NUR 257 CHRONIC EXAM 5: COMPLEX
CHRONIC MANAGEMENT QUESTIONS
AND ANSWERS WITH VERIFIED
SOLUTIONS 2026/2027 UPDATE
1. A patient with Stage 4 Chronic Kidney Disease (CKD) has a glomerular filtration rate (GFR)
of 20 mL/min. Which electrolyte abnormality is the nurse most likely to prioritize?
A. Hypokalemia
B. Hypermagnesemia
C. Hyperkalemia
D. Hyponatremia
Answer: C
Conceptual Explanation: In advanced CKD, the kidneys lose the ability to excrete
potassium, leading to hyperkalemia, which poses a significant risk for cardiac arrhythmias.
2. Which assessment finding in a patient with an arteriovenous (AV) fistula for hemodialysis
requires immediate notification of the provider?
A. Absence of a radial pulse in the same arm
B. Audible bruit upon auscultation
C. Presence of a palpable thrill
,D. Occasional bruising at the needle site
Answer: A
Conceptual Explanation: The absence of a radial pulse distal to the fistula may indicate
‘steal syndrome,’ where the fistula diverts too much blood away from the extremity,
requiring urgent intervention.
3. A patient undergoing peritoneal dialysis (PD) reports that the outflow is significantly less
than the inflow. What is the nurse’s first action?
A. Call the healthcare provider immediately
B. Increase the flow rate of the next dwell
C. Reposition the patient to a side-lying position
D. Check the effluent for cloudiness
Answer: C
Conceptual Explanation: The first action for poor outflow in PD is to check for mechanical
obstructions or kinks and to shift the patient’s position to facilitate drainage.
4. What is the primary rationale for administering Epoetin alfa to a patient with Chronic
Kidney Disease?
A. To treat chronic hypertension
B. To reduce phosphorus levels
C. To prevent metabolic acidosis
, D. To stimulate red blood cell production
Answer: D
Conceptual Explanation: CKD patients often have deficiency in erythropoietin, a hormone
produced by the kidneys; Epoetin alfa is a synthetic form that treats the resulting anemia.
5. A patient with CKD is prescribed Sevelamer (Renagel). When should the nurse instruct the
patient to take this medication?
A. With each meal
B. One hour before breakfast
C. At bedtime
D. Only when feeling nauseated
Answer: A
Conceptual Explanation: Sevelamer is a phosphate binder and must be taken with food to
effectively bind the phosphorus in the meal and prevent its absorption.
6. During hemodialysis, a patient reports a severe headache and becomes increasingly
restless and confused. Which condition does the nurse suspect?
A. Dialysis disequilibrium syndrome
B. Air embolism
C. Hypoglycemia
D. Septicemia
CHRONIC MANAGEMENT QUESTIONS
AND ANSWERS WITH VERIFIED
SOLUTIONS 2026/2027 UPDATE
1. A patient with Stage 4 Chronic Kidney Disease (CKD) has a glomerular filtration rate (GFR)
of 20 mL/min. Which electrolyte abnormality is the nurse most likely to prioritize?
A. Hypokalemia
B. Hypermagnesemia
C. Hyperkalemia
D. Hyponatremia
Answer: C
Conceptual Explanation: In advanced CKD, the kidneys lose the ability to excrete
potassium, leading to hyperkalemia, which poses a significant risk for cardiac arrhythmias.
2. Which assessment finding in a patient with an arteriovenous (AV) fistula for hemodialysis
requires immediate notification of the provider?
A. Absence of a radial pulse in the same arm
B. Audible bruit upon auscultation
C. Presence of a palpable thrill
,D. Occasional bruising at the needle site
Answer: A
Conceptual Explanation: The absence of a radial pulse distal to the fistula may indicate
‘steal syndrome,’ where the fistula diverts too much blood away from the extremity,
requiring urgent intervention.
3. A patient undergoing peritoneal dialysis (PD) reports that the outflow is significantly less
than the inflow. What is the nurse’s first action?
A. Call the healthcare provider immediately
B. Increase the flow rate of the next dwell
C. Reposition the patient to a side-lying position
D. Check the effluent for cloudiness
Answer: C
Conceptual Explanation: The first action for poor outflow in PD is to check for mechanical
obstructions or kinks and to shift the patient’s position to facilitate drainage.
4. What is the primary rationale for administering Epoetin alfa to a patient with Chronic
Kidney Disease?
A. To treat chronic hypertension
B. To reduce phosphorus levels
C. To prevent metabolic acidosis
, D. To stimulate red blood cell production
Answer: D
Conceptual Explanation: CKD patients often have deficiency in erythropoietin, a hormone
produced by the kidneys; Epoetin alfa is a synthetic form that treats the resulting anemia.
5. A patient with CKD is prescribed Sevelamer (Renagel). When should the nurse instruct the
patient to take this medication?
A. With each meal
B. One hour before breakfast
C. At bedtime
D. Only when feeling nauseated
Answer: A
Conceptual Explanation: Sevelamer is a phosphate binder and must be taken with food to
effectively bind the phosphorus in the meal and prevent its absorption.
6. During hemodialysis, a patient reports a severe headache and becomes increasingly
restless and confused. Which condition does the nurse suspect?
A. Dialysis disequilibrium syndrome
B. Air embolism
C. Hypoglycemia
D. Septicemia
