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Certified Nephrology Nurse (CNN) Practice Questions d.

Amyloidosis

1. Diabetic nephropathy results from an elevation of blood 5. Damaged kidneys lose their ability to produce
pressure, increasing the workload of the glomeruli. The erythropoietin, a hormone that stimulates the formation of
glomeruli thicken and allow serum albumin to pass into red blood cells. What is usually prescribed to stimulate
the urine. Which of the following signs and symptoms erythropoiesis in patients with chronic kidney disease?
indicate diabetic nephropathy?
a. Epoetin alfa (Epogen, Procrit)
a. Edema around the eyes upon awakening, progressing b. Cinacalcet HCl (Sensipar)
to general swelling of the legs and body c. Furosemide (Lasix) or bumetanide (Bumex)
b. Weight gain, malaise, fatigue, and frothy urine d. Sevelamer hydrochloride (Renagel)
c. Rust-colored urine, weight loss, and back pain
d. A and C Certified Nephrology Nurse (CNN) Answer Key
e. A and B
1. Answer: E
2. What steps need to be taken to diagnose and eliminate
the problem of dialysate leakage during peritoneal Symptoms and signs of diabetic nephropathy include edema
dialysis? around the eyes upon awakening, progressing to general
swelling of the legs and body, weight gain, frothy urine,
a. Use a Dextrostick to ascertain the presence of malaise, fatigue, nausea and vomiting, headache, hiccoughs,
glucose. and pruritus. Serum creatinine and blood urea nitrogen levels
b. Resuture the exit site, and stabilize or replace the elevate at this stage. The additional diagnosis of retinopathy
catheter. may be evident.
c. LDiscontinue peritoneal dialysis to allow for healing,
or decrease the infusion time with the patient lying on
2. Answer: D
the left side.
d. Both A and B are true.
e. Both B and C are true. Steps that need to be taken include: (1) use a Dextrostick to
ascertain the presence of glucose, (2) resuture the exit site, (3)
discontinue peritoneal dialysis for a minimum of 2 weeks to
3. Certain precautions must be followed when performing allow healing, (3) if unable to stop therapy, decrease volume
dialysis on a recent transplant recipient. All of the with automated peritoneal dialysis in supine position; and (4)
following statements regarding dialysis for the post- stabilize or replace the catheter.
transplant patient are true EXCEPT:
3. Answer: C
a. Close observation is necessary for hypotension
because of the risk of internal bleeding in first 24
hours postsurgery; a physician must be alerted if The main precautions that must be followed when performing
hypotension occurs. dialysis on a recent transplant recipient are:
b. Hypotension must be avoided to prevent ischemia of
the newly transplanted kidney, even if fluid removal (1) Observe for hypotension as a result of the risk of internal
during dialysis is compromised. bleeding in first 24 hours postsurgery, and then alert the
c. High-dose heparin must be used to prevent physician if hypotension occurs. (2) Avoid hypotension to
postoperative clotting; prevent ischemia of the newly transplanted kidney, even if
d. Observation is necessary for electrolyte imbalance, fluid removal during dialysis is compromised. (3) Maintain the
especially hyperkalemia. integrity of the surgical incision site. (4) Use heparin-free or
minimal anticoagulation therapy for newly postoperative
4. A patient is admitted with the following signs and patients and for those who have had a percutaneous renal
symptoms: edema around the eyes upon awakening, biopsy. (5) Observe for an electrolyte imbalance, especially
progressing to general swelling of the legs and body; hyperkalemia.
weight gain; fatigue; headache; nausea; vomiting; frequent
hiccoughs; and itching. A urine specimen is obtained, and 4. Answer: B
the urine is frothy. The patient has a history of insulin-
dependent diabetes (type 1 diabetes), which is poorly Diabetic nephropathy is the most common cause of chronic
controlled, and high blood pressure, and his blood work kidney disease in Western countries. It affects insulin-
comes back showing an elevated cholesterol level. Which of dependent diabetics, or type 1 diabetes, and non-insulin
the following disease processes would you suspect? dependent diabetics, or type 2 diabetes. Those with poorly
controlled blood sugar levels, uncontrolled high blood
a. Nephrosclerosis pressure, and elevated cholesterol levels are at highest risk.
b. Diabetic nephropathy This disease process involves an increase in the blood flow to
c. Polycystic kidney disease the kidney, caused by hyperglycemia. This results in an
elevation of blood pressure, increasing the workload of the
glomeruli. The glomeruli thicken and allow serum albumin to 4. A peritoneal dialysis patient presents with
pass into the urine (albuminuria). This sign is detectable only complaints of abdominal pain, nausea, and
by medical testing and begins several years before symptoms vomiting. He states that the solution he emptied
are apparent. At this stage, kidney biopsy confirms the from his dialysis outflow was cloudy. What tests
diagnosis. Nephrosclerosis is the hardening of the arterioles of should the physician order at this time?
the kidneys caused by uncontrolled high blood pressure.
Polycystic kidney disease is a genetic disorder in which fluid- A. Peritoneal cell count
filled cysts replace normal healthy kidney tissue. Amyloidosis B. Culture of peritoneal effluent
refers to a condition in which proteins (amyloid proteins) have
C. Stool culture
been altered and become insoluble, then deposit in various
D. A and B
organs.
E. A and C
5. Answer: A 5. A patient is admitted for testing as a renal
transplantation recipient. Upon reviewing the
Recombinant human erythropoietin, or epoetin alfa, (Epogen, blood work, the nurse notices that his blood type
Procrit) is used to stimulate red blood cell production in is B-. When determining kidney compatibility for
patients with end state renal disease. Cinacalcet HCl this patient, what are the factors involving blood
(Senispar) is a drug used for lowering the level of parathyroid
type that must be considered?
in the blood. Furosemide (Lasix) and bumetanide (Bumex) are
commonly used diuretics. Sevelamer hydrochloride (Renagel)
is one of the latest drugs used for phosphate-binding.
A. The kidney donor must be B-.
B. The kidney donor must be B, but the Rh (Rhesus)
factor is not a consideration.
C. Human leukocyte antigen (HLA) tests must be
1. There are two mechanisms of dialysis: diffusion
done.
and ultrafiltration. Which of the following
D. Both A and B are true.
statements best describe ultrafiltration
E. Both B and C are true.
(convective transport)?

