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Fitzgerald- CKD Question and answers already passed 2025, Exams of Nursing

Newcastle UniversityNursing

Fitzgerald- CKD Question and answers already passed 2025

Typology: Exams

2024/2025

Available from 07/01/2025

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17
Fitzgerald-
CKD Question and answers already passed 2025
1. 1. All of the following elec-
trolyte disorders are com-
monly found in a person
with CKD except:
A. hypernatremia.
B. hypercalcemia.
C. hyperkalemia.
D. hypophosphatemia.
2. 2. All of the following are
common precipitating fac-
tors in AKI except:
A. acute hypotension.
B. sepsis.
C. hypovolemia.
D. T1DM.
3. 3. Common causes of CKD
include all of the following
except:
A. T2DM.
B. prior history of AKI.
Correct:
D.
hypophosphatemia.
The kidneys play an important role in maintaining
homeosta-
sis. Thus, CKD can lead to imbalances of fluid,
electrolytes, and
acid-base balance. A common finding is
hyperphosphatemia rather than hypophosphatemia (D).
Incorrect:
Electrolyte disorders commonly associated with AKI and advanced
CKD (particularly stages 4 and 5) include hyperkalemia (C), hyper-
calcemia (B), hyperphosphatemia, and hypernatremia (A).
Other
conditions can include bicarbonate deficiency (i.e.,
metabolic aci-
dosis).
Correct:
D.
T1DM.
AKI is characterized by an abrupt change and rapid decline in renal
function, often precipitated by a single event that is easily identifi-
able and potentially correctable. T1DM is a chronic genetic-based
condition with an autoimmune component leading to beta-cell
destruction and insulinopenia that will not likely precipitate rapid
changes in kidney function, though many years of T1DM,
particu- larly with poorly glycemic control, can lead to CKD.
Incorrect:
AKI can occur when there is decreased blood flow to the kidneys,
damage to the kidneys, or urine blockage in the kidneys. Pre-
cipitating events that can cause rapid decline in kidney
function include acute hypotension (A), sepsis (B) or other
infection, and hypovolemia (C) caused by acute blood loss or
dehydration.
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    1. All of the following elec- trolyte disorders are com- monly found in a person with CKD except: A. hypernatremia. B. hypercalcemia. C. hyperkalemia. D. hypophosphatemia.
    1. All of the following are common precipitating fac- tors in AKI except: A. acute hypotension. B. sepsis. C. hypovolemia. D. T1DM.
    1. Common causes of CKD include all of the following except: A. T2DM. B. prior history of AKI. Correct: D. hypophosphatemia. The kidneys play an important role in maintaining homeosta- sis. Thus, CKD can lead to imbalances of fluid, electrolytes, and acid-base balance. A common finding is hyperphosphatemia rather than hypophosphatemia (D). Incorrect: Electrolyte disorders commonly associated with AKI and advanced CKD (particularly stages 4 and 5) include hyperkalemia (C), hyper- calcemia (B), hyperphosphatemia, and hypernatremia (A). Other conditions can include bicarbonate deficiency (i.e., metabolic aci- dosis). Correct: D. T1DM. AKI is characterized by an abrupt change and rapid decline in renal function, often precipitated by a single event that is easily identifi- able and potentially correctable. T1DM is a chronic genetic-based condition with an autoimmune component leading to beta-cell destruction and insulinopenia that will not likely precipitate rapid changes in kidney function, though many years of T1DM, particu- larly with poorly glycemic control, can lead to CKD. Incorrect: AKI can occur when there is decreased blood flow to the kidneys, damage to the kidneys, or urine blockage in the kidneys. Pre- cipitating events that can cause rapid decline in kidney function include acute hypotension (A), sepsis (B) or other infection, and hypovolemia (C) caused by acute blood loss or dehydration.

2 / Correct: C. hypotension. CKD is a gradual loss of renal function over time. One of the most potent risk factors for this condition is hypertension, particularly with poor control, rather than hypotension (C). Hypotension is a risk factor for AKI.

4 / This patient presents with signs of urine blockage, thus indicating a postrenal cause of AKI and not prerenal azotemia (A). Acute glomerulonephritis (B) and acute tubular necrosis (C) are both intrinsic renal causes of AKI.

