Certified Dialysis Nurse
Final Test Review
(Questions & Solutions)
2025
1
,I. Pathologic Processes and Complications
1. A 58-year-old man with CKD stage 5 reports progressive fatigue and
dyspnea on exertion. Labs: Hgb 8.2 g/dL, ferritin 120 ng/mL, TSAT
18%. Which best explains his anemia?
A. Iron‐deficiency anemia from GI bleeding
B. Decreased erythropoietin production
C. Hemolysis due to uremic toxins
D. Vitamin B12 deficiency
ANS: B
Rationale: In advanced CKD, the failing kidney produces less
erythropoietin, causing normocytic, normochromic anemia despite
normal iron stores.
2. A patient on hemodialysis develops severe bone pain and bony
deformities. PTH is 800 pg/mL (normal 10–65). Which process
underlies his condition?
A. Decreased osteoclastic activity
B. Secondary hyperparathyroidism
C. Osteomalacia from vitamin D excess
D. Aluminum‐induced osteodystrophy
ANS: B
Rationale: Chronic phosphate retention and hypocalcemia in CKD
stimulate parathyroid hyperplasia and excess PTH, causing renal
osteodystrophy.
3. A 70-year-old woman with AKI exhibits oliguria and rising
BUN/creatinine. Urinalysis: muddy brown casts. Which stage of AKI is
indicated?
A. Initiation phase
B. Maintenance (oliguric) phase
2
, C. Recovery phase
D. Diuretic phase
ANS: B
Rationale: The maintenance phase presents with persistent
oliguria/anuria, metabolic disturbances, and characteristic granular
(“muddy brown”) casts from tubular necrosis.
4. A PD patient develops hyperphosphatemia (7.2 mg/dL) despite
dietary restriction. Which complication is he at greatest risk for?
A. Vascular calcification
B. Hypocalcemia tetany
C. Metabolic acidosis
D. Renal anemia
ANS: A
Rationale: Elevated phosphate binds serum calcium and deposits in
vessels, leading to medial calcification and increased cardiovascular
mortality.
---
II. Nursing Interventions
5. Mid-hemodialysis, a patient complains of intense pruritus and has
scratch marks. What nursing action is most appropriate?
A. Increase dialysate temperature
B. Administer IV diphenhydramine
C. Apply cool compresses and encourage short nails
D. Increase ultrafiltration rate
ANS: C
Rationale: Uremic pruritus is managed by skin care—cool baths,
moisturizers, avoiding irritants—and non-sedating measures before
systemic antihistamines.
3
Final Test Review
(Questions & Solutions)
2025
1
,I. Pathologic Processes and Complications
1. A 58-year-old man with CKD stage 5 reports progressive fatigue and
dyspnea on exertion. Labs: Hgb 8.2 g/dL, ferritin 120 ng/mL, TSAT
18%. Which best explains his anemia?
A. Iron‐deficiency anemia from GI bleeding
B. Decreased erythropoietin production
C. Hemolysis due to uremic toxins
D. Vitamin B12 deficiency
ANS: B
Rationale: In advanced CKD, the failing kidney produces less
erythropoietin, causing normocytic, normochromic anemia despite
normal iron stores.
2. A patient on hemodialysis develops severe bone pain and bony
deformities. PTH is 800 pg/mL (normal 10–65). Which process
underlies his condition?
A. Decreased osteoclastic activity
B. Secondary hyperparathyroidism
C. Osteomalacia from vitamin D excess
D. Aluminum‐induced osteodystrophy
ANS: B
Rationale: Chronic phosphate retention and hypocalcemia in CKD
stimulate parathyroid hyperplasia and excess PTH, causing renal
osteodystrophy.
3. A 70-year-old woman with AKI exhibits oliguria and rising
BUN/creatinine. Urinalysis: muddy brown casts. Which stage of AKI is
indicated?
A. Initiation phase
B. Maintenance (oliguric) phase
2
, C. Recovery phase
D. Diuretic phase
ANS: B
Rationale: The maintenance phase presents with persistent
oliguria/anuria, metabolic disturbances, and characteristic granular
(“muddy brown”) casts from tubular necrosis.
4. A PD patient develops hyperphosphatemia (7.2 mg/dL) despite
dietary restriction. Which complication is he at greatest risk for?
A. Vascular calcification
B. Hypocalcemia tetany
C. Metabolic acidosis
D. Renal anemia
ANS: A
Rationale: Elevated phosphate binds serum calcium and deposits in
vessels, leading to medial calcification and increased cardiovascular
mortality.
---
II. Nursing Interventions
5. Mid-hemodialysis, a patient complains of intense pruritus and has
scratch marks. What nursing action is most appropriate?
A. Increase dialysate temperature
B. Administer IV diphenhydramine
C. Apply cool compresses and encourage short nails
D. Increase ultrafiltration rate
ANS: C
Rationale: Uremic pruritus is managed by skin care—cool baths,
moisturizers, avoiding irritants—and non-sedating measures before
systemic antihistamines.
3
