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Patient Masks in the Dialysis Unit
Due to the COVID-19 pandemic, the outpatient dialysis facility has adopted a policy stating that patients are to wear face masks at all times. A staff member is distributing masks and an educational handout to each patient as they enter the facility waiting room.

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* 1. A patient says to the staff member, "You take my temperature and you ask me those same questions every time I come here. Why do I need a mask when you know I don't have that infection?" Which of these responses by the staff member would be best?

The correct answer is b. "We honestly don't know who may have the infection. So, you're protecting others and protecting yourself."

Rationale: In early April, the CDC began advising all people to wear non-medical Amasks@--any fabric that covers the nose and mouth when they leave home. However, the dialysis units are able to supply medical masks, which are more effective in a healthcare setting. Many people who are infected with the coronavirus show no symptoms but they can still spread it to others. There is no way to tell who is sick and who is not.


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* 2.  Patients are instructed that they may remove their masks for a very brief time in order to

The correct answer is d. take an oral medication.

Rationale: The mask must remain in place at all times. This includes not removing the mask to talk, eat, drink, or to touch the nose or face. The exception is for patients who take an oral medication, nutritional supplement, or small amount of food that is clinically necessary, as determined by the dietitian. The patient is to remove the mask only for a few seconds. Patients should avoid meals during dialysis. They can bring convenience food such as candy to prevent hypoglycemia.



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* 3. The staff members are educating the patients about safety precautions with COVID-19. They explain that, since the virus is airborne, it can be spread by

The correct answer is d. coughing, sneezing, speaking, and snoring.

Rationale: The virus that causes COVID-19 is an airborne pathogen. The primary means of transmission is via virus-containing microdroplets. Coughing, sneezing and even just speaking release droplets into the air. The virus can spread between people interacting in close proximity, even if those people are not exhibiting symptoms. The larynx is vibrating as the person speaks and it acts as a little nebulizer, turning a liquid into a mist.

Reference: Yannis Drossinos, Nikolaos I. Stilianakis. (2020) What aerosol physics tells us about airborne pathogen transmission. Aerosol Science and Technology, pages 1-5.

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* 4.  A patient complains to the staff member that he put on the unit-supplied medical mask as directed but now feels hot and stuffy. It is most likely that the mask is

The correct answer is a. on correctly.

Rationale: Surgical masks protect against COVID-19 when worn correctly. When putting on the mask, pay close attention to the nose, cheeks, and chin. All must be tight--no gaps! It may feel hot and stuffy, but that means it is being done correctly.

Past Bonus Questions

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* A patient who has COVID-19 is being dialyzed in the isolation room in the outpatient dialysis unit.

1. The technician enters into the room to perform an hourly routine patient evaluation and documentation at chairside. During the evaluation, the patient becomes unresponsive. The technician calls to the nurse for assistance.  Before entering the room, the nurse should put on personal protective equipment and

The correct answer is d. identify essential personnel and limit the number who enter the room.

Rationale: The challenge is to ensure that patients with or without COVID-19 who experience cardiac arrest get the best possible chance of survival without compromising the safety of rescuers, who will be needed to care for future patients.  Resuscitation efforts require numerous providers to work in close proximity to one another and the patient.  It is essential that providers protect themselves and their colleagues from unnecessary exposure.  Exposed providers who contract COVID-19 further decrease the already strained workforce available to respond and have the potential to add additional strain if they become critically ill.  Therefore, one strategy AHA recommends is to limit personnel in the room or on the scene to only those essential for patient care. 


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* 2. The nurse assesses the patient and finds there is no pulse and agonal breathing.  Which of these actions should the nurse take first?

The correct answer is c.  Begin compressions.

Rationale:  If the patient is unresponsive and found to have no pulse and no respirations or agonal breathing, CPR is initiated, beginning with chest compressions.  The AED is attached as soon as it is available and compressions are continued while the AED pads are being applied to the patient.


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* 3. In order to provide oxygenation while minimizing the risk of airborne particles, which of the following oxygen delivery methods is recommended?

The correct answer is a. Passive oxygenation using a non-rebreather face mask.

Rationale:  A general principle for resuscitation of the patient with suspected or confirmed COVID-19 is to prioritize oxygenation and ventilation strategies with lower aerosolization risk. For adults, passive oxygenation with a non-rebreathing face mask can be considered as an alternative to the bag-mask device. The bag-mask requires not only that a HEPA filter be attached securely but it also requires a skilled provider.


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* 4. The AED has been applied and is analyzing the patient's cardiac rhythm.  No shock is advised.  Which of the following actions should the nurse take next?

The correct answer is a. Resume CPR for two minutes.

Rationale:  The AED analyzes the rhythm and, when no shock is advised, the AED prompts the staff to resume CPR immediately.  CPR is performed for about 2 minutes or until the AED prompts the user to allow for a rhythm check.

Past Bonus Questions

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* The Clinical Nurse Educator is performing a competency evaluation on the use of personal protective equipment (PPE). During the observational period, the educator notes that some of the staff hesitate and appear uncertain about how they should properly use PPE.

1. The educator demonstrates the proper use of PPE. The correct sequence for putting on PPE is

The correct answer is (a) gown, mask, face shield, gloves.

Rationale: All PPE MUST be applied in a specific order to ensure the skin, nose, mouth, and eyes are covered to prevent transmission of infection to health care providers.

Reference: CDC. Sequence for Putting On Personal Protective Equipment, p. 1.

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* 2. After receiving instruction about PPE, a staff member correctly identifies the sequence for removing PPE as

The correct answer is (b) gloves, face shield, gown, mask.

Rationale: The sequence for removing PPE is to do it safely, without contaminating clothing, skin, or mucous membranes with potentially infectious materials. Remove all PPE before exiting the patient room except a respirator, if worn. Remove the respirator after leaving the patient room and closing the door.

Reference: CDC. Sequence for Putting On Personal Protective Equipment, p. 2.

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* As part of the clinical competency assessment, the educator discusses the following patient scenario with the staff.

1. During the patient screening process prior to entering the dialysis clinic, the staff identifies a patient with a runny nose, watery eyes, and a temperature of 100•F (37.8•C). According to the current CDC Coronavirus Disease 2019 (COVID-19) Outpatient Dialysis Facility Preparedness Assessment Tool, in addition to having the patient put on a mask, which of the following actions would be appropriate?

The correct answer is (d) Dialyze the patient in a designated chair at the end-of-row.

Rationale: If the facility has an isolation room that is not being used for a patient who is hepatitis B surface antigen positive, the patient with an undiagnosed respiratory infection can be dialyzed there. If a separate room is not available, the patient should be treated at a corner or end-of-row station, away from the main flow of traffic, separated by at least 6 feet from the nearest patient station (in all directions).

Reference: CDC Coronavirus Disease 2019 (COVID-19) Outpatient Dialysis Facility Preparedness Assessment
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