Critical Event Protocols
Which is NOT correct about Code Blue?
a) Nurse brings the cart.
b) At shift change, opened cart stays with patient; incoming staff restocks.
c) Place AED pads away from CVC (opposite chest + back).
d) Outside main entrance (within 20 m): call 911, then 5555.
e) None of the above.
Answer: e
Which is false about fall risk management?
a) Fall risk assessment done within 2 weeks of admission and at pre-dialysis
b) Medications (e.g., diuretics, laxatives, anticoagulants, hypoglycemics, antihypertensives) may increase fall risk
c) Patients are grouped into Green, Yellow, Red by Morse Fall Scale
d) Post-fall: do not move patient until safety assessed (LOC, airway, bleeding, vitals, head/neck)
e) None of the above
Answer: e
Green: Independent
Yellow: Moderate Risk
Red: High Risk for fall.
Which statement is false about TPN/Lipids during dialysis?
a) Lipid emulsion is Y-site compatible with AA/Dextrose
b) Dedicated TPN line not used for other meds/blood
c) IDPN via venous port with 1.2-micron filter, Y-connector, 2 pumps
d) Filter placed below Y-site where AA/Dextrose and Lipids co-infuse
e) All are true
e) All are true
While giving care, a patient’s family member seems unfriendly. As a PSP, what should you do?
a) Ignore and continue your work
b) Respond defensively
c) Acknowledge feelings, stay calm/professional, and communicate openly
d) Ask them to leave or call security
c) Acknowledge feelings, stay calm/professional, and communicate openly
As a pharmacist, when educating a dialysis patient with diabetes on insulin use, which statement is most accurate?
A) Insulin doses generally remain unchanged after starting dialysis
B) Insulin clearance may be reduced in dialysis patients, requiring dose adjustments to prevent hypoglycemia
C) Oral hypoglycemic agents are preferred over insulin for dialysis patients
D) Patients should stop insulin on dialysis days
Correct Answer: B
Which of the following is the FIRST immediate intervention when a patient develops
hypotension during hemodialysis?
a) Administer midodrine, check vitals.
b) Place the patient in Modified Trendelenburg position and stop ultrafiltration
c) Decrease ultrafiltration rate
d) Provide 100-300 mL NS bolus & oxygen
Answer: b)
As hemodialysis nurse, what should you do if a patient arrives with less than 1 hour of treatment time remaining?
a) Do not initiate hemodialysis.
b) Notify the Team Leader.
c) Notify the nephrologist.
d) If the patient consents, obtain STAT blood specimens for electrolytes, urea, and
creatinine levels.
e) Schedule hemodialysis treatment depending on the results of the assessment and unit ability to accommodate.
f) all the above
Answer: f
When drawing pre-hemodialysis blood from AVF/AVG and CVC, which port or line do you use?
Answer:
a) For Arteriovenous Fistula (AVF) or Arteriovenous Graft (AVG):
Draw blood from the arterial needle before flushing it with 0.9% saline.
b) For Central Venous Catheter (CVC):
Draw blood from either patient port before flushing with 0.9% saline.
During your visit at bedside, a hemodialysis patient was talking with her family. The patient expresses a treatment preference that conflicts with what her family wants. As a social worker, what is a prudent decision you will make?
Respect and advocate for patient autonomy
Use therapeutic communication with patient and family
Stay neutral and professional
Involve healthcare team (nephrologist & ethics committee) if conflict continues
Base decisions on ethical principles (autonomy, beneficence, nonmaleficence, justice)
How does effective communication within the dialysis interdisciplinary team benefit patient care? ----- for (PCM/APNS)
A) It reduces the need for patient education
B) It ensures coordinated care, prevents errors, and improves patient outcomes
C) It allows delegation of all tasks to the nephrologist/delegates
D) It eliminates the need for patient involvement in care decisions
Correct Answer: B
What should NOT be done if a patient experiences air embolism during hemodialysis?
a) Immediately clamp both CVC ports and stop the blood pump.
b) Place patient on the left side in lateral Trendelenburg position.
c) Administer 100% Oxygen by mask.
d) Notify nephrologist and proceed as ordered.
e) Perform chest compressions.
e) Perform chest compressions.
A patient develops painful muscle cramps during hemodialysis (from either excess fluid removal or electrolyte shifts). What is the most appropriate immediate nursing action?
a) Decrease ultrafiltration rate
b) On modified Trendelenburg supine position, give 100-300 mL normal saline bolus, set UF to minimum, & administer O2
c) Encourage limb exercise
d) Give meds (vitamin E, carnitine) or adjust prescription
Answer: b
Which of the following factor(s) does NOT contradict the use of alteplase (Cathflo®)?
a) Temporary CVC.
b) CVC lumen volumes less than 1.6 mL or greater than 2.5 mL.
c) First hemodialysis session post-CVC insertion or exchange.
d) Catheter is fully occluded.
e) Patient has a known hypersensitivity to alteplase (Cathflo®).
f) All of the above.
f) All of the above.
