MB Nephrology Nurse Exam Prep
Practice Test

A. Administer a bolus of normal saline and reduce ultrafiltration rate ✓

B. Increase the dialysate temperature

C. Notify the physician immediately and discontinue dialysis

D. Place the patient in Trendelenburg position and administer antihypertensive medication

Correct — A. Intradialytic hypotension is a common complication managed by reducing the ultrafiltration rate, administering normal saline bolus, and placing the patient supine. These measures restore circulating volume and stabilize blood pressure without prematurely terminating the dialysis session.

A. Limiting calcium-rich foods

B. Avoiding high-potassium foods such as bananas and oranges ✓

C. Reducing dietary fat intake

D. Decreasing vitamin D supplementation

Correct — B. Patients with ESRD have impaired potassium excretion, making hyperkalemia a life-threatening risk. High-potassium foods such as bananas, oranges, and potatoes must be restricted to prevent cardiac dysrhythmias.

A. Hyponatremia

B. Hyperkalemia ✓

C. Hypocalcemia

D. Hypermagnesemia

Correct — B. Metabolic acidosis in CKD promotes potassium shift from intracellular to extracellular fluid, worsening hyperkalemia. Impaired renal acid excretion and reduced bicarbonate production contribute to this dangerous combination requiring close monitoring.

A. Primary hyperparathyroidism

B. Secondary hyperparathyroidism ✓

C. Hypoparathyroidism

D. Pseudohypoparathyroidism

Correct — B. Secondary hyperparathyroidism in CKD is characterized by elevated PTH in response to hypocalcemia and hyperphosphatemia. Unlike primary hyperparathyroidism (where calcium is elevated), CKD-related secondary hyperparathyroidism presents with low or normal calcium and elevated PTH.

A. 15–29 mL/min/1.73 m² ✓

B. 30–44 mL/min/1.73 m²

C. 45–59 mL/min/1.73 m²

D. 60–89 mL/min/1.73 m²

Correct — A. CKD is classified by GFR: Stage 1 (≥90), Stage 2 (60–89), Stage 3a (45–59), Stage 3b (30–44), Stage 4 (15–29), and Stage 5 (<15 mL/min/1.73 m²). Stage 4 indicates severely decreased kidney function and preparation for renal replacement therapy.

A. To deliver medications directly into arterial circulation

B. To provide reliable long-term vascular access for dialysis ✓

C. To monitor central venous pressure continuously

D. To facilitate peritoneal fluid exchange

Correct — B. An AV fistula is surgically created by joining an artery and vein, typically in the forearm, to create a durable, high-flow access site for hemodialysis. It is the preferred access type due to its lower infection and thrombosis rates compared to grafts or catheters.

A. A fistula that is soft and flat on palpation

B. A palpable thrill and audible bruit at the access site ✓

C. Absence of redness at the surgical site

D. Blood pressure equilibration between both arms

Correct — B. A mature AV fistula demonstrates a palpable continuous thrill (vibration) and audible bruit (whooshing sound) due to turbulent arterial blood flow. Absence of a thrill or bruit may indicate thrombosis or stenosis requiring urgent evaluation.

A. Clean the site and reinsert the catheter

B. Immediately cover the exit site, assess for signs of peritonitis, and notify the physician ✓

C. Reassure the patient and resume dialysis using a temporary catheter

D. Document the incident and notify the family

Correct — B. Inadvertent catheter dislodgement creates an open portal for bacterial entry into the peritoneal cavity. The nurse must immediately cover the exit site with sterile dressing, assess for peritonitis symptoms (pain, cloudy effluent, fever), notify the nephrologist, and prepare for potential catheter replacement.