Test Taking TipsTest Taking TipsMadeline McLoughlin BSN, RN, CNNMadeline McLoughlin BSN, RN, CNN

Unit Educator, Dialysis ServicesUnit Educator, Dialysis Services

Morristown Memorial HospitalMorristown Memorial Hospital

May 7, 2011May 7, 2011

The following pages are intended as a The following pages are intended as a review of test taking tips and practices for review of test taking tips and practices for you. There are sample questions, some that you. There are sample questions, some that illustrate test taking tips; others are included illustrate test taking tips; others are included as examples that the faculty of this course as examples that the faculty of this course thought might be of assistance to you.thought might be of assistance to you.

In no way is it suggested that these are In no way is it suggested that these are questions directly from the exam or from questions directly from the exam or from anyone who has had input into the questions anyone who has had input into the questions on the exam that you will, or might be, on the exam that you will, or might be, taking. These are meant for practice and to taking. These are meant for practice and to alleviate some anxiety about looking at test alleviate some anxiety about looking at test questions.questions.

Publications to ReviewPublications to Review ANNA’s ANNA’s Standards of Practice and Guidelines of Standards of Practice and Guidelines of

CareCare Contemporary Nephrology Nursing: Principles Contemporary Nephrology Nursing: Principles

and Practicesand Practices text text ANNA’s ANNA’s Core Curriculum for Nephrology NursingCore Curriculum for Nephrology Nursing Chronic Kidney Disease: CD Rom Modules – Chronic Kidney Disease: CD Rom Modules –

Available on ANNA’s Web siteAvailable on ANNA’s Web site

All of the above are available from ANNA and are All of the above are available from ANNA and are valuable resources for more than studying for this valuable resources for more than studying for this exam. exam.

(The ANNA (The ANNA Core CurriculumCore Curriculum will have a new edition out in late 2007 or early 2008.) will have a new edition out in late 2007 or early 2008.)

Other sources that might be of Other sources that might be of useuse

Kesselman-Turkel, J. & Peterson, F. Kesselman-Turkel, J. & Peterson, F. (2004). Test Taking Strategies. (2004). Test Taking Strategies. Madison: University of Wisconsin Madison: University of Wisconsin Press.Press.

www.testtakingtips.com

CNN Test BlueprintCNN Test Blueprint

The following slides are the ideal The following slides are the ideal distribution of 200 items in the distribution of 200 items in the Nephrology Nursing Certification Nephrology Nursing Certification Examination (found on NNCC’s Web Examination (found on NNCC’s Web site).site).

Don’t count questions or worry about Don’t count questions or worry about whether this is exact. It is your total whether this is exact. It is your total score that counts, not how well you score that counts, not how well you do in each section.do in each section.

Concepts of Renal FailureConcepts of Renal Failure

35% of exam35% of exam 14 Pathophysiology/Complications14 Pathophysiology/Complications 11 Interventions11 Interventions 3 Physical/Technical3 Physical/Technical 7 Teaching7 Teaching 5 Meds5 Meds 3 Interdisciplinary3 Interdisciplinary 7 Psychosocial7 Psychosocial 11 Infection11 Infection 3 Professional3 ProfessionalTotal = 70Total = 70

HemodialysisHemodialysis

30% of the exam30% of the exam 13 Path/Comp13 Path/Comp 8 Interventions8 Interventions 7 Phys/Tech7 Phys/Tech 6 Teaching6 Teaching 7 Medications7 Medications 3 Interdisciplinary3 Interdisciplinary 3 Psychosocial3 Psychosocial 10 Infection10 Infection 3 Professional3 ProfessionalTotal = 60Total = 60

Peritoneal DialysisPeritoneal Dialysis

20% of exam20% of exam 8 Path/Comp8 Path/Comp 6 Interventions6 Interventions 5 Phys/Tech5 Phys/Tech 4 Teaching4 Teaching 5 Medications5 Medications 2 Interdisciplinary2 Interdisciplinary 3 Psychosocial3 Psychosocial 6 Infection6 Infection 1 Professional1 ProfessionalTotal = 40Total = 40

TransplantTransplant

15% of exam15% of exam 5 Path/Comp5 Path/Comp 5 Interventions5 Interventions 3 Phys/Tech3 Phys/Tech 3 Teaching3 Teaching 4 Medications4 Medications 2 Interdisciplinary2 Interdisciplinary 2 Psychosocial2 Psychosocial 5 Infections5 Infections 1 Professional1 ProfessionalTotal = 30Total = 30

Other resourcesOther resources

ANA’s Code of EthicsANA’s Code of Ethics Your nursing experienceYour nursing experience

The Code of Ethics reminds us of our The Code of Ethics reminds us of our professional responsibilities to our patients.professional responsibilities to our patients.

Your nursing experience is extremely Your nursing experience is extremely valuable because it is the cornerstone for valuable because it is the cornerstone for your preparation!your preparation!

Test Taking TipsTest Taking Tips

Read the questions all the way through.Read the questions all the way through.– There may be a word at the end that impacts There may be a word at the end that impacts

the answer.the answer. Eliminate the obvious wrong answers.Eliminate the obvious wrong answers.

– You may then have only two choices to work You may then have only two choices to work with, not four.with, not four.

– Sometimes, when you have eliminated all Sometimes, when you have eliminated all but two, you have a true/false question.but two, you have a true/false question.

A patient who is severely dehydrated would most A patient who is severely dehydrated would most likely be treated with which of the following IV likely be treated with which of the following IV solutions initially?solutions initially?

