Renal Replacement Therapies
Renal replacement therapy is therapy that replaces the normal blood-filtering function of the kidneys mostly used when the kidneys are not functioning properly. To figure out how much you know about the subject take this quiz.
- 1.
Hemodialysis/Peritoneal dialysis is
- A.
Removal of fluids by convection
- B.
The removal of solutes by diffusion down a concentration gradient between blood and dialysate
- C.
Refers to the combination of both hemodialysis and hemofiltration
- D.
Combination of hemodialysis, hemofiltration, and hemodiafiltration being applied continuously for days to weeks in patients with AKI
Correct Answer
B. The removal of solutes by diffusion down a concentration gradient between blood and dialysateExplanation
Diffusion from a high to low concentrationRate this question:
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- 2.
Which of the following is NOT a type of renal replacement therapy
- A.
Hemodialysis
- B.
Peritoneal dialysis
- C.
Osmotic Diuretics
- D.
Kidney Transplant
Correct Answer
C. Osmotic Diuretics -
- 3.
Select all that apply. Which of the following is NOT an Indication for Dialysis
- A.
Uremia
- B.
Acid-base abnormalities
- C.
Hyperkalemia
- D.
Intoxications
- E.
Anemia
Correct Answer(s)
C. Hyperkalemia
E. AnemiaExplanation
"AEIOU"
Acid Base Abnormalities
Electrolyte Imbalance
Intoxications
Fluid Overload
UremiaRate this question:
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- 4.
True or False. Dialysis is a process that removes accumulated solute from a patient with some loss of kidney function.
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
process that removes accumulated solute from a patient with TOTAL or NEAR-TOTAL loss of kidney functionRate this question:
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- 5.
Factors that affect the rate of diffusion are:
- A.
Difference in solute concentration between blood and dialysate
- B.
Solute characterisitcs
- C.
Dialyzer composition
- D.
Flow rates of blood and dialysate
- E.
All of the above
Correct Answer
E. All of the above -
- 6.
True or False. Vascular access is required from hemodialysis so that there is a permanent access to a blood stream.
- A.
True
- B.
False
Correct Answer
A. True -
- 7.
True or False. AV fistula (arterovenous fistula) is a good option in patients with AKI
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
Maybe you don't have time for AV fistula to mature? as it require +2 months to matureRate this question:
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- 8.
Which of these is NOT characteristic of an AV fistula?
- A.
Longest survival
- B.
Requires 2 months to mature
- C.
Anastomosis between artery and vein (radiocephalic or brachiocephalic)
- D.
Highest rate of complications
Correct Answer
D. Highest rate of complicationsExplanation
This Hemodialysis access has the lowest rate of complications when compared to synthetic AV grafts and CathetersRate this question:
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- 9.
How many weeks does it take for a synthetic arteriovenous vascular (AV) graft to mature
- A.
1 week
- B.
2-3 weeks
- C.
4-5 weeks
- D.
2 months
- E.
4 months
Correct Answer
B. 2-3 weeks -
- 10.
Which is the most commonly used hemodialysis access?
- A.
AV fistula
- B.
AV graft
- C.
Catheter
Correct Answer
B. AV graft -
- 11.
Because of the synthetic material used in AV grafts. What kind of complications can occur?
- A.
Infection
- B.
Thrombosis
- C.
Inflammation
- D.
Redness/Pain
- E.
All of the above
Correct Answer
E. All of the above -
- 12.
Between AV fistula and AV grafts which one of the following would have the highest rate of complications and shorter survival rate?
- A.
AV fistula
- B.
AV grafts
Correct Answer
B. AV grafts -
- 13.
True or False. Catheters are used as an access site when AV access is not possible.
- A.
True
- B.
False
Correct Answer
A. True -
- 14.
True or False. Catheters are used when non-urgent/non-emergent dialysis is needed.
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
Used for Immediate access for urgent/emergent dialysis is neededRate this question:
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- 15.
Select all that apply. Where can a catheter be placed?
- A.
Femoral Artery
- B.
Femoral Vein
- C.
Subclavian Artery
- D.
Subclavian Vein
- E.
Internal Jugular Vein
Correct Answer(s)
B. Femoral Vein
D. Subclavian Vein
E. Internal Jugular VeinExplanation
Veins onlyRate this question:
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- 16.
What is the biggest concern in regards to catheters?
- A.
Hyperlipidemia
- B.
Higher infection rates
- C.
Hypophosphatemia
- D.
Short survival rate
- E.
None of the Above
Correct Answer
B. Higher infection ratesExplanation
Infection is 15X greater compared to native fistulas ex. bacteremia, endocarditisRate this question:
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- 17.
What is the function of the Dacron cuff use in patients using Catheters?
- A.
Stabilize catheter placement
- B.
Reduction in Infection
- C.
To allow for prolonged time period of use (several week to > 6 months)
- D.
All of the above
Correct Answer
D. All of the above -
- 18.