A. Hydrostatic or osmotic pressure forces water


through a semipermeable membrane, creating a
Answers
1. A: Ultrafiltration occurs when hydrostatic pressure
“solvent drag,” in which water carries solutes at or or an osmotic pressure forces water through the
near their original concentration. semipermeable membrane. The water carries solutes,
B. Large molecules flow through the semipermeable at or near their original concentration, in a process
membrane during “solvent drag.” called “solvent drag.” Larger molecules remain, with
C. Particles in low concentration flow through the the membrane acting as a filter, or sieve. When the
membrane to an area of high particle concentration. concentration of a certain type of particle is higher on
D. Solutes and catabolic wastes transfer into the one side of a membrane than on the other side, a
blood from the high dialysate concentration. concentration gradient exists. In this situation,
particles in high concentration flow through the
2. Which of the following dialyzers uses the membrane to the low concentration side. Solutes and
rectangular cross section for basic blood flow catabolic waste products transfer from the blood
geometries? where a high concentration exists into the lower
dialysate concentration.
A. Synthetic membranes
B. Parallel plate dialyzers 2. B: There are two blood flow geometries, the
C. Hollow fiber dialyzers rectangular cross section seen in parallel plate
D. Cellulose membranes dialyzers and the circular cross section found in
hollow fiber dialyzers. Synthetic and cellulose are
3. Cellulose is a complex carbohydrate polymer, descriptions of the materials used to produce the
which is the main structural material found in membranes used in dialysis.
plant life. Membranes manufactured from
cellulose are frequently used in dialysis. What are 3. C: The advantage of cellulose membrane usage is
the advantages and disadvantages of this type of low cost; the disadvantage is that all cellulose
membrane? membranes have some bioincompatibility with blood.
Synthetic membranes are reusable and
A. It is reusable, but it is expensive. biocompatible. The disadvantages of synthetic
B. It is easy to use, but waste disposal is a problem. membranes include their expense in comparison to
C. It is low cost, but it is bioincompatible with blood. cellulose membranes, their high-water permeability
D. It is biocompatible, but it uses back filtration from that results in the need for ultrafiltration, the
dialysate to blood.
absorption of protein to the membrane surface, and
the risk of backfiltration from dialysate to blood. There
is no major disadvantage resulting from waste
disposal problems.

4. D: One of the possible complications of peritoneal


dialyses is an infection of the peritoneum (peritonitis).
The usual cause is a break in the closed system,
allowing the entrance of microorganisms into the
peritoneal cavity. Signs and symptoms of this type of
infection include: cloudy effluent; abdominal pain;
nausea and vomiting; peritoneal cell count greater
than 100 white blood cells, more than 50% of which
are neutrophils; and culture results, such as Gram +,
Gram-, multiple organisms, and fungi. Treatment
involves prompt diagnosis, peritoneal flushes with
1.5% dialysate, and intraperitoneal antibiotics with
added heparin to prevent fibrin and adhesion
formation, (appropriate antibiotic based on culture
results). A stool culture may be applicable if the
diagnosis of peritoneal infection is eliminated.

5. E: Transplant researchers have identified two main


antigen systems: blood groups (ABO) and human
leukocyte antigen. The ABO blood groups are the first
consideration when determining organ compatibility
with the recipient, with potential recipients divided by
blood type. Rh (Rhesus) factor does not affect solid
organ transplantation.