Hemodialysis Water Treatment Final Study Guide

1) Total Cell Volume (TCV) is an indirect measure of the:
a. Blood Leak
b. Contamination of the dialyzer
c. Performance of the dialyzer
d. Residual chemicals

2) The organization that sets the standards for dialysis water quality is called:
a. AAMI
b. JCAHO
c. KDOQI
d. USRDS

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3) Total chlorine levels in the water are tested:
a. at the end of the day
b. at the beginning and the end of the day
c. before each patients shift or every four hours
d. before the first patient shift

4) Name the two compartments of the dialyzer: blood compartment and dialysate compartment

5) The minimum dwell time to achieve sterilization with the chemical Renalin is:
a. 8 hours
b. 11 hours
c. 14 hours
d. 24 hours

6) The hemodialysis machine continuously monitors many parameters. Which of these parameters must be verified by an external measuring device?
a. Blood flow
b. Dialysate flow
c. pH and conductivity
d. Temperature and Transmembrane pressure

7) Dialysate pH should be:
a. Between 5.0 and 5.4
b. Between 6.0 and 6.4
c. Between 7.0 and 7.4
d. Between 8.0 and 8.4

8) Germicide rebound occurs due to:
a. Germicide bound to the casing
b. Inadequate dialyzer priming
c. Leaching from the potting compound
d. Residual from the O ring

9) The immediate action for a cracked dialyzer header or a dialyzer blood leak is:
a. Return blood, set-up new dialyzer and lines, reinitiate dialysis.
b. Do not return blood, set-up new dialyzer and lines, reinitiate dialysis.

10) The part of the cell wall of bacteria that, when released, can cause fever in hemodialysis is:
a. Endotoxin
b. Nucleus
c. Red blood cell
d. Transferrin

11) Dialysate is sterile.TRUE or FALSE

12) The rationale for disinfecting the internal dialysis delivery system is:
a. maintain proper conductivity
b. prevent blood borne infection
c. prevent bacterial contamination

13) The water softener:
a. is monitored at least once a week
b. is monitored by checking the water pH
c. operates on the principle of ion exchange
d. removes bacteia

14) The reprocessed dialyzer is carefully rinsed prior to patient use to remove:
a. bacteria
b. complement deposits
c. residual blood
d. residual sterilant

15) Patient exposure to chloramines during the hemodialysis treatment may cause:
a. bleeding
b. hemolysis
c. hyponatremia
d. pyrogenic reaction

16) Which of the following is considered to be safe water for dialysis:
a. city water
b. dialysis quality water
c. tap water
d. well water

17) Which organization set the standards and recommendation for dialyzer reprocessing:
a. AAMI
b. CDC
c. CMS
d. FDA

18) The water softener removes:
a. bicarbonate precipitate
b. calcium and magnesium
c. chlorine and chloramines
d. iron and other heavy metals

19) The purpose of using counter-current flow is to:
a. decrease the amount of dialysate used
b. decrease the surface area of the membrane
c. increase the rate of fluid removal
d. increase the rate of waste removal

20) The total pressure that exists across the dialyzer membrane is called: a. hydrostatic pressure
b. oncotic pressure
c. osmotic pressure
d. transmembrane pressure

21) AAMI standards for the total microbial count of dialysate shall not exceed:
a. 200CFU/ml
b. 400CFU/ml
c. 800CFU/ml
d. 1000CFU/ml

22) Name two hazardous chemicals used in the dialysis clinic: Renalin and Bleach

23) Which potassium content would dialyze off the most potassium:
a. K-1
b. K-2
c. K-3
d. K-4

24) Where would you find information about hazardous materials in your clinic: Material Data Safety Sheets – MSDS Manual

25) Dialysate is chemically similar to blood, list four components of
dialysate: Sodium, Potassium, Calcium, Magnesium, Acetate, Chloride and Dextrose.

26) TRUE or FALSE? Patients have the right to refuse dialyzer reprocessing.

27) How often should the bicarbonate central delivery system be disinfected?
a. daily
b. weekly
c. monthly
d. quarterly

28) TRUE or FALSE? Inadequate heparinization can lead to poor reuse.

29) TRUE or FALSE? Will the dialyzer membranes be able to ultrafiltrate if the water temperature is about 80°F?

30) How many uses can a reuse dialyzer, according to the manufacturer, be used? 99 – no limit

31) Explain the process of testing for Chlorine and Chloramines using both meter and strip: METER: Fill both specimen containers to line, wipe off fingerprints and excess water, put 1 total chlorine packet in specimen cap and shake to mix well, put in meter, wait 3-5 minutes then press read. STRIP: hold indicator strip in specimen container and swish vigorously should read 0.0 ppm – 0.01 ppm.

32) What color should the water turn when testing for hardness? Blue If it is NOT the color above, explain why: If its not blue it means the water is above the acceptable hardness level, notify the charge nurse, the biomed technician and FA right away.

33) Explain what you know about the importance of water treatment: It is important because water makes up 90% of the solution used for dialysis (dialysate). Dialysate is not sterile so it is important to remove the chemical and bacterial contaminants which may be harmful to the patients. The only thing that separates the dialysate and the patients blood is the membrane inside the dialyzer.

34) Explain ion exchange pertaining to the water softener: The water softener contains resin beads and operates based on ion exchange. The resin beads are charged with soft sodium ions which are released in exchange for the hard magnesium and calcium ions. The water softener backwashes the hard ions and rinses them down the drain then regenerates from the salt that is in the brine tank. The salt water solution recharges the resin beads in the softener and ion exchange begins again.

35) What things should you look for on are-use dialyzer PRIOR to putting a patient on and why: Patient’s name, ID #, correct prescription, sterilent 2/3 full, dwell time no less than 11 hours and no more than 14 days, overall quality, positive for sterilent, and reuse number per company policy.

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