg from this patient.

47. CAVH is the process of renal replacement therapy whereby:

a. The patient’s own arterial pressure is used to push the blood through the hemofiltration device.*

b. A pump is used to push the blood through the hemofiltration device.c. A pediatric dialyzer is used.d. Short term dialysis takes place.

48. CVVH stands for:

a. Colloidal Venous-to-Venous Hemofiltration.b. Continuous Venous to Venous Hemofiltration.*c. Continuous Venous-to-Venous Hemodialysis.d. None of the above.

49. CAVH-D and CVVH-D include the use of the following:

a. Double D Central Venous Lines.b. Dextrosec. None of the listed answers.d. Dialysate*

50. The major advantage of CAVH or CVVH is:

a. Fast chemistry removal.b. Slow fluid removal.*c. It can be used for a short time three days per week.d. None of the above.

51. CAVH and CVVH are generally renal replacement therapies that are used in the following circumstances:

a. Young patients in congestive heart failure.b. Patients with high K+.c. Severe burns or septicemia.*d. Patients with high Na+.


52. CAVH and CVVH are both forms of Continuous Renal Replacement Therapy. This type of therapy is used for patients that are hemodynamically unstable, with cardiac insufficiency. The hemofiltration devices used in this 24 hour per day therapy have:

a. High volume and moderate resistance to flow.b. Are coil shaped in design.c. Can be used in standard, as well as CRRT dialysis.d. Low volume and low resistance to flow.*

53. The one of the major problems with CRRT is:

a. Clotting of the blood circuit.*b. Rapid fluid removal.c. Rapid chemistry removal.d. Excessive bleeding.

54. Hemoperfusion uses a canister device that is filled with:

a. Polysulfone fibers.b. Sorbent activated charcoal or resin.*c. Cellulose acetate fibers.d. Hemophane fibers.

55. The process of hemoperfussion is for the:

a. Removal of metals, non-dialyzable drugs or chemicals with large molecular weight.*b. Rapid removal of potassium.c. Heavy metal poisoning only.d. Removal of unwanted white cells and platelets.

56. The disadvantage of using a hemoperfussion cartridge is that:

a. It is difficult to detect when the cartridge has reached its absorbtive limit.*b. It requires too much heparin to be practical.e. It requires the use of too much dialysate to be effective.f. It is a therapy that is no longer used.

57. Apheresis is used primarily to:

a. Remove red blood cells, only.b. Selectively remove certain blood constituents such as platelets, antibodies and

immunoglobulins.*c. Treat burn victims and older patients in CHF.d Dialyzed neonatal patients in acute renal failure.

58. Apheresis is achieved by the used of:

a. Various selective pore size membranes.*b. Osmosis, Diffusion and Ultrafiltration.c. High Flux dialysis.d. Hemoperfusion.


59. Immune related disease; such as Goodpastures syndrome, Guillaim-Barre, Myasthenia Gravis and post transplant rejection can be treated by adding ________ to the patient’s treatment regimen.

a. Hemodifiltration.b. Hemoperfusion.c. Aphoresis.*d. CAVH or CVVH.

60. The compounds of the acid part of bicarbonate-based dialysate are:

a. Water, NaCl, Acetate, Glucose, CaCl, KCl and Mg.*b. Acetate, Glucose, CaCl, NaCl and NaHCO3.c. NaHCO3, CaCl, KCl, and Glucose.d. NaHCO3 and Glucose.

61. The major component(s) of the base part of bicarbonate dialysate are:

a. NaHCO3 and H2O.*b. Acetate and water.c. Water, NaCl and NaHCO3.d. KCl and NaCl.

62. The Ready (c) Sorbent hemodialysis system is unique in that it only requires:

a. Six liters of water to complete the entire dialysis treatment.*b. No electricity.c. Two staff members to operate the machine.d. Requires no dialysate to function.

63. The Ready Sorbent dialysis system was created as a result of:

a. Anticipated water shortages.b. The absence of electrical power.c. NASA’s Mercury Space program.*d. The need for a simple home dialysis machine.

64. The Ready Sorbent cartridge has the ability to:

a. Work without the benefit of electricity.b. Work without the benefit of heparin.c. Work without the benefit of a continuous water supply.*d. Remove unwanted blood particulates from the patient’s blood.

65. The Ready Sorbent cartridge works by:

a. Converting urea to ammonium and carbonate.*b. Absorbing urea.c. Absorbing excess water.d. Removing platelets from the patient’s blood.


66. The important disadvantage of the Ready Sorbent system is that:

a. Once the activated carbon of the cartridge is exhausted, ammonia begins to build up in the dialysate.*

b. It requires more water than regular hemodialysis machines.c. It requires 220 Volt service to the patient’s home.d. It is too difficult for patients and staff to learn.

67. You are dialyzing a patient in CHF. This patient’s systolic B/P is below 100 mmHg, predialysis. A simple way to help maintain the patients B/P during the treatment is to:

a. Give the patient 100mls of Albumin.b. Administer 100mls of 50% Mannitol.c. Administer 100mls of 23% Hypertonic Saline.d. Decrease the patient’s dialysate temperature to 36 degrees C.*

68. The primary cause of death in patients with ESRD is:

a. Cardiovascular disease*b. Cancerc. Infectiond. Suicide

69. _______ Dialysate that is too hot causes hemolysis of blood cells. This happens when the dialysate reaches:

a. 41 degrees C.*b. 38 degrees C.c. 41 degrees F.d. 212 degrees F.

70. ABD monitors work using:

a. Hydraulic and Pneumatic pressure monitors.b. Ultrasonic beams.*c. Manual and Automatic light beams.d. ABD-1 and ABD-2 systems.

71. One of the major problems with Deionization tanks are (is):

a. Cost.b. Resistance to magnesium and Calcium particles.c. They require too much salt.d. Flow resistance, exhaustion and Macro/Microbiotic contamination.*

72. Ohms is a measurement of:

a. Conductivity.b. Resistance to electrical current.*c. Electrical efficiency.d. None of the above.


73. Deionization tanks remove ____ and _____ from the softened water:

a. Heavy Metals.b. Endotoxins.c. LAL’s.d. Cations and Anions.*

74. Activated Carbon Tanks remove _____ and _____ from the softened water:

a. Cations and Anions.b. Organic Matter, and primarily Chlorine and Chloramines.*c. Unwanted electrolytes and non-organic matter.d. Chlorine and Organic Matter.

75. In order to maintain a well functioning hemodialysis water treatment system the technician must work closely with the following organizations:

a. The EPA and OSHA.b. The city water plant, the state health department, the EPA, AAMI and the water

company vendor.*c. The FDA, EPA, OSHA and AAMI.d. NANT, AAMI and the city water plant.

76. An AAMI water sample of pre and post treated water are sent for analysis:

a. Monthlyb. Annually*c. Bimonthlyd. Bi-Annually

77. The water included in the report above examines pre and post treated water for:

a. Heavy metals and contaminants.*b. Anions and Cations.c. Chlorine and Chloramines.d. LAL’s and microbial contaminants.

78. Water treatment system cultures and LAL (endotoxin studies) should be collected and reported to the QA committee:

a. Weeklyb. Monthly*c. Annuallyd. Bi-Annually

79. Hemodialysis machine electrolytes studies and cultures should be collected and reported to the QA committee:

a. Weeklyb. Monthly*c. Annuallyd. Biannually


80. The best description of Quality Assurance is:

a. Continuous quality improvement.b. Performance improvement.c. The lowest level of expected achievement in quality (the bottom line).*d. The highest level of expected achievement in quality.

81. Continuous Quality Improvement is:

a. Reaching for a level of quality that has no limits.*b. Reaching for a perceived level of possible achievement.c. Competing with other dialysis facilities for your level of quality.d. The lowest level of expected achievement in quality.

82. All manuals and records pertaining to the function of the hemodialysis water treatment system should always be located in:

a. The Chief Technicians office.b. The Administrative Nurses office.c. The water treatment room.*d. The Performance Improvement manual.

83. Reuse records and manuals should be maintained and stored in:

a. The Chief Technicians office.b. The Administrative Nurses office.c. The dialyzer reuse room.*d. The Performance Improvement manual.

