CCRN Gastrointestinal and Renal Care 3 — Questions and Answers
Question 1: A patient with end-stage renal disease misses dialysis and has peaked T waves on ECG. What is the priority treatment?
- IV calcium gluconate (Correct answer)
- Oral potassium supplement
- Normal saline bolus
- Furosemide alone
Correct answer: IV calcium gluconate
Peaked T waves indicate hyperkalemia, and IV calcium gluconate stabilizes the cardiac membrane immediately.
Question 2: Which acid-base disturbance is most characteristic of chronic kidney disease?
- Metabolic acidosis (Correct answer)
- Metabolic alkalosis
- Respiratory acidosis
- Respiratory alkalosis
Correct answer: Metabolic acidosis
The failing kidney cannot excrete hydrogen ions or regenerate bicarbonate, causing metabolic acidosis.
Question 3: A patient develops disequilibrium syndrome during hemodialysis. What causes this?
- Rapid shift of solutes causing cerebral edema (Correct answer)
- Air embolism
- Hyperkalemia
- Hypoglycemia
Correct answer: Rapid shift of solutes causing cerebral edema
Rapid urea removal creates an osmotic gradient that draws water into brain cells, causing cerebral edema.
Question 4: Which lab finding best distinguishes prerenal azotemia from intrinsic renal failure?
- BUN-to-creatinine ratio greater than 20:1 (Correct answer)
- Elevated white blood cell count
- Low hemoglobin
- Elevated lipase
Correct answer: BUN-to-creatinine ratio greater than 20:1
A BUN:creatinine ratio over 20:1 suggests prerenal azotemia from hypoperfusion rather than intrinsic damage.
Question 5: A patient with a small bowel obstruction is at greatest risk for which complication?
- Bowel ischemia and perforation (Correct answer)
- Hypertension
- Hyperglycemia
- Hypercalcemia
Correct answer: Bowel ischemia and perforation
Increasing intraluminal pressure can compromise blood flow, leading to bowel ischemia and perforation.
Question 6: Which medication should be administered cautiously in a patient with hepatic failure due to impaired metabolism?
- Acetaminophen (Correct answer)
- Lactulose
- Vitamin K
- Albumin
Correct answer: Acetaminophen
Acetaminophen is hepatotoxic and metabolized by the liver, requiring caution or avoidance in hepatic failure.
Question 7: A patient with severe diarrhea has a serum bicarbonate of 14 mEq/L. Which acid-base disorder is present?
- Non-anion gap metabolic acidosis (Correct answer)
- Metabolic alkalosis
- Respiratory acidosis
- Anion gap metabolic acidosis
Correct answer: Non-anion gap metabolic acidosis
Diarrhea causes loss of bicarbonate, producing a normal anion gap (hyperchloremic) metabolic acidosis.
CCRN Gastrointestinal and Renal Care 3
A patient with end-stage renal disease misses dialysis and has peaked T waves on ECG.
What is the priority treatment?