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Monday, 26 December 2011

Improving Hand Hygiene Practice In Healthcare Setting

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Saturday, 24 December 2011

Anticoagulation In Hemodialysis

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✅ Anticoagulation in Hemodialysis – MCQ Set 1 (Questions 1–10)

1. What is the most commonly used anticoagulant in routine hemodialysis?
A. Warfarin
B. Heparin
C. Citrate
D. Aspirin
✅ Correct answer: B

2. The primary purpose of anticoagulation during hemodialysis is to:
A. Prevent anemia
B. Prevent clotting in the dialyzer and extracorporeal circuit
C. Increase blood pressure
D. Reduce infection risk
✅ Correct answer: B

3. What is the usual route of heparin administration in hemodialysis?
A. Intramuscular
B. Oral
C. Intravenous
D. Subcutaneous
✅ Correct answer: C

4. What is a common complication of excessive heparin use during dialysis?
A. Hypertension
B. Bleeding
C. Hyperkalemia
D. Itching
✅ Correct answer: B

5. Which test is commonly used to monitor the effect of heparin?
A. Serum creatinine
B. PT/INR
C. Activated partial thromboplastin time (aPTT)
D. Fibrinogen
✅ Correct answer: C

6. In patients at high risk of bleeding, what anticoagulation approach is often used?
A. Full-dose heparin
B. No anticoagulation or saline flush protocol
C. Double dose heparin
D. Aspirin
✅ Correct answer: B

7. Which of the following is a low molecular weight heparin (LMWH) used in dialysis?
A. Enoxaparin
B. Warfarin
C. Aspirin
D. Sodium citrate
✅ Correct answer: A

8. Heparin-induced thrombocytopenia (HIT) is a:
A. Bleeding disorder
B. Hemolytic reaction
C. Prothrombotic condition with low platelets
D. Sign of dialysis failure
✅ Correct answer: C

9. What is the antidote for heparin overdose?
A. Vitamin K
B. Protamine sulfate
C. Fresh frozen plasma
D. Desmopressin
✅ Correct answer: B

10. What is the function of regional citrate anticoagulation in dialysis?
A. It removes calcium from blood to prevent clotting
B. It enhances potassium removal
C. It increases phosphorus clearance
D. It disinfects the blood circuit
✅ Correct answer: A

11. Which of the following patients is most likely to require a heparin-free dialysis?
A. Patient with diabetes
B. Patient with thrombocytosis
C. Post-operative patient with active bleeding
D. Patient on antihypertensive medications
✅ Correct answer: C

12. What is the mechanism of action of heparin?
A. Inhibits platelet aggregation
B. Chelates calcium
C. Activates antithrombin III to inhibit thrombin and factor Xa
D. Destroys clotting factors
✅ Correct answer: C

13. In low molecular weight heparin (LMWH) use, which test is best for monitoring?
A. aPTT
B. INR
C. Anti-factor Xa level
D. Hemoglobin
✅ Correct answer: C

**14. Which anticoagulant is preferred for patients with heparin-induced thrombocytopenia (HIT)?
A. Low dose heparin
B. Aspirin
C. Argatroban
D. Warfarin
✅ Correct answer: C

15. What is the risk of inadequate anticoagulation during dialysis?
A. Hypertension
B. Dialyzer clotting and circuit loss
C. Hypernatremia
D. Fluid overload
✅ Correct answer: B

16. What is a major concern when using regional citrate anticoagulation?
A. Hypokalemia
B. Hyperglycemia
C. Hypocalcemia
D. Hyponatremia
✅ Correct answer: C

17. When administering intermittent bolus heparin, the first dose is usually given:
A. At the end of dialysis
B. 30 minutes after dialysis begins
C. Before or at the start of dialysis
D. Only if clotting is seen
✅ Correct answer: C

18. During heparin-free dialysis, what technique is used to prevent clotting?
A. Use of aspirin
B. Pulse saline flushes every 15–30 minutes
C. High calcium dialysate
D. Blood flow reduction
✅ Correct answer: B

19. In which condition is systemic anticoagulation during dialysis generally contraindicated?
A. Stable angina
B. Recent hemorrhagic stroke
C. Hypertension
D. Diabetes mellitus
✅ Correct answer: B

20. Why might LMWH be preferred over unfractionated heparin in some dialysis centers?
A. Cheaper and more easily available
B. Longer half-life and easier dosing
C. More reversible with protamine
D. Eliminates risk of thrombosis
✅ Correct answer: B

21. What is the usual half-life of unfractionated heparin when used in dialysis?
A. 5 minutes
B. 30–60 minutes
C. 1–2 hours
D. 6–8 hours
✅ Correct answer: C

