Certified Nephrology Nurse
Final Test Review
(Questions & Solutions)
2025
1
,1. A 54-year-old man with longstanding CKD presents with pruritus,
fatigue, and bone pain. Labs show Ca²⁺ 7.8 mg/dL, PO₄³⁻ 7.1 mg/dL,
and PTH 950 pg/mL. Which complication is he most at risk for?
A. Soft‐tissue calcifications
B. Renal papillary necrosis
C. Hyperkalemic paralysis
D. Nephrogenic diabetes insipidus
ANS: A
Rationale: Secondary hyperparathyroidism in CKD leads to elevated
PTH, high phosphate, low calcium driving extraskeletal calcium‐
phosphate deposition, especially in vessels and soft tissues.
2. A patient on peritoneal dialysis reports progressive dyspnea and
chest pain. Chest X-ray reveals pleural effusion. Dialysate fluid is
clear with a pleural fluid glucose twice that of serum. What is the
most likely diagnosis?
A. Uremic pericardial effusion
B. Pleuroperitoneal leak
C. Heart failure–related effusion
D. Malignant effusion
ANS: B
Rationale: High pleural fluid glucose compared to serum suggests
dialysate movement into the pleural space via a congenital or
acquired pleuroperitoneal communication.
3. A 68-year-old post-transplant patient presents with sudden
oliguria, rising creatinine, and a new bruit over the graft. Doppler
shows reversal of diastolic flow. What complication is most likely?
A. Renal artery thrombosis
2
, B. Acute tubular necrosis
C. Acute cellular rejection
D. Transplant renal artery stenosis
ANS: D
Rationale: Reversed diastolic flow indicates high resistance (e.g.,
stenosis) in the graft artery; thrombosis would produce absent flow
entirely.
4. During CRRT, a patient develops muscle twitching and perioral
numbness. Labs: ionized Ca²⁺ 0.6 mmol/L. Which pathologic process
has occurred?
A. Citrate accumulation
B. Heparin toxicity
C. Metabolic alkalosis
D. Hypermagnesemia
ANS: A
Rationale: Regional citrate anticoagulation binds ionized calcium;
impaired citrate metabolism (e.g., liver failure) leads to hypocalcemia
with neuromuscular excitability.
5. A hemodialysis patient reports diaphoresis, nausea, and headache
20 minutes into treatment. His BP has dropped from 150/85 to 100/60
mmHg. Which pathophysiologic mechanism underlies his
symptoms?
A. Rapid plasma osmolality changes leading to cerebral edema
B. Decreased plasma oncotic pressure
C. Hemoconcentration from ultrafiltration
D. Activation of complement by the dialyzer membrane
ANS: D
3
Final Test Review
(Questions & Solutions)
2025
1
,1. A 54-year-old man with longstanding CKD presents with pruritus,
fatigue, and bone pain. Labs show Ca²⁺ 7.8 mg/dL, PO₄³⁻ 7.1 mg/dL,
and PTH 950 pg/mL. Which complication is he most at risk for?
A. Soft‐tissue calcifications
B. Renal papillary necrosis
C. Hyperkalemic paralysis
D. Nephrogenic diabetes insipidus
ANS: A
Rationale: Secondary hyperparathyroidism in CKD leads to elevated
PTH, high phosphate, low calcium driving extraskeletal calcium‐
phosphate deposition, especially in vessels and soft tissues.
2. A patient on peritoneal dialysis reports progressive dyspnea and
chest pain. Chest X-ray reveals pleural effusion. Dialysate fluid is
clear with a pleural fluid glucose twice that of serum. What is the
most likely diagnosis?
A. Uremic pericardial effusion
B. Pleuroperitoneal leak
C. Heart failure–related effusion
D. Malignant effusion
ANS: B
Rationale: High pleural fluid glucose compared to serum suggests
dialysate movement into the pleural space via a congenital or
acquired pleuroperitoneal communication.
3. A 68-year-old post-transplant patient presents with sudden
oliguria, rising creatinine, and a new bruit over the graft. Doppler
shows reversal of diastolic flow. What complication is most likely?
A. Renal artery thrombosis
2
, B. Acute tubular necrosis
C. Acute cellular rejection
D. Transplant renal artery stenosis
ANS: D
Rationale: Reversed diastolic flow indicates high resistance (e.g.,
stenosis) in the graft artery; thrombosis would produce absent flow
entirely.
4. During CRRT, a patient develops muscle twitching and perioral
numbness. Labs: ionized Ca²⁺ 0.6 mmol/L. Which pathologic process
has occurred?
A. Citrate accumulation
B. Heparin toxicity
C. Metabolic alkalosis
D. Hypermagnesemia
ANS: A
Rationale: Regional citrate anticoagulation binds ionized calcium;
impaired citrate metabolism (e.g., liver failure) leads to hypocalcemia
with neuromuscular excitability.
5. A hemodialysis patient reports diaphoresis, nausea, and headache
20 minutes into treatment. His BP has dropped from 150/85 to 100/60
mmHg. Which pathophysiologic mechanism underlies his
symptoms?
A. Rapid plasma osmolality changes leading to cerebral edema
B. Decreased plasma oncotic pressure
C. Hemoconcentration from ultrafiltration
D. Activation of complement by the dialyzer membrane
ANS: D
3
