MSNCB Renal Nursing 3 — Questions and Answers
Question 1: A patient with nephrotic syndrome presents with pitting edema, proteinuria >3.5 g/day, and hypoalbuminemia. Which mechanism best explains the edema?
- Increased oncotic pressure from excess albumin
- Decreased oncotic pressure due to protein loss in urine (Correct answer)
- Elevated hydrostatic pressure from hypertension
- Lymphatic obstruction caused by renal inflammation
Correct answer: Decreased oncotic pressure due to protein loss in urine
Massive proteinuria depletes serum albumin, reducing oncotic pressure and allowing fluid to shift into the interstitial space.
Question 2: Which sign or symptom indicates uremic encephalopathy in a patient with ESRD?
- Polydipsia
- Asterixis and confusion (Correct answer)
- Peripheral neuropathy only
- Pruritus without neurological changes
Correct answer: Asterixis and confusion
Asterixis (flapping tremor) and altered mental status are classic neurological manifestations of uremia affecting the central nervous system.
Question 3: A nurse is preparing a patient for a renal biopsy. Which post-procedure instruction is most critical?
- Encourage vigorous ambulation within 1 hour
- Monitor urine for hematuria and report persistent bleeding (Correct answer)
- Restrict all fluid intake for 24 hours
- Apply heat to the biopsy site to reduce discomfort
Correct answer: Monitor urine for hematuria and report persistent bleeding
Renal biopsy carries a risk of hemorrhage; monitoring urine for hematuria and reporting persistent or worsening bleeding is the priority post-procedure intervention.
Question 4: Which dietary modification is appropriate for a patient with CKD to manage metabolic acidosis?
- Increase intake of animal proteins
- Reduce consumption of fruits and vegetables high in organic acids
- Use sodium bicarbonate supplementation as directed (Correct answer)
- Restrict all dairy products
Correct answer: Use sodium bicarbonate supplementation as directed
Oral sodium bicarbonate supplementation is a recommended treatment for CKD-associated metabolic acidosis to maintain serum bicarbonate ≥22 mEq/L.
Question 5: A patient receiving continuous renal replacement therapy (CRRT) develops hypotension. What is the nurse's priority action?
- Increase the ultrafiltration rate to remove more fluid
- Decrease or pause ultrafiltration and notify the physician (Correct answer)
- Administer a diuretic to promote fluid removal
- Increase the dialysate flow rate
Correct answer: Decrease or pause ultrafiltration and notify the physician
Hypotension during CRRT is often caused by excessive fluid removal; decreasing or pausing ultrafiltration and notifying the physician prevents hemodynamic compromise.
Question 6: Which intervention best prevents contrast-induced nephropathy in a patient with CKD scheduled for a CT scan with contrast?
- Administer furosemide before the procedure
- Provide IV normal saline hydration before and after the procedure (Correct answer)
- Withhold all medications for 24 hours prior
- Administer mannitol immediately after contrast administration
Correct answer: Provide IV normal saline hydration before and after the procedure
IV isotonic saline hydration before and after contrast administration is the most evidence-based intervention to reduce contrast-induced nephropathy.
Question 7: A patient with polycystic kidney disease (PKD) reports severe flank pain and hematuria. Which complication should the nurse suspect first?
- Urinary tract infection
- Cyst hemorrhage or rupture (Correct answer)
- Nephrolithiasis
- Acute tubular necrosis
Correct answer: Cyst hemorrhage or rupture
Cyst hemorrhage or rupture is a common complication of PKD that presents with acute flank pain and gross hematuria.
MSNCB Renal Nursing 3
A patient with nephrotic syndrome presents with pitting edema, proteinuria >3.5 g/day, and hypoalbuminemia.
Which mechanism best explains the edema?