22. When using LMWH in dialysis, a common complication compared to UFH is:
A. More allergic reactions
B. Higher incidence of thrombocytopenia
C. Increased bleeding risk due to longer half-life
D. Lower cost
✅ Correct answer: C

23. Which of the following anticoagulation methods is most appropriate in a patient with severe liver failure on dialysis?
A. Warfarin
B. Unfractionated heparin
C. Citrate anticoagulation
D. LMWH
✅ Correct answer: C

24. What is the primary site of metabolism for low molecular weight heparin?
A. Liver
B. Kidney
C. Spleen
D. Bone marrow
✅ Correct answer: B

25. Which of the following is a contraindication to regional citrate anticoagulation?
A. Hypocalcemia
B. Sepsis
C. Hypertension
D. Diabetes
✅ Correct answer: A

26. Protamine sulfate reverses which of the following?
A. Warfarin
B. Citrate
C. Unfractionated heparin
D. Dabigatran
✅ Correct answer: C

27. Which anticoagulant does not require routine coagulation monitoring in stable patients?
A. Unfractionated heparin
B. LMWH
C. Warfarin
D. Argatroban
✅ Correct answer: B

28. What is the key reason for choosing heparin-free dialysis in a patient with recent gastrointestinal bleeding?
A. Improve blood pressure
B. Reduce sodium retention
C. Minimize bleeding risk
D. Increase urea clearance
✅ Correct answer: C

29. If clotting is observed in the venous chamber during dialysis, what should be done FIRST?
A. Start saline flushes
B. Increase heparin dose immediately
C. Stop dialysis immediately
D. Re-prime the dialyzer
✅ Correct answer: A

30. Warfarin is generally avoided in chronic hemodialysis patients because:
A. It causes hypokalemia
B. It requires monthly injections
C. It has high bleeding risk and is hard to control in ESRD
D. It reduces dialysis efficacy
✅ Correct answer: C

31. Which patient may need a reduced dose of heparin during dialysis?
A. Obese patient
B. Patient with active infection
C. Elderly patient with a history of GI bleeding
D. Diabetic with well-controlled sugars
✅ Correct answer: C

32. During dialysis, if the arterial pressure alarm is high and clotting is suspected in the line, what is the immediate action?
A. Increase blood flow rate
B. Flush with saline and assess for clot
C. Decrease dialysate flow
D. Ignore if patient is stable
✅ Correct answer: B

33. Which of the following anticoagulation methods is most commonly used in intermittent hemodialysis in outpatient centers?
A. Warfarin
B. LMWH
C. Heparin bolus followed by maintenance infusion
D. Argatroban
✅ Correct answer: C

34. Regional citrate anticoagulation works by binding to which electrolyte?
A. Magnesium
B. Potassium
C. Calcium
D. Phosphate
✅ Correct answer: C

35. When is saline flush protocol preferred over anticoagulation during dialysis?
A. In pediatric patients
B. In patients with severe anemia
C. In patients with high bleeding risk
D. In those on immunosuppressants
✅ Correct answer: C

36. What is a limitation of using LMWH in hemodialysis?
A. Requires frequent INR monitoring
B. Not reversible with protamine sulfate
C. Cannot be used in diabetic patients
D. Causes hypertension
✅ Correct answer: B

37. What is the main advantage of LMWH over UFH in hemodialysis?
A. Shorter half-life
B. Lower cost
C. Simplified dosing with fewer monitoring requirements
D. Safe in all liver diseases
✅ Correct answer: C

38. Which of the following is a sign of underdosing anticoagulation during dialysis?
A. Nosebleeds
B. Recurrent clotting in the circuit
C. Hypotension
D. Hematuria
✅ Correct answer: B

39. Which anticoagulant is sometimes used in patients with heparin allergy or HIT during dialysis?
A. Enoxaparin
B. Aspirin
C. Argatroban
D. Clopidogrel
✅ Correct answer: C

40. What lab finding is most concerning if a patient on heparin develops sudden thrombocytopenia?
A. Hemoglobin drop
B. Platelets <50,000 with thrombosis
C. Elevated creatinine
D. Prolonged PT
✅ Correct answer: B

41. Which of the following is a non-heparin anticoagulant suitable for dialysis in patients with HIT?
A. Fondaparinux
B. Argatroban
C. Warfarin
D. Tranexamic acid
✅ Correct answer: B

42. Why is warfarin generally not initiated solely for anticoagulation during hemodialysis?
A. It causes hyperkalemia
B. It increases calcium levels
C. It does not act quickly enough and is hard to manage in ESRD
D. It increases urea clearance
✅ Correct answer: C

43. A patient undergoing dialysis complains of sudden back pain and hypotension. What complication related to anticoagulation should you consider?
A. Hyperphosphatemia
B. Dialysis disequilibrium
C. Retroperitoneal bleed
D. Clotting in dialyzer
✅ Correct answer: C