True or False. Between dialysis sessions, lumen of catheters are filled with anticoagulant to prevent thrombosis.
- A.
True
- B.
False
Correct Answer
A. True -
- 19.
True or False. Choice of vascular access depends on adequacy of patient's vasculature only.
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
Depends on adequacy of vasculature AND urgency to start hemodialysisRate this question:
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- 20.
True or False. Maintenance of vascular access is a major challenge in chronic hemodialysis.
- A.
True
- B.
False
Correct Answer
A. True -
- 21.
Which of the following is NOT a patient education point on the proper care of vascular access?
- A.
Avoid lifting heavy objects
- B.
Avoid use of arm with access point for other reasons besides dialysis (BP readings, blood draws)
- C.
Cover access point with tight clothing
- D.
Avoid putting pressure on arm with access point
- E.
Check access point pulse daily because if it fails a new access point may need to be created
Correct Answer
C. Cover access point with tight clothingExplanation
Don't cover access point with tight clothing or jewlryRate this question:
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- 22.
What does conventional HD involve:
- A.
Low efficiency/low flux membrane
- B.
High efficiency/ high flux membrane
- C.
Low efficiency/ high flux membrane
- D.
High efficiency/ low flux membrane
- E.
None of the above
Correct Answer
A. Low efficiency/low flux membrane -
- 23.
Fill in the blanks. "High efficiency means a higher rate of removal by diffusion of ___________ solutes (ie. water, urea 60Da)
- A.
Small size
- B.
Middle size
- C.
Large Size
- D.
All of the Above
- E.
None of the above
Correct Answer
A. Small size -
- 24.
Fill in the blanks. "High flux means a higher rate of removal by diffusion of ___________ solutes (ie. water, urea 60Da)
- A.
Small size
- B.
Middle size
- C.
Large Size
- D.
All of the Above
- E.
None of the above
Correct Answer
B. Middle size -
- 25.
All of the following are goals of dialysis EXCEPT...
- A.
Achieve desired wet weight
- B.
Adequate removal of waste products i.e. urea clearance
- C.
Cost effective
- D.
Deliver Optimal Dose (patient specific)
- E.
B and C
Correct Answer
A. Achieve desired wet weightExplanation
achieve desired dry weightRate this question:
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- 26.
True or False. Desired dry weight is an index of optimal fluid status - normotensive, euvolemic
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
If patient's BP is too low don't let pt leave clinic until BP is under controlRate this question:
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- 27.
Another Dialysis goal is to achieve a recommended KT/V of 1.2. This means that you want the URR (calculated by physician) to be approximately what percentage ?
- A.
25%
- B.
45%
- C.
55%
- D.
65%
- E.
*5%
Correct Answer
D. 65%Explanation
KT/V- ratio quantifies fraction of patient's total body water cleared of urea during dialysis (dialyzer clearance of urea)
K- dialyzer clearance of urea
T- time of dialysis session
V- volume of urea distribution
URR = [(pre-dialysis BUN - post-dialysis BUN)/(pre- dialysis BUN)]Rate this question:
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- 28.
All of these are complications of hemodialysis EXCEPT?
- A.
Muscle cramps
- B.
Thrombosis/Stenosis
- C.
Pruritis
- D.
Cardiac arrhythmias
- E.
Hypertension
Correct Answer
E. HypertensionExplanation
Hypotension is the most common complication (occurs 15-50% of the time in pts)Rate this question:
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- 29.
Select all that apply. Infection is a complication of HD. What is the most common infecting organisms.
- A.
Staphylococcus Aureus
- B.
Staphylocccus epidermidis
- C.
Gram Positive Bacilli
- D.
Gram Negative Bacilli
- E.
All of the Above
Correct Answer(s)
A. Staphylococcus Aureus
B. Staphylocccus epidermidis
D. Gram Negative BacilliExplanation
treatment includes systemic antibiotics and antibiotic lock solutionsRate this question:
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- 30.
These are acute management techniques for hypotension EXCEPT?
- A.
Increase dialysis rate
- B.
Administer normal or hpertonic saline
- C.
Decreasing dialysate temperature to produce vasoconstriction
- D.
None of the Above
- E.
All of the Above
Correct Answer
A. Increase dialysis rateExplanation
Decrease dialysis rate or for prophylaxis accurately set "dry weight", dialysate sodium > serum sodium, bicarbonate dialysate, avoid food before or during HD.Rate this question:
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- 31.
What do you do if a thrombus is suspected during HD?
- A.
Clear catheter with saline flushes
- B.
Alteplase: 2mg/2ml per catheter port
- C.
Reteplase: 0.5 units/2ml per catheter port
- D.
Urokinase
- E.
All of the above
Correct Answer
E. All of the aboveExplanation
Place thrombolytics in CatheterRate this question:
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- 32.
Which of the following is NOT an acute managment/prophylaxis technique for muscle cramps?
- A.
IV saline
- B.
Hypertonic Saline
- C.
Vitamin D
- D.
