CHBT Patient Safety and Quality Assurance 2 — Questions and Answers
Question 1: Which of the following is the most critical immediate action when a patient on hemodialysis develops sudden hypotension?
- Place the patient in the Trendelenburg position and administer a normal saline bolus (Correct answer)
- Increase the ultrafiltration rate to remove excess fluid faster
- Disconnect the patient from the dialysis circuit immediately
- Administer a vasopressor medication without notifying the nurse
Correct answer: Place the patient in the Trendelenburg position and administer a normal saline bolus
Sudden hypotension during hemodialysis is managed by placing the patient in Trendelenburg position (legs elevated) and administering a normal saline bolus to restore circulating volume. Increasing ultrafiltration would worsen hypotension.
Sudden hypotension during hemodialysis is managed by placing the patient in Trendelenburg position (legs elevated) and administering a normal saline bolus to restore circulating volume. Increasing ultrafiltration would worsen hypotension.
Question 2: A CHBT technician notices a patient's access site is bleeding excessively after needle removal. What is the first step?
- Apply direct pressure to the site with sterile gauze (Correct answer)
- Reinsert the needle to stop the bleeding
- Elevate the arm above heart level without touching the site
- Document the finding and wait for it to resolve on its own
Correct answer: Apply direct pressure to the site with sterile gauze
Direct pressure with sterile gauze is the immediate first response to control bleeding from a vascular access site. Continuous pressure for the appropriate time is required, and the nurse must be notified.
Direct pressure with sterile gauze is the immediate first response to control bleeding from a vascular access site. Continuous pressure for the appropriate time is required, and the nurse must be notified.
Question 3: What does the term 'Kt/V' measure in hemodialysis quality assurance?
- The adequacy of dialysis, specifically urea clearance relative to body water volume (Correct answer)
- The blood flow rate divided by dialysate volume
- The potassium-to-volume ratio in the dialysate
- The kinetics of toxin transfer across the membrane
Correct answer: The adequacy of dialysis, specifically urea clearance relative to body water volume
Kt/V is the standard measure of dialysis adequacy. K = clearance of urea by the dialyzer, t = treatment time, V = volume of distribution of urea (total body water). A Kt/V ≥ 1.2 per treatment is the minimum recommended target.
Kt/V is the standard measure of dialysis adequacy. K = clearance of urea by the dialyzer, t = treatment time, V = volume of distribution of urea (total body water). A Kt/V ≥ 1.2 per treatment is the minimum recommended target.
Question 4: Which quality assurance measure helps ensure consistent delivery of the prescribed dialysis dose?
- Documenting pre- and post-dialysis BUN values and calculating URR (Correct answer)
- Measuring patient weight only at the end of each session
- Relying solely on patient-reported symptoms of wellness
- Checking blood pressure once at the start of treatment
Correct answer: Documenting pre- and post-dialysis BUN values and calculating URR
Urea Reduction Ratio (URR) and Kt/V calculated from pre- and post-BUN values are the primary quality assurance tools verifying that patients received their prescribed dialysis dose.
Urea Reduction Ratio (URR) and Kt/V calculated from pre- and post-BUN values are the primary quality assurance tools verifying that patients received their prescribed dialysis dose.
Question 5: During a hemodialysis treatment, a patient reports chest pain and shortness of breath. The technician should:
- Stop the treatment immediately, call for emergency assistance, and monitor the patient (Correct answer)
- Slow the blood pump speed and continue treatment while observing
- Increase the dialysate temperature to improve circulation
- Reassure the patient and complete the session before notifying the charge nurse
Correct answer: Stop the treatment immediately, call for emergency assistance, and monitor the patient
Chest pain and shortness of breath are potential signs of a cardiac event or air embolism. Treatment must be stopped immediately, emergency help called, and the patient closely monitored as per emergency protocols.
Chest pain and shortness of breath are potential signs of a cardiac event or air embolism. Treatment must be stopped immediately, emergency help called, and the patient closely monitored as per emergency protocols.
Question 6: What is the purpose of a quality assurance water culture in a hemodialysis unit?
- To detect bacterial contamination levels in the water used to prepare dialysate (Correct answer)
- To measure the chemical composition of the dialysate concentrate
- To verify the proper functioning of the reverse osmosis membrane pressure
- To confirm that chloramine levels are within acceptable pH limits
Correct answer: To detect bacterial contamination levels in the water used to prepare dialysate
Monthly water cultures detect bacterial counts in product water and dialysate. AAMI standards require <100 CFU/mL for product water and <200 CFU/mL for dialysate to ensure patient safety.
Monthly water cultures detect bacterial counts in product water and dialysate. AAMI standards require <100 CFU/mL for product water and <200 CFU/mL for dialysate to ensure patient safety.
CHBT Patient Safety and Quality Assurance 2
Which of the following is the most critical immediate action when a patient on hemodialysis develops sudden hypotension?