Certified Nephrology Nurse – Nurse
Practitioner
Final Test Review
(Questions & Solutions)
2025
1
,1. A 62-year-old patient with type 2 diabetes and hypertension
presents for routine follow-up. Laboratory results show eGFR 42
mL/min/1.73 m², serum creatinine 1.8 mg/dL, and spot urine
albumin-to-creatinine ratio 350 mg/g. According to KDIGO guidelines,
what is the most appropriate next step in management?
A. Begin low-dose ACE inhibitor and schedule renal ultrasound
B. Refer for immediate nephrology evaluation and biopsy
C. Intensify glycemic control only
D. Add high-dose loop diuretic
ANS: A
Rationale: In CKD stage 3 with albuminuria >300 mg/g, ACE inhibitors
slow progression and reduce proteinuria; renal ultrasound is
warranted to rule out obstruction【KDIGO】.
2. A 45-year-old woman with systemic lupus erythematosus develops
acute nephritic syndrome. Urinalysis shows RBC casts, proteinuria
1.2 g/day, and elevated anti-dsDNA titers. Which biopsy finding
confirms a diagnosis of diffuse proliferative glomerulonephritis?
A. Subepithelial “spike and dome” deposits
B. Crescents in >50% of glomeruli
C. Mesangial IgA deposition
D. Thickened GBM without inflammation
ANS: B
Rationale: Crescents in over half the glomeruli indicate diffuse
proliferative GN, requiring aggressive immunosuppression to
preserve renal function.
3. A 70-year-old male with CKD stage 4 presents with fatigue, leg
cramps, and serum potassium 6.2 mmol/L. ECG shows peaked T
2
, waves. Which intervention should be performed first?
A. Initiate sodium polystyrene sulfonate
B. Administer IV calcium gluconate
C. Begin low-dose insulin plus dextrose infusion
D. Start emergent hemodialysis
ANS: B
Rationale: Calcium gluconate stabilizes cardiac membranes
immediately; insulin/dextrose and dialysis follow based on response.
4. A patient with nephrotic syndrome secondary to focal segmental
glomerulosclerosis has edema and hypoalbuminemia. Which diuretic
regimen optimizes diuresis while minimizing intravascular depletion?
A. High-dose loop diuretic alone daily
B. Loop diuretic plus oral metolazone
C. Thiazide diuretic monotherapy
D. Spironolactone alone
ANS: B
Rationale: Combining metolazone with loop diuretics overcomes
diuretic resistance in nephrotic syndrome and enhances sodium
excretion.
5. A 55-year-old male with contrast-induced AKI 24 hours post-
angiography has urine output <0.3 mL/kg/h and rising creatinine.
What’s the best fluid management strategy?
A. Bolus of isotonic saline followed by maintenance
B. Loop diuretics to induce diuresis
C. Restrict fluids to prevent overload
D. Switch to hypotonic solution
ANS: A
Rationale: Early isotonic saline bolus restores renal perfusion and
3
Practitioner
Final Test Review
(Questions & Solutions)
2025
1
,1. A 62-year-old patient with type 2 diabetes and hypertension
presents for routine follow-up. Laboratory results show eGFR 42
mL/min/1.73 m², serum creatinine 1.8 mg/dL, and spot urine
albumin-to-creatinine ratio 350 mg/g. According to KDIGO guidelines,
what is the most appropriate next step in management?
A. Begin low-dose ACE inhibitor and schedule renal ultrasound
B. Refer for immediate nephrology evaluation and biopsy
C. Intensify glycemic control only
D. Add high-dose loop diuretic
ANS: A
Rationale: In CKD stage 3 with albuminuria >300 mg/g, ACE inhibitors
slow progression and reduce proteinuria; renal ultrasound is
warranted to rule out obstruction【KDIGO】.
2. A 45-year-old woman with systemic lupus erythematosus develops
acute nephritic syndrome. Urinalysis shows RBC casts, proteinuria
1.2 g/day, and elevated anti-dsDNA titers. Which biopsy finding
confirms a diagnosis of diffuse proliferative glomerulonephritis?
A. Subepithelial “spike and dome” deposits
B. Crescents in >50% of glomeruli
C. Mesangial IgA deposition
D. Thickened GBM without inflammation
ANS: B
Rationale: Crescents in over half the glomeruli indicate diffuse
proliferative GN, requiring aggressive immunosuppression to
preserve renal function.
3. A 70-year-old male with CKD stage 4 presents with fatigue, leg
cramps, and serum potassium 6.2 mmol/L. ECG shows peaked T
2
, waves. Which intervention should be performed first?
A. Initiate sodium polystyrene sulfonate
B. Administer IV calcium gluconate
C. Begin low-dose insulin plus dextrose infusion
D. Start emergent hemodialysis
ANS: B
Rationale: Calcium gluconate stabilizes cardiac membranes
immediately; insulin/dextrose and dialysis follow based on response.
4. A patient with nephrotic syndrome secondary to focal segmental
glomerulosclerosis has edema and hypoalbuminemia. Which diuretic
regimen optimizes diuresis while minimizing intravascular depletion?
A. High-dose loop diuretic alone daily
B. Loop diuretic plus oral metolazone
C. Thiazide diuretic monotherapy
D. Spironolactone alone
ANS: B
Rationale: Combining metolazone with loop diuretics overcomes
diuretic resistance in nephrotic syndrome and enhances sodium
excretion.
5. A 55-year-old male with contrast-induced AKI 24 hours post-
angiography has urine output <0.3 mL/kg/h and rising creatinine.
What’s the best fluid management strategy?
A. Bolus of isotonic saline followed by maintenance
B. Loop diuretics to induce diuresis
C. Restrict fluids to prevent overload
D. Switch to hypotonic solution
ANS: A
Rationale: Early isotonic saline bolus restores renal perfusion and
3