Quinine
- E.
Accuratley set dry weight diasylate sodium > serum sodium, stationary bike prior to bedtime, stretching excercises
Correct Answer
C. Vitamin DExplanation
Vitamin ERate this question:
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- 33.
True or False. Possible cause of Pruritis is dry skin, hyperphosphatemia, Increase Ca X PO4 deposits in the skin, inadequate dialysis, anemia, histamine release.
- A.
True
- B.
False
Correct Answer
B. False -
- 34.
What are some pharmacological managment techniques for Pruritis?
- A.
Topical emollient (aquaphor)
- B.
4-6 weeks trial of antihistamines, if no response start cholestyramine
- C.
Activated Charcoal
- D.
All of the Above
- E.
None of the Above
Correct Answer
D. All of the Above -
- 35.
If a patient experiences anaphylaxis what do you do?
- A.
Decrease the rate of dialysis
- B.
Make sure that diasylate sodium is > sodium serum
- C.
Stop dialysis and do not return blood in dialyzer too patient
- D.
Treat with Epinephrine, antihistamine, steroids
- E.
C and D
Correct Answer
E. C and D -
- 36.
True or False. Peritoneal dialysis is more efficient that Hemodialysis.
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
It's less efficient due to the lack of ability to regulate blood flow to the surface of the peritoneal membraneRate this question:
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- 37.
In peritoneal dialysis how long is the dialysate allowed to dwell in the peritoneal cavity
- A.
2-3 hours
- B.
4-6 hours
- C.
6-8 hours
- D.
9-10 hours
- E.
10-12 hours
Correct Answer
B. 4-6 hours -
- 38.
True or False. The spent dialysate is put back into the patient.
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
spent dialysate is discardedRate this question:
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- 39.
The most common complication of PD is Peritonitis. The most common cause of it is due to?
- A.
Dialysate contamination
- B.
Touch contamination
- C.
Respiratory contamination
- D.
Animal contamination
- E.
Fecal contamination
Correct Answer
B. Touch contamination -
- 40.
Majority of the infections caused in PD are caused by what time of bacteria?
- A.
Gram (+)
- B.
Gram (-)
Correct Answer
A. Gram (+)Explanation
some gram (-) bacteriaRate this question:
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- 41.
All of the following are signs and symptoms of peritonitis except?
- A.
Abdominal tenderness/pain
- B.
Cloudy effluent
- C.
Fever/chills
- D.
Dialysate WBC >100/mm3
- E.
Headache
Correct Answer
E. Headache -
- 42.
Which is the most correct. Antibiotics can be given what route to patients with peritonitis?
- A.
IV
- B.
IP
- C.
Oral
- D.
A and B
- E.
B and C
Correct Answer
D. A and B -
- 43.
True or False. IP administration of antibiotics are usually given in multiple small doses into multiplex exchanges (with the shortest dwell time) per day.
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
IP admin of antibiotics usually give ONE LARGE dose into ONE exchange (with LONGEST dwell time) per dayRate this question:
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- 44.
Empiric therapy of antibiotics for gram (+) and gram (-) coverage is used to treat peritonitis. Which antibiotics do they use?
- A.
First generation cephalosporin + aminoglycoside
- B.
Vancomycin + amingoglycoside or ceftazidime
- C.
Third/4th Generation cephalosporin
- D.
All of the above
- E.
None of the Above
Correct Answer
D. All of the above -
- 45.
True or False. The exit site infection involves just the exit site.
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
involves the tunnel also or both exit site and tunnelRate this question:
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- 46.
Select all that apply. Signs and symptoms of Exit Site Infection.
- A.
Erythema
- B.
Muscle cramps
- C.
Purulent discharge
- D.
Nausea/Vomiting
- E.
Tenderness
Correct Answer(s)
A. Erythema
C. Purulent discharge
E. Tenderness -
- 47.
Pharmacological treatment of Exit site infection EXCEPT.
- A.
Mupirocin applied topically to exit site daily
- B.
Rifampin 600mg/d X 5 days, repeat every 12 weeks
- C.
Nasal carriers - intranasal mupirocin BID X 5 days
- D.
Catheter removal may be necessary
- E.
Cefazolin
Correct Answer
E. Cefazolin -
- 48.
True or False. Exit site infections do not progress
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
They may progress to tunnel infection then to peritonitisRate this question:
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- 49.
All of these are S/E of PD except
- A.
Anorexia
- B.
Hypotension
- C.
Anemia (Iron Deficiency)
- D.
Risk of Malnutrition
- E.
Blood loss
Correct Answer
A. AnorexiaExplanation
ObesityRate this question:
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- 50.
Fill in the blanks. With regards to pharmacologic PK alterations in the influence of uremia, a drug that has a large Vd, then the Vd in kidney disease may ________________
- A.
Increase
- B.
Be reduced
Correct Answer
B. Be reduced -
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Dec 06, 2017Quiz Edited by
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Jun 04, 2010Quiz Created by
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