cdn reviewer 11-20

Question 1

11. Intrinsic or intrarenal kidney failure refers to a type of ARF that may be caused by which of the following? a. Toxins or medications b. Bladder stones c. Blocked urinary catheter d. Hepatorenal syndrome

Answer 1

11. A: Intrinsic, or intrarenal, ARF may be caused by toxins or medications, myoglobin (from breakdown of muscle, as in blunt trauma), hemolysis, glomerulonephritis, or multiple myeloma. Bladder stones and blockage of the urinary catheter may be causes of postrenal ARF. Hepatorenal syndrome would be associated with prerenal ARF.

Question 2

12. The National Kidney Foundation has identified factors that contribute to a person’s susceptibility to CKD. Which of the following may influence the development of CKD? a. Uncontrolled diabetes, hypertension, systemic lupus b. Cirrhosis c. Smoking, age, ethnicity, family history d. High proteinuria, HIV e. a, c, and d

Answer 2

12. E: Uncontrolled diabetes (type 1 and type 2), hypertension, HIV, systemic lupus, and high proteinuria are all conditions that contribute to the development of CKD. Outside factors include smoking, age, ethnicity (African-Americans, Asians, Native Americans, Latinos, and Pacific Islanders have a higher incidence of CKD), and a family history of kidney disease. Cirrhosis has not been shown to be a cause of CKD.

Question 3

13. The GFR refers to the velocity at which filtrates move through a kidney. Staging is a tool that associates levels of the GFR with degrees of kidney damage. What are the main purposes of staging? a. Staging assesses the level of function of the kidney, predicts clinical signs and symptoms, and aids in evaluating and managing the patient. b. Staging determines azotemia levels, dehydration, and dialysis effectiveness. c. Staging assesses the level of bicarbonate and uric acid in the blood. d. Staging aids in determining fluid overload and anemia.

Answer 3

13. A: Staging is useful as a tool to assess the level of function of the kidney and therefore aid in predicting clinical signs and symptoms, as well as assessing and managing the patient. Answers B, C, and D contain some of the complications associated with the various stages, but do not explain what staging does.

Question 4

Which of the following tests would be appropriate for evaluating a possible CKD patient? a. Complete physical exam, MRI of the lumbar spine, complete blood cell count (CBC), and urinalysis (UA) b. History and physical, clean-catch UA, CBC c. Comprehensive personal/ familial history, complete physical examination, CBC, UA, blood chemistry, and renal ultrasound d. Physical exam, CBC, chest x-ray, UA

Answer 4

14. C: The initial assessment of a patient suspected of chronic kidney disease should include a thorough history, including familial history, complete physical examination, CBC, UA, blood chemistry, and renal ultrasound. The MRI and chest x-ray are unnecessary, although the chest x-ray may be indicated for evaluating lung congestion. The renal ultrasound is also an integral part of the investigation; the size of the kidney is usually found to be small in CKD patients.

Question 5

15. Which of the following disease processes may lead to the development of glomerulonephritis? a. Antigen-antibody complexes from a streptococcal infection b. Congestive heart failure c. COPD d. Pancreatitis

Answer 5

15. A: Antigen-antibody complexes that were formed as a result of a streptococcal infection somewhere in the body collect in the glomeruli and block filtration, resulting in edema, hypertension, low serum albumin, hematuria, and decreased urinary output. Congestive heart failure, COPD, and pancreatitis are not direct causes of glomerulonephritis.

Question 6

16. Why is it so important to determine the type and cause of glomerulonephritis? a. To prevent it from spreading to others b. To develop a successful treatment plan c. To keep it from infecting the liver d. To avoid sepsis

Answer 6

16. B: It is important to determine the type and cause of glomerulonephritis in order to develop an appropriate and effective treatment plan. This in an inflammatory (not an infectious) process and therefore it is not contagious, does not infect other organs, and does not progress to sepsis.

Question 7

17. Glomerulosclerosis refers to the scarring of the glomeruli, the minute blood vessels in the kidney. Which of the following are signs or symptoms of glomerulosclerosis? a. Blurred vision, confusion, restlessness b. Proteinuria, swelling of the ankles, fluid retention in the abdomen c. Albuminuria (frothy urine), periorbital edema, headaches d. Caseation, sterile pyuria, hematuria

Answer 7

17. B: The scarring of the glomeruli allows protein to spill into the urine, resulting in proteinuria, which is the main sign of glomerulosclerosis. As the disease progresses, swelling of the ankles and retention of fluid in the abdomen may occur. Blurred vision, confusion, and restlessness are all associated with malignant nephrosclerosis. Albumenuria (frothy urine), periorbital edema, and headaches are commonly linked to diabetic nephropathy. Caseation, sterile pyuria, and hematuria point to Mycobacterium tuberculosis.

Question 8

18. Conditions that may cause glomerulosclerosis are: a. Excessive aluminum in diet b. Anemia c. Blood transfusion reaction d. Diabetes, drug use, infection

CDN Exam Secrets Test Prep Team (2010-12-22). Certified Dialysis Nurse Exam Practice Questions (First Set): CDN Practice Test & Exam Review for the Certified Dialysis Nurse Exam (Kindle Locations 70-73). . Kindle Edition.

Answer 8

18. D: Diabetes, drug use, and infection may lead to scarring of the glomeruli. This condition is irreversible, but may be treated, depending on the cause, by immunosuppressants, low-protein diets, drugs for hypertension, especially ACE inhibitors, and methods for lowering cholesterol levels. Excess aluminum and anemia are not considered causes of scarring of the glomeruli.

Question 9

19. In stage 3 of CKD, with a GFR of 30 to 59 mL/min per 1.73 m2, what level of kidney damage would be expected? a. Moderate b. Severe c. Little or no damage d. Mild

Answer 9

19. A: In stage 3 of CKD with a GFR of 30 to 59 mL/min per 1.73m2, there would be moderate kidney damage. Severe kidney damage is associated with stage 4. Mild damage would be found in stage 2, and slight damage in stage 1.

Question 10

20. What are some of the common complications of stage 5 CKD? a. Ulcerative colitis, rectal bleeding b. Neuropathy, bleeding disorders c. Sexual dysfunction, serositis, malnutrition d. b and c

Answer 10

20. D: The stage 5 CKD patient may display numerous symptoms, including neuropathy, bleeding disorders, sexual dysfunction, serositis, and malnutrition. Ulcerative colitis and rectal bleeding are not complications normally seen in stage 5 CKD.