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November 2025

Question Title

* During a patient's hemodialysis (HD) treatment, the nurse observes cherry-red blood in the venous line. Hemolysis is suspected. Which of these actions should the nurse take?

The correct answer is c. clamp the extracorporeal lines and remove the patient's HD machine for analysis.

Rationale: Hemolysis is the lysis of red blood cells, which results in the release of intracellular potassium. It may be caused by chemical, thermal, or mechanical events. With hemolysis, the blood in the extracorporeal circuit may appear as cherry-red; conversely, it could appear very dark and opaque.

When acute hemolysis occurs during a dialysis treatment, it is a medical emergency. When hemolysis is suspected, the bloodlines should immediately be clamped, the blood pump stopped, and the HD machine removed for analysis. The patient's blood should not be reinfused, since returning hemolyzed blood could cause or worsen hyperkalemia.

Reference: Counts, C.R. (2020). Core Curriculum for Nephrology Nursing, 7th ed., page 1044; Kallenbach, J.Z. (2026). Review of Dialysis Care for Nurses and Dialysis Personnel, 11th ed., page 159.
December 2024

Question Title

* The nurse is dialyzing a ten-year-old female in the pediatric ICU. Postdialysis, the patient’s heart rate is 90 beats/min, and her blood pressure is 100/60 mm Hg. The nurse should recognize that these findings are indicative of

The correct answer is a. euvolemia.

Rationale: The normal range for heart rate in a child 6-11 years of age is 60-95 beats/min when awake and 58-90 beats/min when asleep. The normal systolic blood pressure in 10-year-old girls is 96-132 mm Hg, depending on height, and the normal diastolic blood pressure is 58-88 mm Hg.

Reference: Counts, C.S. (2020). Core Curriculum for Nephrology Nurses, 7th ed., pages 1460 (Table 34-4) and 1483 (Figure 34-14).
July 2024

Question Title

* When performing an assessment of a patient who has diabetes mellitus and CKD, which of these findings should be of greatest concern to the nurse?

The correct answer is c. small open sore on foot.

Rationale: Diabetic foot complications are the most frequent cause of non-traumatic lower extremity amputations, with more than 80% of the amputations preceded by diabetic foot ulcers. All patients with CKD and diabetes should be taught to perform daily foot checks, to protect their feet from injury, and to promptly report changes, such as wounds or sores on feet.

Reference: Bodin, S.M. (Ed.) (2022). Contemporary Nephrology Nursing, 4th ed., pages 566-567.
February 2024

Question Title

* Patients with chronic kidney disease are generally in which of these physiological states?

The correct answer is a. Metabolic acidosis.

Rationale: If body fluid becomes too acidic, a problem common in kidney patients is metabolic acidosis, a state in which proteins break down and enzymes stop working.

Reference: Kallenbach, J.Z.  (2021).  Review of Hemodialysis for Nurses and Dialysis Personnel, 10th ed.,  p. 42.
September 2023

Question Title

* A patient who is newly prescribed cinacalcet (Sensipar) asks the nurse about common side effects of the medication. The nurse's response should include

The correct answer is a. nausea.

Rationale: The most common side effects of Sensipar are gastrointestinal: nausea, vomiting, and diarrhea.  (Constipation, however, may also occur.)  Less common side effects include hypocalcemia and hypertension.

References: Shields, K. M., Fox, K. L., & Liebrecht, C. (2023).  Pearson Nurse's Drug Guide 2023, pages 363-364; Counts, C. S. (2020). Core Curriculum for Nephrology Nursing, 7th ed., page 482.
April 2023

Question Title

* A patient arrives for hemodialysis and, after treatment is initiated, covers up with a blanket and falls asleep. The patient becomes extremely hypotensive and progresses to cardiac arrest. This event most likely resulted from

The correct answer is a. exsanguination.

Rationale: The patient’s vascular access site, bloodline connections, and face must be visible to a staff member throughout the hemodialysis treatment. A covered access site or line connection provides an opportunity for accidental needle dislodgement or line disconnection to go undetected. The dislodgement or disconnection can result in exsanguination and death in minutes.

