CCHT Patient Assessment and Monitoring 3

Question 1

During hemodialysis, a patient's arterial pressure reading shows a persistently negative value of -250 mmHg. What does this most likely indicate?

Accepted Answer

Access inflow problem—the blood supply to the dialyzer is restricted, often due to poor flow from the access or needle malposition

Answer

The blood pump speed is too slow, causing pooling in the drip chamber

Answer

The venous needle has been placed in the arterial segment of the fistula accidentally

Answer

Normal variation in patients with low systemic blood pressure

Question 2

What does the transmembrane pressure (TMP) represent in hemodialysis, and why is monitoring it important?

Accepted Answer

The pressure driving fluid across the dialyzer membrane; monitors ultrafiltration and can indicate membrane clotting or dysfunction

Answer

The difference between blood and dialysate flow rates; monitors adequacy of dialysis delivery

Answer

The pressure difference between the arterial and venous blood lines; monitors access function

Answer

The osmotic pressure gradient across the membrane; monitors solute removal efficiency

Question 3

A patient undergoing hemodialysis develops sudden pallor, diaphoresis, and complaints of feeling faint. Blood pressure is 88/50 mmHg. After placing the patient in Trendelenburg and stopping ultrafiltration, the blood pressure remains 86/54 mmHg after 5 minutes. What is the next action?

Accepted Answer

Administer a normal saline bolus (100–200 mL) as per standing orders and notify the nurse and physician

Answer

Continue to observe for 10 more minutes before intervening further

Answer

Increase the blood flow rate to improve cardiac output

Answer

Administer a potassium chloride bolus to stabilize the blood pressure

Question 4

Why is it important to assess a patient's mental status and orientation at each dialysis treatment?

Accepted Answer

To identify changes from baseline that may indicate uremic encephalopathy, medication effects, stroke, or other clinical changes requiring intervention

Answer

To determine if the patient can sign consent forms before treatment

Answer

To assess literacy level for educational material selection

Answer

To comply with the facility's billing documentation requirements

Question 5

A patient who has an AV graft for vascular access arrives for dialysis and the graft feels very firm, rope-like, and pulsatile throughout with no audible bruit. What does this finding suggest?

Accepted Answer

The graft is likely thrombosed (clotted), and treatment should be delayed while the access is evaluated

Answer

The graft has matured well and has excellent blood flow

Answer

High blood pressure is causing increased graft pressure—lower blood pressure before cannulation

Answer

This is a normal finding in a graft that has been in place for more than 2 years

Question 6

How frequently should blood pressure be monitored during a standard hemodialysis treatment?

Accepted Answer

Every 30 minutes (minimum) throughout treatment, with more frequent monitoring if unstable

Answer

Once at the start of treatment and once at the end

Answer

Every 2 hours or when the patient complains of symptoms

Answer

Only when the patient requests it or the blood pressure alarm triggers