LP2 Water

1. Patients dialysing 3 times per week, 4 hours per treatment at a 500mL/minute dialysis fluid
flow rate, are
exposed to approximately now mucn Water?
350 Liter per week? Tx? Year? Month?

2. We water is usually considered soft.

Select TRUE or FALSE

3. The correct order of the 4 stages for water puritication are:

Pre-treatment; reverse osmosis; distribution loop; Ultrafilter (Diasafe)

4. Identify the incorrect statement:

Water softner removes chlorine and chloramine

5. If present in the dialysis fluid, chlorine and chloramine can cause

haemolysis (destruction or red blood cells).
Select TRUE or FALSE

6. Which of the following is correct regarding acceptable standards for "ultrapure dialysis
fluid", as specified by ISO standards:
<O.1 CFU/mL and <0.03 FU/m

7. Hard water can damage the RO membrane

Select TRUE or FALSE

8. The RO rejection percentage and conductivity should be checked and

documented: Daily

9. Biofilm growth within the distribution loop can be reduced or prevented by regular
disinfection of the loop
Select TRUE or FALSE

10. The purpose of the ultrafilter (Diasafe®) is to remove_____from the dialysis fluid. by the
processes of filtration
and adsorption.
Endotoxin and fragments of endotoxin

LP 3 HDF
1.The two most common methods of delivery of substitution fluid are
Pre dillution and Post dillution

2. Patients who may benefit from HDF therapy include those with:
All of the bove

3. The principal transport mechanism for removal of middle molecules in HDF is:

Convection-
Osmosis
Dillution-
4. After how many treatments must the Diasate filter be changed?
After every 100 treatments

5. In the Catalonian high volume HDF stay, cardiovascular mortalty risk was reduced by:
33%

6. To achieve "high volume HDF". the substitution volume must be greater than 15 litres per
treatment
Select TRUE or FALSE
7. For patients with some residual renal function, it is more advisable to stay on conventional
HD and not commence HDF
Select TRUE or FALSE

8. If present in the dialysis fluid and substitution fluid. endotoxins can

All of the above.

9. High incidence of cardiovascular disease in patents with end-stage kidney failure is related
to
Accumulation of uremic toxins.

10. High-volume HDF can improve survival by(select all that apply)
•Enhancing uraic toxin removal
•Reducing hospitalization risk
•Facilitating hypertension control

LP 4 Dialysis Fluid
1.Which condition does not lead to metabolic acidosis
Vomiting

2.Which of the following are the main buffers in the human body
Chemical buffers, Respiratory system, Kidneys

3. A substance with a pH of 3 is an"alkali"

Select TRUE or FALSE
pH<7- Acidic pH>7 Alkaline

4. Choose the incorrect statement

Dialysis fluid helps to balance the body's blood composition by directly mixing with the blood
during standard HD treatment

5. Select the correct statement

Bucarbonate is the most common buffer used in hemodialysis

6. When entering bicarbonate information into the 4008S dialysis machines, "Base Na+" means

7.Which cation is the most abundant in extracellular fluid and also constitutes most of
conduvity in dialysis fluid?
Bicarbonate

8. Conductivity is the combination of all the charges or cations in a solution

Select TRUE or FALSE

9. When included in dialysis fluid, glucose will do all of the following except:
Provide glucose when the patient is severely hyperglycaemic (high bloodglucose level)
10. Choose the correct proportion (parts) or concentrates and water to achieve the precise
volume of 35 mls of dialysis fluid solution.
None of the above.

LP 1
1. The approximate amount of urine excreted by healthy kidneys daily is:
Only 1.5-2L becomes urine

2. The kidney is about the size of the hand fist: (150-170g)

Select True or False

3. The movement of solute from an area of high to low concentration is called:

Diffusion is the movement of solute from an area of high to low solute concentration.

4. The movement of water through a membrane caused by a pressure gradient is called:

Ultrafiltration is the movement of water through a membrane caused by a pressure gradient.

LP6 Dialyzer
1.The two main types of membrane structure are.
Symmetric and Asymmetric

2. Which dialyser sterilisation

method can cause allergic reactions?
Ethylene Oxide

з Choose the correct statement for high-flux dialyzer.