84. When operating a hemodialysis machine you should follow the _______ recommended standards of procedure and maintenance.

a. AAMI.b. NANTc. BONENTd. Manufacturer’s*

85. Besides the costs savings of a good dialyzer reuse program the benefits to the patients are (is):

a. Absence of first use syndrome and increased biocompatability.*b. Absence of Coombs syndrome.c. Increased levels of oxygenation.d. Direct increased savings for the patient.

86. Once used, to qualify for reprocessing (reuse) a dialyzer must have the following characteristic(s):

a. Be high flux or high efficiency.b. Have passed the pressure test, the 80% volume test and have an acceptable

appearance.*c. Look like new.d. It must have 80% of its original cell volume.


87. According to the experts in dialyzer reuse, for best results, the dialyzer should be reprocessed within ____ hours of patient use:

a. Within 12 hours.b. Within 24 hours.c. Within 2 hours.d. Within 6 hours.*

88. The three dialyzer reuse solutions that are being used in the United States are:

a. Hypochlorite, Peracetic Acid and Formaldehyde.b. Gluteraldehyde, Formaldehyde and Peracetic Acid.*c. Hydrogen Peroxide, Bleach and Formaldehyde.d. Hypochlorite, Hydrogen Peroxide and Acetic Acid.

89. When reprocessing dialyzers with formaldehyde a ___% is instilled over a ___ hour period:

a. 2%-12 hourb. 1%-36 hourc. 4%-24 hour*d. 10%-12 hour

90. When reprocessing a dialyzer with peracetic acid a ____ % solution is instilled over a ___ hour period:

a. 2%-24 hour.b. 2%-12 hourc. 4%-11 hour*d. 10%-24 hour

91. _______ Anions consists of the following chemicals:

a. Cl-, F-, SO4=, NO3-*b. Na+, K+, Ca++, Mg++c. Chloraminesd. Fluoride

92. Cations consists of the following chemicals:

a. Cl-, F-, SO4=, NO3-b. Na+, K+, Ca++, Mg++*c. Chloraminesd. Fluoride

93. Deionization tanks may have the following resin configurations:

a. Seriesb. Tandemc. Polisher-Workerd. Two bed (cation & anion), Single bed (cation or anion) or three bed (cation, anion

and cation).*


94. For home dialysis use, deionization tanks may produce good quality, but they do not remove pyrogenes and indeed may contribute to the production of:

a. Chloraminesb. Bacteria and Endotoxins*c. High Sodium levelsd. High Floride levels

95. Although not in the mainstream of dialyzer reuse, another means of disinfecting reused dialyzers is:

a. Heated normal salineb. Hypochlorite solutionc. Heated Sodium Citrate solution*d. Hypertonic Saline

96. Another benefit of dialyzer reuse (reprocessing) is that facilities have the financial means to use more expensive dialyzers with high flux membranes, which remove more ______ , reducing the mortality and morbidity caused by the retention of that molecule in the patient’s body.

a. Ureab. Creatininec. Creatined. Beta 2 Microglobulin*

97. Dialysis facilities that use formaldehyde as a disinfectant for their dialyzer reuse (reprocessing) program generally use the following chemical to strip protein from the fibers of the dialyzer before reprocessing:

a. Peracetic Acidb. Gluteraldehydec. Formalind. Hypochlorite*

98. When managing a dialyzer-reprocessing (reuse) program, it is vital that different chemicals are:

a. Mixed according to AAMI standardsb. Are never mixed together*c. Are diluted before mixingd. Are labeled properly

99. In relation to the previous question, mixing of two chemicals may cause:

a. A volatile chemical reaction.*b. No reaction.c. Is of no concern.d. May cause a mild chemical reaction.


100. If a patient’s dialyzer is being reused (reprocessed) and the volume drops below the standard of 80%, the following will most likely occur:

a. Kt/V and URR will improve.b. Kt/V and URR will not change.c. Kt/V and URR will decline.*d. URR will decline, but Creatinine removal will improve.

101. If a patient’s dialyzer is being reprocessed (reused) and the volume drops below the expected standard of 80% the following will occur:

a. Coefficiency will deteriorate.*b. Coefficiency will improve.c. Coefficiency will remain the same.d. None of the above.

102. When carrying out any dialyzer reuse (reprocessing) program, chemicals may become airborne (ambient). Therefore, it is vital that:

a. A ventilation fan be installed and monthly air testing be done.*b. A high volume ventilation fan is installed.c. That monthly ambient air testing is done.d. None of the above.

103. Automated dialyzer reprocessing can be carried out by several machines, such as the ECHO, the Renatron or Seratronics. Automated dialyzer reprocessing provides the most important advantage(s) of:

a. Lower labor costs.b. Reduced staff exposure to chemicals and reduction of human error.*c. Reduced supply costs.d. Reduced regulatory compliance.

104. Citric Acid can also be used as a reuse solution if it is:

a. Mixed properly.b. Mixed in a high percentage.c. Heat incubated at 100 to 105 degree C for 20 hours.*d. Mixed with Hypochlorite solution.

105. The disadvantage of using citric acid for dialyzer reuse is:

a. The mixture of two chemicals may cause severe chemical reactions.b. Deterioration of the dialyzer membrane.c. The high costs.d. Use of the solution is very limited and more studies must be conducted before it is

widely accepted for use.*

106. Before reusing a dialyzer it is vital for the reuse technician to assure that, first and foremost, the dialyzer is:

a. Chemically pretreated.b. Labeled for multiple use by the manufacturer.*c. Cleaned properly.d. Labeled with the patients name.


107. According to the FDA, activated carbon tanks in the hemodialysis water treatment system should have enough cubic feet of activated charcoal to provide ____ minutes of empty bed contact time for the removal of chlorine and ___ minutes for the removal of Chloramines.

a. 15 and 20 min.b. 6 and 10*c. 18 and14 min.d. None of the above

108. According to AAMI, activated Carbon tanks in the hemodialysis water treatment system should have enough cubic feet of activated charcoal to provide ____ to _____ minutes of empty bed contact time for the removal of Chlorine and Chloramines.

a. 18 to 20 min.b. 1 to 2 min.c. 10 to 14 min.d. 3 to 5 min.*

109. Like the Deionization tanks, the carbon tanks should be set up in a _____-_____ fashion.

a. Link-link.b. Series-Parallel.c. Pre RO-Post RO.d. Worker-Polisher.*

110. An audible and visual water quality alarm is to be available to staff:

a. In the water treatment area.b. In the clinic treatment area.*c. In the staff lounge.d. In the Chief Technician’s office.

111. The temperature of incoming city water is to be maintained at about ___ degrees F.

a. 65b. 45c. 77*d. 25

112. Failure to maintain the proper pretreatment temperature of incoming city water will:

a. Markedly reduce the efficiency of the RO membranes.*b. Make the patients too cold.c. Cause the dialysis machine heaters to work too hard.d. Markedly reduce the efficiency of the DI tanks.


113. Water softeners should regenerate at:

a. Non-operating hours.*b. Mid day.c. At the beginning of the day.d. At the beginning of the last shift.

114. Each component of the water treatment system must be labeled with:

a. The name of the vendor.*b. The FDA approval of the device.c. The name of the facility.d. The name of the Chief Tech

115. .2 Submicron Filters should be installed at the final outlet of treated water, before it goes to the hemodialysis machines. The purpose of this filter is:

a. Removal of sand and other particles.b. Removal of endotoxins and bacteria.*c. Removal of Chloramines and Chlorine.d. None of the above.

116. 5 Micron filters are placed before the RO machines. The purpose of these filters is to:

a. Remove gross particulate matter.*b. Remove endotoxins and bacteria.c. Remove Chloramines and Chlorine.d. None of the above.

117. Failure to use carbon tanks to pretreat water going to the deionization tanks may cause _______ to form in the water system.

a. Chloramines and Chlorine.b. Cancer causing Nitroamines*c. Bacteriad. Endotoxins

118. The water system should be tested for water hardness, chloramines and chlorine and all monitoring should be recorded before:

a. The beginning of the day.b. The end of each patient shift.c. Once a week.d. The beginning of each patient shift.*

119. If the water softener cycles during patient treatments, the following will happen:

a. The supply of water will be contaminated.b. The supply of water to the RO will be interrupted.*c. The supply of water will increase in quality.d. None of the above.


