Renal Replacement Therapy Quiz

A hemodialysis patient starts bleeding from the vascular access site during dialysis. The patient received a standard dose of unfractionated heparin. The most appropriate nursing analysis regarding the cause is

• the patient's blood pressure is too high.

• the vascular access site was not cleaned properly.

• the dialysis machine is set to a high ultrafiltration rate.

• the heparin dose may have exceeded the patient's requirement.

During preparing to administer heparin during a hemodialysis session. The patient has a history of HIT (Heparin-Induced Thrombocytopenia). The most appropriate action is to

• Substitute heparin with warfarin

• Administer a reduced dose of heparin.

• Delay dialysis until platelet count improves.

• Notify the physician and prepare a heparin-free dialysis protocol.

During dialysis, a patient on anticoagulation therapy develops prolonged clotting in the dialyzer despite receiving standard heparin dosing. The most possible analysis of this situation is

• the blood flow rate is too high.

• the ultrafiltration volume is too low.

• the dialyzer is faulty and should be replaced.

• the patient may have developed heparin resistance.

A nurse notices that a new staff member is unsure about flushing the circuit in a patient with high bleeding risk who is on a heparin-free protocol. The most responsible action is to

• advise the staff to check the SOP later

• report the incident to the nurse manager

• allow the staff to proceed under supervision

• immediately step in, demonstrate the technique, and explain its importance

During preparing the dialysis machine for a patient prescribed regional citrate anticoagulation. The specific preparation step is essential to prevent complications is

• prime the circuit with saline only

• add protamine sulfate to the circuit

• increase the dialysate potassium level

• ensure calcium-free dialysate is available