CERTIFIED DIALYSIS NURSE EXAMS REVIEW WITH VERIFIED QUESTIONS AND ANSWERS

Certified Dialysis Nurse Test x x x


Review x



1. A patient withatchronic
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x renal failure asks the nurse why he is anemic.The
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nurse explains that anemia accompanies chronic renal failure secondary to:
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A. blood loss via the urine x x x x


B. renal insensitivity to vitamin A (retinol)
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C. inadequate production of erythropoietin x x x


D. inadequate retention of serum iron: C. inadequate production of erythropoietin
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The kidney is sensitive to oxygen saturation, and secretes erythropoietin as needed
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x to signal the bone marrow to make more RBC's. When the kidneys fail, erythropoietin
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x reduces and eventually stops being produced, causing anemia.
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2. Functions of kidney include: x x x


A. formation of urine x x


B. regulation of body water and electrolytes x x x x x


C. acid-base balance x


D. all of the above: D. all of the above
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the kidney regulates many hormonal and electrolyte functions. the major
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xfunctions are: formation of urine, regulation of body water and electrolytes, acid-
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base balabce, production of erythropoietin, and production of renin
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3. Renal regulation of homeostasis includes:
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A. excretion of metabolic waste x x x


B. promotion of perfusion x x


C. secretion of anti-diuretic hormone x x x


D. absorption of vancomycin: A. excretion of metabolic waste x x x x x x x


one of the major functions of the kidney is to remove waste products.
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perfusion is supported by cardiac function and volume status, secretion of
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xADH is from the pituitary, and absorption of vancomycin occurs at the tissue
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xlevel- vancomycin is cleared via the kidney.
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4. The three processes of urine formation include:
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A. glomerular filtration, tubular filtration, and tubular secretion x x x x x x


B. glomerular filteration, tubular reabsorption, and tubular secretion. x x x x x x


C. glomerular filtration, water reabsorption, excretion of sodium x x x x x x


D. glomerular filtration, water secretion,and sodium secretion.: The formation
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xof the urine begins with glomerular filtration- then the tubules reabsorb or
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xsecrete electrolytes and particles.
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NB: the tubules do not filtrate; sodium is regulated by multiple processes and is
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not a major process of the kidney funtion. water reabsorption is a function of
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tubular reabsorption or secretion.
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, Certified Dialysis Nurse Test x x x


Review x



5. The Study
glomerular
online at filtration
x rate (GFR):
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A. equals about 180 L/day x x x


B. equals about 125 mL/ minute x x x x


C. Is often calculated by pharmacy and intensivists for drug administration
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D. All of the above: D. All of the above
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GFR, a good indication of renal function, equals about 180 L/day or about 125
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mL/min, and is a calculated number by critical care specialists to dose drugs.
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GFR is excellent measure of current renal function.
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6. Renal assessment includes: x x


A. Glomerular filtration rate (GFR) x x x


B. Creatinine
C. Urine output for 24 hours x x x x


D. All of the above: D. All of the above
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The best measure of current renal function is to measure 24-hour-urine
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formation, GFR, and creatinine. These three focus on the kidney's abililty to
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filter, absorb and secret. This information is found in the RIFLE study.
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7. Blood-urea-nitrogen (BUN) is a reflection of: x x x x x


A. Hydration, catabolic state and presence of blood in the gut x x x x x x x x x


B. Hydration, liver function and renal clearance x x x x x


C. Renal absorption of sodium, total parenteral nutrition (TPN) and dissemi-
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xnated intravasular coagulation (DIC)
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D. Renal excretion of potassium, liver failure and fluid overload: A. Hydration,
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xcatabolic state and presence of blood in the gut
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- BUN is refection of the intravascular volume status; if intravascularly
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dehydrated; the BUN will rise without creatinine elevation.
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- If the patient has not had enough protein in their diet- the body will break
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down muscle to make protein and that will release nitrogen into the blood,
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elevating BUN.
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- Free blood in the gut (GI bleed) will also break down to protein and elevate
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the BUN.
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8. The RIFLE criteria includes the risk of renal injury. List the criteria for
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determining renal risk, injury and failure:
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A. Creatinine, urine output and GFR x x x x


B. Creatinine, BP and HR x x x


C. BP, pulse pressure and GFR
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D. BP, GFR and urine output: A. creatinine, urine output and GFR
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Creatinine, urine output and GFR are the major criteria for the assessment of current
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xrenal function according to the RIFLE study. Looking at creatinine alone does
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not reflect the current status of renal function.
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Review x



9. Strategies to prevent
Study online acute kidney injury include:
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A. limiting dehydration x


B. limiting and correcting hypotension x x x


C. limiting exposure to nephrotoxins x x x


D. All of the above: D. All of the above
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Excellent strategies for protecting renal function include: limiting intravascular
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dehy- dration, limiting and correcting hypotension, and limiting exposure to
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nephrotoxins- pharmokinetic therapy for pt on nephrotoxic drugs, renal
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protection for those receiv- ing contrast media would also be included in this
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function
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10. Preventative measures for the onset of acute kidney injury include: x x x x x x x x x


A. IV isotonic hydration before nephrotoxins are administered
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B. Maintenance of adequate MAP x x x


C. Use of N-acetylcysteine for renal protection
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D. All of the above: D. All of the x x x x x x x


above Renal protection includes:
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- IV hydration before administering nephrotoxins, such as intravenous contras
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dye. x


- Use of drugs to further protect the kidney- the use of N-acetylcysteine before
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IV contrast dye (this is an oxygen radical scavenger that protects the nephrons
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from injury that occurs with IV contrast dye)
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- Maintenance of an adequate MAP to profuse the kidney, x x x x x x x x


11. Prerenal failure is caused by: x x x x


A. Poor cardiac output x x


B. Poor volume status x x


C. Renal artery stenosis x x


D. All of the above: D. All of the above
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The three main causes of prerenal failure are: poor cardiac function, poor volume
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xstatus, and renal artery stenosis. All three prevent blood from reaching the
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kidney
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12. In the oliguric phase of acute renal failure the urine output:
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A. Is less than 400 ml/24 hours
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B. Is greater than 500 ml/24 hours
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C. Totally ceases x


D. Is not measure: A. Is less than 400 ml/24 hours
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This is the marker of oliguria to the nephrologist. If the urine output is less than
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400 ml/24 hours, the patient is said to be oliguric.
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13. In the diuretic phase of renal failure:
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A. Urine output does not change x x x x


B. Oxygenation becomes worse x x

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