120. Every part and mechanism of the water treatment system must be:

a. AAMI approved.b. NANT approved.c. BONENT approved.d. FDA approved.*

121. Upon or immediately after installation, the vendor-manufacturer of the water treatment system must have the following available to staff:

a. Phone numbers to the FDA and OSHA.b. Phone numbers to the manufacturer and the FDA.c. Phone numbers to the CDC and the FDA.d. Schematics, operation manuals and adequate training.*

122. The specific approval for any FDA approved medical device is:

a. 2728b. 2746-U3c. 510K*d. The patent number

123. The most efficient part of the system of water treatment for purification and particulate removal is:

a. The carbon tanksb. The RO machine*c. The DI tanksd. The submicron filters

124. In any water treatment system for hemodialysis, it is vital that there be no “dead ends” or “dead legs” in the water pathway to the hemodialysis machines. Dead ends, or dead legs, tend to produce:

a. Bacteria and endotoxins*b. Chloraminesc. Leaksd. Low pressure

125. In order to prevent the production of bacteria and endotoxins, the water delivery pathway of the water treatment system is designed to be in a____, which should flow 24 hours a day and seven days a week:

a. Modified dead end.b. A continuous loop.*c. A single pass to the drain.d. None of the above.


126. UV lamps are generally discouraged in the water loop due to the fact that they may kill bacteria and expose patients to:

a. The release of chloraminesb. The release of endotoxins*c. The growth of algaed. None of the above

127. If UV lights are used in the water treatment system, they should be placed:a. Post water holding tankb. Pre water holding tankc. Post ROd. Pre Ultrafilter and RO*

128. Routinely, water treatment loops should be disinfected:

a. Weeklyb. Bi-annuallyc. Monthly*d. Annually

129. Dead ends or “Dead Legs” results when:

a. The flow of water is totally disrupted.b. The flow of water is slightly restricted.c. The flow of water cannot pass smoothly and completely through a water treatment

loop, due to side (perpendicular) plumbing, which has greater than 1.5 to 2 inches of linear dead space.*

d. None of the above.

130. Patients who decide to discontinue hemodialysis should be able to have comprehensive and open discussion with staff. The patient has the right:

a. To withdraw from treatment with a physician’s order.b. To refuse to begin dialysis or to terminate their treatment at any time.*c. To withdraw from dialysis after intensive psychological evaluations.d. None of the above.

131. Many patients find their dialysis regimen restrictive and have difficulty adjusting to ESRD and their therapy. A patient who seems to be arbitrary concerning their dialysis regimen may be doing so in order to:

a. Control the dialysis staff.b. Protest their dialysis regimen.c. Gain some sense of control in their lives.*d. None of the above.

132. Besides the improvement of the patient’s level of wellness, one of the major goals of the ESRD program is to ________ the patient.

a. Transplant.b. Move the patient to home dialysis.c. Rehabilitate*d. None of the above.

133. ESRD patients have many physical factors that may affect their sexual


performance. Other factors that may affect sexual performance are:

a. An unwilling sexual partner.b. Medications.c. Emotional problems.d. All of the above.*

134. Patients that do well in their adjustment to ESRD and dialysis usually have:

a. Solid family support.b. A working relationship with the interdisciplinary team.c. The willingness to learn.d. All of the above.*

135. A patient cannot be considered to be “non-compliant” until:

a. Every means of education has been exhausted.b. Until the patient’s learning style has been evaluated by a psychologists.c. Until the family has been involved in the education process.d. All of the above.*

136. Common psychological problems often seen in dialysis patients are:

a. Anxietyb. Depressionc. Hostility and Angerd. Deniale. All of the above*

137. Most patients that have long term survival on dialysis are generally those that have a history of:

a. No diabetes.b. No cardiac illness.c. Personal responsibility and independence.*d. None of the above.

138. _______ Patients that complain of frequent nightmares and insomnia may:

a. Be in need of psychological counseling.b. May have their internal clocks off schedule.c. May be in need of a more efficient dialysis treatment.d. All of the above.*

139. A patient with HIV should be:

a. Dialyzed at the end of the day to avoid exposure to other patients.b. Dialyzed at home to avoid exposure to other patients and maintain privacy.c. Dialyzed in the general population using universal precautions.*d. None of the above.

140. Infectious and Biohazardous waste needs to be:


a. Disposed of with the regular trash.b. Disposed of in Biohazardous containers and taken away by a company approved by

the EPA and DOT for the disposal of Biohazardous Waste.*c. Burned on site.d. Put in containers separate from regular trash and then burned.

141. Hypochlorite solution to clean and disinfect surface areas of the clinic must be mixed at a dilution factor of:

a. 70%b. 1 to 10%*c. 25%d. 15%

142. According to the CDC, dialysis uniforms and linen can be washed in:

a. Conventional home laundry systems with hot or cold water.*b. Commercial laundry systems with hot water of 160 degrees F.c. Conventional home laundry systems with a veridical agent.d. None of the above.

143. The only two infections that require isolation booths or rooms are:

a. Hepatitis Cb. VRE and HIVc. VRE and Hepatitis B antigen+ *d. VRE and Hepatitis C

144. The CDC serologic screening recommendations for Hepatitis B surface antigen are:

a. Before admission to the facility and annually.*b. It is not necessary.c. Monthlyd. None of the above.

145. A patient complains of constipation. You ask them what medications they are taking. You are primarily checking to see if they are taking _______ and ______.

a. Vitamins and phosphate bindersb. Phosphate binders and stool softeners*c. Vitamins and stool softenersd. None of the above.

146. Secondary hyperparathyroidism is a direct result of a consistently high:

a. Calciumb. Potassiumc. Magnesiumd. Phosphorus*

147. In relation to the previous question, high levels of the chemistry mentioned


above can be controlled by the following medications.

a. Vitamins and Ironb. Calcium Acetate, Calcium Carbonate and Aluminum Hydroxide.*c. Stool Softenersd. Magnesium Sulfate and Sorbitol

148. Secondary Hyperparathyroidism, if left unchecked, will result in:

a. Renal Osteodystrophy*b. Constipationc. Anemiad. Cardiovascular Disease

149. Aluminum based phosphate binders, such as Alternagel and Basogel are used as a last line of defense in renal osteodystrophy because:

a. Aluminum causes damage to the bones, as well as the central nervous system.*b. This medication too expensive.c. These drugs can cause constipation.d. None of the above.

150. Renagel is a resin-based medication that can be used in the place of aluminum and calcium based phosphate binders. The primary reason why this medication is not widely used is:

a. It is more constipating than aluminum or calcium based medications.b. It is too expensive for out of pocket costs for the majority of patients.*c. It raises serum calcium to dangerous levels.d. None of the above.


National Hemodialysis Certificaton Prep Test

Part: C

Answers may be found in the book: Review of Hemodialysis for Nurse and Dialysis Personnel5th or 6th EditionGutch, Stoner and Corea, Mosby Pub.


The following questions revolve around the subjects of ethics and communications between patients and staff in the dialysis facility. Remember that sometimes it is not what you say, but how you say it:

The following questions involve the use of various hemodialysis accesses.

1. Your patient has a left IJ Ash Split Catheter. You notice that the catheters blood flow rate (Qb) has been dropping significantly in the past four weeks. Today, you are the staff educator. What would be the best advice to give the staff concerning this situation?

a. Ask the physician to prescribe a clot buster, such as Activase.b. Observe and investigate the staff’s methods of working with the catheter and then

devise an intervention with the staff.*c. Observe and investigate who has been working with the catheter and suggest

disciplinary action for poor work performance.d. Suggests that the catheter be replaced with a new one.

2. Your patient has an Optiflow catheter. As you are preparing to connect the patient to the hemodialysis tubing, you notice that the venous female luer connector is cracked. Under the circumstances, your actions would be the following:

a. Continue to connect the patient to the hemodialysis tubing and initiate dialysis and address the situation after dialysis.

b. Apply superglue to the crack, allowing it to dry and then continue to initiate the dialysis treatment.

c. Bring the situation to the attention of the physician or nurse in charge.*d. Cut the luer connector off of the catheter tubing and forcibly insert the male end of the

hemodialysis tubing into the tubing of the venous branch of the catheter.