A. HypertonicA. Hypertonic B. IsotonicB. Isotonic C. HypotonicC. Hypotonic D. ColloidalD. Colloidal

A patient who is severely dehydrated would most A patient who is severely dehydrated would most likely be treated with which of the following IV likely be treated with which of the following IV solutions initially?solutions initially?

A. A. Hypertonic – Would pull fluid off tissue, Hypertonic – Would pull fluid off tissue, perhaps perhaps causing organ failure.causing organ failure.

B. B. Isotonic – Correct because of the need to Isotonic – Correct because of the need to increase increase perfusion to the vital organs.perfusion to the vital organs.

C. C. Hypotonic – Incorrect. These would Hypotonic – Incorrect. These would replenish the replenish the tissue which is not an initial tissue which is not an initial concern.concern.

D. D. Colloidal – Would increase fluid loss to the Colloidal – Would increase fluid loss to the tissue.tissue.

The key word in this question is the last word of The key word in this question is the last word of the question, which could be easy to miss. the question, which could be easy to miss.

Kathy White has pyelonephritis. The symptoms you Kathy White has pyelonephritis. The symptoms you would expect her to exhibit are:would expect her to exhibit are:

A. Burning on urination, fever, and malaise.A. Burning on urination, fever, and malaise. B. Pyuria, proteinuria, and fatigue.B. Pyuria, proteinuria, and fatigue. C. Flank pain, increased WBC, and fever.C. Flank pain, increased WBC, and fever. D. Glucosuria, malaise, and positive blood D. Glucosuria, malaise, and positive blood

culture.culture.

Kathy White has pyelonephritis. The symptoms you Kathy White has pyelonephritis. The symptoms you would expect her to exhibit are:would expect her to exhibit are:

A. A. Burning on urination, fever, and malaise – Burning on urination, fever, and malaise – Incorrect Incorrect because burning on urination would be a because burning on urination would be a sign of a sign of a bladder infection, not a kidney infection.bladder infection, not a kidney infection.

B. B. Pyuria, proteinuria, and fatigue – Incorrect Pyuria, proteinuria, and fatigue – Incorrect because because proteinuria would not be an expectation proteinuria would not be an expectation (would (would indicate severe damage has occurred).indicate severe damage has occurred).

C. C. Flank pain, increased WBC, and fever – Correct.Flank pain, increased WBC, and fever – Correct. D. D. Glucosuria, malaise, and positive blood culture – Glucosuria, malaise, and positive blood culture –

Incorrect because glucosuria is not a normal Incorrect because glucosuria is not a normal finding.finding.

This an example of needing to rule out information that This an example of needing to rule out information that is incorrect from each choice.is incorrect from each choice.

Test Taking TipsTest Taking Tips

Have a good reason to change your Have a good reason to change your answers:answers:– Don’t want to change right answers to Don’t want to change right answers to

wrong.wrong.– Statistically, there are more chances to Statistically, there are more chances to

change from a right to a wrong than the change from a right to a wrong than the other way around.other way around.

– If you didn’t read the whole question, If you didn’t read the whole question, etc.etc.

Test Taking TipsTest Taking Tips

Choose answers based on Choose answers based on nephrology nursing principles.nephrology nursing principles.

Mr. Mendez returns from the operating Mr. Mendez returns from the operating room with a new AVF. You would check room with a new AVF. You would check for the presence of:for the presence of: 1. Resonance.1. Resonance. 2. Crepitus.2. Crepitus. 3. Fremitus.3. Fremitus. 4. Bruit.4. Bruit.

Mr. Mendez returns from the operating Mr. Mendez returns from the operating room with a new AVF. You would check room with a new AVF. You would check for the presence of:for the presence of: 1. Resonance.1. Resonance. 2. Crepitus.2. Crepitus. 3. Fremitus.3. Fremitus. 4. Bruit – Correct.4. Bruit – Correct.

Test Taking TipsTest Taking Tips

Choose answers that are therapeutic Choose answers that are therapeutic in nature (even if you’d like to in nature (even if you’d like to choose another one!).choose another one!).

Mrs. Nameonly comes into your clinic today Mrs. Nameonly comes into your clinic today and says, “If you would have called me and says, “If you would have called me back yesterday like I asked you to, I back yesterday like I asked you to, I wouldn’t have to be in here today.” Your wouldn’t have to be in here today.” Your response would be:response would be:

A. A. What do you mean? I talked to you for What do you mean? I talked to you for an an hour yesterday on the phone!hour yesterday on the phone!

B. B. I had a clinic full of patients who were I had a clinic full of patients who were quite quite time-consuming.time-consuming.

C. C. Mrs. Jones came in bleeding from her Mrs. Jones came in bleeding from her fistula, fistula, so I didn’t have time.so I didn’t have time.

D. What can I do for you today, Mrs. D. What can I do for you today, Mrs. Nameonly?Nameonly?

Mrs. Nameonly comes into your clinic today and says, “If you would have Mrs. Nameonly comes into your clinic today and says, “If you would have called me back yesterday like I asked you to, I wouldn’t have to be in here called me back yesterday like I asked you to, I wouldn’t have to be in here today.” Your response would be:today.” Your response would be:

A. What do you mean? I talked to you for an hour yesterday on the phone!A. What do you mean? I talked to you for an hour yesterday on the phone! B. I had a clinic full of patients who were quite time consuming.B. I had a clinic full of patients who were quite time consuming. C. Mrs. Jones came in bleeding from her fistula, so I didn’t have time.C. Mrs. Jones came in bleeding from her fistula, so I didn’t have time. D. What can I do for you today, Mrs. Nameonly?D. What can I do for you today, Mrs. Nameonly?