44. What is the most accurate test to detect early HIT (Heparin-Induced Thrombocytopenia)?
A. PT
B. aPTT
C. Platelet factor 4 antibody (ELISA)
D. Bleeding time
✅ Correct answer: C

45. In hemodialysis, what is the target activated clotting time (ACT) during heparin use?
A. 60–90 seconds
B. 120–180 seconds
C. 180–220 seconds
D. >300 seconds
✅ Correct answer: B

46. What is a benefit of regional citrate anticoagulation over systemic heparin?
A. Easy to administer
B. Eliminates need for calcium monitoring
C. Less bleeding risk
D. Shorter dialysis time
✅ Correct answer: C

47. What is the function of calcium infusion during citrate anticoagulation?
A. Prevent clotting in the dialyzer
B. Maintain systemic calcium levels
C. Reduce potassium
D. Promote citrate clearance
✅ Correct answer: B

48. Which medication is not used for anticoagulation in dialysis patients?
A. Enoxaparin
B. Argatroban
C. Clopidogrel
D. Unfractionated heparin
✅ Correct answer: C

49. Heparin-induced thrombocytopenia typically occurs within how many days of starting heparin?
A. 1–2 days
B. 3–5 days
C. 5–10 days
D. 14–21 days
✅ Correct answer: C

50. Which of the following indicates the need for immediate discontinuation of anticoagulation during dialysis?
A. Mild bruising
B. Elevated creatinine
C. Sudden drop in blood pressure with active bleeding
D. Slight prolongation of aPTT
✅ Correct answer: C


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Water for Haemodialysis System Consideration

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Thursday, 22 December 2011

Anticoagulation In Hemodialysis

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✅ Anticoagulation in Hemodialysis – MCQs

1. What is the primary purpose of anticoagulation during hemodialysis?
A. Prevent clotting in the extracorporeal circuit
B. Increase blood pressure
C. Reduce ultrafiltration rate
D. Improve dialysate flow
➡️ Answer: A. Prevent clotting in the extracorporeal circuit

2. Which anticoagulant is most commonly used during hemodialysis?
A. Heparin
B. Warfarin
C. Aspirin
D. Clopidogrel
➡️ Answer: A. Heparin

3. What is the main risk of anticoagulation during hemodialysis?
A. Bleeding complications
B. Hypotension
C. Infection
D. Electrolyte imbalance
➡️ Answer: A. Bleeding complications

4. Which type of heparin is commonly used in dialysis anticoagulation?
A. Unfractionated heparin
B. Low molecular weight heparin
C. Fondaparinux
D. Direct thrombin inhibitors
➡️ Answer: A. Unfractionated heparin

5. What is the recommended method to monitor anticoagulation during hemodialysis?
A. Activated clotting time (ACT) or clinical monitoring of bleeding and clotting
B. INR
C. Platelet count only
D. D-dimer
➡️ Answer: A. Activated clotting time (ACT) or clinical monitoring of bleeding and clotting

6. Which of the following is a contraindication to systemic heparin use in hemodialysis?
A. Active bleeding or high bleeding risk
B. Hypertension
C. Diabetes mellitus
D. Hyperkalemia
➡️ Answer: A. Active bleeding or high bleeding risk

7. What alternative anticoagulation strategy can be used in patients with high bleeding risk?
A. Regional anticoagulation with citrate or heparin-free dialysis
B. Increase heparin dose
C. Use warfarin instead
D. No dialysis
➡️ Answer: A. Regional anticoagulation with citrate or heparin-free dialysis

8. How is heparin usually administered during hemodialysis?
A. Initial bolus dose followed by continuous infusion or intermittent doses
B. Single oral dose before dialysis
C. Continuous oral administration
D. Subcutaneous injection only
➡️ Answer: A. Initial bolus dose followed by continuous infusion or intermittent doses

9. Which of the following complications can arise from inadequate anticoagulation during dialysis?
A. Clotting of the extracorporeal circuit or dialyzer
B. Hyperkalemia
C. Hypotension
D. Dialysis disequilibrium syndrome
➡️ Answer: A. Clotting of the extracorporeal circuit or dialyzer

10. What is the antidote for heparin overdose or bleeding?
A. Protamine sulfate
B. Vitamin K
C. Aspirin
D. Warfarin
➡️ Answer: A. Protamine sulfate

11. What is a common starting bolus dose of unfractionated heparin for hemodialysis?
A. 50 to 100 units/kg
B. 5000 units
C. 5 units/kg
D. 1000 units only
➡️ Answer: A. 50 to 100 units/kg

12. Which factor is a major consideration when adjusting heparin dosing during dialysis?
A. Patient’s bleeding risk and previous clotting events
B. Patient’s weight only
C. Dialysate composition
D. Dialysis machine brand
➡️ Answer: A. Patient’s bleeding risk and previous clotting events

