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CNeph(C) Nephrology Nursing study materials
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CNeph(C) Nephrology Nursing practice questions

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Question 1Renal Anatomy, Physiology, and Pathophysiology

Which structure in the nephron is primarily responsible for the reabsorption of the majority of filtered water and sodium?

  1. Collecting duct
  2. Glomerular capsule
  3. Distal convoluted tubule
  4. Proximal convoluted tubule Correct answer.

Explanation

The proximal convoluted tubule reabsorbs roughly 65 percent of filtered sodium and water, driven largely by active sodium transport and followed by osmotic water movement. Its abundant brush border and mitochondria support this high-capacity work, making it the dominant site of reabsorption.

Question 2Renal Anatomy, Physiology, and Pathophysiology

Which hormone increases water reabsorption in the collecting duct by inserting aquaporin-2 channels into the luminal membrane?

  1. Parathyroid hormone
  2. Aldosterone
  3. Antidiuretic hormone Correct answer.
  4. Atrial natriuretic peptide

Explanation

Antidiuretic hormone binds V2 receptors on collecting duct cells and triggers insertion of aquaporin-2 water channels, allowing water to move down its osmotic gradient. This concentrates the urine and reduces water loss when plasma osmolality rises.

Question 3Renal Anatomy, Physiology, and Pathophysiology

The glomerular filtration rate is best described as which of the following?

  1. The volume of blood flowing through both kidneys each minute
  2. The concentration of solute excreted in the final urine
  3. The volume of filtrate formed by all functioning nephrons per minute Correct answer.
  4. The pressure within the renal artery

Explanation

Glomerular filtration rate is the total volume of plasma ultrafiltrate produced by all functioning nephrons each minute, normally about 125 mL per minute. It reflects filtration across the glomerular membrane and is distinct from renal blood flow and from final urine output.

Question 4Renal Anatomy, Physiology, and Pathophysiology

Which portion of the nephron is the primary site of action for aldosterone?

  1. Distal nephron, especially the collecting duct Correct answer.
  2. Descending limb of the loop of Henle
  3. Glomerulus
  4. Proximal convoluted tubule

Explanation

Aldosterone acts on the distal nephron, chiefly the collecting duct principal cells, where it increases sodium reabsorption and potassium secretion. This action fine-tunes sodium balance and blood pressure rather than providing bulk reabsorption.

Question 5Renal Anatomy, Physiology, and Pathophysiology

Which cells of the juxtaglomerular apparatus secrete renin in response to reduced renal perfusion?

  1. Granular cells of the afferent arteriole Correct answer.
  2. Podocytes
  3. Macula densa cells
  4. Mesangial cells

Explanation

Granular cells located in the wall of the afferent arteriole store and release renin when they sense reduced stretch or lowered perfusion pressure. This initiates the renin-angiotensin-aldosterone cascade that raises blood pressure and sodium retention.

Question 6Renal Anatomy, Physiology, and Pathophysiology

Which of the following substances is normally almost completely reabsorbed by the renal tubules and therefore should not appear in significant amounts in the final urine?

  1. Creatinine
  2. Hydrogen ions
  3. Glucose Correct answer.
  4. Urea

Explanation

Glucose is fully reabsorbed in the proximal tubule by sodium-coupled transporters until the transport maximum is exceeded. Its appearance in urine therefore signals that filtered glucose exceeded reabsorptive capacity, as in uncontrolled diabetes.

Question 7Renal Anatomy, Physiology, and Pathophysiology

Which structure carries urine from the kidney to the urinary bladder?

  1. Renal pelvis
  2. Urethra
  3. Ureter Correct answer.
  4. Calyx

Explanation

The ureter is the muscular tube that transports urine from the renal pelvis to the bladder through peristaltic contractions. The urethra instead carries urine from the bladder to the exterior.

Question 8Renal Anatomy, Physiology, and Pathophysiology

A patient with severe vomiting develops metabolic alkalosis and hypokalemia. Which renal response best explains the worsening hypokalemia?

  1. Enhanced proximal potassium reabsorption lowers serum potassium
  2. Increased distal sodium delivery stimulates potassium secretion in the collecting duct Correct answer.
  3. Reduced aldosterone levels decrease potassium excretion
  4. Decreased tubular flow reduces potassium loss

Explanation

Vomiting causes volume depletion and alkalosis; the resulting aldosterone effect plus increased distal sodium delivery promotes potassium secretion into the tubular lumen. This renal potassium wasting can worsen hypokalemia despite total body potassium depletion.