Although you might like to choose A, it’s not a therapeutic Although you might like to choose A, it’s not a therapeutic response! She doesn’t care that you had a clinic full of patients, response! She doesn’t care that you had a clinic full of patients, so B is also incorrect. C is incorrect for two reasons – it doesn’t so B is also incorrect. C is incorrect for two reasons – it doesn’t respond to Mrs. Nameonly’s concern, and you’ve just violated respond to Mrs. Nameonly’s concern, and you’ve just violated patient confidentiality. So, D would be the most therapeutic patient confidentiality. So, D would be the most therapeutic response for this question.response for this question.

Don’t choose answers based solely on what you Don’t choose answers based solely on what you do in your practice setting.do in your practice setting.– Make sure answers are based on evidence-based Make sure answers are based on evidence-based

practice throughout the country.practice throughout the country.– Even though your own practice will be good, at times Even though your own practice will be good, at times

standing orders aren’t those done by other physicians.standing orders aren’t those done by other physicians.

Don’t take the entire test a second time when Don’t take the entire test a second time when you finish!you finish!– Leave questions you don’t know blank and then only Leave questions you don’t know blank and then only

look at those questions when you go back through.look at those questions when you go back through.– It has been found that when you review questions again, It has been found that when you review questions again,

you start reading material into an exam question that you start reading material into an exam question that isn’t relevant.isn’t relevant.

Stress reduction techniquesStress reduction techniques

Review prior to the exam, but don’t Review prior to the exam, but don’t “cram” the night before (raises stress “cram” the night before (raises stress levels).levels).

Take time during the exam to take deep Take time during the exam to take deep breaths and relax.breaths and relax.– Because you do actually have time to do this, Because you do actually have time to do this,

promise yourself you will take 3 deep breath promise yourself you will take 3 deep breath each time you turn the page to a new question. each time you turn the page to a new question. You’ll be surprised at how tense your shoulders You’ll be surprised at how tense your shoulders have gotten. After all, we’re putting our ego on have gotten. After all, we’re putting our ego on the line by taking a test like this!the line by taking a test like this!

Test questionsTest questions

Answers and some rationales Answers and some rationales are on slides following this are on slides following this

series of questions.series of questions.

NKF K/DOQI guidelines define NKF K/DOQI guidelines define chronic kidney disease as:chronic kidney disease as: 1. GFR < 60ml/min/1.731. GFR < 60ml/min/1.7322 for greater for greater

than than 3 months and kidney damage.3 months and kidney damage. 2. GFR < 60ml/min/1.732. GFR < 60ml/min/1.7322 for any time for any time

period regardless of kidney damage.period regardless of kidney damage. 3. GFR < 60ml/min/1.733. GFR < 60ml/min/1.7322 for greater for greater

than than 3 months or kidney damage.3 months or kidney damage. 4. GFR 60-89ml/min/1.734. GFR 60-89ml/min/1.7322 in the elderly in the elderly

regardless of kidney damage.regardless of kidney damage.

The most frequent sign or The most frequent sign or symptom of kidney damage is:symptom of kidney damage is: 1. 1. Urinary frequency.Urinary frequency. 2. Asymptomatic.2. Asymptomatic. 3. Dark urine.3. Dark urine. 4. Shortness of breath.4. Shortness of breath.

The primary diagnosis for the The primary diagnosis for the etiology of chronic kidney etiology of chronic kidney disease in the US is:disease in the US is: 1. Hypertension.1. Hypertension. 2. Glomerulonephritis.2. Glomerulonephritis. 3. Renal stones (nephrolithiasis).3. Renal stones (nephrolithiasis). 4. Diabetes.4. Diabetes.

Which of the following is a Which of the following is a modifiable risk factor for CKD?modifiable risk factor for CKD? 1. Smoking.1. Smoking. 2. Family history.2. Family history. 3. Ethnicity.3. Ethnicity. 4. Gender.4. Gender.

One of the most common One of the most common contributing factors in anemia contributing factors in anemia of CKD is:of CKD is: 1. Folate deficiency.1. Folate deficiency. 2. Vitamin B12 deficiency.2. Vitamin B12 deficiency. 3. Iron deficiency.3. Iron deficiency. 4. Homocystiene deficiency.4. Homocystiene deficiency.

Which of the following classes Which of the following classes of antihypertensive of antihypertensive medications does not decrease medications does not decrease proteinuria?proteinuria? 1. Nondihydropyridine calcium 1. Nondihydropyridine calcium

channel channel blockers.blockers. 2. Diuretics.2. Diuretics. 3. Beta blockers.3. Beta blockers. 4. Angiotensin converting enzyme 4. Angiotensin converting enzyme

inhibitors.inhibitors.

Exclusion criteria for patient Exclusion criteria for patient selection of peritoneal dialysis selection of peritoneal dialysis includes all of the following includes all of the following except:except: 1. Large abdominal aortic aneurysm 1. Large abdominal aortic aneurysm

(AAA).(AAA). 2. Delivery of a son by caesarian 2. Delivery of a son by caesarian

section section 14 years ago.14 years ago. 3. Colostomy.3. Colostomy. 4. Psoriasis of the abdominal wall.4. Psoriasis of the abdominal wall.

