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

Arterial (pre-pump) pressure is normally negative because the pump pulls blood from the access. A very negative value (e.g., -250 mmHg) indicates high resistance to blood inflow—the access cannot supply blood fast enough for the set blood flow rate. Common causes include needle malposition, access stenosis, or arm position.

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

TMP is the pressure gradient driving fluid (water) across the dialyzer membrane from the blood to the dialysate side. Monitoring TMP allows assessment of ultrafiltration efficiency and can detect clotting within the dialyzer (rising TMP) or membrane dysfunction.

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

After initial Trendelenburg positioning and stopping ultrafiltration fail to restore blood pressure within a reasonable time, a saline bolus (per standing orders or physician order) is the next intervention for intradialytic hypotension. The nurse and physician must be notified for further management.

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

Serial mental status assessment at each treatment establishes a baseline and detects changes that may indicate serious conditions including uremic encephalopathy (inadequate dialysis), medication toxicity, hypoglycemia, stroke, or other acute medical events requiring prompt intervention.

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

A thrombosed AV graft typically feels firm and pulsatile (transmitted cardiac pulsation without actual flow) without the continuous thrill or bruit of a patent graft. Absence of bruit and thrill strongly suggests thrombosis. The technician should not cannulate the graft and must notify the nurse immediately.

CCHT - Certified Clinical Hemodialysis Technician Practice Test

CCHT - Certified Clinical Hemodialysis Technician Practice Test

CCHT Patient Assessment and Monitoring 3