13. What is the mechanism of action of unfractionated heparin?
A. Activates antithrombin III, which inhibits thrombin and factor Xa
B. Directly inhibits platelet aggregation
C. Blocks vitamin K-dependent clotting factors
D. Inhibits fibrinolysis
➡️ Answer: A. Activates antithrombin III, which inhibits thrombin and factor Xa

14. Which anticoagulant has a longer half-life and is sometimes used as an alternative to unfractionated heparin?
A. Low molecular weight heparin (LMWH)
B. Aspirin
C. Warfarin
D. Clopidogrel
➡️ Answer: A. Low molecular weight heparin (LMWH)

15. Why might low molecular weight heparin (LMWH) be preferred in some dialysis patients?
A. More predictable anticoagulant response and less frequent dosing
B. Cheaper than unfractionated heparin
C. No risk of bleeding
D. Oral administration possible
➡️ Answer: A. More predictable anticoagulant response and less frequent dosing

16. What is the main disadvantage of heparin-free dialysis?
A. Higher risk of clotting in the dialysis circuit
B. Increased risk of bleeding
C. Increased risk of infection
D. Lower dialysis adequacy
➡️ Answer: A. Higher risk of clotting in the dialysis circuit

17. Which of the following is NOT a common side effect of heparin?
A. Heparin-induced thrombocytopenia (HIT)
B. Bleeding
C. Hyperkalemia
D. Hypertension
➡️ Answer: D. Hypertension

18. How is heparin-induced thrombocytopenia (HIT) diagnosed?
A. Drop in platelet count >50% after heparin exposure, with or without thrombosis
B. Increased platelet count after heparin use
C. Elevated INR
D. Elevated D-dimer only
➡️ Answer: A. Drop in platelet count >50% after heparin exposure, with or without thrombosis

19. What is the management for a patient with suspected HIT?
A. Stop all heparin products and use alternative anticoagulants such as argatroban or danaparoid
B. Continue heparin and monitor platelet counts
C. Increase heparin dose
D. Start aspirin
➡️ Answer: A. Stop all heparin products and use alternative anticoagulants such as argatroban or danaparoid

20. Which of the following is a commonly used regional anticoagulation method in dialysis?
A. Citrate anticoagulation
B. Aspirin
C. Warfarin
D. Clopidogrel
➡️ Answer: A. Citrate anticoagulation

21. How does regional citrate anticoagulation work during dialysis?
A. Citrate chelates calcium, preventing clotting in the circuit, with calcium reinfused post-filter
B. Citrate inhibits vitamin K activity systemically
C. Citrate increases platelet aggregation
D. Citrate acts as a fibrinolytic agent
➡️ Answer: A. Citrate chelates calcium, preventing clotting in the circuit, with calcium reinfused post-filter

22. What laboratory parameter must be closely monitored during citrate anticoagulation?
A. Ionized calcium levels
B. Platelet count
C. INR
D. Hemoglobin
➡️ Answer: A. Ionized calcium levels

23. What is a potential complication of citrate anticoagulation?
A. Metabolic alkalosis
B. Hyperkalemia
C. Hypertension
D. Hyperglycemia
➡️ Answer: A. Metabolic alkalosis

24. In which patients is regional citrate anticoagulation particularly useful?
A. Patients with high bleeding risk
B. Patients with normal coagulation
C. Patients with hyperkalemia
D. Pediatric patients only
➡️ Answer: A. Patients with high bleeding risk

25. What is the usual route of administration for protamine sulfate in reversing heparin effects?
A. Intravenous
B. Oral
C. Subcutaneous
D. Intramuscular
➡️ Answer: A. Intravenous

26. Which statement about low molecular weight heparin (LMWH) in dialysis is TRUE?
A. It has a longer half-life and does not require continuous infusion
B. It is ineffective for dialysis anticoagulation
C. It requires routine coagulation monitoring
D. It causes more bleeding than unfractionated heparin
➡️ Answer: A. It has a longer half-life and does not require continuous infusion

27. What is the mechanism of heparin-induced thrombocytopenia (HIT)?
A. Immune-mediated platelet activation leading to thrombosis
B. Platelet destruction by the spleen
C. Excessive anticoagulation causing bleeding
D. Decreased production of platelets in bone marrow
➡️ Answer: A. Immune-mediated platelet activation leading to thrombosis

28. How soon after starting heparin therapy can HIT typically develop?
A. 5 to 10 days
B. Immediately
C. After 1 month
D. After 6 months
➡️ Answer: A. 5 to 10 days