Your CAPD patient calls to inform you that she has Your CAPD patient calls to inform you that she has blood in her drain bags. Through phone triage, you blood in her drain bags. Through phone triage, you learn that she has her menses. Blood in the effluent learn that she has her menses. Blood in the effluent is common in pre-menopausal woman because:is common in pre-menopausal woman because:

1. Ovaries and fallopian tubes are 1. Ovaries and fallopian tubes are outside outside of the peritoneal cavity.of the peritoneal cavity.

2. Menses causes the peritoneal 2. Menses causes the peritoneal membrane to bleed.membrane to bleed.

3. Ovaries and fallopian tubes are 3. Ovaries and fallopian tubes are inside inside the peritoneal cavity.the peritoneal cavity.

4. All of the above.4. All of the above.

An early post-op complication An early post-op complication of PD is:of PD is: 1. Migration of the drain bag.1. Migration of the drain bag. 2. Migration of the catheter tip.2. Migration of the catheter tip. 3. Cuff extrusion.3. Cuff extrusion. 4. Chronic exit site infection.4. Chronic exit site infection.

Post op teaching for a new PD Post op teaching for a new PD patient includes:patient includes: 1. Secure catheter to abdomen.1. Secure catheter to abdomen. 2. Primary dressing will be removed 2. Primary dressing will be removed

after after 5-7 days.5-7 days. 3. Constipation is common post-PD 3. Constipation is common post-PD

catheter placement.catheter placement. 4. All of the above.4. All of the above.

An established CAPD patient is hospitalized with a broken An established CAPD patient is hospitalized with a broken tibia. While recovering from surgery, the in-patient nurses tibia. While recovering from surgery, the in-patient nurses complete his CAPD exchanges. As the patient’s home CAPD complete his CAPD exchanges. As the patient’s home CAPD unit, you receive a call from the hospital informing you that unit, you receive a call from the hospital informing you that the patient’s body weight is down 7 lbs, he has hypotension, the patient’s body weight is down 7 lbs, he has hypotension, and the nurse reports that he is only returning 2,400 ml of and the nurse reports that he is only returning 2,400 ml of dark yellow effluent of his past exchange of 2,500 ml. You dark yellow effluent of his past exchange of 2,500 ml. You encourage the nurse to:encourage the nurse to: 1. 1. Keep following MD orders and increase from 4 Keep following MD orders and increase from 4

exchanges per exchanges per day to 5 exchanges per day.day to 5 exchanges per day. 2. 2. Call the covering MD and report these changes. Call the covering MD and report these changes.

Anticipate changing PD fluid from all 2.5% concentration of Anticipate changing PD fluid from all 2.5% concentration of dextrose to all 4.25% concentration of dextrose.dextrose to all 4.25% concentration of dextrose.

3. 3. Call the covering MD and report these changes. Call the covering MD and report these changes. Anticipate Anticipate changing PD fluid from all 2.5% concentration changing PD fluid from all 2.5% concentration of dextrose to of dextrose to all 1.5% concentration of dextrose.all 1.5% concentration of dextrose.

4. 4. Continue CAPD as ordered and wish her luck.Continue CAPD as ordered and wish her luck.

During a training session with a new CAPD patient, During a training session with a new CAPD patient, you realize that he is falling asleep during every you realize that he is falling asleep during every other sentence you speak. Which is the least likely other sentence you speak. Which is the least likely reason for this patient’s sleepiness:reason for this patient’s sleepiness:

1. You’ve talked for the past 3 hours, and 1. You’ve talked for the past 3 hours, and he he wants to stay awake but now has wants to stay awake but now has information over load.information over load.

2. He has not achieved readiness to learn.2. He has not achieved readiness to learn. 3. He has uremia and cognitively can’t 3. He has uremia and cognitively can’t

focus due to metabolic changes.focus due to metabolic changes. 4. He slept well last night and wants to 4. He slept well last night and wants to

continue.continue.

The pre-transplant evaluation The pre-transplant evaluation process for a potential process for a potential recipient:recipient: 1. 1. Is basically the same for all potential Is basically the same for all potential

recipients.recipients. 2. 2. Cannot begin until the patient has Cannot begin until the patient has

begun begun dialysis.dialysis. 3. 3. Explores only living, related donors Explores only living, related donors

as live as live donor options, as well as donor options, as well as deceased donors.deceased donors.

4. 4. Varies based upon the individual Varies based upon the individual potential potential recipient diagnosis and co-recipient diagnosis and co-morbidities.morbidities.

The dialysis unit is expected to send The dialysis unit is expected to send monthly blood samples to the transplant monthly blood samples to the transplant center monthly. This sample is center monthly. This sample is immunogolically screened once and immunogolically screened once and discarded.discarded. 1. True.1. True. 2. False.2. False.

Post operative management of the recipient of a Post operative management of the recipient of a kidney transplant includes monitoring urine output. kidney transplant includes monitoring urine output. Low urine output, less than 50 mL/hour, suggests Low urine output, less than 50 mL/hour, suggests which of the following except:which of the following except:

1. 1. Delayed graft function.Delayed graft function. 2. 2. Preoperative dialysis rendered the Preoperative dialysis rendered the

patient patient too “dry” despite hydration in the too “dry” despite hydration in the OR.OR.

3. 3. Urine leak at the ureteral anastamosis Urine leak at the ureteral anastamosis in the in the bladder.bladder.

