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August 2024

Question Title

* It is important to wait several weeks before cannulating a newly created arteriovenous (AV) fistula to

The correct answer is b. achieve adequate fistula maturation.

Rationale: A newly created AV fistula needs time to properly mature and develop before it is used for cannulation for a hemodialysis treatment. According to the Fistula First Breakthrough Initiative, a fully matured AV fistula is one that can support a blood flow rate of 600 mL/min and sustain three consecutive two-needle cannulations with no infiltration.

Reference: Kallenbach, J.Z. (2021). Review of Hemodialysis for Nurses and Dialysis Personnel, 10th ed., pages 95-96.
April 2024

Question Title

* Which of these components of the water treatment system removes bacteria?

The correct answer is d. ultrafiltration membranes.

Rationale: Ultrafiltration membranes as part of the water purification system can remove particles as small as 0.001 microns in size, including bacteria and endotoxin, to help ensure the microbiological quality of water for dialysis. Most often, ultrafiltration membranes are placed just before the piping for the distribution of water either to the stations or to a storage tank.

References: Medical Education Institute. (2018). Core Curriculum for the Dialysis Technician, 6th ed., pages 87 & 278; Kallenbach, J.Z. (2021). Review of Hemodialysis for Nurses and Dialysis Personnel, 10th ed., p. 73.
November 2023

Question Title

* When cleaning a patient’s access prior to needle placement, the dialysis technician should

The correct answer is c. allow it to dry before cannulation.

Rationale: Before needles are placed, the patient’s skin is cleaned and prepped with an antiseptic solution, which must be allowed to air dry.  After the skin is prepared, it should never be retouched except by someone wearing sterile gloves.  

Reference: Kallenbach, J.Z.  (2021). Review of Hemodialysis for Nurses and Dialysis Personnel, 10th ed., page 104; Medical Education Institute. (2018). Core Curriculum for the Dialysis Technician, 6th ed., page 161.
June 2023

Question Title

* Which of the following laboratory results is reviewed as part of anemia management for hemodialysis patients?

The correct answer is b. Iron.

Rationale: Kidney patients often have anemia, a condition in which there are not enough red blood cells to carry oxygen through the body. The building block of red blood cells is iron.  In fact, 70% of the iron in the body is located in the hemoglobin of red blood cells. Therefore, anemia management includes monthly measurement of hemoglobin and hematocrit levels for all patients in the facility. If the goals for anemia management are not met, additional iron tests are done, such as ferritin and transferrin saturation (TSAT) levels.  Patient issues to track are dosages and responses to erythropoietin stimulating agents (ESAs), as well as blood loss caused by insufficient rinseback of red blood cells or prolonged bleeding after-treatment.

Reference:  Medical Education Institute. (2018). Core Curriculum for the Dialysis Technician, 6th ed., pages 30-31; CMS Conditions for Coverage, Interpretive Guidance, 2008, V tag V632.
January 2023

Question Title

* The most common cause of hypotension late during a hemodialysis treatment is

The correct response is d. excessive fluid removal.

Rationale: Hypotension occurring late during dialysis is usually attributable to the removal of fluid from the vascular space that exceeds the patient’s ability to compensate.  

Reference: Kallenbach, J.Z. (2021). Review of Hemodialysis for Nurses and Dialysis Personnel, 10th ed., page 115.
August

Question Title

* Primary functions of the human kidney include which of the following?

The correct answer is d. Balancing fluid and electrolytes to maintain a homeostatic environment.

Rationale: The primary functions of the kidney include keeping a constant internal balance by regulating fluid volume and electrolyte balance to maintain homeostasis.

Reference: Medical Education Institute. Core Curriculum for the Dialysis Technician, 6th ed., page 23.
March

Question Title

* A patient tells the technician about a recent newspaper article. “It said that over 30% of dialysis patients in the United States are candidates for home treatment.  Can I do home dialysis?”  Which of these responses by the technician would be appropriate?

The correct answer is b "That would be great to discuss in your care planning meeting."

Rationale: The technician should encourage the patient to discuss their choices with their healthcare team.  According to the Centers for Medicare and Medicaid Services (CMS) Conditions for Coverage for End-Stage Renal Disease, the facility staff must provide unbiased education to patients about all dialysis treatment options (modalities and settings) offered for kidney failure, whether or not those options are offered at the current dialysis facility.

Reference: CMS, Conditions for Coverage for End-Stage Renal Disease, V458
October

Question Title

* One hour into a hemodialysis treatment, the technician sees that the patient’s venous needle has become dislodged.  In addition to calling for help, which of these actions should the technician take immediately?

The correct answer is b. Stop the blood pump and clamp the line.

Rationale: If the venous needle becomes dislodged, the technician should immediately stop the blood pump and clamp the separated bloodlines. The technician should then apply direct pressure to the bleeding site.

Reference: Medical Education Institute. Core Curriculum for the Dialysis Technician, 6th ed., pages 254 & 262.
May

Question Title

* Prior to having surgery to create an arteriovenous fistula, a patient asks, “Why do I need to have this vein mapping procedure?”  Which of these responses by the technician would be best?

The correct answer is d. "To identify a vein suitable for access placement.”

Rationale: Using ultrasound, upper extremity vessel (or vein) mapping is done to identify veins that are of sufficient size and flow to support the creation and patency of an arteriovenous fistula.

Reference: Medical Education Institute, Core Curriculum for the Dialysis Technician, 6th ed., p. 156
December

Question Title

* Which of the following complications can be associated with venous needle dislodgement during a hemodialysis treatment?

The correct answer is c. Unnoticed blood loss.

Rationale: Bleeding, a potentially life-threatening emergency, can occur if a needle is dislodged during a hemodialysis treatment. Therefore, it is essential to ensure all bloodline connections are secure and the patient’s access is always visible throughout the entire treatment.

Reference: Medical Education Institute, Core Curriculum for the Dialysis Technician, 6th ed., p. 177
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