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October 2024

Question Title

* Within the first hour of a hemodialysis treatment, a patient complains of feeling cold and is shaking involuntarily. The technician should suspect that the patient most likely has

The correct answer is a pyrogenic reaction.

Rationale: Endotoxins can pass into the patient's blood through an intact dialyzer membrane. If this happens, a pyrogenic reaction may occur, and the patient may have chills and/or fever, low blood pressure, nausea and vomiting, and muscle aches.

Reference: MEI. (2024). Core Curriculum for the Dialysis Technician, 7th ed., pages 212, 257, 279, & 363; Kallenbach, J.Z. (2021). Review of Hemodialysis for Nurses and Dialysis Personnel, 10th ed., page 118.
May 2024

Question Title

* Patients with chronic kidney disease are generally in which of these physiological states?

The correct answer is a. metabolic acidosis

Rationale: Metabolic acidosis is a condition that occurs when the acid/base balance of body fluid and tissues shifts toward acid. This is a frequent problem in dialysis patients. Their kidneys no longer reabsorb as much bicarbonate, a buffer that keeps blood pH stable.

Reference: Medical Education Institute. (2018). Core Curriculum for the Dialysis Technician, 6th ed., pages 60 and 351.
December 2023

Question Title

* A patient's dialysis machine alarms and displays a lowered (more negative) arterial pressure. The lines are intact and no kinks are present. Which of the following should the technician evaluate as another possible cause of the low arterial pressure?

The correct answer is a. needle infiltration.

Rationale: An infiltration occurs when the tip of the needle goes into the fistula or graft and punctures the back wall of the access. Blood leaks out of the back wall into the patient's tissue, causing painful bruising. When there is an infiltration in the arterial needle, the arterial pressure becomes more negative and is likely to set off the arterial pressure alarm and stop the blood pump.

Reference: Medical Education Institute. (2018). Core Curriculum for the Dialysis Technician, 6th ed., pages 175-176.
July 2023

Question Title

* A patient who is receiving dialysis has a high serum phosphorus level and has been given instructions about the phosphorus content of foods. If the instructions were effective, the patient should identify which of the following types of food as highest in phosphorus?

The correct answer is d. dairy.

Rationale:  Generally, dairy products and high protein foods contain the most phosphorus, while fruits and vegetables contain the least.  Patients should be reminded to take phosphate binders as ordered with meals and snacks, since not taking prescribed phosphate binders is a common cause of high serum phosphorus levels.

Reference: Kallenbach, J.Z. (2021).  Review of Hemodialysis for Nurses and Dialysis Personnel, 10th ed., Elsevier, Table 15.1, p. 132.
February 2023

Question Title

* A technician is unloading supplies. To avoid muscle strain and prevent injury, the technician uses good body mechanics, which include

The correct answer is c. avoiding quick, forceful movements.

Rationale: The use of good body mechanics helps prevent muscle strain, fatigue, and injuries. Repetitive motion, awkward postures, and forceful exertion should be avoided. Arm and leg muscles are used to lift objects, not a person’s back, which should remain straight. It is also important to ask for help when it is needed.

Reference:  Medical Education Institute.  (2018). Core Curriculum for the Dialysis Technician, 6th ed., pages 220-221.
September 2022

Question Title

* Within the first 20 minutes of a hemodialysis treatment, a patient complains of shortness of breath, chest pain, and back pain. A drop in blood pressure is noted. The technician should suspect that the patient most likely has had a reaction to

The correct answer is a. The dialyzer.

Rationale: The patient most likely has had a Type B dialyzer reaction, which occurs in 3-5% of treatments with new modified cellulose membranes. The reaction is caused by an immune response to the dialyzer membrane (called “complement activation”) and tends to start in the first 10-30 minutes of treatment. Symptoms may include chest and/or back pain, trouble breathing, nausea and vomiting, and hypotension.

References: Medical Education Institute. (2018). Core Curriculum for the Dialysis Technician, 6th ed., p. 106; Kallenbach, (2021). Review of Hemodialysis for Nurses and Dialysis Personnel, 10th ed., p. 118.

 
April 2022

Question Title

* Immediately after initiation of treatment, a patient has a sudden onset of nausea, headache, and back pain. The technician suspects hemolysis caused by

The correct answer is c. exposure to a disinfectant.

Rationale: Red blood cell rupture (hemolysis) is a life-threatening problem that needs urgent care from a doctor or nurse practitioner. Hemolysis may be due to dialysate that is too hot or too dilute, has the wrong conductivity, or contains bleach, formaldehyde, chloramines, copper or nitrates.

References: Reference: Medical Education Institute. (2018). Core Curriculum for the Dialysis Technician, 6th ed., p. 250; Daugirdas, et al. (2015). Handbook of Dialysis, p. 232
November 2021

Question Title

* The technician learns that a patient has had a decreased Kt/V for one month.  Which of these treatment changes is likely to be made to improve the patient's Kt/V?

The correct answer is d. Increase the blood flow.

Rationale: If the patient=s Kt/V goal is not met, the patient’s dialysis prescription may be changed by such measures as increasing the blood flow rate, extending the treatment time, or changing the dialyzer.

Reference: Medical Education Institute. (2018). Core Curriculum for the Dialysis Technician, 6th ed., p. 108; Kallenbach, J.Z. (2021). Review of Hemodialysis for Nurses and Dialysis Personnel, 10th ed., p. 137
June

Question Title

* The abnormal bruit heard most frequently in stenosis is a

The correct answer is d. high-pitched, discontinuous sound.

Rationale: When a fistula or graft is stenosed, the bruit is likely to sound louder, higher in pitch, and discontinuous--with each sound being separate, rather than continuous.  

Reference: Medical Education Institute. (2018). Core Curriculum for the Dialysis Technician, 6th ed., p. 181
January

Question Title

* A dialysis facility changed the type of acid concentrate used from one with acetic acid to one that also has citric acid. The technician should understand that this was done to

The correct answer is b. reduce the amount of heparin needed.

Rationale: The use of citric acid rather than acetic acid in the acid concentrate for dialysis can be used with reduced heparin or as part of a heparin-free dialysis technique.  

Reference: Medical Education Institute. (2018). Core Curriculum for the Dialysis Technician, 6th ed., p. 246; Daugirdas, et al. (2015). Handbook of Hemodialysis, 5th ed., p. 262.
August

Question Title

* Hemolysis in hemodialysis patients can be caused by

The correct answer is b. kinked blood tubing.

Rationale: Hemolysis means rupture of red blood cells. It is a life-threatening problem that requires immediate medical treatment. Hemolysis has many causes, including dialysate that is too hot or that contains bleach or chlorine, blood pump rollers that are too tight, excessive negative arterial pressure, and kinked blood tubing.

Reference:  Medical Education Institute. (2018). Core Curriculum for the Dialysis Technician, 6th ed., pp. 124, 168, 346; Kallenbach, J. Z. (2016). Review of Hemodialysis for Nurses and Dialysis Personnel, 9th ed., p. 171.
March

Question Title

* Due to a water main break, the municipal water provider has alerted the dialysis unit of its temporary plan to increase the concentration of disinfectant (chlorine/chloramines) in the water source. To ensure patient safety, the CCHT-A should increase the

The correct answer is frequency of water testing.

Rationale: Increased concentration of disinfectant (chlorine/chloramines) in source water can prematurely exhaust carbon adsorption of these chemicals. According to CMS, when chlorine levels in water increase, more frequent testing of chlorine/chloramines must be performed (every 30-60 minutes).

Reference: Center for Medicare and Medicaid Services (CMS), Conditions for Coverage, V177
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