Question 9Renal Anatomy, Physiology, and Pathophysiology

A patient has a serum creatinine that has doubled over 24 hours. What is the most likely explanation for the change in glomerular filtration rate?

  1. A fall in GFR to roughly half of baseline Correct answer.
  2. No meaningful change in GFR
  3. A proportional increase in GFR
  4. An increase in renal blood flow only

Explanation

Serum creatinine is inversely related to GFR, so a doubling of creatinine generally reflects a fall in GFR to approximately half of the previous value. This relationship holds in steady state and helps identify acute kidney injury.

Question 10Renal Anatomy, Physiology, and Pathophysiology

Which mechanism best explains how the loop of Henle generates a hypertonic medullary interstitium?

  1. Active sodium transport out of the thin descending limb
  2. Filtration of protein into the medulla
  3. Countercurrent multiplication with active transport in the thick ascending limb Correct answer.
  4. Passive water reabsorption in the thick ascending limb

Explanation

The thick ascending limb actively transports sodium and chloride into the interstitium while remaining water impermeable, and the countercurrent arrangement multiplies this gradient along the loop. The result is a hypertonic medulla that enables water reabsorption in the collecting duct.

Question 11Renal Anatomy, Physiology, and Pathophysiology

A patient with SIADH has concentrated urine and low serum sodium. Which renal process is most directly responsible for the concentrated urine?

  1. Increased glomerular filtration of water
  2. Increased aquaporin-2 mediated water reabsorption in the collecting duct Correct answer.
  3. Reduced sodium reabsorption in the proximal tubule
  4. Decreased medullary tonicity

Explanation

In SIADH, excess antidiuretic hormone increases aquaporin-2 channels in the collecting duct, so more water is reabsorbed and the urine becomes concentrated. The retained water dilutes serum sodium, producing euvolemic hyponatremia.

Question 12Renal Anatomy, Physiology, and Pathophysiology

Which change in renal physiology is expected as part of normal aging?

  1. Increased ability to excrete a water load rapidly
  2. Increase in renal reserve and GFR
  3. Enhanced renin release with age
  4. Loss of nephrons with declining GFR and impaired concentrating ability Correct answer.

Explanation

Aging is associated with progressive nephron loss, reduced renal blood flow and GFR, and diminished urinary concentrating and diluting capacity. These changes reduce renal reserve and make older adults more vulnerable to fluid and electrolyte disturbances.

Question 13Renal Anatomy, Physiology, and Pathophysiology

A patient with chronic kidney disease has a low serum bicarbonate and a normal anion gap. Which renal defect most likely contributes?

  1. Reduced tubular hydrogen ion secretion and bicarbonate regeneration Correct answer.
  2. Excessive bicarbonate filtration
  3. Increased ammonia production by the kidney
  4. Increased proximal bicarbonate reabsorption

Explanation

In chronic kidney disease, reduced nephron mass limits ammonia production and hydrogen ion secretion, impairing bicarbonate regeneration and producing a normal anion gap metabolic acidosis. This is a hyperchloremic acidosis typical of renal tubular dysfunction.

Question 14Renal Anatomy, Physiology, and Pathophysiology

Which factor directly opposes glomerular filtration by reducing net filtration pressure?

  1. Bowman space hydrostatic pressure Correct answer.
  2. Afferent arteriolar dilation
  3. Glomerular capillary hydrostatic pressure
  4. Oncotic pressure of Bowman space fluid

Explanation

Net filtration pressure equals glomerular capillary hydrostatic pressure minus the opposing forces of Bowman space hydrostatic pressure and plasma oncotic pressure. Increased pressure in Bowman space therefore directly reduces net filtration.

Question 15Renal Anatomy, Physiology, and Pathophysiology

A patient with acute kidney injury has a fractional excretion of sodium below 1 percent. This finding most suggests which category of injury?

  1. Acute tubular necrosis with tubular dysfunction
  2. Postrenal obstruction with tubular damage
  3. Prerenal azotemia with intact tubular sodium avidity Correct answer.
  4. Intrinsic glomerular disease with salt wasting

Explanation

In prerenal states, reduced perfusion stimulates avid tubular sodium reabsorption, so little filtered sodium is excreted and fractional excretion falls below 1 percent. Intrinsic tubular injury typically impairs reabsorption and raises the fractional excretion.