4. 4. Clot occluding the ureter or the Foley Clot occluding the ureter or the Foley catheter.catheter.

An early post transplant An early post transplant complication is:complication is: 1. Cholecystitis.1. Cholecystitis. 2. Graft dysfunction secondary to 2. Graft dysfunction secondary to

nephrotoxic drugs.nephrotoxic drugs. 3. Lymphocele.3. Lymphocele. 4. Post-transplant 4. Post-transplant

lymphoproliferative lymphoproliferative disorder disorder (PTLD).(PTLD).

An immunosuppressive agent An immunosuppressive agent that is used for induction that is used for induction therapy is:therapy is: 1. Cyclosporine.1. Cyclosporine. 2. Methylprednisolone (Solu-2. Methylprednisolone (Solu-

MedrolMedrol®®).). 3. Mycophenolate mofetil 3. Mycophenolate mofetil

(Cellcept(Cellcept®®).). 4. Polyclonal antibodies (Atgam4. Polyclonal antibodies (Atgam®®, ,

ThymoglobinThymoglobin®®).). 5. Tacrolimus (Prograf5. Tacrolimus (Prograf®®).).

An example of a medication An example of a medication that may be used post that may be used post transplant to prevent transplant to prevent cytomegalovirus (CMV) is:cytomegalovirus (CMV) is: 1. Acyclovir (Zovirax1. Acyclovir (Zovirax®®).). 2. Fluconazole (Diflucan2. Fluconazole (Diflucan®®).). 3. Nystatin (Mycostatin3. Nystatin (Mycostatin®®, Nilstat, Nilstat®®).). 4. Trimepthoprim/sulfamethoxazole 4. Trimepthoprim/sulfamethoxazole

(Bactrim(Bactrim®®, Septra, Septra®®).).

The nurse assessing the patient for The nurse assessing the patient for possible acute rejection should possible acute rejection should observe for what symptoms indicative observe for what symptoms indicative of this most common type of rejection?of this most common type of rejection?

1.1. Fever, malaise, tenderness over the Fever, malaise, tenderness over the graft.graft.

2.2. Hematuria.Hematuria.

3.3. No symptoms.No symptoms.

4.4. Proteinuria.Proteinuria.

As renal function significantly As renal function significantly decreases, laboratory data reflect decreases, laboratory data reflect all of the following except:all of the following except:

1. An increased serum creatinine.1. An increased serum creatinine. 2. An increased BUN.2. An increased BUN. 3. An increased hematocrit and red 3. An increased hematocrit and red

blood blood cell count.cell count. 4. A decreased creatinine clearance.4. A decreased creatinine clearance.

You instruct Mrs. Smith that she will You instruct Mrs. Smith that she will begin exercising her fistula to facilitate begin exercising her fistula to facilitate maturation of the blood vessel. This maturation of the blood vessel. This process includes:process includes:

1. Dilation and hypertrophy.1. Dilation and hypertrophy. 2. Constriction and atrophy.2. Constriction and atrophy. 3. Dilation and atrophy.3. Dilation and atrophy. 4. Constriction and hypertrophy.4. Constriction and hypertrophy.

You explain to your patient that a You explain to your patient that a creatinine clearance test determines:creatinine clearance test determines:

1. The number of milligrams of 1. The number of milligrams of creatinine creatinine excreted in the urine excreted in the urine per hour.per hour.

2. The ratio of serum creatinine to 2. The ratio of serum creatinine to blood blood urea nitrogen.urea nitrogen.

3. Urine flow in milliliters per minute.3. Urine flow in milliliters per minute. 4. The rate at which the kidneys 4. The rate at which the kidneys

remove remove creatinine from the plasma.creatinine from the plasma.

Mrs. Johnson had a graft placed in her left Mrs. Johnson had a graft placed in her left upper arm. She complains of pain in her left upper arm. She complains of pain in her left hand that increases in intensity during hand that increases in intensity during hemodialysis. Management of this syndrome hemodialysis. Management of this syndrome would include:would include: 1. Keeping the hand warm and 1. Keeping the hand warm and

elevated.elevated. 2. Keeping the arm extended and 2. Keeping the arm extended and

elevated.elevated. 3. Keeping the hand warm and 3. Keeping the hand warm and

dependent.dependent. 4. Keeping the arm extended and 4. Keeping the arm extended and

dependent.dependent.

To calculate the percent recirculation, To calculate the percent recirculation, the nurse draws arterial, venous, and the nurse draws arterial, venous, and systemic blood samples:systemic blood samples:

1. Randomly.1. Randomly. 2. Simultaneously.2. Simultaneously. 3. Alternately.3. Alternately. 4. Sequentially.4. Sequentially.

Assessment of your patient’s Assessment of your patient’s skin may show:skin may show: 1. Excessive oiliness.1. Excessive oiliness. 2. Dry, scaly skin with excoriations 2. Dry, scaly skin with excoriations

from from scratching.scratching. 3. Cyanosis.3. Cyanosis. 4. Hirsutism.4. Hirsutism.

Answers/Rationales Answers/Rationales to Test Questionsto Test Questions

NKF K/DOQI Guidelines define NKF K/DOQI Guidelines define chronic kidney disease as:chronic kidney disease as: 1. GFR < 60ml/min/1.731. GFR < 60ml/min/1.7322 for greater than 3 for greater than 3

months and kidney damage. – months and kidney damage. – Incorrect because it Incorrect because it states both criteria must be met.states both criteria must be met.

