CCHT Medication Administration and Anticoagulation 2 — Questions and Answers
Question 1: A hemodialysis patient receives intravenous sodium bicarbonate during treatment. What is the primary indication for this medication?
- Hypernatremia
- Metabolic acidosis (Correct answer)
- Hypercalcemia
- Hyperphosphatemia
Correct answer: Metabolic acidosis
IV sodium bicarbonate is administered to correct metabolic acidosis, which is common in end-stage renal disease patients.
Question 2: Which phosphate binder is commonly administered with meals to dialysis patients to control serum phosphorus levels?
- Aluminum hydroxide only
- Calcium carbonate or sevelamer (Correct answer)
- Sodium polystyrene sulfonate
- Cholestyramine
Correct answer: Calcium carbonate or sevelamer
Calcium carbonate and sevelamer are commonly used phosphate binders taken with meals to reduce phosphorus absorption from food.
Question 3: When using a continuous heparin infusion during dialysis, what laboratory test is used to monitor anticoagulation levels?
- Prothrombin time (PT)
- Activated clotting time (ACT) or APTT (Correct answer)
- Platelet count
- Serum creatinine
Correct answer: Activated clotting time (ACT) or APTT
The activated clotting time (ACT) or activated partial thromboplastin time (APTT) is used to monitor heparin anticoagulation during dialysis.
Question 4: A patient on hemodialysis develops heparin-induced thrombocytopenia (HIT). Which finding on laboratory results would support this diagnosis?
- Elevated hemoglobin
- Platelet count drop of >50% from baseline (Correct answer)
- Increased white blood cell count
- Elevated serum potassium
Correct answer: Platelet count drop of >50% from baseline
HIT is characterized by a significant drop in platelet count (>50% from baseline) occurring 5–10 days after heparin initiation due to antibody formation.
Question 5: What is the purpose of administering vitamin D analogs (e.g., calcitriol) to hemodialysis patients?
- Treat metabolic acidosis
- Suppress secondary hyperparathyroidism and manage bone disease (Correct answer)
- Lower blood pressure
- Reduce fluid overload
Correct answer: Suppress secondary hyperparathyroidism and manage bone disease
Active vitamin D analogs suppress parathyroid hormone (PTH) secretion to manage secondary hyperparathyroidism and renal osteodystrophy in dialysis patients.
Question 6: Which route of administration is preferred for erythropoiesis-stimulating agents (ESAs) in hemodialysis patients?
- Oral
- Intramuscular
- Intravenous or subcutaneous (Correct answer)
- Transdermal
Correct answer: Intravenous or subcutaneous
ESAs are most commonly given IV (directly into the dialysis circuit) or subcutaneously; IV is convenient during dialysis sessions.
Question 7: A dialysis patient's hemoglobin rises above 13 g/dL while on ESA therapy. What is the appropriate action?
- Increase the ESA dose
- Discontinue ESA and monitor
- Reduce or hold the ESA dose (Correct answer)
- Add an oral iron supplement
Correct answer: Reduce or hold the ESA dose
ESA dose should be reduced or held when hemoglobin exceeds target levels (typically >13 g/dL) to avoid increased cardiovascular risk associated with high hemoglobin.
CCHT Medication Administration and Anticoagulation 2
A hemodialysis patient receives intravenous sodium bicarbonate during treatment.
What is the primary indication for this medication?