Question 16Renal Anatomy, Physiology, and Pathophysiology

Which segment of the nephron is the main site of regulated calcium reabsorption under parathyroid hormone control?

  1. Collecting duct
  2. Distal convoluted tubule Correct answer.
  3. Thick ascending limb
  4. Proximal convoluted tubule

Explanation

Parathyroid hormone enhances calcium reabsorption in the distal convoluted tubule through increased luminal calcium channel activity and basolateral exchange. This fine regulation determines final urinary calcium excretion, whereas the proximal tubule handles bulk but largely unregulated reabsorption.

Question 17Renal Anatomy, Physiology, and Pathophysiology

A patient with nephrotic syndrome has heavy proteinuria and edema. Which pathophysiologic mechanism best explains the edema?

  1. Reduced plasma oncotic pressure from urinary protein loss Correct answer.
  2. Increased glomerular filtration of water
  3. Increased renal sodium excretion
  4. Elevated plasma oncotic pressure

Explanation

Massive protein loss in urine lowers plasma albumin and oncotic pressure, allowing fluid to move into the interstitium and producing edema. The associated intravascular volume depletion also activates sodium-retaining pathways that worsen fluid accumulation.

Question 18Renal Anatomy, Physiology, and Pathophysiology

Which finding is most characteristic of a reduced glomerular filtration surface area?

  1. Increased creatinine clearance
  2. Increased filtration of large proteins
  3. Reduced serum potassium
  4. A rise in serum creatinine and urea Correct answer.

Explanation

When filtration surface area falls, filtration of urea and creatinine decreases, so both accumulate in blood. Creatinine clearance and GFR therefore decline, and serum creatinine and urea rise as markers of impaired filtration.

Question 19Renal Anatomy, Physiology, and Pathophysiology

A patient with a ureteral stone develops severe flank pain and a rising creatinine. Which mechanism best explains the rising creatinine?

  1. Excessive sodium reabsorption in the proximal tubule
  2. Increased renal blood flow
  3. Increased glomerular filtration from obstruction
  4. Obstruction raising tubular pressure and reducing net filtration Correct answer.

Explanation

Obstruction raises pressure within the tubular system and Bowman space, lowering net filtration pressure and reducing GFR. Bilateral obstruction or obstruction in a solitary kidney can therefore cause a rapid rise in creatinine.

Question 20Renal Anatomy, Physiology, and Pathophysiology

Which statement best describes the role of the proximal tubule in acid-base balance?

  1. It excretes bicarbonate to acidify the urine
  2. It generates new bicarbonate only in the collecting duct
  3. It secretes hydrogen ions and reabsorbs most filtered bicarbonate Correct answer.
  4. It has no role in acid-base regulation

Explanation

The proximal tubule reclaims about 80 to 90 percent of filtered bicarbonate and secretes hydrogen ions, largely through sodium-hydrogen exchange. This reclamation preserves the body's bicarbonate buffer and is essential for normal acid-base balance.

Question 21Renal Anatomy, Physiology, and Pathophysiology

A patient has hypokalemia and metabolic alkalosis with a urine chloride below 10 mmol/L. Which mechanism best explains the alkalosis?

  1. Chloride-rich fluid loss with volume depletion and enhanced distal hydrogen secretion Correct answer.
  2. Primary renal bicarbonate wasting
  3. Excess mineralocorticoid effect independent of volume status
  4. Reduced aldosterone secretion

Explanation

Low urine chloride indicates chloride depletion from vomiting or diuretic use, with volume depletion that increases aldosterone and distal hydrogen and potassium secretion. The result is a chloride-responsive metabolic alkalosis that corrects with saline and chloride replacement.

Question 22Renal Anatomy, Physiology, and Pathophysiology

Which of the following changes would most increase potassium secretion into the tubular lumen?

  1. Increased tubular flow and aldosterone effect Correct answer.
  2. Reduced serum potassium
  3. Decreased collecting duct sodium reabsorption
  4. Decreased distal sodium delivery

Explanation

Potassium secretion in the collecting duct is enhanced by aldosterone, increased distal sodium delivery, and higher tubular flow, all of which favor sodium entry and potassium exit. These factors explain potassium wasting in states of high aldosterone and high distal flow.

Question 23Renal Anatomy, Physiology, and Pathophysiology

A patient has a normal anion gap metabolic acidosis, a urine pH above 5.5, and hypokalemia. Which renal tubular defect is most likely?

