MSNCB Renal Nursing 5 — Questions and Answers
Question 1: A renal transplant patient is prescribed tacrolimus. Which adverse effect requires regular laboratory monitoring?
- Bone marrow stimulation causing polycythemia
- Nephrotoxicity and neurotoxicity (Correct answer)
- Pulmonary fibrosis
- Severe hypokalemia
Correct answer: Nephrotoxicity and neurotoxicity
Tacrolimus is a calcineurin inhibitor with dose-dependent nephrotoxicity and neurotoxicity; trough levels and renal function must be monitored closely.
Question 2: A patient with renal artery stenosis is started on an ACE inhibitor. Which laboratory change requires immediate attention?
- Decrease in serum sodium
- Acute rise in serum creatinine >30% from baseline (Correct answer)
- Decrease in serum potassium below 3.5 mEq/L
- Increase in hemoglobin
Correct answer: Acute rise in serum creatinine >30% from baseline
A creatinine rise of >30% after starting an ACE inhibitor in renal artery stenosis suggests significant reduction in glomerular filtration pressure, warranting dose adjustment or discontinuation.
Question 3: Which nursing action is essential before drawing blood from the arm with an AV fistula?
- Apply a tourniquet above the fistula to enhance venous access
- Avoid all venipuncture and blood pressure measurements in that arm (Correct answer)
- Use the fistula as a preferred site for IV access
- Draw blood slowly through the fistula needle
Correct answer: Avoid all venipuncture and blood pressure measurements in that arm
The arm with an AV fistula must be protected from venipuncture, BP cuffs, and IVs to preserve the access site and prevent damage or thrombosis.
Question 4: A patient with CKD develops pruritus. Which intervention is most appropriate to address uremic pruritus?
- Apply ice packs to the affected areas
- Ensure adequate dialysis and prescribe emollients or antihistamines (Correct answer)
- Increase dietary protein intake
- Administer corticosteroids
Correct answer: Ensure adequate dialysis and prescribe emollients or antihistamines
Uremic pruritus is managed with optimized dialysis to reduce uremic toxins, combined with topical emollients and antihistamines for symptomatic relief.
Question 5: Which finding in a 24-hour urine collection indicates nephrotic-range proteinuria?
- Protein excretion of 150 mg/day
- Protein excretion of 1.0 g/day
- Protein excretion >3.5 g/day (Correct answer)
- Protein excretion of 2.5 g/day
Correct answer: Protein excretion >3.5 g/day
Nephrotic syndrome is defined by proteinuria exceeding 3.5 g/day in adults, reflecting significant glomerular damage.
Question 6: A nurse is caring for a patient with AKI in the diuretic (recovery) phase. Which electrolyte imbalance is most likely?
- Hyperkalemia
- Hypernatremia
- Hypokalemia and hyponatremia (Correct answer)
- Hyperphosphatemia
Correct answer: Hypokalemia and hyponatremia
During the diuretic phase of AKI, large volumes of urine are excreted, causing loss of potassium and sodium, requiring close electrolyte monitoring and replacement.
Question 7: Which dietary recommendation is appropriate for a CKD patient to slow disease progression?
- High-protein diet to prevent muscle wasting
- Moderate protein restriction (0.6–0.8 g/kg/day) (Correct answer)
- Unrestricted protein with increased caloric intake
- Plant-based protein avoided due to phosphorus content
Correct answer: Moderate protein restriction (0.6–0.8 g/kg/day)
Moderate protein restriction (0.6–0.8 g/kg/day) reduces uremic toxin production and glomerular hyperfiltration, slowing CKD progression.
MSNCB Renal Nursing 5
A renal transplant patient is prescribed tacrolimus.
Which adverse effect requires regular laboratory monitoring?