1. DaVita RN Final Exam Prep: 100 Practice Questions with Answers
and Rationales – Hemodialysis, Vascular Access, Complications,
and More
Section 1: Chronic Kidney Disease (CKD) & End-Stage Renal
Disease (ESRD) (Questions 1–10)
1. A nurse is caring for a client with stage 5 chronic kidney disease (CKD) who is
scheduled to start hemodialysis. Which of the following laboratory findings is
most consistent with this stage of CKD?
A. Glomerular filtration rate (GFR) > 60 mL/min
B. Glomerular filtration rate (GFR) < 15 mL/min
C. Serum creatinine 0.8 mg/dL
D. Blood urea nitrogen (BUN) 10 mg/dL
Answer: B. Glomerular filtration rate (GFR) < 15 mL/min
Explanation: Stage 5 CKD (end-stage renal disease) is defined by a GFR of less than 15
mL/min. At this stage, kidney function is insufficient to maintain homeostasis, and renal
replacement therapy (dialysis or transplant) is required. Normal GFR is 90–120 mL/min.
Elevated serum creatinine and BUN are expected, not normal values.
2. A nurse is assessing a client with ESRD. Which of the following findings is most
characteristic of uremia?
A. Polyuria and polydipsia
B. Anorexia, nausea, and metallic taste
C. Hypertension and bradycardia
D. Hypercalcemia and hypophosphatemia
Answer: B. Anorexia, nausea, and metallic taste
Explanation: Uremia (accumulation of waste products in the blood) causes
gastrointestinal symptoms including anorexia, nausea, vomiting, and a metallic taste in
the mouth. Other manifestations include fatigue, pruritus, peripheral neuropathy, and
cognitive changes. Oliguria (not polyuria) is common in ESRD. Hyperphosphatemia and
,hypocalcemia are typical in ESRD due to impaired phosphate excretion and decreased
vitamin D activation.
3. A nurse is providing teaching to a client with CKD about dietary restrictions.
Which of the following instructions should the nurse include?
A. "Increase your intake of phosphorus-rich foods such as dairy products and nuts."
B. "Limit foods high in potassium such as bananas, oranges, and potatoes."
C. "Increase your protein intake to prevent muscle wasting."
D. "Consume a high-sodium diet to maintain blood pressure."
Answer: B. "Limit foods high in potassium such as bananas, oranges, and
potatoes."
Explanation: Clients with CKD and ESRD are at risk for hyperkalemia due to impaired
potassium excretion. Potassium-rich foods (bananas, oranges, potatoes, tomatoes,
avocados) should be limited. Phosphorus should be restricted (dairy, nuts, beans) to
prevent hyperphosphatemia and secondary hyperparathyroidism. Protein is typically
restricted (not increased) in CKD to reduce uremic toxins, though dialysis clients may
need increased protein. Sodium is restricted to manage fluid balance and hypertension.
4. A nurse is assessing a client with ESRD who is receiving erythropoietin (epoetin
alfa) therapy. The nurse understands that this medication is prescribed to treat
which of the following complications of CKD?
A. Hyperkalemia
B. Metabolic acidosis
C. Anemia
D. Hyperphosphatemia
Answer: C. Anemia
Explanation: Anemia in CKD is caused by decreased production of erythropoietin by the
kidneys. Erythropoietin (epoetin alfa) stimulates red blood cell production in the bone
marrow and is used to treat anemia and reduce the need for blood transfusions.
Hyperkalemia is managed with dietary restriction, kayexalate, or dialysis. Metabolic
,acidosis is managed with sodium bicarbonate. Hyperphosphatemia is treated with
phosphate binders.
5. A nurse is assessing a client with ESRD who reports severe itching (pruritus).
Which of the following is the most likely cause of pruritus in this population?
A. Hyperkalemia
B. Hyperphosphatemia and uremic toxins
C. Hyponatremia
D. Hypercalcemia
Answer: B. Hyperphosphatemia and uremic toxins
Explanation: Pruritus (itching) in ESRD is multifactorial but is strongly associated with
hyperphosphatemia, elevated calcium-phosphate product, and accumulation of uremic
toxins. Management includes adequate dialysis, phosphate binders, and topical
treatments. Hyperkalemia causes cardiac and neuromuscular symptoms. Hyponatremia
causes neurological symptoms. Hypercalcemia is less common in ESRD (hypocalcemia is
more typical).