29. Which anticoagulant is preferred for patients with a history of HIT requiring dialysis?
A. Direct thrombin inhibitors (e.g., argatroban) or danaparoid
B. Unfractionated heparin
C. Warfarin alone
D. Aspirin
➡️ Answer: A. Direct thrombin inhibitors (e.g., argatroban) or danaparoid

30. What is the main disadvantage of citrate anticoagulation?
A. Complex monitoring and risk of metabolic disturbances
B. Increased bleeding risk
C. Short half-life requiring continuous infusion
D. Ineffectiveness in preventing clotting
➡️ Answer: A. Complex monitoring and risk of metabolic disturbances

31. Which of the following is a contraindication to the use of citrate anticoagulation?
A. Severe liver failure
B. Hypertension
C. Diabetes mellitus
D. Hyperkalemia
➡️ Answer: A. Severe liver failure

32. What is the main monitoring parameter during heparin anticoagulation in hemodialysis?
A. Activated partial thromboplastin time (aPTT)
B. Prothrombin time (PT)
C. Platelet count only
D. Blood glucose
➡️ Answer: A. Activated partial thromboplastin time (aPTT)

33. What is the effect of heparin on potassium levels?
A. Can cause hyperkalemia by inhibiting aldosterone secretion
B. Causes hypokalemia
C. No effect on potassium
D. Causes hypocalcemia
➡️ Answer: A. Can cause hyperkalemia by inhibiting aldosterone secretion

34. Which of the following anticoagulants is NOT commonly used in hemodialysis?
A. Warfarin
B. Unfractionated heparin
C. Low molecular weight heparin
D. Citrate
➡️ Answer: A. Warfarin

35. What is the typical duration of action of unfractionated heparin after a bolus dose?
A. 4 hours
B. 1 hour
C. 12 hours
D. 24 hours
➡️ Answer: A. 4 hours

36. Why might heparin dosage need adjustment in patients with liver disease?
A. Reduced clearance leads to prolonged anticoagulant effect
B. Increased metabolism leads to decreased effect
C. No adjustment is needed
D. Liver disease increases platelet production
➡️ Answer: A. Reduced clearance leads to prolonged anticoagulant effect

37. Which clinical sign suggests excessive anticoagulation during hemodialysis?
A. Excessive bleeding from vascular access site
B. Hypertension
C. Muscle cramps
D. Hypokalemia
➡️ Answer: A. Excessive bleeding from vascular access site

38. What is a common cause of inadequate anticoagulation in hemodialysis?
A. Under-dosing of heparin or missed doses
B. Excessive ultrafiltration
C. Dialysate contamination
D. Patient dehydration
➡️ Answer: A. Under-dosing of heparin or missed doses

39. Which of the following is an advantage of regional anticoagulation over systemic anticoagulation?
A. Lower systemic bleeding risk
B. Easier to administer
C. No monitoring required
D. Less effective in preventing clotting
➡️ Answer: A. Lower systemic bleeding risk

40. What is the most important consideration when choosing an anticoagulation strategy for hemodialysis?
A. Balance between preventing circuit clotting and minimizing bleeding risk
B. Cost of anticoagulant
C. Patient age only
D. Duration of dialysis session only
➡️ Answer: A. Balance between preventing circuit clotting and minimizing bleeding risk

41. Which of the following is TRUE regarding heparin resistance?
A. It may require higher doses of heparin to achieve anticoagulation
B. It is caused by excessive antithrombin III activity
C. It leads to increased bleeding risk with normal heparin dose
D. It is common in patients with low platelet counts
➡️ Answer: A. It may require higher doses of heparin to achieve anticoagulation

42. What laboratory test can help diagnose heparin resistance?
A. Antithrombin III levels
B. Platelet count
C. Prothrombin time (PT)
D. Serum calcium
➡️ Answer: A. Antithrombin III levels

43. What is the mechanism by which low molecular weight heparin (LMWH) exerts its anticoagulant effect?
A. Inhibits factor Xa more selectively than thrombin
B. Inhibits vitamin K-dependent clotting factors
C. Activates plasminogen
D. Blocks platelet aggregation
➡️ Answer: A. Inhibits factor Xa more selectively than thrombin

44. Which of the following is NOT a recognized indication for heparin-free dialysis?
A. Active bleeding
B. Recent surgery
C. Severe thrombocytopenia
D. Routine maintenance dialysis without bleeding risk
➡️ Answer: D. Routine maintenance dialysis without bleeding risk

45. Which clinical monitoring parameter is most important during anticoagulation therapy in hemodialysis?
A. Signs of bleeding and clotting in the dialysis circuit
B. Blood pressure only
C. Heart rate only
D. Dialysate flow rate
➡️ Answer: A. Signs of bleeding and clotting in the dialysis circuit