  1. Prerenal azotemia
  2. Type 1 distal renal tubular acidosis Correct answer.
  3. Acute tubular necrosis
  4. Type 2 proximal renal tubular acidosis

Explanation

In type 1 distal renal tubular acidosis, the distal nephron cannot secrete hydrogen ions adequately, so the urine cannot be maximally acidified despite systemic acidosis. Hypokalemia is common because impaired distal hydrogen secretion is accompanied by increased potassium loss.

Question 24Renal Anatomy, Physiology, and Pathophysiology

Which mechanism best explains why a high-protein diet increases urinary calcium excretion?

  1. Protein directly increases proximal calcium reabsorption
  2. Protein increases filtered calcium by reducing glomerular filtration
  3. Protein metabolism generates acid that buffers calcium from bone and reduces tubular reabsorption Correct answer.
  4. Protein reduces intestinal calcium absorption

Explanation

High protein intake increases endogenous acid production; bone buffers the acid and releases calcium, while the acid load also reduces renal tubular calcium reabsorption. The combined effect increases urinary calcium and the risk of stone formation.

Question 25Assessment and Management of the Person with Chronic Kidney Disease

Which laboratory value is used to stage chronic kidney disease according to the KDIGO classification?

  1. Estimated glomerular filtration rate Correct answer.
  2. Urine specific gravity
  3. Blood urea nitrogen level
  4. Serum creatinine concentration

Explanation

CKD staging is based on the estimated glomerular filtration rate, which reflects overall kidney function and divides disease into stages G1 through G5. Serum creatinine is used to calculate eGFR but is not itself the staging variable because it varies with muscle mass and age.

Question 26Assessment and Management of the Person with Chronic Kidney Disease

A patient with stage 4 chronic kidney disease reports fatigue and is found to have a hemoglobin of 8.9 g/dL with normal iron studies. Which cause of anemia is most characteristic of CKD?

  1. Reduced erythropoietin production by the kidneys Correct answer.
  2. Dietary vitamin B12 deficiency
  3. Chronic blood loss from colonic polyps
  4. Hemolysis from mechanical valve damage

Explanation

The kidneys produce erythropoietin, which stimulates red blood cell production, and failing kidneys secrete insufficient amounts, producing a normocytic normochromic anemia. Iron studies should be checked because iron deficiency frequently coexists and must be corrected before or alongside erythropoiesis-stimulating therapy.

Question 27Assessment and Management of the Person with Chronic Kidney Disease

Which dietary instruction is most appropriate for a patient with advanced CKD who has hyperphosphatemia?

  1. Limit foods high in phosphate additives and processed foods Correct answer.
  2. Increase cola beverage intake to maintain hydration
  3. Take calcium supplements with every meal without prescription
  4. Increase intake of dairy products and whole grains

Explanation

Phosphate additives in processed foods and colas are highly bioavailable and raise serum phosphate, so limiting them is a cornerstone of management. Dairy products and whole grains are also high in phosphorus and should be moderated rather than increased.

Question 28Assessment and Management of the Person with Chronic Kidney Disease

Which blood pressure target is generally recommended for most adults with chronic kidney disease and albuminuria?

  1. Less than 120/70 mm Hg
  2. Less than 140/90 mm Hg
  3. Less than 160/100 mm Hg
  4. Less than 130/80 mm Hg Correct answer.

Explanation

Guidelines generally recommend a systolic target under 130 mm Hg and diastolic under 80 mm Hg for adults with CKD, particularly when albuminuria is present, because tighter control slows progression. Targets should be individualized, but 130/80 is the standard reference point.

Question 29Assessment and Management of the Person with Chronic Kidney Disease

Which class of medication slows CKD progression in patients with albuminuria by reducing intraglomerular pressure?

  1. Loop diuretics
  2. Beta blockers
  3. Thiazolidinediones
  4. Angiotensin-converting enzyme inhibitors Correct answer.

Explanation

ACE inhibitors dilate the efferent arteriole, lowering intraglomerular pressure and reducing proteinuria, which slows decline in kidney function. Serum creatinine and potassium should be monitored after initiation because both may rise.

Question 30Assessment and Management of the Person with Chronic Kidney Disease

A patient with CKD reports new-onset generalized itching without rash. Which intervention should the nurse anticipate first?