6. A nurse is reviewing laboratory results for a client with ESRD. Which of the
following findings is expected?
A. Elevated serum calcium
B. Elevated serum phosphorus
C. Decreased serum creatinine
D. Decreased blood urea nitrogen (BUN)
Answer: B. Elevated serum phosphorus
Explanation: In ESRD, phosphorus excretion is impaired, leading to hyperphosphatemia.
Calcium is typically low due to decreased active vitamin D (calcitriol) production, leading
to decreased intestinal calcium absorption. Creatinine and BUN are elevated due to
impaired clearance.
, 7. A nurse is teaching a client with CKD about the purpose of phosphate binders.
Which of the following statements indicates understanding?
A. "I will take my phosphate binder with meals to bind phosphorus from food."
B. "I will take my phosphate binder on an empty stomach for better absorption."
C. "I will stop taking my phosphate binder if my phosphorus level is normal."
D. "I will take my phosphate binder with my other medications."
Answer: A. "I will take my phosphate binder with meals to bind phosphorus from
food."
Explanation: Phosphate binders (calcium acetate, sevelamer, lanthanum) are taken with
meals to bind dietary phosphorus in the gastrointestinal tract, preventing absorption.
They should be taken immediately before, during, or after meals. They should not be
taken on an empty stomach or with other medications (binding may affect absorption of
other drugs). Phosphate binders are continued even if phosphorus is normal to maintain
control.
8. A nurse is assessing a client with ESRD who reports fatigue and shortness of
breath. The nurse notes pallor and tachycardia. Which of the following laboratory
findings is most likely?
A. Hemoglobin 8.5 g/dL
B. Platelet count 400,000/mm³
C. White blood cell count 15,000/mm³
D. Serum potassium 5.0 mEq/L
Answer: A. Hemoglobin 8.5 g/dL
Explanation: The client is exhibiting signs of anemia (fatigue, shortness of breath, pallor,
tachycardia). In ESRD, anemia is common due to decreased erythropoietin production.
Normal hemoglobin is 12–16 g/dL; 8.5 g/dL indicates moderate to severe anemia. The
other values may be abnormal but do not explain the presenting symptoms.
and Rationales – Hemodialysis, Vascular Access, Complications,
and More
Section 1: Chronic Kidney Disease (CKD) & End-Stage Renal
Disease (ESRD) (Questions 1–10)
1. A nurse is caring for a client with stage 5 chronic kidney disease (CKD) who is
scheduled to start hemodialysis. Which of the following laboratory findings is
most consistent with this stage of CKD?
A. Glomerular filtration rate (GFR) > 60 mL/min
B. Glomerular filtration rate (GFR) < 15 mL/min
C. Serum creatinine 0.8 mg/dL
D. Blood urea nitrogen (BUN) 10 mg/dL
Answer: B. Glomerular filtration rate (GFR) < 15 mL/min
Explanation: Stage 5 CKD (end-stage renal disease) is defined by a GFR of less than 15
mL/min. At this stage, kidney function is insufficient to maintain homeostasis, and renal
replacement therapy (dialysis or transplant) is required. Normal GFR is 90–120 mL/min.
Elevated serum creatinine and BUN are expected, not normal values.
2. A nurse is assessing a client with ESRD. Which of the following findings is most
characteristic of uremia?
A. Polyuria and polydipsia
B. Anorexia, nausea, and metallic taste
C. Hypertension and bradycardia
D. Hypercalcemia and hypophosphatemia
Answer: B. Anorexia, nausea, and metallic taste
Explanation: Uremia (accumulation of waste products in the blood) causes
gastrointestinal symptoms including anorexia, nausea, vomiting, and a metallic taste in
the mouth. Other manifestations include fatigue, pruritus, peripheral neuropathy, and
cognitive changes. Oliguria (not polyuria) is common in ESRD. Hyperphosphatemia and
,hypocalcemia are typical in ESRD due to impaired phosphate excretion and decreased
vitamin D activation.
3. A nurse is providing teaching to a client with CKD about dietary restrictions.
Which of the following instructions should the nurse include?
A. "Increase your intake of phosphorus-rich foods such as dairy products and nuts."
B. "Limit foods high in potassium such as bananas, oranges, and potatoes."
C. "Increase your protein intake to prevent muscle wasting."
D. "Consume a high-sodium diet to maintain blood pressure."
Answer: B. "Limit foods high in potassium such as bananas, oranges, and
potatoes."
