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CNN-NP

NNCC Certified Nephrology Nurse-Nurse Practitioner

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Question: 1

Which of the following interventions is appropriate for evaluating and treating the progression of chronic kidney disease?

Prescribing angiotensin-converting enzyme (ACE) inhibitors.
Administering erythropoietin-stimulating agents (ESAs).

onitoring blood glucose levels. wer: A
anation: Prescribing angiotensin-converting enzyme (ACE) inhibitors opriate intervention for evaluating and treating the progression of chro ey disease (CKD). ACE inhibitors help to reduce proteinuria and bloo ure, which can slow the progression of CKD. Administering
ropoietin-stimulating agents (ESAs) is indicated for managing anemi ciated with CKD. Implementing a low-protein diet and monitoring blo ose levels are important aspects of CKD management but do not direc uate and treat its progression.

stion: 2

tient with chronic kidney disease (CKD) is scheduled for a renal biop uate the progression of the disease. Which of the following complicati ld the NP monitor for following the procedure?
Implementing a low-protein diet.
M

Que

Hematuria.
Hypertension.
Hyperkalemia.
Hypoglycemia. Answer: A

Explanation: Following a renal biopsy, the NP should monitor for complications such as hematuria, which is the presence of blood in the urine. Hematuria is a common complication of renal biopsy and can range from mild to severe. Hypertension (B), hyperkalemia (C), and hypoglycemia (D) are not typically associated with renal biopsy complications.

tient with end-stage renal disease (ESRD) is receiving hemodialysis. ng hemodialysis, the NP notices that the patient develops hypotension ch of the following interventions should the NP implement first?

ecrease the ultrafiltration rate. dminister a bolus of intravenous fluids.

crease the dialysate sodium concentration. dminister a vasopressor medication.

anation: Hypotension is a common complication during hemodialysis e caused by rapid fluid removal (ultrafiltration) during the treatment. intervention should be to decrease the ultrafiltration rate to slow do luid removal and prevent further drops in blood pressure. Administeri of intravenous fluids (B) may be necessary if the hypotension persist

ite reducing the ultrafiltration rate. Increasing the dialysate sodium

D
A
In
A

concentration (C) can be considered in some cases, but it is not the first-line intervention for hypotension during hemodialysis. Administering a vasopressor medication (D) may be necessary in severe cases, but it is not the initial intervention and should be reserved for refractory hypotension.

Question: 4

A patient with chronic kidney disease (CKD) is at increased risk for cardiovascular disease. Which of the following interventions should the NP prioritize to reduce the patient's cardiovascular risk?

Blood pressure control.
Lipid-lowering therapy.
Smoking cessation.

wer: A

anation: Blood pressure control is a critical intervention to reduce the ovascular risk in patients with CKD. Hypertension is a common orbidity in CKD and a significant risk factor for cardiovascular diseas efore, achieving and maintaining optimal blood pressure control is a ity. Lipid-lowering therapy (B) may also be indicated if the patient ha pidemia. Smoking cessation (C) is important for overall cardiovascula h but is not specific to CKD. Diabetes management (D) is crucial for nts with CKD and coexisting diabetes, but it may not be applicable to
patients.

stion: 5

ch formula is commonly used to estimate glomerular filtration rate (e ults?
Diabetes management. Ans

Que

Cockcroft-Gault equation.
MDRD equation.
Schwartz equation.
DuBois formula. Answer: B

Explanation: The Modification of Diet in Renal Disease (MDRD) equation is commonly used to estimate glomerular filtration rate (eGFR) in adults. The Cockcroft-Gault equation is used to estimate creatinine clearance, the Schwartz equation is used to estimate GFR in children, and the DuBois formula is used to estimate body surface area.

ch of the following equations is used to estimate the glomerular filtrati GFR) in adults?

DRD equation. ockcroft-Gault equation. chwartz equation.

odification of Diet in Renal Disease (MDRD) equation. wer: A

anation: The Modification of Diet in Renal Disease (MDRD) equation mmonly used to estimate the glomerular filtration rate (GFR) in adult ockcroft-Gault equation (B) is an alternative equation used to estima

inine clearance, which is often used in drug dosing calculations. The wartz equation (C) is used to estimate GFR in children.

stion: 7

M
C
S
M

Que

A patient with end-stage renal disease (ESRD) is receiving hemodialysis. During the dialysis session, the patient's blood pressure drops significantly. What is the nurse-nurse practitioner's initial action?