2. GFR < 60ml/min/1.732. GFR < 60ml/min/1.7322 for any time period for any time period regardless of kidney damage. – regardless of kidney damage. – Incorrect because Incorrect because no time period is specified and kidney damage is no time period is specified and kidney damage is not confirmed.not confirmed.

3. GFR < 60ml/min/1.733. GFR < 60ml/min/1.7322 for greater than 3 for greater than 3 months or kidney damage. – Cmonths or kidney damage. – Correct. Only one orrect. Only one criterion is needed if GFR < 60 more than 3 criterion is needed if GFR < 60 more than 3 monthsmonths..

4. GFR 60-89ml/min/1.734. GFR 60-89ml/min/1.7322 in the elderly regardless in the elderly regardless of kidney damage. – of kidney damage. – Incorrect because decreased Incorrect because decreased damage to this level may be normal aging. Need damage to this level may be normal aging. Need evidence of kidney damage to label with CKDevidence of kidney damage to label with CKD..

The most frequent sign or The most frequent sign or symptom of symptom of kidney damage is: damage is: 1. 1. Urinary frequency.Urinary frequency. 2. Asymptomatic. – 2. Asymptomatic. – CorrectCorrect 3. Dark urine.3. Dark urine. 4. Shortness of breath.4. Shortness of breath.

The other symptoms may occur but The other symptoms may occur but are not common primary symptoms,are not common primary symptoms,

The primary diagnosis for the The primary diagnosis for the etiology of chronic kidney etiology of chronic kidney disease in the U.S. is:disease in the U.S. is: 1. Hypertension. – 1. Hypertension. – Incorrect. Incorrect.

Accounts Accounts for about 30% CKD.for about 30% CKD. 2. Glomerulonephritis – 2. Glomerulonephritis – Incorrect.Incorrect.

Accounts for about 15% CKD.Accounts for about 15% CKD. 3. Renal stones (nephrolithiasis) – 3. Renal stones (nephrolithiasis) –

Incorrect. Accounts for <10% CKDIncorrect. Accounts for <10% CKD.. 4. Diabetes – 4. Diabetes – Correct. Diabetes Correct. Diabetes

accounts accounts for about 50% of CKD.for about 50% of CKD.

Which of the following is a Which of the following is a modifiable risk factor for CKD?modifiable risk factor for CKD? 1. Smoking. – 1. Smoking. – Correct.Correct. 2. Family history.2. Family history. 3. Ethnicity.3. Ethnicity. 4. Gender.4. Gender.

The other risk factors cannot be The other risk factors cannot be changed by the patient or the health changed by the patient or the health care provider.care provider.

One of the most common One of the most common contributing factors in anemia contributing factors in anemia of CKD is:of CKD is: 1. Folate deficiency. – 1. Folate deficiency. – Incorrect as it is Incorrect as it is

not usually the primary contributor.not usually the primary contributor. 2. Vitamin B12 deficiency. – 2. Vitamin B12 deficiency. – Incorrect as Incorrect as

it is not usually the primary it is not usually the primary contributorcontributor

3. Iron deficiency. – 3. Iron deficiency. – Correct.Correct. 4. Homocystiene deficiency. – 4. Homocystiene deficiency. – Incorrect. Incorrect.

It is not a part of the usual workup.It is not a part of the usual workup.

Which of the following classes Which of the following classes of antihypertensive of antihypertensive medications does not decrease medications does not decrease proteinuria?proteinuria? 1. Nondihydropyridine calcium channel 1. Nondihydropyridine calcium channel

blockers. blockers. 2. Diuretics. – C2. Diuretics. – Correctorrect 3. Beta blockers.3. Beta blockers. 4. Angiotensin converting enzyme inhibitors.4. Angiotensin converting enzyme inhibitors.

The other classes have all shown benefit in The other classes have all shown benefit in decreasing proteinuria. decreasing proteinuria. Dihydropyridine CCBDihydropyridine CCB (such as amlodipine [Norvasc(such as amlodipine [Norvasc®®]) have not ]) have not been shown to decrease proteinuria. been shown to decrease proteinuria.

Exclusion criteria for patient Exclusion criteria for patient selection of peritoneal dialysis selection of peritoneal dialysis includes all of the following includes all of the following except?except? 1. Large abdominal aortic aneurysm 1. Large abdominal aortic aneurysm

(AAA).(AAA). 2. Delivery of a son by caesarian 2. Delivery of a son by caesarian

section section 14 years ago. – 14 years ago. – Correct.Correct. 3. Colostomy.3. Colostomy. 4. Psoriasis of the abdominal wall.4. Psoriasis of the abdominal wall.

Your CAPD patient calls to inform you that she has Your CAPD patient calls to inform you that she has blood in her drain bags. Through phone triage, you blood in her drain bags. Through phone triage, you learn that she has her menses. Blood in the effluent learn that she has her menses. Blood in the effluent is common in pre-menopausal woman because:is common in pre-menopausal woman because:

1. Ovaries and fallopian tubes are outside of 1. Ovaries and fallopian tubes are outside of the the peritoneal cavity. peritoneal cavity. – Incorrect.– Incorrect.

2. Menses causes the peritoneal membrane 2. Menses causes the peritoneal membrane to to bleed. – bleed. – Incorrect. This only occurs if Incorrect. This only occurs if

endometrial tissue has entered the endometrial tissue has entered the peritoneal cavity.peritoneal cavity.

