CNN Practice Questions

1. There are two mechanisms of dialysis: diffusion and

ultrafiltration. Which of the following statements best describe
ultrafiltration (convective transport)?
a Hydrostatic or osmotic pressure forces water through a semipermeable
membrane, creating a "solvent drag," in which water carries solutes at
or near their original concentration.
b Large molecules flow through the semipermeable membrane during
"solvent drag."
c Particles in low concentration flow through the membrane to an area of
high particle concentration.
d Solutes and catabolic wastes transfer into the blood from the high
dialysate concentration.
2. Which of the following dialyzers uses the rectangular cross
section for basic blood flow geometries?
a Synthetic membranes
b Parallel plate dialyzers
c Hollow fiber dialyzers
d Cellulose membranes
3. Cellulose is a complex carbohydrate polymer, which is the main
structural material found in plant life. Membranes manufactured
from cellulose are frequently used in dialysis. What are the
advantages and disadvantages of this type of membrane?
a It is reusable, but it is expensive.
b It is easy to use, but waste disposal is a problem.
c It is low cost, but it is bioincompatible with blood.
d It is biocompatible, but it uses back filtration from dialysate to blood.
4. A peritoneal dialysis patient presents with complaints of
abdominal pain, nausea, and vomiting. He states that the solution
he emptied from his dialysis outflow was cloudy. What tests should
the physician order at this time?
a Peritoneal cell count
b Culture of peritoneal effluent
c Stool culture
d A and B
e A and C
5. A patient is admitted for testing as a renal transplantation
recipient. Upon reviewing the blood work, the nurse notices that his
blood type is B-. When determining kidney compatibility for this
patient, what are the factors involving blood type that must be
considered?
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 done.
d Both A and B are true.

e Both B and C are true.

Answers
1. A: Ultrafiltration occurs when hydrostatic pressure or an osmotic pressure
forces water through the semipermeable membrane. The water carries
solutes, at or near their original concentration, in a process called "solvent
drag." Larger molecules remain, with the membrane acting as a filter, or
sieve. When the concentration of a certain type of particle is higher on one
side of a membrane than on the other side, a concentration gradient exists.
In this situation, particles in high concentration flow through the membrane
to the low concentration side. Solutes and catabolic waste products transfer
from the blood where a high concentration exists into the lower dialysate
concentration.
2. B: There are two blood flow geometries, the rectangular cross section
seen in parallel plate dialyzers and the circular cross section found in hollow
fiber dialyzers. Synthetic and cellulose are descriptions of the materials used
to produce the membranes used in dialysis.
3. C: The advantage of cellulose membrane usage is low cost; the
disadvantage is that all cellulose membranes have some bioincompatibility
with blood. Synthetic membranes are reusable and biocompatible. The
disadvantages of synthetic membranes include their expense in comparison
to cellulose membranes, their high-water permeability that results in the
need for ultrafiltration, the 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.
Certified Nephrology Nurse (CNN) Practice Questions
1. Diabetic nephropathy results from an elevation of blood pressure,
increasing the workload of the glomeruli. The glomeruli thicken and allow

