MSNCB Renal Nursing 2 — Questions and Answers
Question 1: A patient with chronic kidney disease (CKD) stage 4 has a serum potassium of 6.2 mEq/L. Which dietary instruction is the priority?
- Restrict phosphorus-containing foods
- Avoid high-potassium foods such as bananas and oranges (Correct answer)
- Increase fluid intake to flush excess potassium
- Limit sodium to 2 g/day
Correct answer: Avoid high-potassium foods such as bananas and oranges
Hyperkalemia (K+ >5.5 mEq/L) is life-threatening; dietary restriction of high-potassium foods is the priority nursing intervention.
Question 2: Which finding in a patient receiving peritoneal dialysis (PD) most warrants immediate notification of the physician?
- Cloudy peritoneal effluent (Correct answer)
- Mild shoulder discomfort after drainage
- Weight gain of 0.5 kg between exchanges
- Glucose level of 180 mg/dL
Correct answer: Cloudy peritoneal effluent
Cloudy effluent is the hallmark sign of peritoneal dialysis-associated peritonitis requiring immediate medical intervention.
Question 3: A nurse is caring for a patient on hemodialysis with an arteriovenous (AV) fistula. Which assessment finding requires immediate action?
- Palpable thrill over the fistula site
- Audible bruit on auscultation
- Absence of thrill and bruit (Correct answer)
- Mild edema distal to the fistula
Correct answer: Absence of thrill and bruit
Loss of thrill and bruit indicates fistula thrombosis, which requires immediate reporting to preserve vascular access.
Question 4: Which electrolyte imbalance is most commonly associated with end-stage renal disease (ESRD)?
- Hypokalemia
- Hyperphosphatemia (Correct answer)
- Hyponatremia
- Hypocalcemia due to increased calcitonin
Correct answer: Hyperphosphatemia
ESRD impairs phosphate excretion, leading to hyperphosphatemia, which secondarily contributes to renal osteodystrophy.
Question 5: A patient with acute kidney injury (AKI) has a urine output of 25 mL/hour for the past 3 hours. How should the nurse classify this finding?
- Normal urine output
- Oliguria requiring evaluation (Correct answer)
- Anuria requiring urgent intervention
- Polyuria suggesting recovery phase
Correct answer: Oliguria requiring evaluation
Oliguria is defined as urine output <0.5 mL/kg/hr or <30 mL/hr in adults, warranting prompt clinical evaluation.
Question 6: When educating a patient about phosphate binders, which instruction is most important?
- Take the medication on an empty stomach 1 hour before meals
- Take the medication with meals to bind dietary phosphate (Correct answer)
- Take the medication at bedtime to enhance absorption
- Avoid taking the medication with water
Correct answer: Take the medication with meals to bind dietary phosphate
Phosphate binders must be taken with meals to bind phosphate from food before it is absorbed in the GI tract.
Question 7: Which laboratory value best reflects the adequacy of hemodialysis treatment?
- Serum creatinine level
- Urine specific gravity
- Kt/V ratio (Correct answer)
- Serum albumin level
Correct answer: Kt/V ratio
The Kt/V ratio (dialyzer clearance × time / urea volume of distribution) is the standard measure of hemodialysis adequacy; a target of ≥1.2 is recommended.
MSNCB Renal Nursing 2
A patient with chronic kidney disease (CKD) stage 4 has a serum potassium of 6.2 mEq/L.
Which dietary instruction is the priority?