Certified Nephrology Nurse (CNN) Practice Questions
Amyloidosis
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?
a. Edema around the eyes upon awakening, progressing
to general swelling of the legs and body
b. Weight gain, malaise, fatigue, and frothy urine
c. Rust-colored urine, weight loss, and back pain
d. A and C
e. A and B
2. What steps need to be taken to diagnose and eliminate
the problem of dialysate leakage during peritoneal
dialysis?
a. Use a Dextrostick to ascertain the presence of
glucose.
b. Resuture the exit site, and stabilize or replace the
catheter.
c. LDiscontinue peritoneal dialysis to allow for healing,
or decrease the infusion time with the patient lying on
the left side.
d. Both A and B are true.
e. 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:
a. 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.
b. Hypotension must be avoided to prevent ischemia of
the newly transplanted kidney, even if fluid removal
during dialysis is compromised.
c. High-dose heparin must be used to prevent
postoperative clotting;
d. 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?
a. Nephrosclerosis
b. Diabetic nephropathy
c. Polycystic kidney disease
d.
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?
a. Epoetin alfa (Epogen, Procrit)
b. Cinacalcet HCl (Sensipar)
c. Furosemide (Lasix) or bumetanide (Bumex)
d. 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.
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.