  1. Assessment of phosphate and parathyroid hormone levels Correct answer.
  2. Oral antibiotic therapy
  3. Topical corticosteroid application
  4. Immediate initiation of hemodialysis

Explanation

Pruritus in CKD is strongly associated with hyperphosphatemia and secondary hyperparathyroidism, so these values should be evaluated before symptomatic treatment. Management then includes phosphate binders, dietary restriction, and skin moisturizers.

Question 31Assessment and Management of the Person with Chronic Kidney Disease

Which finding best indicates that a patient with CKD is adhering to a fluid restriction?

  1. Report of thirst throughout the day
  2. Decreasing serum albumin
  3. Weight stable between dialysis sessions Correct answer.
  4. Increasing blood pressure readings

Explanation

Stable weight between treatments indicates that fluid intake matches output and removal, which is the practical measure of adherence to fluid restriction. Rapid interdialytic weight gain suggests excess intake and risk of volume overload.

Question 32Assessment and Management of the Person with Chronic Kidney Disease

Which vaccine is specifically recommended for adults with CKD because of increased risk of severe disease?

  1. Hepatitis B vaccine Correct answer.
  2. Rabies vaccine
  3. Yellow fever vaccine
  4. Typhoid vaccine

Explanation

Patients with CKD have impaired immune responses and are at higher risk for hepatitis B, so vaccination is recommended, often with higher antigen doses and booster monitoring. Live vaccines such as yellow fever are generally avoided in immunocompromised patients.

Question 33Assessment and Management of the Person with Chronic Kidney Disease

A patient with CKD stage 3b has an eGFR of 38 mL/min/1.73 m2 and asks about medication safety. Which action by the nurse is most appropriate?

  1. Reassure that all medications are safe because the patient is not on dialysis
  2. Advise the patient to double the dose of any diuretic
  3. Tell the patient to avoid all analgesics permanently
  4. Review the medication list for renally cleared drugs and recommend dose adjustment Correct answer.

Explanation

Many drugs are cleared by the kidney and require dose reduction or avoidance when eGFR is reduced, so a structured medication review is essential. Nonsteroidal anti-inflammatory drugs in particular should be avoided, but not every analgesic must be withheld.

Question 34Assessment and Management of the Person with Chronic Kidney Disease

A patient with CKD and type 2 diabetes has an HbA1c of 7.2%. Which consideration is most relevant when interpreting this result?

  1. HbA1c may be unreliable in CKD because of anemia and altered red cell turnover Correct answer.
  2. HbA1c should be replaced entirely by fasting glucose in all CKD stages
  3. HbA1c is falsely low in advanced CKD because of reduced red cell survival
  4. HbA1c is unaffected by kidney function and can be interpreted normally

Explanation

Anemia, erythropoietin therapy, and altered red cell survival in CKD can make HbA1c unreliable, so glucose monitoring or glycated albumin may be needed. The target is also individualized because of hypoglycemia risk from reduced insulin clearance.

Question 35Assessment and Management of the Person with Chronic Kidney Disease

A patient on hemodialysis gains 3.5 kg between sessions and weighs 70 kg dry weight. Which nursing action is most appropriate?

  1. Skip the next dialysis session to allow equilibration
  2. Increase the sodium content of the diet to improve thirst
  3. Document the finding and reinforce fluid restriction teaching Correct answer.
  4. Encourage liberal water intake to prevent dehydration

Explanation

Interdialytic weight gain above roughly 4 to 5 percent of dry weight suggests excess fluid intake and raises the risk of hypertension and cardiac strain. The nurse should document, assess for contributing factors, and reinforce restriction and sodium avoidance.

Question 36Assessment and Management of the Person with Chronic Kidney Disease

Which electrolyte abnormality is most life-threatening in a patient with untreated stage 5 CKD and requires urgent treatment?

  1. Mild hypocalcemia
  2. Hyperphosphatemia without symptoms
  3. Hyperkalemia with peaked T waves Correct answer.
  4. Metabolic alkalosis

Explanation

The kidneys normally excrete potassium, and in advanced CKD hyperkalemia can cause fatal arrhythmias, with peaked T waves being an early electrocardiographic sign. Emergency treatment includes calcium gluconate, insulin with glucose, and definitive removal by dialysis.

Question 37Assessment and Management of the Person with Chronic Kidney Disease

A patient with CKD is prescribed sodium bicarbonate. Which finding best indicates the therapy is achieving its intended effect?

