NNCC Nephrology Nurse Question of the Month Survey

Question Title

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

a. Metabolic acidosis.

b. Metabolic alkalosis.

c. Respiratory acidosis.

d. Respiratory alkalosis.

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.

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

a. nausea

b. ankle swelling.

c. headache.

d. metallic taste.

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.

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

a. exsanguination

b. a pulmonary embolus.

c. hypocoagulation syndrome.

d. disseminated intravascular coagulation.

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.

Question Title

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

a. Citrate is administered through a Y-port on the venous line.

b. Calcium is administered through a Y-port on the arterial line.

c. When the blood pump stops, the citrate pump must be stopped.

d. When the blood pump stops, the citrate pump rate must be increased based on the calcium level.

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.

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?

a. Stop saline rinses and monitor patient for signs/symptoms of bleeding.

b. Continue heparin flushes for catheter lock only, and transfuse platelets.

c. Infuse two units of fresh frozen plasma and avoid citrate anticoagulation.

d. Discontinue all heparin, including lock, and monitor for thromboembolism.

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.

Question Title

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

a. Temperature.

b. Blood pressure.

c. Urea and creatinine levels.

d. Phosphorus and calcium levels.

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

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

a. cumulative use of drugs known to be hepatotoxic.

b. number of procedures using intravenous contrast media.

c. presence of polycystic hepatobiliary liver disease.

d. number of years receiving hemodialysis treatments.

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

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

a. discontinued for 7 days prior to administering Parsabiv.

b. continued until Parsabiv reaches a therapeutic level.

c. discontinued the day before Parsabiv is administered.

d. continued for two weeks after starting Parsabiv.

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

Question Title

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

provide more content in a shorter amount of time.

reinforce the learning principles being taught.

validate the literacy level of the learner.

confirm that the patient understands the content.

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.

Question Title

* Water softeners in dialysis water treatment systems are used to

a. remove bacteria and endotoxin from treated water.

b. increase the life‑span of the reverse osmosis membrane.

c. decrease the sodium and chloride content of the feed water.

d. prevent biofilm formation in the distribution system.

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

NNCC Nephrology Nurse Question of the Month

February 2024

Question Title

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

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

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

Question Title

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

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?

Question Title

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

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

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

Question Title

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

Question Title

* Water softeners in dialysis water treatment systems are used to