CERTIFIED DIALYSIS NURSE EXAM QUESTIONS AND ANSWERS
WITH RATIONALES EACH | CURRENTLY TESTING AND FREQUENTLY
TESTED QUESTIONS | EXPERT VERIFIED FOR GUARANTEED PASS |CDN
EXAM PREP LATEST UPDATE
SECTION 1 – CONCEPTS OF KIDNEY DISEASE (Q1–Q84)
Q1. A patient with Chronic Kidney Disease (CKD) is classified as Stage 4.
What is the estimated Glomerular Filtration Rate (GFR) for this stage?
A) ≥ 90 mL/min/1.73m²
B) 60-89 mL/min/1.73m²
C) 30-59 mL/min/1.73m²
D) 15-29 mL/min/1.73m²
[ANSWER] D) 15-29 mL/min/1.73m²
[RATIONALE] CKD Stage 4 is characterized by a GFR of 15-29 mL/min/1.73m²,
representing severe kidney impairment. Stage 1 is ≥90, Stage 2 is 60-89,
Stage 3 is 30-59, and Stage 5 (ESRD) is <15. Understanding these stages
helps nurses anticipate clinical manifestations and prepare patients for
renal replacement therapy.
Q2. Which of the following laboratory findings is most consistent with a
diagnosis of Chronic Kidney Disease?
A) Elevated GFR
B) Decreased serum creatinine
C) Elevated serum creatinine with decreased GFR
D) Decreased blood urea nitrogen (BUN)
[ANSWER] C) Elevated serum creatinine with decreased GFR
[RATIONALE] In CKD, the kidneys lose their ability to filter waste
products, leading to elevated serum creatinine and BUN with a corresponding
decrease in GFR. GFR is the best overall indicator of kidney function.
A decreased GFR with elevated creatinine is the hallmark of kidney
dysfunction.
1
,Q3. What is the primary pathophysiological mechanism underlying anemia in
Chronic Kidney Disease?
A) Iron deficiency due to poor diet
B) Decreased production of erythropoietin by the kidneys
C) Increased destruction of red blood cells
D) Vitamin B12 deficiency
[ANSWER] B) Decreased production of erythropoietin by the kidneys
[RATIONALE] The kidneys produce approximately 90% of the body's
erythropoietin (EPO), which stimulates red blood cell production in the
bone marrow. As kidney function declines, EPO production decreases,
resulting in normocytic, normochromic anemia. While iron deficiency (A) may
coexist, it is not the primary mechanism. RBC destruction (C) and B12
deficiency (D) are not the main causes.
Q4. A patient with CKD Stage 5 presents with fatigue, shortness of breath, and
pallor. The nurse anticipates which of the following interventions?
A) Immediate blood transfusion
B) Administration of erythropoiesis-stimulating agents (ESAs)
C) High-dose iron supplementation only
D) Restriction of all fluids
[ANSWER] B) Administration of erythropoiesis-stimulating agents (ESAs)
[RATIONALE] The patient's symptoms are consistent with anemia of CKD. ESAs
(such as epoetin alfa or darbepoetin) are the primary treatment. While iron
supplementation (C) may be needed if stores are low, ESAs directly address
the EPO deficiency. Blood transfusion (A) is reserved for severe,
symptomatic anemia or when ESAs are ineffective. Fluid restriction (D)
addresses fluid overload, not anemia.
Q5. Which of the following electrolyte imbalances is most commonly associated
with CKD Stage 5?
A) Hypokalemia
B) Hyperkalemia
C) Hypophosphatemia
2
, D) Hyponatremia
[ANSWER] B) Hyperkalemia
[RATIONALE] Hyperkalemia is a common and potentially life-threatening
electrolyte disturbance in advanced CKD due to decreased renal excretion of
potassium. The kidneys normally excrete 90-95% of daily potassium intake.
As GFR declines below 20-30 mL/min, potassium excretion becomes impaired.
Hypokalemia (A) is not typical; hypophosphatemia (C) is rare as phosphorus
accumulates; hyponatremia (D) can occur but is less characteristic.
Q6. A patient newly diagnosed with CKD asks the nurse, "What happens to my
kidneys that causes this disease?" The nurse's best response is based on
understanding that CKD is characterized by:
A) Reversible acute inflammation of the glomeruli
B) Progressive, irreversible loss of nephron function
C) Temporary decrease in renal blood flow
D) Complete recovery with appropriate treatment
[ANSWER] B) Progressive, irreversible loss of nephron function
[RATIONALE] CKD is defined as progressive, irreversible loss of kidney
function over months to years. The loss of nephrons is permanent, and
remaining nephrons undergo hyperfiltration injury. Unlike acute kidney
injury (A, C), CKD does not typically resolve. Treatment focuses on slowing
progression and managing complications, not achieving complete recovery (D).
