FLORIDA BOARD OF NURSING
NEPHROLOGY NURSING CERTIFICATION
EXAM WITH ACTUAL QUESTIONS AND
VERIFIED ANSWERS, PLUS EXPLAINED
RATIONALES/EXPERT VERIFIED FOR
GUARANTEED 100% PASS 2026/LATEST
UPDATE/INSTANT DOWNLOAD PDF
1.
A patient with stage 5 chronic kidney disease has a serum potassium
level of 6.8 mEq/L. The cardiac monitor demonstrates tall, peaked T
waves followed by progressive QRS widening. Which intervention
should the nephrology nurse anticipate as the highest priority?
A. Administer oral sodium polystyrene sulfonate
B. Administer IV calcium gluconate
C. Restrict dietary potassium
D. Administer oral furosemide
Answer: B. Administer IV calcium gluconate
Rationale: IV calcium gluconate is used immediately to stabilize the
cardiac membrane in severe hyperkalemia with ECG changes. It does
not remove potassium from the body, but it reduces the risk of fatal
ventricular dysrhythmias while definitive potassium-lowering
interventions are initiated. Sodium polystyrene sulfonate has a delayed
effect, dietary restriction is insufficient for an acute emergency, and
furosemide may be ineffective in advanced renal failure with minimal
urine output.
2.
1
,A patient receiving maintenance hemodialysis reports severe muscle
weakness and palpitations immediately before dialysis. The serum
potassium is 7.1 mEq/L. Which finding requires the nurse's most
immediate attention?
A. BUN of 96 mg/dL
B. Serum creatinine of 9.4 mg/dL
C. Peaked T waves on ECG
D. Hemoglobin of 9.1 g/dL
Answer: C. Peaked T waves on ECG
Rationale: Severe hyperkalemia can cause life-threatening cardiac
conduction abnormalities. Peaked T waves are an early ECG
manifestation and indicate myocardial effects of potassium elevation.
The markedly elevated BUN and creatinine are expected in advanced
kidney failure, while anemia is common in chronic kidney disease but
is not the immediate threat.
3.
A patient with chronic kidney disease has persistent hyperphosphatemia
despite dietary phosphate restriction. Which medication should the nurse
teach the patient to take with meals?
A. Epoetin alfa
B. Sevelamer
C. Calcitriol
D. Sodium bicarbonate
Answer: B. Sevelamer
Rationale: Sevelamer is a non-calcium phosphate binder that binds
dietary phosphate in the gastrointestinal tract, reducing phosphate
absorption. It must be taken with meals because it acts on phosphate
contained in food. Epoetin alfa treats anemia, calcitriol affects vitamin
2
,D metabolism and calcium-phosphate regulation, and sodium
bicarbonate is used for metabolic acidosis.
4.
A patient with end-stage kidney disease receives epoetin alfa. Which
laboratory value is most important for evaluating the effectiveness of
this therapy?
A. Serum sodium
B. Hemoglobin
C. Serum phosphorus
D. Blood urea nitrogen
Answer: B. Hemoglobin
Rationale: Epoetin alfa stimulates erythropoiesis and is used to treat
anemia associated with chronic kidney disease. Hemoglobin and
hematocrit are therefore central indicators of response. Iron status
must also be monitored because adequate iron is necessary for
erythropoiesis.
5.
A hemodialysis patient has a newly created arteriovenous fistula. Which
assessment finding indicates that the fistula is functioning properly?
A. Absence of a pulse over the fistula
B. Presence of a palpable thrill and audible bruit
C. Coolness and cyanosis of the access arm
D. Severe pain with gentle palpation
Answer: B. Presence of a palpable thrill and audible bruit
3
, Rationale: A functioning AV fistula should have blood flow that can
be assessed as a palpable thrill and audible bruit. Loss of the thrill or
bruit may indicate thrombosis or another access complication
requiring urgent evaluation. The access arm should not normally be
cyanotic, markedly cool, or severely painful.
6.
Which instruction is most appropriate for a patient with an arteriovenous
fistula?
A. Allow blood pressure measurements on the access arm
B. Sleep with the access arm underneath the body
C. Avoid venipuncture in the access arm
D. Apply a tight elastic band around the access arm during exercise
Answer: C. Avoid venipuncture in the access arm
Rationale: Venipuncture, IV insertion, and blood pressure
measurements can traumatize the vascular access and compromise
blood flow. Patients should protect the access arm from compression,
injury, and infection while regularly assessing for a thrill and
reporting changes promptly.
7.
A patient receiving hemodialysis develops headache, nausea, confusion,
and restlessness during the first dialysis treatment after a prolonged
period of severe azotemia. Which complication should the nurse
suspect?