3. You are preparing to initiate hemodialysis on your patient. As you withdraw the indwelling heparin from the arterial branch of the catheter, you notice that a large string of clot is moving into your 10cc syringe. Prior to injecting saline into the catheter branch it would first be wise to:

a. Attach another dry syringe and pull back a few more milliliters of blood to assure that the entire clot has been removed and then “jet” in your saline.*

b. Continue to the next step and “jet” in your saline.c. Refuse to use the catheter out of fear that it might kill the patient if you did so.d. Send the patient to the emergency room and have the surgeon paged.

4. You are changing the patient’s central venous line dressing and you notice that the “cuff” of the catheter, which anchors the catheter into the patient’s body, is approximately 6 centimeters outside of the exit site. Your following actions in this case should be:

a. Continue to initiate hemodialysis and then call the physician.b. Stop and inform the physician or nurse in charge.c. Secure the catheter on the patient’s chest area with tape and then ask for assistance.*d. Betadine the catheter, allowing it to dry and then attempt to push the catheter back into

the patients exit site.

5. You have received a new patient who has transferred in from another dialysis facility. This patient tells you that since she has had her catheter, that it clots continually and the previous dialysis facility’s staff had to use a lot of Activase (clot buster) in order to keep their catheter open. The patient becomes disturbed when they realize that we do not use Activase in our facility. Your response to the patient’s concerns are the following:

a. “The reason that your staff had to use Activase so often is that they were lazy and did not do a very good job of catheter maintenance.”

b. “Activase is too expensive and we cannot get paid for it, so we don’t use it.”c. “We have not had the need to use Activase because, over time, we have developed

very good methods of catheter maintenance.”*d. We have not had the need to use Activase because we use good methods of catheter

toileting.”

6. You are changing the CVL (central venous line) dressing of an elderly woman. When you peel off her old dressing, you immediately notice that there is white pus draining from the CVL exit site, mixed with a small amount of blood. Your actions in this situation would be the following:

a. Inform the nurse in charge and then acquire a culture of the exudates, using aseptic technique.*

b. Immediately apply hydrogen peroxide to the exit site, heavily Betadine the entire dressing area and especially the exit site and then apply a new dressing.

c. Inform the nurse in charge and redress the catheter exit site.d. Clean the site, as usual, and report it to the nurse in charge after you have completed

the dressing change.


7. Continuing on the scenario in question number six, the patient informs you that she showers every day, but does try to cover her CVL exit site with a piece of plastic kitchen wrap. Your best response to this information is the following:

a. Showering is OK as long as you keep your catheter dressing covered up with that kitchen wrap.

b. Showering presents a risk of infection for all patients with CVL’s.*c. You may shower with a central venous line as long as you are changing your CVL

dressing every day.d. You should remove your dressing and then apply an antibacterial soap directly to your

exit site, lathering and then rinsing well, twice. After that you blow dry the exit site and then apply a new CVL dressing.

8. You have a patient with a CVL that is confused. During the dialysis treatment, the patient is constantly reaching for their CVL and hemodialysis lines and pulling on them. The proper response under these circumstance is to:

a. Direct the hemodialysis tubing out of the patient’s reach, as well as out of their immediate view and take care to secure the lines as needed with tape and/or plastic clamps. Restraints of any kind being used as a last resort.*

b. Tie both of the patient’s wrists down to each side of the dialysis chair, taking care not to cut off circulation to the hand.

c. Do nothing, as the patient has the right to pull their lines out if they want to.d. Have the social worker call the family and inform them that if the activity does not stop

the patient will be dismissed from the facility.

9. A twenty two year old patient is admitted to the facility with a well functioning permanent CVL. You are attempting to educate the patient concerning the patients need to have an AV Fistula inserted in their non-dominant left arm. The patient refused and says, “As long as this thing is working, why should I go through the pain and suffering to have an AVF (arteriole-venous fistula) surgery?” The best response to this patients concerns would be the following:

a. Break off all discussions in this area, as it is the patient’s right not to have an AVF.b. Avoid being argumentative, but let the patient know that it is your duty to educate them

concerning the negative effects and impact that CVL’s may have upon his overall level of wellness.*

c. Be firm with the patient, letting him know that he is foolishly putting his life at risk and, as a result, will suffer harsh consequences.

d. Avoid wasting your time, seeing that the patient will never change his mind anyway.

10. You are the technician. You are changing a dressing in our facility and a new nurse runs up to you and tells you that, by changing the patient’s dressing, you are violating the Ohio (or other state) Nurse Practice Act. The nurse says this in front of the patient. If you are a nurse, the nurse in question is saying that, according to the Nurse Practice Act that you may not suture in CVL’s. Your proper response in this situation would be:

a. Tell this person to shut up and mind her own business.b. Calmly ask the nurse in charge to come over and assist you with the situation,

maintaining your temper in front of the patient.*c. Tell her that she is mistaken and that you have been trained to carry out the procedure.d. Tell the patient that the nurse is new and is not aware of our policies and procedures.


11. Following up on question number 10, the nurse in question continues to badger you, becoming extremely verbal, threatening to call the OBN and report you for practicing beyond your “level of education”. Your response to this situation would be the following:

a. Break off communication with the nurse, allowing the administrator or clinical coordinator to deal with that person.*

b. Have a nurse take over for you and take the nurse in question back into the supply room to “straighten her out”.

c. Tell the patient that the person in question is “an idiot” and that she does not know what she is doing.

d. Threaten to file a grievance against her if she does not stop harassing you.

12. Referring to questions number 10 and 11, you are in the position of the clinical coordinator. The person in question is overbearing and insistent that she is correct in her assumptions on the issue in question. She threatens to report the technician (or the nurse) to the board of nursing. Furthermore, the person is aggressive and verbally combative in her attitude and approach with the other staff, as well as you. The nurse in question should be handled in the following manner:

a. The nurse in question should be referred to the Administrator for disciplinary action.*b. The nurse is to be fired, immediately.c. The nurse is invited to contact the board on her own and is handed the telephone.d. You back down, allowing the situation to continue.

13. A staff member asks you to look over his/her needle stick in a horseshoe Gortex graft in the patient’s lower arm. You look at the needles and notice that the venous needle is on the arterial side of the graft and that it is pointed in the direction of the blood flow. The arterial needle is on the venous side of the graft, pointed in the direction of the flow of blood. Your advice to your co-worker is the following:

a. “It’s fine! Just leave the needles and your connection to the machine the way that it is, now.”

b. “Your sticks are OK, but you need to switch your venous and arterial lines so that you are not recirculating (cleaning the same blood over and over) your blood system.”*

c. “Your sticks are all wrong! I’m going to have to stick this patient again. What were you thinking?”

d. “Pull the needles out, hold the sites until the bleeding stops and start over, again.”

The following questions relate to inter-staff and staff-patient relationships, ethics and interactions. Remember to choose the best answer.


14. You are a single staff person at our facility. A young good looking and charming person is admitted to the facility. In your mind, make the patient male or female depending on your own gender or lifestyle. This patient has a difficult to cannulate AV Fistula and you are the only person that is able to successfully cannulate it. Time goes on, but the access does not improve and you continue putting the patient on for several months. The patient likes you very much and is grateful for your skill and good care. Out of a deep gratitude, the patient says “I really appreciate all that you have done for me and would like to express that gratitude by taking you out for a nice meal, no strings attached.” In view of the standards of ethics and the rules and regulations of the Nurse Practice Act, your response to the invitation should be:

a. Graciously accept the patient’s offer, fearing that refusal would offend them.b. Report the patient to the administrator for sexual harassment.c. Graciously thank the patient for his/her kind offer, but then explain that ethically, as a

healthcare professional, it would be inappropriate to accept such an invitation. Further, that it would be a clear violation of the Nurse Practice Act and could cause you to lose your license/certification.*

d. Quietly tell the patient that you would love to have dinner with him/her, but they cannot tell anybody because it would put you at risk of losing your job.