46. What is the potential risk of using citrate anticoagulation in patients with impaired metabolism?
A. Citrate accumulation leading to metabolic alkalosis and hypocalcemia
B. Hyperkalemia
C. Hypertension
D. Hypoglycemia
➡️ Answer: A. Citrate accumulation leading to metabolic alkalosis and hypocalcemia

47. How is the anticoagulation effect reversed in case of heparin overdose?
A. Protamine sulfate neutralizes heparin
B. Vitamin K administration
C. Platelet transfusion
D. Aspirin administration
➡️ Answer: A. Protamine sulfate neutralizes heparin

48. Which patient factor increases the risk of bleeding during hemodialysis anticoagulation?
A. Concurrent use of antiplatelet or anticoagulant medications
B. Young age
C. High platelet count
D. Adequate nutritional status
➡️ Answer: A. Concurrent use of antiplatelet or anticoagulant medications

49. What is the typical protocol if clotting occurs in the dialysis circuit despite anticoagulation?
A. Increase anticoagulant dose and evaluate dialysis machine settings
B. Decrease anticoagulant dose
C. Stop dialysis permanently
D. Ignore and continue dialysis
➡️ Answer: A. Increase anticoagulant dose and evaluate dialysis machine settings

50. Which anticoagulant can be used in hemodialysis patients who have contraindications to heparin?
A. Direct thrombin inhibitors like argatroban
B. Warfarin only
C. Aspirin only
D. No anticoagulation options available
➡️ Answer: A. Direct thrombin inhibitors like argatroban


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Wednesday, 21 December 2011

Concept of Dry Weight in Haemodialysis


1. What is the best definition of "dry weight" in a hemodialysis patient?
A. The weight after a meal
B. The weight with maximum fluid overload
C. The weight at which the patient is normotensive without signs of fluid overload or depletion
D. The patient’s weight during hospitalization
Answer: C. The weight at which the patient is normotensive without signs of fluid overload or depletion

2. Which of the following is a clinical sign that a patient's post-dialysis weight is above dry weight?
A. Hypotension
B. Muscle cramps
C. Edema
D. Dizziness
Answer: C. Edema

3. What is a common symptom if a patient is dialyzed below their dry weight?
A. Hypertension
B. Dyspnea
C. Post-dialysis hypotension
D. Peripheral edema
Answer: C. Post-dialysis hypotension

4. Which of the following tools can help in assessing a patient's dry weight more accurately?
A. MRI
B. Bioimpedance spectroscopy
C. CT scan
D. ECG
Answer: B. Bioimpedance spectroscopy

5. Which of the following is NOT a reliable indicator to adjust dry weight?
A. Blood pressure trends
B. Presence of lung crepitations
C. Patient’s appetite
D. Post-dialysis symptoms
Answer: C. Patient’s appetite

6. Which of the following statements is TRUE regarding dry weight?
A. It should remain fixed over time
B. It usually increases in elderly patients
C. It may need to be adjusted based on patient’s clinical status
D. It is measured before dialysis starts
Answer: C. It may need to be adjusted based on patient’s clinical status

7. A dialysis patient complains of cramps and lightheadedness after dialysis. What is the likely cause?
A. Inadequate ultrafiltration
B. Fluid overload
C. Dry weight set too low
D. Dry weight set too high
Answer: C. Dry weight set too low

8. A key goal of determining dry weight in hemodialysis is to:
A. Maximize urine output
B. Prevent catheter infection
C. Avoid intradialytic hypotension and fluid overload
D. Ensure anticoagulation is effective
Answer: C. Avoid intradialytic hypotension and fluid overload

9. When is the ideal time to reassess a patient’s dry weight?
A. After every dialysis session
B. Every 3 months
C. When there are changes in blood pressure or signs of volume overload/depletion
D. Only during hospitalization
Answer: C. When there are changes in blood pressure or signs of volume overload/depletion

10. Which of the following would suggest a patient is not yet at dry weight after dialysis?
A. Normal heart rate
B. No edema or shortness of breath
C. Crackles in lungs and elevated blood pressure
D. Slight fatigue
Answer: C. Crackles in lungs and elevated blood pressure

11. Which of the following factors can make dry weight estimation more challenging?
A. Good appetite
B. Stable hemoglobin
C. Congestive heart failure (CHF)
D. Stable blood pressure
Answer: C. Congestive heart failure (CHF)

12. What is the most appropriate action if a patient experiences intradialytic hypotension frequently?
A. Increase ultrafiltration rate
B. Lower the dry weight
C. Reassess and possibly increase the dry weight
D. Skip next dialysis session
Answer: C. Reassess and possibly increase the dry weight

13. Overestimating dry weight in a hemodialysis patient can lead to:
A. Muscle cramps
B. Postural hypotension
C. Hypertension and left ventricular hypertrophy
D. Syncope
Answer: C. Hypertension and left ventricular hypertrophy