3. Ovaries and fallopian tubes are inside the 3. Ovaries and fallopian tubes are inside the peritoneal cavity. – peritoneal cavity. – Correct ,which Correct ,which

means means that retrograde reflux is not that retrograde reflux is not uncommon.uncommon.

4. All of the above.4. All of the above.

An early post-op complication An early post-op complication of PD is:of PD is: 1. Migration of the drain bag. – 1. Migration of the drain bag. – IncorrectIncorrect 2. Migration of the catheter tip. – 2. Migration of the catheter tip. – CorrectCorrect 3. Cuff extrusion. – 3. Cuff extrusion. – Incorrect. TheIncorrect. The

primary cause is placement of the primary cause is placement of the cuff too cuff too close to the exit site so that close to the exit site so that anchoring too anchoring too tightly will increase the risk tightly will increase the risk of extrusion.of extrusion.

4. Chronic exit site infection. – 4. Chronic exit site infection. – Incorrect Incorrect because looking for an acute because looking for an acute

complication complication that is not chronic.that is not chronic.

Post-op teaching for a new PD Post-op teaching for a new PD patient includes:patient includes: 1. Secure catheter to abdomen.1. Secure catheter to abdomen. 2. Primary dressing will be removed 2. Primary dressing will be removed

after after 5-7 days.5-7 days. 3. Constipation is common post PD 3. Constipation is common post PD

catheter placement.catheter placement. 4. All of the above – 4. All of the above – Correct.Correct.

An established CAPD patient is hospitalized with a broken An established CAPD patient is hospitalized with a broken tibia. While recovering from surgery, the in-patient nurses tibia. While recovering from surgery, the in-patient nurses completes his CAPD exchanges. As the patient’s home CAPD completes his CAPD exchanges. As the patient’s home CAPD unit, you receive a call from the hospital informing you that unit, you receive a call from the hospital informing you that the patient’s body weight is down 7 lbs, he has hypotension the patient’s body weight is down 7 lbs, he has hypotension and the nurse reports that he is only returning 2,400 ml of and the nurse reports that he is only returning 2,400 ml of dark yellow effluent of his past exchange of 2,500 ml. You dark yellow effluent of his past exchange of 2,500 ml. You encourage the nurse to:encourage the nurse to: 1. 1. Keep following MD orders and increase from 4 Keep following MD orders and increase from 4

exchanges per exchanges per day to 5 exchanges per day. – day to 5 exchanges per day. – Incorrect.Incorrect. 2. 2. Call the covering MD and report these changes. Call the covering MD and report these changes.

Anticipate Anticipate changing PD fluid from all 2.5% concentration changing PD fluid from all 2.5% concentration of dextrose to of dextrose to all 4.25% concentration of dextrose. – all 4.25% concentration of dextrose. – Incorrect. Would pull Incorrect. Would pull even more fluid.even more fluid.

3. 3. Call the covering MD and report these changes. Call the covering MD and report these changes. Anticipate Anticipate changing PD fluid from all 2.5% concentration changing PD fluid from all 2.5% concentration of dextrose to of dextrose to all 1.5% concentration of dextrose – all 1.5% concentration of dextrose – Correct.Correct.

4. 4. Continue CAPD as ordered and wish her luck. – Continue CAPD as ordered and wish her luck. – Incorrect.Incorrect.

During a training session with a new CAPD patient, During a training session with a new CAPD patient, you realize that he is falling asleep during every you realize that he is falling asleep during every other sentence you speak. Which is the least likely other sentence you speak. Which is the least likely reason for this patient’s sleepiness:reason for this patient’s sleepiness:

1. You’ve talked for the past 3 hours and 1. You’ve talked for the past 3 hours and he he wants to stay awake but now has wants to stay awake but now has information over load.information over load.

2. He has not achieved readiness to learn.2. He has not achieved readiness to learn. 3. He has uremia and cognitively can’t 3. He has uremia and cognitively can’t

focus due to metabolic changes.focus due to metabolic changes. 4. He slept well last night and wants to 4. He slept well last night and wants to

continue. – continue. – Correct.Correct.

The pre-transplant evaluation The pre-transplant evaluation process for a potential process for a potential recipient:recipient: 1. Is basically the same for all potential 1. Is basically the same for all potential

recipients.recipients. 2. Cannot begin until the patient has 2. Cannot begin until the patient has

begun begun dialysis.dialysis. 3. Explores only living, related donors as 3. Explores only living, related donors as

live live donor options, as well as deceased donor options, as well as deceased donors.donors.

4. Varies based upon the individual 4. Varies based upon the individual potential potential recipient diagnosis and co-recipient diagnosis and co-morbidities. – morbidities. – Correct.Correct.

The dialysis unit is expected to send The dialysis unit is expected to send monthly blood samples to the transplant monthly blood samples to the transplant center monthly. This sample is center monthly. This sample is immunogolically screened once and immunogolically screened once and discarded.discarded. 1. True. – 1. True. – Incorrect.Incorrect. 2. False. – 2. False. – Correct.Correct.

Post-operative Post-operative management of the recipient of a of the recipient of a kidney transplant includes monitoring urine output. kidney transplant includes monitoring urine output. Low urine output, less than 50 mL/hour, suggests Low urine output, less than 50 mL/hour, suggests which of the following except:which of the following except:

1. 1. Delayed graft function.Delayed graft function. 2. 2. Pre-operative dialysis rendered the Pre-operative dialysis rendered the

patient patient too “dry” despite hydration in too “dry” despite hydration in the OR. – the OR. – Correct.Correct.

