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December 2022

Question Title

* A 75-year-old patient on maintenance hemodialysis frequently experiences intradialytic hypotension.  To maintain the patient’s blood pressure during a hemodialysis treatment, the NP initially should order midodrine hydrochloride (ProAmatine) to be taken

The correct answer is b. predialysis.

Rationale: Midodrine, an oral α-adrenergic agonist, reduces the frequency of intradialytic hypotension. It is administered prior to the dialysis treatment.

Reference: Counts, C. S.  (Ed.)  ANNA Core Curriculum for Nephrology Nursing, 7th ed, page 1290.

July 2022

Question Title

* An NP prescribes minoxidil (Loniten) for a patient who has CKD.  The patient should be monitored for

The correct answer is a. pericardial effusion.

Rationale:  Minoxidil may produce serious adverse effects. It can cause pericardial effusion that may progress to tamponade, and angina pectoris may be exacerbated. Patients with kidney impairment who are not on dialysis may be at higher risk. Therefore, CKD patients receiving minoxidil must be closely supervised.

Reference: Counts, C. (Ed.) ANNA Core Curriculum for Nephrology Nursing, 7th ed., page 477; Pfizer, Minoxidil package insert - Note boxed warning.
February 2022

Question Title

* An 8-year-old child diagnosed with renal dysplasia is preparing to start hemodialysis.  The NP understands that the best time to begin education regarding transitioning to adult care is when the child

The correct answer is c. is 10-14 years of age.

Rationale: The formal transition process from child to adult care should begin between the ages of 10-14 and should be individualized according to the child’s neurocognitive and developmental status.

Reference: Counts, C. (Ed.) ANNA Core Curriculum for Nephrology Nursing, 7th ed., page 747.
September 2021

Question Title

* A patient with secondary hyperparathyroidism (SHPT) is on maintenance hemodialysis. Despite increasing doses of cinacalcet (Sensipar), the patient’s PTH level has not decreased/improved.  The NP prescribes etelcalcetide (Parsabiv) in place of Sensipar.  The recommended starting dose of Parsabiv is

The correct answer is b. 5 mg.

Rationale:  Etelcalcetide (Parsabiv) is indicated for the treatment of secondary hyperparathyroidism (SHPT) in ESRD patients on hemodialysis. It is most often prescribed for those patients who fail to respond sufficiently to cinacalcet. The initial recommended dose is 5 mg IV bolus three times per week at the end of the treatment.

Reference:  Quarles, L.D. & Berkoben, M. Management of secondary hyperparathyroidism in adult hemodialysis patients. UpToDate. Last updated: March 15,2021
April 2021

Question Title

* According the KDOQI Guidelines for pediatric vascular access, which characteristic indicates a patient should be referred for permanent vascular access placement?

The correct answer is a. Weight of 25 kg (55 lb).

Rationale: Serious consideration should be given to placing permanent vascular access in children greater than 20 kg who are expected to wait more than 1 year for a kidney transplant. A central venous catheter may be acceptable for patients bridging on hemodialysis awaiting transition to peritoneal dialysis.

Reference: ANNA Core Curriculum for Nephrology Nursing, 7th ed., page 1473
November 2020

Question Title

* During rounds in an in-center hemodialysis facility, the NP notes that a patient is prescribed pregabalin (Lyrica) 75 mg BID for neuropathic pain.  Which of these actions should the NP take?

The correct answer is a. decrease the dose.

Rationale: Pregabalin is primarily excreted by the kidney and requires dosage adjustment in patients with kidney disease. It is also removed by conventional dialysis, and a supplemental dose is required post-hemodialysis. Both the prescribed Lyrica dose and the supplemental dose are too high for a patient with ESRD on hemodialysis.

Reference: Lexicomp, Drug Information Handbook for Advanced Practice Nursing, 17th ed., page 1862 - for eGFR < 15 mL/min - single daily dose of 25-75 mg; Post-hemodialysis supplemental dosage as a single supplemental dose based on usual daily dose, e.g., “25 mg/day schedule: Single supplementary dose of 25 mg or 50 mg.”

June 2020

Question Title

* The NP is teaching a patient who is in peritoneal dialysis (PD) training about the need for routine dialysis adequacy testing.  The NP should explain that the most common reason for a reduction in PD adequacy is


The correct answer b. decreasing residual kidney function.

Rationale: Residual kidney function can account for approximately 50% of the clearance of salt, water, small and medium size solutes in new-start patients on PD.  As residual kidney function decreases, so does adequacy.

Reference: References: Daugirdas, J. T., et al. (2015). Handbook of Dialysis, 5th ed., pp. 406, 468, 471, & 476; Gilbert. S.J., & Weiner, D.E. (Eds.). (2018). NKF Primer on Kidney Diseases, 7th ed., pp. 546, 550.
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