14. Which tool is NOT typically used to help assess dry weight?
A. Clinical assessment
B. Chest X-ray
C. ECG
D. Lung ultrasound
Answer: C. ECG

15. Which statement is TRUE regarding the relationship between residual urine output and dry weight?
A. Residual urine output does not affect dry weight
B. Patients with residual diuresis may have lower dry weight
C. All anuric patients have the same dry weight
D. Dry weight is fixed if urine is present
Answer: B. Patients with residual diuresis may have lower dry weight

16. A patient continues to have shortness of breath post-dialysis. What does this suggest?
A. Weight below dry weight
B. Reaching ideal weight
C. Overestimation of dry weight
D. Normal dialysis response
Answer: C. Overestimation of dry weight

17. Which of the following is a consequence of repeatedly removing too much fluid (below dry weight)?
A. Fluid retention
B. Intradialytic hypertension
C. Recurrent hypotension and organ ischemia
D. Increased dry weight
Answer: C. Recurrent hypotension and organ ischemia

18. Adjusting dry weight downward is appropriate in which scenario?
A. Edema increases
B. Patient gains muscle mass
C. Appetite improves
D. Weight loss from catabolism or chronic illness
Answer: D. Weight loss from catabolism or chronic illness

19. The "target weight" in dialysis treatment refers to:
A. Weight before dialysis
B. Estimated dry weight post-dialysis
C. The ideal BMI
D. Random fluid goal
Answer: B. Estimated dry weight post-dialysis

20. Which method provides the most objective estimate of volume status to assist with dry weight adjustment?
A. Asking the patient
B. Measuring interdialytic weight gain
C. Bioimpedance spectroscopy
D. Using dialysis machine alarms
Answer: C. Bioimpedance spectroscopy

21. A patient complains of headache and high BP pre-dialysis, and still has mild edema post-dialysis. What does this likely indicate?

A. Reached dry weight
B. Below dry weight
C. Above dry weight
D. Normal post-dialysis state
Answer: C. Above dry weight

22. A consistent interdialytic weight gain of >5% of dry weight suggests:
A. Patient has reached target weight
B. Good fluid management
C. Poor fluid restriction or inaccurate dry weight
D. Overuse of diuretics
Answer: C. Poor fluid restriction or inaccurate dry weight

23. In which condition should dry weight not be aggressively reduced, even if the patient appears overloaded?
A. Well-nourished patient
B. Chronic liver disease with ascites
C. Mild hypertension
D. Peripheral edema only
Answer: B. Chronic liver disease with ascites

24. A newly dialyzed patient experiences lightheadedness, yawning, and cramps during the last hour. What's the best next step?
A. Increase ultrafiltration
B. Reassess and possibly increase dry weight
C. Increase blood flow rate
D. Continue dialysis as usual
Answer: B. Reassess and possibly increase dry weight

25. Which statement about dry weight is FALSE?
A. It can change over time
B. It can be used to control blood pressure
C. It is the lowest tolerated post-dialysis weight
D. It is based solely on pre-dialysis weight
Answer: D. It is based solely on pre-dialysis weight

26. When assessing dry weight in a patient with amputation, which factor should be most carefully monitored?
A. Post-dialysis fatigue
B. Blood pressure trends
C. Changes in limb circumference
D. Appetite
Answer: B. Blood pressure trends

27. Which organ system is most vulnerable to repeated dialysis below dry weight?
A. Lungs
B. Liver
C. Heart
D. GI tract
Answer: C. Heart

28. Overestimating dry weight increases the risk of:
A. Infections
B. Hyperkalemia
C. Left ventricular hypertrophy and uncontrolled hypertension
D. Dialyzer clotting
Answer: C. Left ventricular hypertrophy and uncontrolled hypertension

29. Why might a dialysis nurse track “post-dialysis blood pressure trends” over several sessions?
A. To decide if the dialyzer is adequate
B. To assess vascular access function
C. To help determine correct dry weight
D. To track medication effects
Answer: C. To help determine correct dry weight

30. Which professional should be involved when significant changes to dry weight are needed?
A. Only the dialysis technician
B. Pharmacist
C. Nephrologist and dialysis nurse
D. Surgeon
Answer: C. Nephrologist and dialysis nurse

31. A patient feels well after dialysis but has elevated BP and mild ankle edema. What is the likely implication?
A. Patient is below dry weight
B. Dry weight is appropriate
C. Patient is above dry weight
D. Dialysis was excessive
Answer: C. Patient is above dry weight

32. Which patient symptom suggests underestimation of dry weight (i.e., too much fluid removed)?
A. Hypertension
B. Edema
C. Shortness of breath
D. Dizziness and fatigue post-dialysis
Answer: D. Dizziness and fatigue post-dialysis