5 / 1.4 mg/dL and eGFR was 48 mL/min/1.73 m2. This clini- cal assessment is most con- sistent with: A. prerenal azotemia. B. acute glomerulonephri- tis. C. acute tubular necrosis. D. postrenal AKI.

    1. You see a 68-year-old woman with a history of hypertension, T2DM, and dyslipidemia for 20 years. She has a history of an acute coronary syndrome Correct: D. CKD For this patient with heart failure, her eGFR has held steady for the past 2 years and is stable at this visit, suggesting the absence of acute renal injury (AKI). CKD is present due to heart failure along with her long history of multiple comorbidities, including hypertension, T2DM, and dyslipidemia. She is currently at stage 3b event occurring 2 years ago based on her eGFR value. resulting in heart failure with reduced left ventric- ular ejection fraction. Her eGFR has held steady at Incorrect: There is no report of a rapid change in her renal function and so AKI should not be suspected for this patient. Her reduced renal function is likely a result of heart failure causing CKD due to, in part, around 42 mL/min/1.73 m2. chronic renal hypoperfusion that is caused by lower cardiac output. Today she presents with no symptoms, an eGFR of 44 mL/min/1.73 m2, SCr of 1.3 mg/dL, and BUN of 24 mg/dL. How would you best categorize her kidney dis- ease? A. prerenal AKI

7 / C. postrenal AKI D. CKD

    1. The patient in the pre- vious question experiences an exacerbation of heart failure. Today, her blood pressure is 90/68 mm Hg, BUN is 58 mg/dL (20. mmol/L), and SCr is 2. mg/dL (212.1 mmol/L), and Correct: A. prerenal AKI. In this patient following an exacerbation of heart failure, there is likely hypoperfusion of the kidneys due to a further acute decrease in cardiac output. Thus, this is a prerenal cause of AKI, superim- posed on her CKD, leading to azotemia, elevated SCr, and further decreased eGFR. Incorrect: The rapid changes in laboratory values and eGFR suggest AKI on eGFR is 20 mL/min/1.73 m2. top of her CKD (D). The most likely cause resulting from the heart These changes are most likely caused by: A. prerenal AKI. B. intrinsic AKI. C. postrenal AKI. D. CKD.
    1. Which of the following is found early in the develop- ment of CKD? A. persistent proteinuria B. anemia C. acute uremia D. hyperkalemia
    1. You see a 63-year-old man with a documented failure exacerbation is hypoperfusion of the kidneys leading to decreased renal function. This is a predominantly prerenal cause of AKI, thus not related to direct damage to the kidneys (intrinsic AKI [B]) or due to blockage of urine in the kidneys (postrenal AKI [C]). Correct: A. persistent proteinuria Protein in the urine is an early indicator of CKD, and recommenda- tions to screen for CKD include urinalysis, urine albumin/creatinine ratio (ACR), and SCr. Incorrect: Uremia (C), or elevated BUN, is a condition of high levels of urea in the blood, and acute uremia will more likely occur during AKI or more advanced CKD. Electrolyte disorders, such as hyperkalemia (D), and anemia (B) are associated with later stages

8 / of renal failure and not early development of CKD. Correct: C. elevated BUN; normal SCr. For an individual with normal renal function who experiences an

10 /

C

K

D

w it h o r w it h o u t d ia b e t e s m el li t u s. T hese agents work by re- ducing etterent arteriolar resistance (B), thus improving perfusion of the kidneys and reducing albuminuria. Combinations of these agents should not be used as there is greater risk of complications, such as AKI, without added benefit. These agents should also be avoided in patients with bilateral renal artery stenosis.

