MSNCB Renal Nursing 4 — Questions and Answers
Question 1: Which acid-base disturbance is most characteristic of ESRD?
- Respiratory alkalosis
- Metabolic alkalosis
- Metabolic acidosis with elevated anion gap (Correct answer)
- Respiratory acidosis
Correct answer: Metabolic acidosis with elevated anion gap
ESRD impairs renal acid excretion and bicarbonate regeneration, resulting in high anion gap metabolic acidosis.
Question 2: A post-renal transplant patient develops oliguria, fever, and graft tenderness on day 5. What does this most likely indicate?
- Hyperacute rejection occurring in the first minutes
- Acute rejection requiring immediate evaluation (Correct answer)
- Chronic rejection over months to years
- Surgical anastomosis failure unrelated to immunity
Correct answer: Acute rejection requiring immediate evaluation
Fever, oliguria, and graft tenderness appearing days to weeks post-transplant are classic signs of acute cellular rejection requiring prompt biopsy and treatment.
Question 3: Which serum laboratory value is the most reliable indicator of glomerular filtration rate (GFR)?
- Blood urea nitrogen (BUN)
- Serum creatinine
- Cystatin C (Correct answer)
- Serum uric acid
Correct answer: Cystatin C
Cystatin C is produced at a constant rate by all nucleated cells and is freely filtered by the glomerulus, making it a more accurate GFR marker than creatinine.
Question 4: A patient with AKI is receiving kayexalate (sodium polystyrene sulfonate) for hyperkalemia. Which adverse effect requires monitoring?
- Hypercalcemia
- Intestinal necrosis (Correct answer)
- Hypermagnesemia
- Respiratory depression
Correct answer: Intestinal necrosis
Sodium polystyrene sulfonate (Kayexalate) carries a risk of intestinal necrosis, particularly in post-operative patients or those with reduced gut motility.
Question 5: Which fluid assessment technique is most appropriate to monitor fluid status in a hemodialysis patient between sessions?
- Daily urine output measurement
- Daily weight measurement (Correct answer)
- Central venous pressure monitoring
- Serum sodium levels every 6 hours
Correct answer: Daily weight measurement
Daily weight is the most reliable and practical method to assess fluid accumulation between hemodialysis sessions in anuric or oliguric patients.
Question 6: A nurse notes that a patient's PD dwell time has been extended inadvertently. Which complication should the nurse anticipate?
- Hypokalemia from excessive potassium removal
- Hyperglycemia from prolonged glucose absorption (Correct answer)
- Respiratory alkalosis from bicarbonate diffusion
- Hypertension from sodium depletion
Correct answer: Hyperglycemia from prolonged glucose absorption
Prolonged dwell time increases glucose absorption from the hypertonic dialysate, leading to hyperglycemia, especially in diabetic patients.
Question 7: Which medication class must be used cautiously in patients with CKD stage 3 or higher due to risk of lactic acidosis?
- ACE inhibitors
- Metformin (Correct answer)
- Calcium channel blockers
- Beta-blockers
Correct answer: Metformin
Metformin is contraindicated or requires dose adjustment in CKD stage 3b and above because impaired renal clearance allows accumulation, increasing lactic acidosis risk.
MSNCB Renal Nursing 4
Which acid-base disturbance is most characteristic of ESRD?