33. What is a common consequence of removing too little fluid during hemodialysis (above dry weight)?
A. Cramps
B. Hypotension
C. Volume overload and hypertension
D. Nausea
Answer: C. Volume overload and hypertension

34. Bioimpedance spectroscopy helps assess dry weight by measuring:
A. Protein levels
B. Electrolyte imbalance
C. Body fluid composition
D. Hemoglobin
Answer: C. Body fluid composition

35. Which of the following would require a reduction in dry weight over time?
A. Congestive heart failure
B. Muscle gain from rehabilitation
C. Progressive malnutrition and muscle wasting
D. Dialysis vintage < 6 months
Answer: C. Progressive malnutrition and muscle wasting

36. Which of the following is a risk of chronically maintaining a patient above their true dry weight?
A. Orthostatic hypotension
B. Tachycardia
C. Left ventricular hypertrophy
D. Muscle cramps
Answer: C. Left ventricular hypertrophy

37. A post-dialysis BP is 80/60 mmHg, and the patient reports weakness. What does this suggest?
A. Excess fluid remains
B. Dry weight too high
C. Dry weight may be too low
D. Patient needs more ultrafiltration
Answer: C. Dry weight may be too low

38. Which action is appropriate when dry weight is suspected to be inaccurate?
A. Increase dialysate temperature
B. Increase ultrafiltration rate without discussion
C. Collaborate with the nephrologist to reassess
D. Ignore unless patient complains
Answer: C. Collaborate with the nephrologist to reassess

39. What is the best way to confirm that a patient has reached their true dry weight over time?
A. They feel tired after every session
B. Their weight is consistent with pre-dialysis weight
C. They remain normotensive post-dialysis without fluid-related symptoms
D. They lose >3 kg per week
Answer: C. They remain normotensive post-dialysis without fluid-related symptoms

40. Which of the following conditions may mask true fluid overload and delay dry weight reduction?
A. Anemia
B. Diarrhea
C. Chronic hypotension
D. Malnutrition with low albumin
Answer: D. Malnutrition with low albumin

41. Which physical assessment is most helpful in evaluating fluid status during dry weight determination?
A. Visual inspection of AV fistula
B. Palpation of liver
C. Jugular venous pressure (JVP) assessment
D. Skin turgor
Answer: C. Jugular venous pressure (JVP) assessment

42. A patient’s BP is consistently low post-dialysis and they feel dizzy. What might this indicate?
A. Too little fluid was removed
B. Dialysis was insufficient
C. Dry weight is set too low
D. Patient is overhydrated
Answer: C. Dry weight is set too low

43. The purpose of determining and adjusting dry weight is to:
A. Prevent infection
B. Avoid medication use
C. Maintain fluid balance and prevent cardiovascular complications
D. Increase protein intake
Answer: C. Maintain fluid balance and prevent cardiovascular complications

44. A rapid drop in weight after initiating dialysis in a new patient typically indicates:
A. An error in dry weight estimation
B. Clearance of excess fluid (fluid overload)
C. Muscle loss
D. Hemoglobin drop
Answer: B. Clearance of excess fluid (fluid overload)

45. A sudden drop in post-dialysis BP, cramps, and fainting are signs of:
A. Good dialysis tolerance
B. Excessive ultrafiltration—overshooting dry weight
C. Dialysis adequacy
D. Appropriate dry weight
Answer: B. Excessive ultrafiltration—overshooting dry weight

46. What would support the need to increase a patient’s dry weight?
A. Decreased appetite and weight loss
B. Frequent post-dialysis hypotension
C. Persistent hypertension
D. Increased interdialytic weight gain
Answer: B. Frequent post-dialysis hypotension

47. Which lab value might indirectly support the need to reassess dry weight?
A. Elevated serum sodium
B. Hemoglobin > 12 g/dL
C. Persistently low serum albumin
D. Normal potassium
Answer: C. Persistently low serum albumin
(Note: Low albumin may mask signs of fluid overload)

48. What is the best time to evaluate a patient's true dry weight?
A. Immediately after dialysis
B. Before dialysis
C. During a hypertensive crisis
D. 24 hours post-dialysis
Answer: A. Immediately after dialysis

49. In elderly dialysis patients, dry weight management is more complicated due to:
A. Increased appetite
B. High urine output
C. Poor skin turgor and cardiovascular fragility
D. High muscle mass
Answer: C. Poor skin turgor and cardiovascular fragility

50. One of the long-term effects of maintaining weight consistently above dry weight is:
A. Dehydration
B. Hypotension
C. Pulmonary edema and LVH (left ventricular hypertrophy)
D. Anemia
Answer: C. Pulmonary edema and LVH (left ventricular hypertrophy)


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