A. Disequilibrium syndrome
B. Peritonitis
4
NEPHROLOGY NURSING CERTIFICATION
EXAM WITH ACTUAL QUESTIONS AND
VERIFIED ANSWERS, PLUS EXPLAINED
RATIONALES/EXPERT VERIFIED FOR
GUARANTEED 100% PASS 2026/LATEST
UPDATE/INSTANT DOWNLOAD PDF
1.
A patient with stage 5 chronic kidney disease has a serum potassium
level of 6.8 mEq/L. The cardiac monitor demonstrates tall, peaked T
waves followed by progressive QRS widening. Which intervention
should the nephrology nurse anticipate as the highest priority?
A. Administer oral sodium polystyrene sulfonate
B. Administer IV calcium gluconate
C. Restrict dietary potassium
D. Administer oral furosemide
Answer: B. Administer IV calcium gluconate
Rationale: IV calcium gluconate is used immediately to stabilize the
cardiac membrane in severe hyperkalemia with ECG changes. It does
not remove potassium from the body, but it reduces the risk of fatal
ventricular dysrhythmias while definitive potassium-lowering
interventions are initiated. Sodium polystyrene sulfonate has a delayed
effect, dietary restriction is insufficient for an acute emergency, and
furosemide may be ineffective in advanced renal failure with minimal
urine output.
2.
1
,A patient receiving maintenance hemodialysis reports severe muscle
weakness and palpitations immediately before dialysis. The serum
potassium is 7.1 mEq/L. Which finding requires the nurse's most
immediate attention?
A. BUN of 96 mg/dL
B. Serum creatinine of 9.4 mg/dL
C. Peaked T waves on ECG
D. Hemoglobin of 9.1 g/dL
Answer: C. Peaked T waves on ECG
Rationale: Severe hyperkalemia can cause life-threatening cardiac
conduction abnormalities. Peaked T waves are an early ECG
manifestation and indicate myocardial effects of potassium elevation.
The markedly elevated BUN and creatinine are expected in advanced
kidney failure, while anemia is common in chronic kidney disease but
is not the immediate threat.
3.
A patient with chronic kidney disease has persistent hyperphosphatemia
despite dietary phosphate restriction. Which medication should the nurse
teach the patient to take with meals?
A. Epoetin alfa
B. Sevelamer
C. Calcitriol
D. Sodium bicarbonate
Answer: B. Sevelamer
Rationale: Sevelamer is a non-calcium phosphate binder that binds
dietary phosphate in the gastrointestinal tract, reducing phosphate
absorption. It must be taken with meals because it acts on phosphate
contained in food. Epoetin alfa treats anemia, calcitriol affects vitamin
2
,D metabolism and calcium-phosphate regulation, and sodium
bicarbonate is used for metabolic acidosis.
4.
A patient with end-stage kidney disease receives epoetin alfa. Which
laboratory value is most important for evaluating the effectiveness of
this therapy?
A. Serum sodium
B. Hemoglobin
C. Serum phosphorus
D. Blood urea nitrogen
Answer: B. Hemoglobin
Rationale: Epoetin alfa stimulates erythropoiesis and is used to treat
anemia associated with chronic kidney disease. Hemoglobin and
hematocrit are therefore central indicators of response. Iron status
must also be monitored because adequate iron is necessary for
erythropoiesis.
5.
A hemodialysis patient has a newly created arteriovenous fistula. Which
assessment finding indicates that the fistula is functioning properly?
A. Absence of a pulse over the fistula
B. Presence of a palpable thrill and audible bruit
C. Coolness and cyanosis of the access arm
D. Severe pain with gentle palpation
Answer: B. Presence of a palpable thrill and audible bruit
3
, Rationale: A functioning AV fistula should have blood flow that can
be assessed as a palpable thrill and audible bruit. Loss of the thrill or
bruit may indicate thrombosis or another access complication
requiring urgent evaluation. The access arm should not normally be
cyanotic, markedly cool, or severely painful.
6.
Which instruction is most appropriate for a patient with an arteriovenous
fistula?
A. Allow blood pressure measurements on the access arm
B. Sleep with the access arm underneath the body
C. Avoid venipuncture in the access arm
D. Apply a tight elastic band around the access arm during exercise
Answer: C. Avoid venipuncture in the access arm
Rationale: Venipuncture, IV insertion, and blood pressure
measurements can traumatize the vascular access and compromise
blood flow. Patients should protect the access arm from compression,
injury, and infection while regularly assessing for a thrill and
reporting changes promptly.
7.
A patient receiving hemodialysis develops headache, nausea, confusion,
and restlessness during the first dialysis treatment after a prolonged
period of severe azotemia. Which complication should the nurse
suspect?
A. Disequilibrium syndrome
B. Peritonitis
4