Explanation: Clients with CKD and ESRD are at risk for hyperkalemia due to impaired
potassium excretion. Potassium-rich foods (bananas, oranges, potatoes, tomatoes,
avocados) should be limited. Phosphorus should be restricted (dairy, nuts, beans) to
prevent hyperphosphatemia and secondary hyperparathyroidism. Protein is typically
restricted (not increased) in CKD to reduce uremic toxins, though dialysis clients may
need increased protein. Sodium is restricted to manage fluid balance and hypertension.
4. A nurse is assessing a client with ESRD who is receiving erythropoietin (epoetin
alfa) therapy. The nurse understands that this medication is prescribed to treat
which of the following complications of CKD?
A. Hyperkalemia
B. Metabolic acidosis
C. Anemia
D. Hyperphosphatemia
Answer: C. Anemia
Explanation: Anemia in CKD is caused by decreased production of erythropoietin by the
kidneys. Erythropoietin (epoetin alfa) stimulates red blood cell production in the bone
marrow and is used to treat anemia and reduce the need for blood transfusions.
Hyperkalemia is managed with dietary restriction, kayexalate, or dialysis. Metabolic
,acidosis is managed with sodium bicarbonate. Hyperphosphatemia is treated with
phosphate binders.
5. A nurse is assessing a client with ESRD who reports severe itching (pruritus).
Which of the following is the most likely cause of pruritus in this population?
A. Hyperkalemia
B. Hyperphosphatemia and uremic toxins
C. Hyponatremia
D. Hypercalcemia
Answer: B. Hyperphosphatemia and uremic toxins
Explanation: Pruritus (itching) in ESRD is multifactorial but is strongly associated with
hyperphosphatemia, elevated calcium-phosphate product, and accumulation of uremic
toxins. Management includes adequate dialysis, phosphate binders, and topical
treatments. Hyperkalemia causes cardiac and neuromuscular symptoms. Hyponatremia
causes neurological symptoms. Hypercalcemia is less common in ESRD (hypocalcemia is
more typical).
6. A nurse is reviewing laboratory results for a client with ESRD. Which of the
following findings is expected?
A. Elevated serum calcium
B. Elevated serum phosphorus
C. Decreased serum creatinine
D. Decreased blood urea nitrogen (BUN)
Answer: B. Elevated serum phosphorus
Explanation: In ESRD, phosphorus excretion is impaired, leading to hyperphosphatemia.
Calcium is typically low due to decreased active vitamin D (calcitriol) production, leading
to decreased intestinal calcium absorption. Creatinine and BUN are elevated due to
impaired clearance.
, 7. A nurse is teaching a client with CKD about the purpose of phosphate binders.
Which of the following statements indicates understanding?
A. "I will take my phosphate binder with meals to bind phosphorus from food."
B. "I will take my phosphate binder on an empty stomach for better absorption."
C. "I will stop taking my phosphate binder if my phosphorus level is normal."
D. "I will take my phosphate binder with my other medications."
Answer: A. "I will take my phosphate binder with meals to bind phosphorus from
food."
Explanation: Phosphate binders (calcium acetate, sevelamer, lanthanum) are taken with
meals to bind dietary phosphorus in the gastrointestinal tract, preventing absorption.
They should be taken immediately before, during, or after meals. They should not be
taken on an empty stomach or with other medications (binding may affect absorption of
other drugs). Phosphate binders are continued even if phosphorus is normal to maintain
control.
8. A nurse is assessing a client with ESRD who reports fatigue and shortness of
breath. The nurse notes pallor and tachycardia. Which of the following laboratory
findings is most likely?
A. Hemoglobin 8.5 g/dL
B. Platelet count 400,000/mm³
C. White blood cell count 15,000/mm³
D. Serum potassium 5.0 mEq/L
Answer: A. Hemoglobin 8.5 g/dL
Explanation: The client is exhibiting signs of anemia (fatigue, shortness of breath, pallor,
tachycardia). In ESRD, anemia is common due to decreased erythropoietin production.
Normal hemoglobin is 12–16 g/dL; 8.5 g/dL indicates moderate to severe anemia. The
other values may be abnormal but do not explain the presenting symptoms.