Administer a fluid bolus.
Decrease the blood flow rate during dialysis.
Initiate cardiopulmonary resuscitation (CPR).
Discontinue the dialysis session. Answer: B

pressure and prevent further complications. Administering a fluid bo ting CPR, or discontinuing the dialysis session may be appropriate in in situations but are not the initial actions in this case.

stion: 8

tient with chronic kidney disease (CKD) has multiple risk factors for ovascular disease. Which of the following interventions is appropriat atient?

rescribing statins for dyslipidemia. itiating antiplatelet therapy. dministering anticoagulants.

ecommending coronary artery bypass graft (CABG) surgery. wer: A

anation: Prescribing statins for dyslipidemia is an appropriate interven

Explanation: When a patient's blood pressure drops significantly during a hemodialysis session, the nurse-nurse practitioner's initial action should be to decrease the blood flow rate during dialysis. This can help stabilize the patient's blood lus,

Que

P
In
A
R

for a patient with chronic kidney disease (CKD) and multiple risk factors for cardiovascular disease. Statins help to reduce cholesterol levels and decrease the risk of cardiovascular eventsin CKD patients. Initiating antiplatelet therapy, administering anticoagulants, and recommending coronary artery bypass graft (CABG) surgery may be considered in specific cases but are not the initial interventions for CKD patients with multiple risk factors for cardiovascular disease.

Question: 9

When teaching a patient and their significant others about the multisystem effects of kidney disease, which of the following should be included?

Neuropsychiatric manifestations.
astrointestinal symptoms. ardiac arrhythmias.

wer: A

anation: When teaching a patient and their significant others about the isystem effects of kidney disease, it is important to include informatio neuropsychiatric manifestations, such as cognitive impairment, moo ders, and peripheral neuropathy. Dermatological changes, gastrointest ptoms, and cardiac arrhythmias can also be associated with kidney dis europsychiatric manifestations are particularly important to address.

stion: 10

rmining the need for initiation of acute kidney replacement therapy ves assessing various factors. Which of the following is NOT a factor idered in this determination?
Dermatological changes.
G
C

Que

Dete invol cons

Presence of hyperkalemia.
Persistent oliguria.
Rapidly deteriorating kidney function.
Mild proteinuria. Answer: D

Explanation: When determining the need for initiation of acute kidney replacement therapy, factors such as the presence of hyperkalemia (high potassium levels), persistent oliguria (low urine output), and rapidly deteriorating kidney function are considered. However, the presence of mild proteinuria alone is not typically a sole determinant for initiating acute kidney replacement therapy.

ch of the following laboratory findings would be consistent with acute ey injury (AKI)?

erum creatinine level within the patient's baseline range. lood urea nitrogen (BUN) level at the upper limit of normal. rine output of 2,000 mL in 24 hours.

levated levels of urinary sodium and potassium. wer: D

anation: Elevated levels of urinary sodium and potassium would be istent with acute kidney injury (AKI). In AKI, the kidneys are unable erly regulate the excretion of sodium and potassium, leading to their mulation in the urine. Serum creatinine level above the patient's baseli e, an elevated blood urea nitrogen (BUN) level, and decreased urine o ypical findings in AKI.

S
B
U
E

Question: 12

When prescribing pharmacological agents for patients with kidney disease, which of the following factors is most important to consider?

Disease etiology.
Drug cost.
Patient's age.
Level of kidney function. Answer: D

Explanation: When prescribing pharmacological agents for patients with kidney disease, the most important factor to consider is the level of kidney function.

ion to prevent toxicity or adverse drug reactions. Disease etiology, dr and patient's age are also important considerations but are secondary evel of kidney function.

stion: 13

tient was referred to the nephrology practice because of an acute rise i m creatinine. One month ago, his creatinine was 1.3 mg/dL and today

g/dL. To help establish a diagnosis, the NP should determine if the p rescribed which type of medication during the past month?

calcium channel blocker.

n angiotensin-converting enzyme inhibitor. macrolide antibiotic.

third-generation cephalosporin. wer: D

Medications must be adjusted or avoided in patients with impaired kidney funct ug

Que

A
A
A
A

Explanation: A significant rise in serum creatinine levels can indicate acute kidney injury (AKI). One of the causes of AKI is drug-induced nephrotoxicity. Third-generation cephalosporins have been associated with nephrotoxic effects, and their use should be evaluated in patients with an acute rise in serum creatinine. Calcium channel blockers (A) and angiotensin-converting enzyme inhibitors (B) are not typically associated with nephrotoxicity. Macrolide antibiotics (C) generally do not cause significant nephrotoxic effects.