Q7. The nurse is assessing a patient with CKD. Which of the following skin
changes is most commonly observed?
A) Erythema and warmth
B) Pallor and ecchymosis
C) Jaundice
D) Cyanosis of the extremities
[ANSWER] B) Pallor and ecchymosis
[RATIONALE] Patients with CKD commonly exhibit pallor (from anemia) and
easy bruising/ecchymosis (from platelet dysfunction and uremic bleeding
3
, tendency). Uremic pruritus and dry skin are also common. Erythema (A) is
not typical; jaundice (C) suggests liver disease; cyanosis (D) indicates
oxygenation issues, not CKD directly.
Q8. Which of the following medications is commonly prescribed to manage
hyperphosphatemia in CKD patients?
A) Calcium acetate
B) Furosemide
C) Metoprolol
D) Epoetin alfa
[ANSWER] A) Calcium acetate
[RATIONALE] Calcium acetate (PhosLo) is a phosphate binder that binds
dietary phosphorus in the GI tract, preventing its absorption.
Hyperphosphatemia is common in advanced CKD. Furosemide (B) is a diuretic;
Metoprolol (C) is a beta-blocker for hypertension; Epoetin alfa (D) treats
anemia. Phosphate binders are a cornerstone of CKD management.
Q9. A patient with CKD asks the nurse about dietary restrictions. Which of the
following is the most important dietary modification for a patient with
Stage 4 CKD?
A) Increased potassium intake
B) Increased phosphorus intake
C) Reduced protein intake
D) Increased sodium intake
[ANSWER] C) Reduced protein intake
[RATIONALE] In advanced CKD (Stages 3-5), protein restriction is often
recommended to reduce the buildup of nitrogenous wastes (urea) and slow
progression. Potassium (A) and phosphorus (B) are typically restricted, not
increased. Sodium (D) is often restricted to manage fluid balance and
hypertension.
Q10. A patient with CKD develops peripheral neuropathy. The nurse recognizes
this is most likely due to:
A) Uremic toxin accumulation causing nerve damage
4
WITH RATIONALES EACH | CURRENTLY TESTING AND FREQUENTLY
TESTED QUESTIONS | EXPERT VERIFIED FOR GUARANTEED PASS |CDN
EXAM PREP LATEST UPDATE
SECTION 1 – CONCEPTS OF KIDNEY DISEASE (Q1–Q84)
Q1. A patient with Chronic Kidney Disease (CKD) is classified as Stage 4.
What is the estimated Glomerular Filtration Rate (GFR) for this stage?
A) ≥ 90 mL/min/1.73m²
B) 60-89 mL/min/1.73m²
C) 30-59 mL/min/1.73m²
D) 15-29 mL/min/1.73m²
[ANSWER] D) 15-29 mL/min/1.73m²
[RATIONALE] CKD Stage 4 is characterized by a GFR of 15-29 mL/min/1.73m²,
representing severe kidney impairment. Stage 1 is ≥90, Stage 2 is 60-89,
Stage 3 is 30-59, and Stage 5 (ESRD) is <15. Understanding these stages
helps nurses anticipate clinical manifestations and prepare patients for
renal replacement therapy.
Q2. Which of the following laboratory findings is most consistent with a
diagnosis of Chronic Kidney Disease?
A) Elevated GFR
B) Decreased serum creatinine
C) Elevated serum creatinine with decreased GFR
D) Decreased blood urea nitrogen (BUN)
[ANSWER] C) Elevated serum creatinine with decreased GFR
[RATIONALE] In CKD, the kidneys lose their ability to filter waste
products, leading to elevated serum creatinine and BUN with a corresponding
decrease in GFR. GFR is the best overall indicator of kidney function.
A decreased GFR with elevated creatinine is the hallmark of kidney
dysfunction.
1
,Q3. What is the primary pathophysiological mechanism underlying anemia in
Chronic Kidney Disease?
A) Iron deficiency due to poor diet
B) Decreased production of erythropoietin by the kidneys
C) Increased destruction of red blood cells
D) Vitamin B12 deficiency
[ANSWER] B) Decreased production of erythropoietin by the kidneys
[RATIONALE] The kidneys produce approximately 90% of the body's
erythropoietin (EPO), which stimulates red blood cell production in the
bone marrow. As kidney function declines, EPO production decreases,
resulting in normocytic, normochromic anemia. While iron deficiency (A) may
coexist, it is not the primary mechanism. RBC destruction (C) and B12
deficiency (D) are not the main causes.