15. A patient likes you very much and relates well with you. The patient discovers your birthday and, on their next visit to the facility, presents you with a Rolex watch. The proper response (your response) in this case should be:

a. Thank the patient and accept the watch without drawing attention to the situation.b. Thank the patient and tell them how much you appreciate the thought, but that it would

be unprofessional, inappropriate and illegal to accept the gift.*c. Whisper “thank you” to the patient and slip the gift into your pocket.d. Accept the gift and then attempt to give the gift back at a later date.

16. A patient is about your age. This person, who happens to be very good looking, becomes despondent and depressed. You discover that their mate of five years has left them for another person. The patient asks you out for a few drinks “just to talk about it”. Your proper response to this conundrum would be:

a. Say “OK’ and meet the patient at the local pub.b. Say “OK” and stipulate that the meeting will be “strictly professional”.c. Say “OK” and let the patient know that you are only doing this “as a friend”.d. Inform the patient that it would be unethical to meet under such circumstances, but that

you realize that they are in need of assistance and then pass the patient’s needs onto the social worker.*

The following questions involve fluid removal from dialysis patients.


17. A patient walks over to his/her dialysis station and tells you that they weigh 55 Kg. You know that the patient is usually correct on their weight, but today, the patient looks a little full in the face and short of breath. The patient is nice most of the time, but can be known to become angry if challenged. Your proper response in this scenario would be:

a. “I didn’t see the weight. May I weigh you again, please? We might be having some difficulties with the scale and I want to be sure that I get your fluid removal set up correctly.”*

b. “If I didn’t see the weight myself, I cannot accept it. It’s my job and my license/certification is on the line if I get this wrong.”

c. “Our policy states that the person putting you on must see your weight. It’s not that I don’t trust you, it’s just our policy and we do it for each and every patient.”

d. “You’re getting old, now, and your vision is not very good. Let me check that weight, again.”

18. A new patient arrives for his/her first dialysis. The patient has an L BKA (below the knee) and an R AKA (above the knee). The patient is also presently wheel chair bound and is unable to stand up; therefore, you transfer them back and forth between the dialysis chair and wheelchair with a Hoyer lift sheet. To attain the most accurate weight on this patient, it would be best to:

a. Just subtract the wheelchair at this time and establish the base weight later on in the week, giving the patient time to adjust.

b. To avoid embarrassing the patient, you take them back to the exam room and remove both prosthesis and weigh them. You also weigh the Hoyer lift sheet. Then after moving the patient to his/her chair with the lift, you weigh the wheelchair.*

c. Move the patient to his/her chair with the Hoyer lift and then weigh the prosthesis, lift sheet and wheelchair.

d. Move the patient to his/her chair with the aid of other staff members, be sure to put the Hoyer lift on the chair before moving the patient.

19. A new patient arrives to our facility. They are a transferring patient and have been on dialysis for ten years. The patient is pleasant until you ask if you can check their pre and post dialysis weights. The patient says to you “You don’t trust me! I might as well go back to my old unit where I am trusted.” Your proper response to this scenario is:

a. Tell the patient that it is their choice. If they want to go back to their old unit “so be it.”b. Tell the patient that checking their weight is no reflection upon them, but is something

that should be done in order to assure that they have the proper amount of fluid removed during their treatment.*

c. Tell the patient that “trust is a two way street and that it must be given as well as received.”

d. Tell the patient that if they are uncomfortable with you that they can choose to have another care giver.

The following questions involve various scenarios of patients’ levels of consciousness.


20. A patient arrives to the dialysis center drooling and is unable to speak or respond to verbal or physical stimuli. Your proper response, with what limited information you have would be:

a. Put the patient on dialysis and call the physician.b. Put the patient on dialysis and re-evaluate them after the treatment has begun. If they

do not improve, call the physician.c. Call 911 and have the patient seen by a physician in the emergency room.d. Call 911 and have the patient seen by a physician in the emergency room. If the

patient returns re-evaluate them and if they have improved and are able to respond, dialyze them.*

21. A patient is brought to the dialysis unit by her husband. The patient has a large hematoma on the left side of her head. She is very slow to respond. The husband is 92 and is in poor condition, himself. He tells you that she fell in the shower at home, but he “thinks she is OK.” You look at her eyes and notice that the right eye is dilated and does not respond to light. Your proper response, under these circumstances would be:

a. Put the patient on the dialysis machine and call the physician.b. Ask the husband for more details, such as how she fell.c. Call the physician and ask him what to do.d. Call EMS so that the patient can be seen as soon as possible in the emergency room.*

22. A patient arrives to dialysis by ambulet. When you speak to the patient, they respond in gibberish. This patient is normally very mentally alert and able to respond appropriately. The driver states that the patient’s spouse told him that the patient had been constipated for over two weeks, but that she “cured him” by giving him a laxative. Your line of reasoning in helping to resolve this case would be:

a. Put the patient on dialysis and then call the physician.b. Put the patient on dialysis and then call the patient’s spouse.c. Put the patient on dialysis and call the emergency room for advice.d. Call the patient’s wife and ask her (exactly) what she gave the patient. Then based on

what she tells you, contact the physician to inform him/her of what has occurred.*

23. A patient who normally is very mentally alert comes to dialysis in a stuporus state. The patient takes 4 Tums three times a day with meals, is on a 3K 3Ca dialysate. The patient receives Zemplar, 10 mcg per dialysis treatment. With the limited information at hand, you suspect that:

a. The patient has possibly had a stroke.b. The patient is suffering from magnesium over dose.c. The patient has abused their sleeping medication.d. The patient may be suffering from hypercalcemia.*

24. In reference to the last question, what should your actions be:

a. Call the physician and explain the patient’s condition and what your suspicions are.*b. Call 911 and have the patient evaluated by a physician.c. Give the patient 50/50 D5W to correct their hypoglycemia.d. Call the physician and explain the patient’s condition. Suggests that he put the patient

on a high calcium bath.


25. The physician has taken in your suggestions and calls you back with the following orders:

a. “Send the patient to the emergency room.”b. “Put the patient on dialysis and put them on a zero calcium bath for the first two hours

of treatment, then switch them to a two calcium bath for the remainder of the treatment.*

c. “Send the patient to the emergency room for a Kayexalate enema.”d. “Give the patient one milligram of Narcan.”

The following questions concern electrolyte balance.

26. A patient presents to the dialysis facility with a weak, irregular pulse. Furthermore, the patient is suffering from generalized muscle weakness, barely able to raise his arms and legs. He is alert and oriented. He is only 2 Kg above his base weight. You ask the following question:

a. Have you used any salt substitute or “lite” salt?*b. Have you been eating extra Tums?c. Have you eaten a lot of cheese since your last treatment?d. What was your last blood sugar and did you take your insulin this morning?

27. Continuing with question 26, from the limited signs and symptoms expressed by the patient, you surmise that the patient may:

a. Have hypercalcemia.b. Have hypermagnesemia.c. Have hypernatremia.d. Have hyperkalemia.*

28. Continuing with the scenario as stated in questions 26 and 27, the proper action to take is the following:

a. Call 911 and send the patient to the emergency room.b. Call the physician, inform him of the patient’s signs and symptoms and dialyze the

patient, as prescribed.*c. Call the physician and tell him that you suspect that the patient has hyperkalemia.d. Call the physician and tell him that you suspect that the patient is hyponatremic.e. Call the physician and tell him that you feel that the patient has an electrolyte

imbalance, possibly, hypokalemia.

29. Continuing with questions 26, 27 and 28, the physician would most likely order the following:

a. “Dialyze the patient on a 0K 3Ca dialysate.”b. “Dialyze the patient on a 2K 3Ca dialysate.”c. “Send the patient to the emergency room.”d. “If you feel the patient is at risk, send them to the emergency room, otherwise, dialyze

the patient with a 0K 3Ca dialysate.”*


30. Clarify this statement: “Patients with electrolyte imbalances should always be sent to the hospital.”

a. If the nursing staff feels that the patient is at high risk of a life threatening imbalance and is in need of more advanced care.*

b. Only if the physician orders it.c. Only if the patient requests to go to the emergency room.d. Patients should be forced to go to the emergency room, whether they want to or not.

31. Clarify this statement: “All patients suspected of electrolyte imbalances should be sent to the emergency room.”

a. I agree.b. I disagree.*c. It should be done in all cases.d. It should never be done in any case.

