CDN Basics Practice Questions (100 Flashcards)

The nurse must perform hand hygiene (alcohol-based hand rub or soap and water) immediately before touching the patient and again specifically before performing the aseptic task (cannulation). **Rationale:** CDC Five Moments for Hand Hygiene specifies that hand hygiene must occur: 1) Before touching a patient, 2) Before clean/aseptic procedures, 3) After body fluid exposure, 4) After touching a patient, and 5) After touching patient surroundings. **Exam Tip:** The NNCC emphasizes that clean tasks (like charting) and dirty tasks (like touching the environment) must be separated from aseptic tasks (cannulation/access) by hand hygiene. Distractors often suggest that wearing gloves replaces the need for hand hygiene; it does not.

KoA represents the maximum theoretical clearance (in mL/min) of urea that a dialyzer can achieve at infinite blood and dialysate flow rates. It is the product of the membrane's permeability (K) and its surface area (A). A higher KoA (typically >700 for high-efficiency) indicates a greater capacity to remove small solutes like urea. Exam Tip: While KoA is a fixed physical property of the dialyzer, actual clearance in practice is always lower because it is limited by the prescribed blood (Qb) and dialysate (Qd) flow rates.

The maximum allowable level for chloramines is 0.1 mg/L. Chloramine is a combination of free chlorine and ammonia. Because it is a stable compound, it is not effectively removed by RO membranes and requires granulated activated carbon (GAC) tanks for adsorption. Toxicity leads to hemolysis because chloramines cross the dialyzer membrane and denature hemoglobin, forming Heinz bodies. Exam Strategy: The NNCC often tests the distinction between total chlorine (limit 0.5 mg/L) and the chloramine component (limit 0.1 mg/L). If a question asks for the Total Chlorine level used to ensure safety, the answer is often <0.1 mg/L to provide a safety margin for chloramines.

The primary purpose is to protect the municipal (city) water supply from contamination by preventing the reverse flow of water from the dialysis clinic back into the public system. The RPZ is considered the most reliable backflow preventer because it includes two independent check valves and a pressure-monitored relief valve. CMS and AAMI/ISO 23500 standards require these devices to ensure that chemicals used in dialysis (like disinfectants) or potentially contaminated water do not enter the potable water supply. Exam Tip: NNCC often tests the why behind components; the RPZ is about public safety and regulatory compliance.

Self-Concept. Adult learners move from dependency toward self-direction. In dialysis, fostering this involves involving the patient in goal-setting and treatment choices (e.g., choosing Peritoneal Dialysis over Hemodialysis). NNCC Tip: The exam emphasizes patient empowerment; look for options that promote autonomy rather than passive compliance. Identifying the patient as an active partner is a core 2026 nephrology nursing competency.