Back-filtration will occur in all high-flux dialyzer

4. "In vitro" clearance is less than "in-vivo clearance, as it reflects the actual conditions of
a treatment. FALSE

5. Which one of the following is not an essential component of dialyser construction?

Outer packaging

6.Membrane sieving coefficient is:

The ratio of the solute concentration in the ultrafiltrate to that of the incoming
blood

7. Molecular weight cut-off is:

The molecular weignt in Datons at wnich
90% of the molecule is retained by the membrane

8.Mass transfer coefficient is:

A measure of dialyser performance which enables estimation of dialyser clearance under
various flow conditio.
9. To ensure optimal dialyser pertormance, which ot the following can the dialysis
clinician directly control?
Dialyser fibres fully primed

10. Which one of the following membranes is the strongest complement activator of all
membranes?
Modified Cellulosic

VASSCULAR ACCESS Part 1

1.Vascular access related complications account for most of the morbidity and mortality
observed in the haemodialysis (HD) population. Select True
Explanation: An efficient and well performing vascular access is a mandatory
requirement for HD therapy to be effective. The placement and maintenance are crucial,
by the fact that vascular access-related complications account for most of the morbidity
and mortality observed in the HD population.

2. Which form of vascular access should be considered as first option?

a.Central Venous Catheter (CVC)
b.Arteriovenous Fistula (AVF)
c.Arteriovenous Graft (AVG)
d.Any of the above (no order of preference)

3.Compared to the AVF, the following statements are true about AVG, except:
Explanation: The native AVF accesses have the best 4-5-year patency rates and require
the fewest interventions compared with other access

4. 'Antegrade' arteria needle positioning is:

a.Arterial needle with tip facing towards the anastomosis
b.Arterial needle with tip facing in the opposite direction as blood flow
c.Arterial needle with the bevel facing downward
d.Arterial needle with tip facing in the same direction as blood flow

The arterial needle may point in either

direction. Antegrade needle direction is the placement of arterial needle pointing in the
direction of blood flow (towards the body).

5.The following statements are true about rope- ladder technique, except:
a.Site of next cannulation is the same as the last one
b.Rope- ladder technique helps extend the life span of the fistula
c.Aneurysms are less likely to develop
d.Rope- ladder technique allows healing of previous cannulation sites

Rope- ladder technique should be the first

choice of method in cannulation, with lower potential of access cannulation. It is also
known as site- rotaion technique.

6.One of the advantages of Buttonhole technique is the decreased risk of infiltration

during cannulation. True

Explanation: The creation of tunnel track with buttonhole

technique eliminates risks of infiltrations.

7. Asia Pacific Work Instruction (Gold Standard) - Cannulation of Arteriovenous Access

(AVF/AVG) - states: "For AVG, the bevel should face up, for AVF the bevel should face
down. False

Explanation: AP Work Instruction (Gold Standard) -Cannulation of Arteriovenous

Access (AVF/AVG) - states: "For AVG, the bevel should face down, for AVF the bevel
should face up

8. Bloodlines should be secured to the bed, chair, or pillow. False

Explanation: Bloodlines should be looped and secured to the patient to allow for patient
movement (EDTNA, 2009). Bloodlines must not be taped to the palm of the hand, bed,
chair or pillow

9. A physical assessment must be carried out before every cannulation regardless of when
the AV/ AVG was created. True
Explanation: Physical examination is important to evaluate the proper function and to
detect possible signs of complications

10. AF assessment of maturation includes all the following statements, except:

a.The maturation should be assessed by an expert within 6 weeks of creation
b.Flow through the vessel should not exceed 600 mL/min
c.The vessel should be greater than 6 mm
in diameter
d.The vessel should be less than 6 mm
beneath the skin surface
e.when bruit is strong on auscultation

AVF cannulation should not be simply

based on the time criteria or when the fistula looks physically mature. Clinically, flow
through the vessel should exceed 600 mL/min.
LP VASCULAR ACCESS

1. For first cannulation, the needle gauge recommended to use initially is:
This is a single choice question. Selections are automatically selected as you use arrow to move.
a. 14gauge
b. 15gauge
c. 16gauge
d. 17gauge
e. either c or d
For first cannulation, it is suggested to use a smaller needle gauge, either use 16gauge or 17gauge
initially.