32. When considering the following: the time it takes to process a patient through the emergency room, the time it takes to be seen by a physician, the time it takes to have blood test collected and tested by the laboratory and the time that it would take to notify acute dialysis nursing staff and allow them time to set up the machine and initiate dialysis, it would be better for the patient, if the nursing staff feels he is stable enough, to dialyze him at the facility.

a. Time is never an issue.b. Due to the efficiency of emergency rooms, time would not matter.c. By the time it takes to run the patient through emergency room processing to the actual

time of acute hemodialysis could lead the patient to further and more serious complications. It is therefore better, if the physician believes the patient is stable, to dialyze them in the chronic facility.*

d. I totally disagree.

33. A patient presents himself to dialysis 8 Kg over his base weight. The patient claims, as often is the case, that he doesn’t have any idea concerning how he gained so much weight. He does admit that he is constantly thirsty. In examining his diet, you would ask to find out if he has been consuming the following:

a. Salty snacks and preserved meats (lunch meat and salted pork).*b. Beans and rice with tomato sauce.c. Dairy products, especially milk and yogurt.d. Eggs and whip cream.

34. A patient arrives from the nursing home. She is stuporus and unable to respond to verbal commands. You call her nurse to acquire a faxed list of her medications. The patient takes Renagel (non-calcium based) as a phosphate binder, is not taking IV Zemplar or any other calcium-based medication. You suspect that you will discover that the cause of the patient’s problem is one of the following:

a. Hypermagnesemia.*b. Hypomagnesemia.c. Hypocalcaemia.d. Hyperkalemia.

The following questions involve Nurse Practice Acts as it pertains to RN’s, LPN’s and Hemodialysis Technicians who work in dialysis facilities (Look at Ohio OBN Law concerning Ohio Certified Hemodialysis Technicians or OCDT’s).


35. According to most Nurse Practice Acts, Hemodialysis Technicians, LPN’s and RN’s are to take an accredited course on Nurse Practice law:

a. Once a year.b. Once every two years.c. Once every three yearsd. Once every re-certification or re-licensure cycle.*

36. You are an LPN or a Hemodialysis Technician. An RN gives you an order to carry out a procedure that is not only incorrect, but is unsafe and could present risk to the patient. The proper action in this scenario is:

a. Carry out the order out of fear that you will be reprimanded or fired.b. Carry out the order since the RN is responsible for what happens, anyway.c. Carry out the order, but then inform the physician when the RN is not looking or aware.d. Refuse to carry out the order; pointing out the risk it imposes to the patient’s life and

keeping in mind that each individual is responsible for his/her own actions. Furthermore, always bring such issues to the attention of the administration.*

37. You are the RN in charge today. A new technician has been hired into the facility. She has been employed for nine months and, so far, has been doing fine. She is putting a patient on dialysis and afterwards, becomes very anxious. You ask her what is wrong and he tells you “nothing!” Upon making rounds you discover that the patient has a very large hematoma on their arm due to multiple sticks (six). The technician neglected to seek help. As a result, the hematoma has blocked the flow of the AV fistula and the patient now has to be sent to the surgeon. The proper way to handle this situation would be the following:

a. Fire the technician.b. Reprimand the technician by suspending her for two weeks.c. Ask the technician why she did not ask for help and attempt to discover why the

technician felt that she could not report the incident. In the meantime, document the incident and counsel the technician setting goals and time limits for changed behavior.*

d. Fire the technician and call the board of nursing to report the technician for malpractice.

38. You are the nurse in charge today. You recently discover, quite by accident, that one of the other staff members is secretly dating a patient. According to most Nurse Practice Acts, such relationships with patients is:

a. Acceptable within limits, as long as it does not interfere with the patient’s care and the overall operations of the facility.

b. Acceptable as long as both parties don’t ask and don’t tell.c. Is a violation, which could cause the professional, in question to have his/her

certification/license suspended.*d. Is morally and ethically unacceptable, but is not a violation of the Ohio Nurse Practice

Act.


39. Referring back to question number 38, such relationships are referred to as:

a. Independentb. Co-dependent*c. Interdependentd. Intradependent

40. Continuing with questions 38 and 39, most professionals who involve themselves in such relationships do so for the following reasons:

a. Most of them are homely and unable to get dates.b. Most of them are desperados and never get dates.c. Most of them appear to be normal individuals until they display this behavior.*d. Most of them have halitosis and BO.

The following questions revolve around the rare, but ever more occurring, pregnant patients on Hemodialysis

41. Although pregnancy in dialysis is a rare occurrence, with improved technology, it is occurring more than is has in the past. You have a patient at your dialysis facility that has recently received a positive pregnancy test from her OB/GYN physician. In light of the vitamin and nutritional needs of a pregnant patient, how would you address this issue?

a. The patient would need increased fluid and protein intake.b. The patient would need maternity vitamins (especially folic acid), increased protein

intake, as well as increased calcium, zinc and iron.*c. The patient needs more protein, but regular vitamins would suffice.d. The patient would not need any change in her nutritional regimen.

42. Concerning dialysis time, the pregnant patient would require the following:

a. Less time on dialysis for fear that it might negatively affect the fetus.b. The same amount of time of dialysis before she became pregnant.c. She should dialyze for a minimum of two hours six days a week.d. She should receive a minimum of 18 to 20 hours of dialysis per week.*

43. Evaluation of the patient’s need for Epogen Alpha, the patient would require:

a. An increase in Epogen Alpha.*b. A change from IV to SC dosing.c. A decrease in Epogen Alpha.d. No change in prescription for Epogen Alpha.

The following questions are specific to dialyzer reuse and water treatment. Answers to these questions may be found in the 2001 edition of the AAMI standards for hemodialyzer reuse.


44. You are removing a patient’s dialyzer post dialysis in order to prepare it for reuse. The patient states, “I do not want to do reuse, anymore and I withdraw my consent”. Your first proper action in this case would be:

a. Inform the patient that it is the policy of the facility that all patients participate and reuse, and that they have not choice in the matter.

b. Inform the patient that you appreciate their point of view, but there is nothing that you can do about it.

c. Inform the patient that you will “stop dialyzer reuse, immediately”.d. Inform the patient that you will pass their request onto the administration.*

45. The inspector from the state health department comes in to inspect the maintenance records of the automated dialyzer reuse machine (ECHO or Renatron). Unfortunately, you are six months behind on your PM for this equipment. The inspector makes the following statement:

a. This is not good, but I will allow you to PM the machine while I am still here and you can continue reuse.

b. This is a minor citation, but you can still continue to do reuse.c. This is a major violation and I am shutting your reuse program down, immediately.*d. This is a major violation, but if you call the manufacturer’s service repairman

immediately, I will allow you to continue reuse.

46. You are in the process of inspecting a dialyzer prior to reprocessing it. You notice that the fibers are filled with dark clotted blood and the headers are also packed with dark clotted blood. Your actions in this scenario would be:

a. Proceed with reverse ultrafiltration and reinspect the dialyzer in five to ten minutes.*b. Throw the dialyzer away without further thought.c. Connect the dialyzer directly to the reuse machine and if it comes out below 80%

volume, discard it.d. Clean the headers with pipe cleaners and then reprocess it.

47. The person ultimately responsible for the quality and content of the dialyzer reuse training program is:

a. The medical director.*b. The facility administrator.c. The Chief Biomedical Technologist.d. The Head Nurse.

48. The contracted Medicare inspector comes into your facility and asks to view the “reuse patient complaint log.” Choose the answer that best describes the patient complaint log:

a. The patient complaint log is a federal and AAMI required document, which maintains a chronological list of complaints from patients and staff concerning the reuse program, as well as the actions take to resolve each complaint.*

b. The patient complaint log is an optional program strictly depending on the facilities choice to participate.

c. The patient complaint log is a non-existent document.d. The patient complaint log is optional, depending upon the state of operations of your

facility.


49. The state inspector asks you to explain patient informed consent for dialyzer reuse. You explanation to the inspector is:

a. Informed consent is a separate document, which is only for patients participating in the reuse program.

b. Informed consent for dialyzer reuse must be included in the general hemodialysis consent.*

c. The patient may verbally give informed consent.d. Informed consent for reuse is optional for patients who are on reuse.