As a PAA, how do you understand person-centred care?
a) Focus on the whole person, not just disease
b) Respect patient preferences, keep them informed, support decision-making
c) Team provides compassionate, timely care
d) All of the above
Answer: d
Patient requests his nurse which of the following is a good protein source that is generally lower in phosphorus and potassium?
A. Peanut butter
B. Eggs
C. Nuts and seeds
D. Cheddar cheese
Correct Answer: B
A patient develops chest tightness, shortness of breath, and itching within 10–30 minutes of starting their first dialysis with an Elisio 25 H dialyzer. What do you suspect, and what is the most appropriate nursing action?
a) Slow blood flow and continue dialysis
b) Stop dialysis immediately, do not return blood, give prn Benadryl if available, and notify fellow/nephrologist
c) Give Benadryl and continue dialysis
d) Reassure and monitor; use anaphylaxis kit if needed
Answer: b)
You notice your assignment is heavier than colleagues’. What should you do as a dialysis nurse?
Advocate for safety: raise workload concerns professionally to TL.
Document in Grasp: record assignment and actions taken.
Seek support: if consistent & unresolved, escalate to manager & unit ONA rep, .
Prioritize: focus on critical patient needs first.
Follow policy: adhere to staffing/workload guidelines.
Communicate professionally: remain calm with team and leadership.
After checking/setting up machine, as technologist/TA, you came out from Droplet/Contact room (e.g. influenza),
What is the correct order for PPE removal ?
Gloves
Gown (inside out)
Hand hygiene
Eye protection
Mask/respirator
Hand hygiene again
What is “the Slow Flow technique” to draw blood specimen post dialysis?
a) Slow the blood pump speed to 50-100 mL/min.
b) Turn off dialysate flow by placing the machine in BYPASS mode.
c) Decrease ultrafiltration rate to minimum, insert the needle into the arterial port, and draw
the specimen.
d) All of the above.
Answer: D
As a dietitian you noticed a clinical sign for malnutrition, and before suggesting IDPN order for dialysis patient, Which lab values are most critical to monitor (evaluate) ?
A. BUN, creatinine, sodium
B. Potassium, phosphorus, albumin, calcium
C. Glucose, calcium, TSH
D. Hemoglobin, hematocrit, WBC
Correct Answer: B
Definition: IDPN (Intradialytic Parenteral Nutrition): a specialized form of nutrition given directly into bloodstream during hemodialysis.
68-year-old male suddenly confused, slurred speech, right arm weakness, BP 190/110. Dialysis normal, access unchanged. What’s happening and next steps?
Stroke
Assess FAST (Face, Arms, Speech &Time) + vitals
Stabilize & adjust dialysis
Escalate (TL/NP/Nephrologist& call Code stroke) — within 4.5 hr window
Communicate (SBAR, patient/family/team)
Document & monitor
When should dalteparin (Fragmin®) be held after consulting the nephrologist/delegate?
a) Same-day CVC procedure
b) Post-thrombolysis of AVF/AVG
c) Dental extraction
d) Recent fall, active bleeding, or fresh bruising
e) All of the above
Answer: e
When multiple blood specimens are to be collected at one time, what is the proper order for drawing the tubes?
Answer:
- Blood culture samples first
- Light Blue (e.g INR)
- Red Top (drug level, e.g vancomycin)
- Gold (SST)
- Green,
- Lavender,
- Pink,
- Grey.
After sending a STAT electrolytes blood work, the lab calls you with a critical potassium level
of K⁺ = 6.8. How would you classify this result in terms of the ladder of escalation to contact the fellow/nephrologist?
a) Emergent
b) Urgent
c) Routine
d) write the message in the NUT list.
e) email to the Dr. & wait for the response.
Answer: B, Rationale: Immediate action required within minutes.
Note:
Emergent: e.g code blue, code brown
Urgent: e.g critical lab result, unstable BP, ! LOC, K+ in dialysate
In patients receiving maintenance hemodialysis, which of the following statements best reflects current guidelines regarding the use of Eprex (epoetin alfa) and hemoglobin (Hb) levels?
a) Start if Hb <130, target 130–150
b) Use only if ferritin <100
c) Start if Hb <100, target 100–115
d) Rapidly increase dose if Hb ↑ <20 in 1 week
Correct Answer: C