3. 3. Urine leak at the ureteral Urine leak at the ureteral anastamosis in the anastamosis in the bladder.bladder.

4. 4. Clot occluding the ureter or the Foley Clot occluding the ureter or the Foley catheter.catheter.

An early post-transplant An early post-transplant complication is:complication is: 1. Cholecystitis.1. Cholecystitis. 2. Graft dysfunction secondary to 2. Graft dysfunction secondary to

nephrotoxic drugs.nephrotoxic drugs. 3. Lymphocele. – 3. Lymphocele. – Correct.Correct. 4. Post-transplant 4. Post-transplant

lymphoproliferative lymphoproliferative disorder disorder (PTLD).(PTLD).

An An immunosuppressive agent agent that is used for induction that is used for induction therapy is:therapy is: 1. Cyclosporine.1. Cyclosporine. 2. Methylprednisolone (Solu-2. Methylprednisolone (Solu-

MedrolMedrol®®)) 3. Mycophenolate mofetil. 3. Mycophenolate mofetil.

(Cellcept(Cellcept®®)) 4. Polyclonal antibodies (Atgam4. Polyclonal antibodies (Atgam®®, ,

ThymoglobinThymoglobin®®). – ). – Correct.Correct. 5. Tacrolimus (Prograf5. Tacrolimus (Prograf®®). ).

An example of a medication An example of a medication that may be used post that may be used post transplant to prevent transplant to prevent cytomegalovirus (CMV) is:cytomegalovirus (CMV) is: 1. Acyclovir (Zovirax1. Acyclovir (Zovirax®®). – ). – Correct.Correct. 2. Fluconazole (Diflucan2. Fluconazole (Diflucan®®).). 3. Nystatin (Mycostatin3. Nystatin (Mycostatin®®, Nilstat, Nilstat®®).). 4. Trimepthoprim/sulfamethoxazole 4. Trimepthoprim/sulfamethoxazole

(Bactrim(Bactrim®®, Septra, Septra®®).).

The nurse assessing the patient for The nurse assessing the patient for possible acute rejection should possible acute rejection should observe for what symptoms indicative observe for what symptoms indicative of this most common type of rejection?of this most common type of rejection?

1.1. Fever, malaise, tenderness over the Fever, malaise, tenderness over the graft. – graft. – Correct.Correct.

2.2. Hematuria.Hematuria.

3.3. No symptoms.No symptoms.

4.4. Proteinuria.Proteinuria.

As renal function significantly As renal function significantly decreases, laboratory data reflect decreases, laboratory data reflect all of the following except:all of the following except:

1. An increased serum creatinine.1. An increased serum creatinine. 2. An increased BUN.2. An increased BUN. 3. An increased hematocrit and red 3. An increased hematocrit and red

blood blood cell count. – cell count. – Correct.Correct. 4. A decreased creatinine clearance.4. A decreased creatinine clearance.

You instruct Mrs. Smith that she will You instruct Mrs. Smith that she will begin exercising her fistula to facilitate begin exercising her fistula to facilitate maturation of the blood vessel. This maturation of the blood vessel. This process includes:process includes:

1. Dilation and hypertrophy. – 1. Dilation and hypertrophy. – Correct.Correct.

2. Constriction and atrophy.2. Constriction and atrophy. 3. Dilation and atrophy.3. Dilation and atrophy. 4. Constriction and hypertrophy.4. Constriction and hypertrophy.

You explain to your patient that a You explain to your patient that a creatinine clearance test determines:creatinine clearance test determines:

1. The number of milligrams of 1. The number of milligrams of creatinine creatinine excreted in the urine per excreted in the urine per hour.hour.

2. The ratio of serum creatinine to 2. The ratio of serum creatinine to blood blood urea nitrogen.urea nitrogen.

3. Urine flow in milliliters per minute.3. Urine flow in milliliters per minute. 4. The rate at which the kidneys 4. The rate at which the kidneys

remove remove creatinine from the plasma. – creatinine from the plasma. – Correct.Correct.

Mrs. Johnson had a graft placed in her left Mrs. Johnson had a graft placed in her left upper arm. She complains of pain in her left upper arm. She complains of pain in her left hand that increases in intensity during hand that increases in intensity during hemodialysis. Management of this syndrome hemodialysis. Management of this syndrome would include:would include: 1. Keeping the hand warm and 1. Keeping the hand warm and

elevated.elevated. 2. Keeping the arm extended and 2. Keeping the arm extended and

elevated.elevated. 3. Keeping the hand warm and 3. Keeping the hand warm and

dependent. – dependent. – Correct.Correct. 4. Keeping the arm extended and 4. Keeping the arm extended and

dependent.dependent.

To calculate the percent recirculation, To calculate the percent recirculation, the nurse draws arterial, venous, and the nurse draws arterial, venous, and systemic blood samples:systemic blood samples:

1. Randomly.1. Randomly. 2. Simultaneously. – 2. Simultaneously. – Correct.Correct. 3. Alternately.3. Alternately. 4. Sequentially.4. Sequentially.

Assessment of your patient’s Assessment of your patient’s skin may show:skin may show: 1. Excessive oiliness.1. Excessive oiliness. 2.2. Dry, scaly skin with excoriations Dry, scaly skin with excoriations

from from scratching. – scratching. – Correct.Correct. 3. Cyanosis.3. Cyanosis. 4. Hirsutism.4. Hirsutism.