Q4. A patient with CKD Stage 5 presents with fatigue, shortness of breath, and
pallor. The nurse anticipates which of the following interventions?
A) Immediate blood transfusion
B) Administration of erythropoiesis-stimulating agents (ESAs)
C) High-dose iron supplementation only
D) Restriction of all fluids
[ANSWER] B) Administration of erythropoiesis-stimulating agents (ESAs)
[RATIONALE] The patient's symptoms are consistent with anemia of CKD. ESAs
(such as epoetin alfa or darbepoetin) are the primary treatment. While iron
supplementation (C) may be needed if stores are low, ESAs directly address
the EPO deficiency. Blood transfusion (A) is reserved for severe,
symptomatic anemia or when ESAs are ineffective. Fluid restriction (D)
addresses fluid overload, not anemia.
Q5. Which of the following electrolyte imbalances is most commonly associated
with CKD Stage 5?
A) Hypokalemia
B) Hyperkalemia
C) Hypophosphatemia
2
, D) Hyponatremia
[ANSWER] B) Hyperkalemia
[RATIONALE] Hyperkalemia is a common and potentially life-threatening
electrolyte disturbance in advanced CKD due to decreased renal excretion of
potassium. The kidneys normally excrete 90-95% of daily potassium intake.
As GFR declines below 20-30 mL/min, potassium excretion becomes impaired.
Hypokalemia (A) is not typical; hypophosphatemia (C) is rare as phosphorus
accumulates; hyponatremia (D) can occur but is less characteristic.
Q6. A patient newly diagnosed with CKD asks the nurse, "What happens to my
kidneys that causes this disease?" The nurse's best response is based on
understanding that CKD is characterized by:
A) Reversible acute inflammation of the glomeruli
B) Progressive, irreversible loss of nephron function
C) Temporary decrease in renal blood flow
D) Complete recovery with appropriate treatment
[ANSWER] B) Progressive, irreversible loss of nephron function
[RATIONALE] CKD is defined as progressive, irreversible loss of kidney
function over months to years. The loss of nephrons is permanent, and
remaining nephrons undergo hyperfiltration injury. Unlike acute kidney
injury (A, C), CKD does not typically resolve. Treatment focuses on slowing
progression and managing complications, not achieving complete recovery (D).
Q7. The nurse is assessing a patient with CKD. Which of the following skin
changes is most commonly observed?
A) Erythema and warmth
B) Pallor and ecchymosis
C) Jaundice
D) Cyanosis of the extremities
[ANSWER] B) Pallor and ecchymosis
[RATIONALE] Patients with CKD commonly exhibit pallor (from anemia) and
easy bruising/ecchymosis (from platelet dysfunction and uremic bleeding
3
, tendency). Uremic pruritus and dry skin are also common. Erythema (A) is
not typical; jaundice (C) suggests liver disease; cyanosis (D) indicates
oxygenation issues, not CKD directly.
Q8. Which of the following medications is commonly prescribed to manage
hyperphosphatemia in CKD patients?
A) Calcium acetate
B) Furosemide
C) Metoprolol
D) Epoetin alfa
[ANSWER] A) Calcium acetate
[RATIONALE] Calcium acetate (PhosLo) is a phosphate binder that binds
dietary phosphorus in the GI tract, preventing its absorption.
Hyperphosphatemia is common in advanced CKD. Furosemide (B) is a diuretic;
Metoprolol (C) is a beta-blocker for hypertension; Epoetin alfa (D) treats
anemia. Phosphate binders are a cornerstone of CKD management.
Q9. A patient with CKD asks the nurse about dietary restrictions. Which of the
following is the most important dietary modification for a patient with
Stage 4 CKD?
A) Increased potassium intake
B) Increased phosphorus intake
C) Reduced protein intake
D) Increased sodium intake
[ANSWER] C) Reduced protein intake
[RATIONALE] In advanced CKD (Stages 3-5), protein restriction is often
recommended to reduce the buildup of nitrogenous wastes (urea) and slow
progression. Potassium (A) and phosphorus (B) are typically restricted, not
increased. Sodium (D) is often restricted to manage fluid balance and
hypertension.
Q10. A patient with CKD develops peripheral neuropathy. The nurse recognizes
this is most likely due to:
A) Uremic toxin accumulation causing nerve damage
4