References: Counts, C. S. (2020). Core Curriculum for Nephrology Nursing, 7th ed., page 590; Bodin, S. (2022). Contemporary Nephrology Nursing, 4th ed, pages 271-272; CMS Conditions for Coverage for ESRD Facilities - Interpretive Guidance. (2008). V tag 407.
November 2022

Question Title

* When reviewing protocols of continuous renal replacement therapy (CRRT) with the ICU nurse, it is essential to emphasize which of the following?

The correct answer is c. When the blood pump stops, the citrate pump must be stopped.

Rationale: It is essential that IV infusions of calcium and citrate stop whenever the blood pump is stopped. This prevents backflow, which would result in direct administration of citrate and/or calcium to the patient.

Reference: Reference: Counts, C.S. (Ed.). ANNA Core Curriculum for Nephrology Nursing, 7th ed., page 1412.
June 2022

Question Title

* A patient hospitalized with AKI has a central venous catheter that is locked with heparin. On day three of his admission, the patient’s platelet count drops from 110,000/mm3 to 50,000/mm3. Which of these plans of action would most effectively address his thrombocytopenia?

The correct answer is d. Discontinue all heparin, including lock, and monitor for thromboembolism.

Rationale: If heparin-induced thrombocytopenia (HIT) is suspected, all heparin use must be stopped, even before laboratory tests are available confirming the presence of antibodies. Within 2-3 days of heparin therapy, direct heparin-induced degradation of platelets can result in a modest reduction of platelet count.

Reference: Counts, C. (Ed.) Core Curriculum for Nephrology Nursing, 7th ed., page 1013.
January 2022

Question Title

* By regulating the renin-angiotensin-aldosterone system (RAAS), healthy kidneys control which of these functions?

The correct answer is b. blood pressure. 

Rationale: A healthy kidney can contribute to blood pressure control via the renin-angiotensin-aldosterone system (RAAS).  RAAS activation leads to blood vessel constriction, as well as salt and fluid retention, which raise blood pressure.

Reference: Bodin, S. (Ed.) Comprehensive Nephrology Nursing, 3rd ed., pages 426-427; Kallenbach, J.Z. (2021). Review of Hemodialysis for Nurses and Dialysis Personnel, 10th ed., page 34

 
August 2021

Question Title

* In patients who have CKD Stage 5 and are on kidney replacement therapy, a major risk factor linked to acquiring infection with the hepatitis C virus (HCV) is the

The correct answer is d. number of years receiving hemodialysis treatments.

Rationale: The number of years on hemodialysis is the major risk factor independently associated with higher rates of HCV infection in patients with CKD Stage 5 who are receiving kidney replacement therapy.  

Reference: Bodin, S.M. (2017). Contemporary Nephrology Nursing, 3rd ed., p. 884
March 2021

Question Title

* A patient who has been taking cinacalcet (Sensipar) is being switched to etelcalcetide (Parsabiv). When initiating treatment with Parsabiv, the Sensipar must be

The correct answer is a. discontinued for 7 days prior to administering Parsabiv.

Rationale: Sensipar should be discontinued for at least 7 days prior to starting Parsabiv, which should then be initiated at a starting dose of 5 mg.  Also, a corrected serum calcium level at or above the lower limit of normal must be ensured prior to Parsabiv initiation.

Reference: Amgen package insert for etelcalcetide (Parsabiv), 2017, p. 3
October 2020

Question Title

* One helpful patient education technique is the Teach-Back method, which allows the nurse to

The correct answer is d. confirm that the patient understands the content.

Rationale: Teach Back is a way to confirm that the nurse has explained to the patient and/or family what they need to know in a manner that was understood. The understanding is confirmed when they explain the information back (Teach Back) to the nurse.

Reference: Bodin, S.M. (2017). Contemporary Nephrology Nursing, 3rd ed., pp. 145-146.
May 2020

Question Title

* Water softeners in dialysis water treatment systems are used to

The correct answer is b. increase the life‑span of the reverse osmosis membrane.

Rationale: If feed water contains calcium and/or magnesium, these elements must be removed to prevent scaling of the reverse osmosis (RO) membrane. The softened water increases the life span of the RO membrane.

 Reference:  Bodin, S.M. (2017). Contemporary Nephrology Nursing, 3rd ed., p. 176
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