50. Dialyzer reuse records are viewed in the following context by Medicare:

a. Reuse records may be erased or destroyed after one year.b. Reuse records may be erased or destroyed after two years.c. Reuse records are to be maintained as a part of the patient’s medical records and

should be maintained for a minimum of seven years.*d. Reuse records may be erased or destroyed after the patient has been discharged from

the facility.

51. The water supply to operate the automated dialyzer reuse equipment should be of the following quality:

a. Since the patient does not come in direct contact with the reuse machine, tap water may be used.

b. The water should be at least 1 mega-Ohm of resistance, with negative LAL’s and cultures that are within AAMI standards for hemodialysis.*

c. The water should be at least 12 mega-Ohms of resistance.d. The water should be at least 20 mega-Ohms of resistance.

52. The equipment used for dialyzer reprocessing should have been approved for use by:

a. The state health department.b. The Food and Drug Administration.*c. AAMId. NANT and ANNA.

53. Reuse staff are exposed to substances, which may be viewed as toxic by OSHA or other regulatory agencies. In light of this, the following are (is) required:

a. Employees are to be monitored for Hepatitis and TB.b. Employees are to receive annual pulmonary function test.c. Employees should receive Hepatitis B vaccinations.d. Employees should receive annual pulmonary function test, as well, ambient air should

be tested for residual exposure to airborne toxins.*

54. Following up on question 53, what else would be a sensible requirement for dialyzer reuse staff?

a. Reuse staff should be rotated out of the reuse room on an every other month basis to reduce exposure to toxic substances.

b. A ventilation system that is able to change air at 200 cfm should be installed.*c. Staff should only be permitted to work in the reuse room for one year at a time in order

to reduce the amount of pulmonary damage inflicted upon any one employee.d. Reuse staff should be required to use mask filtered with activated charcoal.


55. Continuing with questions 53 and 54, what documents are mandated by OHSA and recommended by the AAMI standards for dialyzer reuse program employees?

a. MSDS and reuse personnel medical records.*b. MSDS records and information.c. Reuse machine water cultures and LAL records.d. The reuse machine PM logs.

56. A new technician accidentally spills an undiluted bottle of peracetic acid on the floor. Your first response, in this scenario, would be the following:

a. Tell the technicianb. The administrator.c. Close the door to the water treatment room.d. Close the door to the dialyzer reprocessing room.*

57. In order to maintain the facility reuse program within AAMI standards, QA evaluations and reports should be carried out on a ___________ basis:

a. Weeklyb. Annuallyc. Biannuallyd. Monthly*

58. The initials LAL stands for:

a. Low aluminum levelsb. Limulus amebocyte lysate (assay)*c. Levels of aluminum and leadd. Lead & aluminum levels

59. The OSHA upper limits for ambient hydrogen peroxide in parts per million (airborne) are:

a. 20 ppm TWAb. 1ppm TWA*c. 0.5 ppm TWAd. 200 ppm TWA

60. The OSHA upper limits for ambient Acetic acid in parts per million (airborne) are:

a. 50 ppmb. 20 ppmc. 5 ppmd. 10 ppm*

61. Which statement is the most correct in describing how reprocessed dialyzers should be marked?

a. All manufacturer data should be visible and un-obscured.b. Reuse labels take precedent over manufacturer labels.c. All manufacturer data should be visible, the label should include the patient’s name,

social security number, and all reuse data, and the blood pathway of the dialyzer should be clearly visible for inspection.*

d. The reuse technician only needs to be concerned with the patient label.


62. The OSHA action level, in other words, the limit at which action should be take place in order to protect staff from Formaldehyde in ambient air is:

a. 0.5 ppm*b. 75 ppmc. 25 ppmd. 64 ppm

63. In regard to the time of labeling for dialyzer reuse, all of the following are false, except:

a. The dialyzer may be labeled after it has been removed from the dialysis machine and the patient care station.

b. The dialyzer should be labeled prior to or at the first use of the device.*c. The dialyzer should always be preprocessed prior to being used on a patient.d. The dialyzer must have a brand new label applied to the outer jacket of the dialyzer

each time it is used.

64. One of the following statements concerning dialyzer reuse is true:

a. Patients with the same or similar names should have special labels to identify their dialyzers, for example a red grid or background.*

b. Even if a patient runs on a dialyzer that is not theirs, it’s OK as long as it is the same model dialyzer.

c. Dialyzers may only be used up to thirty (30) times.d. Dialyzers may be used up to one hundred (100) times.

65. A new patient has begun dialyzer reuse. The patient’s medical history problem list states that he/she has a history of diabetic retinopathy. The patient is only getting three to four reuses per dialyzer. You are speaking with the nephrologist about this issue. You comment, in this scenario should be:

a. This patient is not getting enough reuses per dialyzer. You need to increase his/her heparin.

b. This patient is eating the wrong things, again, and we are not getting the reuses we need to, which is costing us money.

c. The patient is having some clotting problems and may need coumadin therapy.d. The most important thing for this patient is to maintain his/her vision.*

66. You receive a call from a friend who is in the process of planning a new dialysis facility. This person has never done this before. He/she asks you what type of piping or tubing should be put in to be used for the hemodialysis water treatment loop. Your response would be all of the following, except:

a. Hospital grade copper plumbing.b. Hospital grade galvanized, rust free tubing.c. Schedule 40 PVC or stainless steely tubing.d. Schedule 80 PVC or stainless steel tugging.*

67. Endotoxins are the major components of the outer wall of _________ _________ bacteria.

a. E. Colib. Positive rodsc. Gram Positived. Gram Negative*


68. “Product water” is water that is/has:a. Been purified and disinfected by the city water plant.b. Been completely treated by an FDA approved water system for hemodialysis.*c. Filtered DI water.d. Been filtered and bottle for potable use.

69. A “sorbent” regeneration system requires the following to be effective:

a. A multilevel cartridge, which regenerates dialysate, requiring only 6 L of water.*b. A canister filled with activated charcoal.c. A combination of DI and Carbon tanks, followed by particle filters.d. A stand-alone activated carbon tank with an empty bed contact time of 20 minutes.

70. Endotoxin units or EU’s are assayed by the ______ or ______ :

a. Colony Counts or CC’sb. Limulus Bacillus or LBL’sc. Limulus Amebocyte Lysate or LAL’s*d. Endotoxin Markers or EM’s

71. Feed water is water that”

a. Untreated city water*b. Water that has been treated, which is feeding the hemodialysis water system loop.c. Water, which has been softened, but has not yet passed through the RO’s.d. Water, which has been partially treated, but has not yet passed through the UV light.

72. The maximum level of LAL assay for water treated for hemodialysis is:

a. 5 EU/mlb. 9 EU/mlc. 20 EU//mld. 2 EU/ml*

73. For the preparation of water for hemodialysis the maximum number of bacteria per ml accepted by AAMI standards is:

a. 2000 bacteria per ml.b. 600 bacteria per ml.c. 100 bacteria per mld. 200 bacteria per ml*

74. According to AAMI, hemodialysis patients are exposed to ______ water than/as the average person who is not on hemodialysis:

a. 26 times more*b. Half thec. The same amount ofd. 1000 times more


75. The most recent publication of the AAMI standards for water quality were updated by AAMI in:

a. 2003b. 2002c. 2001*d. 1989

76. The Chief Technician is on vacation and you have been chosen to take his/her place for a two-week period. On the fifth day of his/her vacation, a nurse comes to you stating that all of the patients have increased temperatures and are experiencing shortness of breath and some chest pain. Your advice to this nurse would be:

a. Continue hemodialysis, but draw blood cultures on each patient.b. Continue dialysis on all patients that have normal temperatures, but to discontinue

dialysis on those with high temperatures.c. Discontinue dialysis on all patients.d. Discontinue dialysis on all patients, but do not return their blood.*

77. Follow the scenario in question 76, the patients could be experiencing the following:

a. A pyrogenic reaction with Hemolysis.*b. A pyrogenic reaction with Crenation.c. A pyrogenic reaction.d. Simple Hemolysis.