11 /

  1. Objective findings in patients with glomeru- Correct: D. hypotension. Glomerulonephritis is an intrinsic cause of renal disease and can be lonephritis include all of the due to poststreptococcal infection or an autoimmune reaction. As following except: A. edema. B. urinary RBC casts. C. proteinuria. D. hypotension. with other forms of AKI, this condition can lead to the development of edema as well as proteinuria and the presence of renal casts in the urine. Hypotension is not a typical finding associated with glomerulonephritis (D), though hypertension is. Incorrect: Similar to other forms of AKI, glomerulonephritis can be associated with edema (A) and proteinuria (C). RBC casts can also be present in the urine with this condition (B).
    1. A doubling of SCr is typi- Correct: B. 50% cally seen with a GFR reduc- Measurement of creatinine is used as a surrogate marker of kid- tion of. A. 25% B. 50% C. 75% D. 100%
    1. Creatinine clearance usually: A. approximates GFR. B. does not change as part of normative aging. ney function; in healthy individuals, creatinine production equals creatinine excretion. With decreased renal function, the SCr value increases. When the SCr level doubles, the eGFR is considered to have been halved; when SCr increases threefold, the eGFR is decreased by 75%. Incorrect: An increase in SCr generally indicated a decrease in eGFR. When SCr increases threefold, eGFR will decrease by 75% (C). An increase in SCr of 50% will cause a decrease in eGFR of 25% (A). A decrease of 100% in eGFR will indicate no renal function (D).

13 / D. increases with hypoten- sion.

    1. Creatinine is best de- scribed as: A. a substance produced by the kidney. B. a product related to skeletal muscle metabo- lism. Incorrect: Renal function decline is a normal age-related change and, thus, would impact creatinine clearance (B). SCr is proportional to mus- cle mass, and so males would have higher levels of SCr and higher creatinine clearance when compared to women (C). Hypotension can result is decreased perfusion of the kidneys and diminished renal function, thus lowering creatinine clearance (and GFR) (D). Correct: B. a product related to skeletal muscle metabolism. Creatinine is the end-product of creatine metabolism, which arises from skeletal muscle. Because creatinine excretion by a healthy kid- ney is eflcient, measurement of creatinine is used as a surrogate marker of kidney function. Incorrect: Creatinine is not produced by the kidney, but it is excreted by the C. produced by the liver and kidney (A). Creatinine is produced by skeletal muscles, not the liver filtered by the kidney. D. a by-product of protein metabolism.
    1. A referral to a nephrol- ogist should be considered with an ACR of: A. less than 1 mg/g. B. less than 10 mg/g. C. greater than 50 mg/g. D. greater than 300 mg/g.
      1. Guidelines recommend considering initiating treat- ment with an erythro-

14 / (C) , and is a by-product of creatine metabolism, which is not a protein (D). Correct: D. greater than 300 mg/g. ACR can provide a more sensitive and specific indicator for CKD than protein/creatinine ratio, as ACR is able to detect lower levels of protein in the urine. Even small amounts of albumin in the urine are considered an important prognostic factor. An ACR of 30 to 299 mg/g is moderately elevated, while values greater than 300 mg/g are severely elevated, typically requiring referral to a nephrologist (D). Correct: C. less than 10 mg/dL. Anemia of chronic disease is a common finding among patients with CKD. ESAs such as epoetin-α should be considered when he-

16 / fL ); re ti c ul o cy te s =

6 % ( % to 2 % ). disease is addressed or following administration of erythropoiet- ic- stimulating therapy.

17 /

  1. Which of the following is the most likely candidate to initiate dialysis resulting from CKD? A. a 46-year-old man with Correct: B. a 64-year-old woman with T2DM and eGFR = 28 mL/min/1.73 m Dialysis and kidney transplantation can be considered for patients approaching stage 4 CKD (eGFR 15 to 29 mL/min/1. m2) and/or who have advanced kidney damage. These patients are more likely hypertension and eGFR = 42 to develop severe complications from CKD. mL/min/1.73 m B. a 64-year-old woman with T2DM and eGFR = 28 mL/min/1.73 m C. a 76-year-old man with anemia and eGFR = 55 mL/min/1.73 m D. a 58-year-old woman with heart disease and eGFR = 46 mL/min/1.73 m Incorrect: Dialysis is not warranted for patients at stage 3 or below CKD (A, C, D), though these patients should be monitored closely for any changes in renal function. Patients with advanced renal disease and a limited life expectancy without intervention would also not be considered for renal replacement therapy. Conversely, in the presence of multiple life-shortening or a terminal illness other than CKD, the patient with stages 4 to 5 CKD could make the decision to forgo dialysis.