  1. Rising serum bicarbonate toward the normal range Correct answer.
  2. Increasing serum phosphate
  3. Falling serum potassium to 3.0 mEq/L
  4. Decreasing hemoglobin

Explanation

Sodium bicarbonate is given to correct the metabolic acidosis of CKD, so serum bicarbonate should rise toward the normal range. Overcorrection can cause metabolic alkalosis and hypokalemia, so levels are monitored.

Question 38Assessment and Management of the Person with Chronic Kidney Disease

Which statement about dietary protein for a patient with CKD stage 3 who is not on dialysis is most accurate?

  1. Protein intake should be increased to 2 g/kg/day
  2. Moderate protein restriction around 0.8 g/kg/day is generally recommended Correct answer.
  3. Protein intake has no relationship to CKD progression
  4. Protein should be eliminated entirely to protect the kidneys

Explanation

Guidelines suggest a moderate protein intake near 0.8 g/kg/day for non-dialysis CKD to reduce hyperfiltration and nitrogenous waste while preventing malnutrition. Very high intake increases glomerular workload, and protein should never be eliminated.

Question 39Assessment and Management of the Person with Chronic Kidney Disease

A patient with CKD reports muscle cramps and numbness around the mouth after receiving a phosphate binder. Which electrolyte should the nurse suspect is abnormal?

  1. Magnesium
  2. Sodium
  3. Calcium Correct answer.
  4. Chloride

Explanation

Calcium-based phosphate binders can cause hypercalcemia, whose symptoms include muscle cramps, perioral numbness, confusion, and constipation. Serum calcium should be checked and the binder regimen reviewed with the prescriber.

Question 40Assessment and Management of the Person with Chronic Kidney Disease

Which intervention best supports a patient with CKD who is preparing for possible kidney replacement therapy?

  1. Advising the patient to avoid discussing advance care planning
  2. Early education about transplantation, dialysis modalities, and vascular access Correct answer.
  3. Restricting all social contact to reduce infection risk
  4. Waiting until symptoms are severe before discussing options

Explanation

Early modality education allows time for informed decision-making, transplant evaluation, and timely access creation such as an arteriovenous fistula that needs weeks to mature. Late referral is associated with worse outcomes and emergency dialysis initiation.

Question 41Assessment and Management of the Person with Chronic Kidney Disease

A patient with CKD has a hemoglobin of 9.5 g/dL and ferritin of 40 ng/mL with transferrin saturation of 12%. What is the priority intervention?

  1. Transfuse packed red blood cells immediately
  2. Increase dietary potassium
  3. Begin iron replacement therapy Correct answer.
  4. Start an erythropoiesis-stimulating agent without iron

Explanation

Low ferritin and low transferrin saturation indicate absolute iron deficiency, which must be corrected before or with erythropoiesis-stimulating agents for them to work effectively. Transfusion is reserved for severe or symptomatic anemia.

Question 42Assessment and Management of the Person with Chronic Kidney Disease

Which self-management behavior should the nurse emphasize to reduce cardiovascular risk in a patient with CKD?

  1. Avoiding all physical activity
  2. Increasing salt intake to improve appetite
  3. Stopping statins once eGFR falls below 60
  4. Smoking cessation and control of lipids and blood pressure Correct answer.

Explanation

Cardiovascular disease is the leading cause of death in CKD, and smoking cessation along with blood pressure and lipid control substantially reduces risk. Physical activity should be encouraged rather than avoided.

Question 43Assessment and Management of the Person with Chronic Kidney Disease

A patient with CKD reports taking an over-the-counter nonsteroidal anti-inflammatory drug daily for back pain. What is the nurse's best response?

  1. Recommend doubling the dose for better pain control
  2. Suggest combining it with an ACE inhibitor for kidney protection
  3. Encourage continued use because it is available without prescription
  4. Advise stopping the drug and discuss safer alternatives with the prescriber Correct answer.

Explanation

NSAIDs inhibit prostaglandin-mediated afferent arteriolar dilation, reducing renal blood flow and causing acute kidney injury, especially in CKD or with ACE inhibitors. Safer alternatives such as acetaminophen or topical agents should be discussed.

Question 44Assessment and Management of the Person with Chronic Kidney Disease

A patient with CKD has a serum potassium of 6.2 mEq/L and peaked T waves on ECG. Which action should the nurse take first?