78. Following the scenario in questions 76 and 77, what would be your first course of action in the water treatment area?

a. Call 911b. Call the city water treatment office and ask them if they have, for any reason,

chlorinated any sections of the city’s water system.c. Immediately test the level of total chlorine for the worker and polisher carbon tanks, as

well as the city feed water.*d. Call your water equipment vendor and ask for new DI tanks, ASAP.

79. Following up on questions 76, 77 and 78, an investigation is conducted by your state health inspector. The investigation bears out that pre-shift water tests had not been conducted prior to the initiation of dialysis for the patients who were harmed. Several patients died in the facility and some died on route to the hospital. The person(s) responsible for this incident is/are the following:

a. The medical director.b. You, as the interim Chief Technician.c. You and the Medical Director.d. You, the Medical Director, the corporation or company and anyone who was

responsible for your supervision.*


80. City water treatment systems often add chemicals to their drinking water for various reasons. One additive, fluoride, aids in hardening the dentin of children, thereby helping to reduce the incidents of dental caries. AAMI has identified two specific incidents, in which fluoride caused patient deaths. The part of the water system that removed fluoride is:

a. Activated carbon tanks.b. The water softener.c. A 0.5 micron filterd. The deionization tanks.*

81. RO membranes can become “scaled up” with calcium if the following pre-treatment system becomes dysfunctional.

a. The ultrafiltration system.b. The Water Softener.*c. Sediment filtration systems.d. 2 micro filters.

82. Post RO, only two materials are FDA approved for contact with water to be used for hemodialysis or dialyzer reuse. These materials are:

a. Copper and PVC.b. Stainless steel and copper.c. Stainless steel and PVC.*d. None of the above.

83. Chlorine and Chloramines are used as disinfectant additives in city water treatment systems. In drinking water, these chemicals provide protection against infection, making the water safe for potable use. Unfortunately, patients on hemodialysis that are exposed to these chemicals exhibit the following signs and symptoms:

a. Chest pain and shortness of breath.*b. Burning lungs and shortness of breath.c. Dizziness and shortness of breath.d. None of the above.

84. Continuing with question number 83, if a patient were exposed to Chlorine or Chloramines, what unusual phenomenon might you see in the hemodialysis blood circuit?

a. Foam in the blood tubing.b. A gross contamination could lead to black blood syndrome with clear, Kool-Aid-black-

cherry affect, but it could also be so mild a reaction as to be undetectable to the human eye.*

c. No change in appearance since no hemolysis or crenation takes place.d. Blue blood syndrome due to crenation of red blood cells.


85. City water treatment systems often add chlorine and chloramines as a disinfectant to make the water potable for consumption. Even if a city water system does not inject chloramines into the water system, there are other ways in which chloramines can be generated, such as:

a. Injection of chloramines in the hemodialysis water treatment system.b. Bacterial growth in the water treatment system.c. Forming naturally from the combination of rotting vegetation and chlorine.*d. Forming naturally from the combination of rotting fungi and chlorine.

86. Your dialysis facility is located near a farming community. Nitrate contamination is a common problem, especially after heavy rains and flooding. These nitrates are formed due to water table contamination by animal feces, fertilizers and bacteria. If permitted to enter water that has been treated for hemodialysis the following symptom(s) can/could occur:

a. Nausea and vomiting with Hemolysis, ending eventually in convulsions with long term low level exposure potential for cancer.*

b. No problems or negative signs or symptoms.c. Crenation of red blood cells.d. Cancer, only.

87. For hemodialysis water treatment systems, the following materials may be used for piping and storage:

a. Lead, copper and PVC (plastic)b. Copper, Zinc and PVC.c. Zinc, Iron and Copper.d. PVC and stainless steel.*

88. Following up on question number 87, the proper way to connect a metal used in the hemodialysis water system loop would be:

a. Solderingb. Welding*c. Gluingd. Screwing the pipes together using plumbing putty as the sealant.

89. The tubing for the hemodialysis water delivery loop should be installed by:

a. A subcontracted commercial plumber.b. A subcontracted residential master plumber.c. The person who is going to be your Chief Technician.d. A medical water treatment vendor who has an FDA approved water treatment system.*

90. The policy and procedures for maintenance and operation of the water treatment systems for hemodialysis and reuse should be reviewed and updated on the following schedule:

a. Every five years.b. Every two years.c. Only as the staff feels it is necessary.d. Annually.*


91. Sediment and endotoxin filters should have the following in order to be monitored and be effective:

a. Opaque housing to keep out the light, as well as a pre and a post pressure monitor.*b. A clear housing to visualize the filter so that UV light can kill bacteria.c. A clear housing to visualize the filer as well as pre and post pressure monitors.d. Pre and post pressure monitors, with a clear or opaque housing making no difference.

92. AAMI recommends the following salt for water softeners used for the treatment of water for hemodialysis and reuse:

a. Potassium chloride crystals.b. Pellet salt used be designed for softeners.*c. Any granulated sodium chloride.d. Iodized salt.

93. The person directly responsible for the quality of the water treatment system for hemodialysis and dialyzer reuse is:

a. The Chief Biomedical Technician.b. The Head Nurse.c. The Administrator.d. The Physician in charge of the facility or his/her designee.*

94. According to AAMI, the vendor or manufacturer of the is responsible for the quality out put of the water treatment system under the following circumstances:

a. Throughout the life of the water treatment system.b. Up to and at the time of the initial installation of the water treatment system.*c. For a period of five years.d. The manufacturer and vendor have no responsibility for the quality of the system.

95. According to AAMI, home hemodialysis patient’s water treatment systems are not held to the standard of monthly checks for the following reasons:

a. Bacterial growth in the home water treatment system for hemodialysis is of no consequence.

b. These systems are continuously self-disinfecting.c. Less testing is acceptable and justifiable only on a costs basis and the fact that only

one person is being affected as opposed to a group of patients.*d. The question is misleading, since all hemodialysis water treatment systems are held to

the same standards.

96. Which statement is untrue concerning deionization tanks?

a. When ordering DI tanks, it is vital that the vendor separate and be knowledgeable of the difference between industrial and medical DI resins.

b. Pre DI carbon treatment is necessary to prevent nitroamines.c. Awareness of antifreeze and preservative content in the tanks is not a concern.*d. A one megohm resistivity, temperature compensated monitor is recommended.


97. Provisions exist in the AAMI standards for reuse of other disposable, besides dialyzers, that disposable is:

a. AV fistula needles.b. Syringes.c. Hemodialysis machine blood tubing.*d. Transducer protectors.

98. A patient’s monthly Kt/V has dropped significantly since the previous months results. Directly related to the reuse process, the following are possible reasons why this may have happened:

a. The dynamic flow of the patient’s AV fistula has become compromised.b. The patient’s blood flow rate of his central venous line was below 400ml/min.c. The patient’s heparin requirements needed to be increased.d. The dialyzer was left overnight in the reuse refrigerator and was not reverse ultrafiltered

and processes with peracetic acid until 12 hours before the dialyzer was going to be used, again.*

99. The nurse responsible for Kt/V calculations and QA/CQI comes to you and informs you that a patient’s Kt/V has dropped from 1.42 to 1.01 the previous month before. The patient’s dialyzer is still well above 80% of the original volume. Your advice to this nurse would be to look at the following:

a. The patient’s dialysis access flow studies, as well as Qb and Qd.*b. Look at the brand model and membrane of the dialyzer.c. Look at the patient’s dialysate formula.d. Look at the patient’s dietary intake.

100. A new patient is transferred to your dialysis facility. Unfortunately, all of the patient’s medical records have yet to arrive, in particular, the patient’s Hepatitis B status (for the purpose of this question, the fault of this omission is not your concern). After the patient’s dialysis is complete, you overhear a nurse instruct a staff person to take the dialyzer back to the reuse room. Your response to this would be the following:

a. “Go ahead and I’ll process it as soon as I can”.b. “Please take the dialyzer back to the sink while I recheck the patient’s chart”.c. “Please dispose of the dialyzer, since we have not yet received evidence of his

Hepatitis B status”.*d. You would say anything, because it would not matter one-way or the other.

Note: CEU4U programmer. There is an asterisk at the end of the correct answer.

the national hemodialysis certification prep examination 2014

Documents

certification test

test candidate

test taker

review of hemodialysis

hemodialysis therapy

hemodialysis technicians

intended certification

specific area of hemodialysis