2.The vascular access complication often related to venous stenosis and is the leading cause of failure
and loss of AVF/ AVG patency is called :
This is a single choice question. Selections are automatically selected as you use arrow to move.
a.Stenosis-narrowing of blood vessel
b. Thrombosis-common complication in AV
C. Aneurysm-weak spot in the wall of your access that can expand and eventually burst if not treated.
d. Steal syndrome-Diversion of blood flow from its natural route.

The formation of clot (thrombus) in the AVF/ AVG is the leading cause of failure and loss of access
patency.

3.All the following are clinical signs of pseudo- aneurysm, except:

This is a single choice question. Selections are automatically selected as you use arrow to move.
a.Prolonged bleeding after needle removal
b.Poor eschar formation after needle removal
c.A straight segment for cannulation
d.Spontaneous bleeding from access sites
Pseudo- aneurysm is a local disruption of the vessel wall caused by a leakage of blood from an access
vessel or graft into the surrounding tissue. Prolonged bleeding and poor eschar formation after needle
removal, and spontaneous bleeding from the access sites are signs of pseudo- aneurysm formation. It
usually resulst from repeated cannulation at the same site.

4.If during haemodialysis treatment there’s failure to attain a sufficient blood flow rate of ≥300 mL/min
with a pre- pump arterial pressure lower than -250 mmHg, what is the possible catheter related
complication?
b. Thrombus
c. Fibrin sheath
d. Venous air embolism
e. b and

Thrombus and fibrin sheath formation are late catheter dysfunction that can result to failure to attain a
sufficient extracorporeal blood flow rate (BFR) of ≥300 mL/min with a pre- pump arterial pressure lower
than -250 mmHg (NKF/DOQI).
5.A condition where a diversion of blood flow from its natural route within the internal vascular access
away from the distal artery resulting in ischaemia of the limb, is called:
This is a single choice question. Selections are automatically selected as you use arrow to move.
a.Congestive heart failure (CHF)
b.Stenosis
c.Aneurysms
d.Steal syndrome
Steal syndrome is clinically defined as the hypoperfusion to the haemodialysis access due to the
diverting of an excessive amount of blood away from the distal artery.

6.In the presence of extravasation or infiltration during cannulation, the nurse must insert the needle
directly above the haematoma or infiltration site. False*
Do not attempt to insert a needle through a haematoma. It will often clot and is an infection risk. If the
venous needle must be placed below the infiltration site, it should be placed as far as possible from the
previous puncture site.

7. During internal vascular access assessment, the thrill should feel like a continuous vibration, not a
strong pulsation. True*
With palpation, the clinician must feel the vascular access thrill and expect a continuous vibration, and
not a strong pulsation.

8.Vascular access stenosis can be suspected when the following occurs prior, during, or after a
haemodialysis treatment, except:
This is a single choice question. Selections are automatically selected as you use arrow to move.
A.Difficult needle placement
B. Persistently swollen area around the AVF/ AVG
C. Increased Kt/V or URR
D. Clotting of the dialysis circuit

Difficulty of needle placement, persistently swollen area around the AVF/AVG, consistent higher machine
pressures, poor haemostasis at the end of treatment, decreased Kt/V or URR, increased access
recirculation, and clotting of the extracorporeal circuit signals access stenosis.

9.The choice of the correct cannulation site and technique are fundamental factors for an optimal
dialysis session. The least favoured technique is the area cannulation technique. True**

Explaination: Cannulation of the vascular access is one of the most important procedure during
haemodialysis treatment and carried out by the clinician on numerous occasions. The ideal technique
has not yet been established, although area technique is the least favoured.

Proper preparation in cannulation procedure is critically important. Basic requirements for cannulation
must include all the following, except:
This is a single choice question. Selections are automatically selected as you use arrow to move.
A. A physician’s order
B. Tourniquet for AVF
C.15gauge needle for initial cannulation
D. An experienced, qualified staff
Explaination: Cannulation technique and skill is paramount in a successful cannulation. It is highly
recommended to use a 17gauge needle initially. Using a tourniquet to enlarge and stabilize the vessel is
also recommended. Ensure a physician’s order to cannulate is written.