serum albumin to pass into the urine. Which of the following signs and
symptoms indicate diabetic nephropathy?
e Edema around the eyes upon awakening, progressing to general
swelling of the legs and body
f Weight gain, malaise, fatigue, and frothy urine
g Rust-colored urine, weight loss, and back pain
h A and C
i A and B
2. What steps need to be taken to diagnose and eliminate the problem of
dialysate leakage during peritoneal dialysis?
e Use a Dextrostick to ascertain the presence of glucose.
f Resuture the exit site, and stabilize or replace the catheter.
g LDiscontinue peritoneal dialysis to allow for healing, or decrease the
infusion time with the patient lying on the left side.
h Both A and B are true.
i Both B and C are true.
3. Certain precautions must be followed when performing dialysis on a recent
transplant recipient. All of the following statements regarding dialysis for the
post-transplant patient are true EXCEPT:
e Close observation is necessary for hypotension because of the risk of
internal bleeding in first 24 hours postsurgery; a physician must be
alerted if hypotension occurs.
f Hypotension must be avoided to prevent ischemia of the newly
transplanted kidney, even if fluid removal during dialysis is
compromised.
g High-dose heparin must be used to prevent postoperative clotting;
h Observation is necessary for electrolyte imbalance, especially
hyperkalemia.
4. A patient is admitted with the following signs and symptoms: edema
around the eyes upon awakening, progressing to general swelling of the legs
and body; weight gain; fatigue; headache; nausea; vomiting; frequent
hiccoughs; and itching. A urine specimen is obtained, and the urine is frothy.
The patient has a history of insulin-dependent diabetes (type 1 diabetes),
which is poorly controlled, and high blood pressure, and his blood work
comes back showing an elevated cholesterol level. Which of the following
disease processes would you suspect?
f Nephrosclerosis
g Diabetic nephropathy
h Polycystic kidney disease
i Amyloidosis
5. Damaged kidneys lose their ability to produce erythropoietin, a hormone
that stimulates the formation of red blood cells. What is usually prescribed to
stimulate erythropoiesis in patients with chronic kidney disease?
f Epoetin alfa (Epogen, Procrit)
g Cinacalcet HCl (Sensipar)
h Furosemide (Lasix) or bumetanide (Bumex)

i Sevelamer hydrochloride (Renagel)

Certified Nephrology Nurse (CNN) Answer Key
1. Answer: E
Symptoms and signs of diabetic nephropathy include edema around the eyes
upon awakening, progressing to general swelling of the legs and body,
weight gain, frothy urine, malaise, fatigue, nausea and vomiting, headache,
hiccoughs, and pruritus. Serum creatinine and blood urea nitrogen levels
elevate at this stage. The additional diagnosis of retinopathy may be evident.
2. Answer: D
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 allow healing, (3) if unable to stop
therapy, decrease volume with automated peritoneal dialysis in supine
position; and (4) stabilize or replace the catheter.
3. Answer: C
The main precautions that must be followed when performing dialysis on a
recent transplant recipient are:
(1) Observe for hypotension as a result of the risk of internal bleeding in first
24 hours postsurgery, and then alert the physician if hypotension occurs. (2)
Avoid hypotension to prevent ischemia of the newly transplanted kidney,
even if fluid removal during dialysis is compromised. (3) Maintain the
integrity of the surgical incision site. (4) Use heparin-free or minimal
anticoagulation therapy for newly postoperative patients and for those who
have had a percutaneous renal biopsy. (5) Observe for an electrolyte
imbalance, especially hyperkalemia.
4. Answer: B
Diabetic nephropathy is the most common cause of chronic kidney disease in
Western countries. It affects insulin-dependent diabetics, or type 1 diabetes,
and non-insulin dependent diabetics, or type 2 diabetes. Those with poorly
controlled blood sugar levels, uncontrolled high blood pressure, and elevated
cholesterol levels are at highest risk. This disease process involves an
increase in the blood flow to 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 pass into the
urine (albuminuria). This sign is detectable only by medical testing and
begins several years before symptoms are apparent. At this stage, kidney
biopsy confirms the diagnosis. Nephrosclerosis is the hardening of the
arterioles of the kidneys caused by uncontrolled high blood pressure.
Polycystic kidney disease is a genetic disorder in which fluid-filled cysts
replace normal healthy kidney tissue. Amyloidosis refers to a condition in
which proteins (amyloid proteins) have been altered and become insoluble,
then deposit in various organs.
5. Answer: A
Recombinant human erythropoietin, or epoetin alfa, (Epogen, Procrit) is used
to stimulate red blood cell production in patients with end state renal
disease. Cinacalcet HCl (Senispar) is a drug used for lowering the level of

parathyroid 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.