  1. Give oral sodium polystyrene sulfonate and reassess in four hours
  2. Obtain a routine follow-up appointment next week
  3. Administer intravenous calcium gluconate as prescribed Correct answer.
  4. Encourage a high-potassium diet

Explanation

Hyperkalemia with ECG changes is a cardiac emergency, and intravenous calcium stabilizes the myocardium immediately while other measures shift and remove potassium. Insulin with glucose, beta agonists, and dialysis follow to lower the potassium level.

Question 45Assessment and Management of the Person with Chronic Kidney Disease

A patient with CKD stage 3 develops acute confusion, and the medication list includes an ACE inhibitor, metformin, and a proton pump inhibitor. Which assessment is the priority?

  1. Assume the confusion is dementia and document only
  2. Check serum creatinine and potassium to evaluate for acute kidney injury Correct answer.
  3. Restrict fluids to 500 mL per day
  4. Discontinue all medications permanently without prescriber input

Explanation

Acute confusion in CKD may reflect uremia, electrolyte disturbance, or drug accumulation, so renal function and potassium should be evaluated promptly. Metformin in particular can accumulate with declining kidney function and contribute to lactic acidosis.

Question 46Assessment and Management of the Person with Chronic Kidney Disease

A patient with CKD is prescribed an ACE inhibitor and returns with a creatinine rise from 1.8 to 2.1 mg/dL and potassium of 5.6 mEq/L. Which interpretation is most appropriate?

  1. The ACE inhibitor should be doubled immediately
  2. A small creatinine rise may be expected, but the potassium requires prompt evaluation Correct answer.
  3. The patient should be started on a potassium supplement
  4. Both changes are harmless and require no action

Explanation

A creatinine increase of up to about 30 percent after ACE inhibitor initiation can be acceptable, but hyperkalemia above 5.5 mEq/L needs prompt review and possible dose adjustment. Potassium supplements would be dangerous in this setting.

Question 47Assessment and Management of the Person with Chronic Kidney Disease

A patient with CKD and heart failure is on furosemide and reports a 3-kg weight gain with increasing dyspnea. Which assessment finding is most concerning?

  1. Serum potassium of 4.2 mEq/L
  2. Urine output of 1.5 L per day
  3. Blood pressure of 128/78 mm Hg
  4. Bibasilar crackles and elevated jugular venous pressure Correct answer.

Explanation

Crackles and elevated jugular venous pressure indicate volume overload and pulmonary congestion, requiring escalation of diuretic therapy and close monitoring. The other values are within acceptable ranges and do not signal decompensation.

Question 48Assessment and Management of the Person with Chronic Kidney Disease

Which finding most strongly suggests that a patient with CKD has developed secondary hyperparathyroidism?

  1. Low parathyroid hormone with hypercalcemia
  2. Elevated parathyroid hormone with normal calcium and normal phosphate
  3. Elevated parathyroid hormone with low calcium and low vitamin D Correct answer.
  4. Low parathyroid hormone with hypophosphatemia

Explanation

In CKD, reduced phosphate excretion and impaired vitamin D activation lower serum calcium, which stimulates parathyroid hormone release and causes secondary hyperparathyroidism. Management includes phosphate binders, active vitamin D, and calcimimetics.

Question 49Assessment and Management of the Person with Chronic Kidney Disease

A patient with CKD asks why a kidney biopsy has been recommended despite an established diagnosis of CKD. Which rationale is most accurate?

  1. Biopsy replaces the need for laboratory monitoring
  2. Biopsy can identify a potentially treatable cause and guide prognosis Correct answer.
  3. Biopsy is required before any antihypertensive is prescribed
  4. Biopsy is used only to measure kidney size

Explanation

When the cause of CKD is unclear or an acute component is suspected, biopsy can reveal treatable conditions such as glomerulonephritis and inform prognosis and therapy. Risks including bleeding must be weighed against the potential benefit.

Question 50Assessment and Management of the Person with Chronic Kidney Disease

A patient with CKD stage 4 asks the nurse why blood pressure control matters so much. Which response best reflects the current understanding of CKD progression?

  1. Tight control is needed only after dialysis has been started, not before.
  2. Blood pressure control mainly prevents painful muscle cramps during dialysis sessions.
  3. Lowering blood pressure slows the decline in kidney function and reduces cardiovascular risk. Correct answer.
  4. Blood pressure has little effect on kidney function once CKD stage 4 is reached.

Explanation

Hypertension both results from and accelerates CKD, so controlling it slows loss of glomerular filtration and lowers cardiovascular events, the leading cause of death in CKD. The benefit is present in earlier stages, not only after dialysis begins.