CHRONIC KIDNEY DISEASE (CKD) – CNN FINAL EXAMINATION 2026
COURSE CODE: NURS 3130
COURSE TITLE: Adult Health Nursing II
CNN EXAM – CHRONIC KIDNEY DISEASE (CKD)
(Clinical Nursing Competency Examination)
ACADEMIC YEAR: 2025/2026
SEMESTER: II
EXAM TYPE: Comprehensive Written Examination
TIME ALLOWED: 3 Hours
TOTAL MARKS: 100 Marks
The patient with CKD is receiving dialysis, and the nurse observes excoriations on the patient's
skin. What
pathophysiologic changes in CKD can contribute to this finding (select all that apply)?
a. Dry skin
b. Sensory neuropathy
c. Vascular calcifications
d. Calcium-phosphate skin deposits
e. Uremic crystallization from high BUN
a, b, d. Pruritus is common in patients receiving dialysis.
It causes scratching from dry skin, sensory neuropathy,
,and calcium-phosphate deposition in the skin. Vascular
calcifications contribute to cardiovascular disease, not to
itching skin. Uremic frost rarely occurs without BUN levels
greater than 200 mg/dL, which should not occur in a patient
on dialysis; urea crystallizes on the skin and also causes
pruritus.
What accurately describes the care of the patient with CKD?
a. A nutrient that is commonly supplemented for the patient on dialysis because it is dialyzable
is iron.
b. The syndrome that includes all of the signs and symptoms seen in the various body systems in
CKD is azotemia.
c. The use of morphine is contraindicated in the patient with CKD because accumulation of its
metabolites may
cause seizures.
d. The use of calcium-based phosphate binders in the patient with CKD is contraindicated when
serum calcium
levels are increased.
d. In the patient with CKD, when serum calcium levels
are increased, calcium-based phosphate binders are not
used. The nutrient supplemented for patients on dialysis is
folic acid. The various body system manifestations occur
with uremia, which includes azotemia. Meperidine is
contraindicated in patients with CKD related to possible
seizures.
,The patient with chronic kidney disease is considering whether to use peritoneal dialysis (PD) or
hemodialysis (HD).
What are advantages of PD when compared to HD (select all that apply)?
a. Less protein loss
b. Rapid fluid removal
c. Less cardiovascular stress
d. Decreased hyperlipidemia
e. Requires fewer dietary restrictions
c, e. Peritoneal dialysis is less stressful for the
cardiovascular system and requires fewer dietary
restrictions. Peritoneal dialysis actually contributes to more
protein loss and increased hyperlipidemia. The fluid and
creatinine removal are slower with peritoneal dialysis than
hemodialysis.
In which type of dialysis does the patient dialyze during sleep and leave the fluid in the
abdomen during the day?
a. Long nocturnal hemodialysis
b. Automated peritoneal dialysis (APD)
c. Continuous venovenous hemofiltration (CVVH)
d. Continuous ambulatory peritoneal dialysis (CAPD)
b. Automated peritoneal dialysis (APD) is the type of
dialysis in which the patient dialyzes during sleep and
leaves the fluid in the abdomen during the day. Long
nocturnal hemodialysis occurs while the patient is
, sleeping and is done up to six times per week. Continuous
venovenous hemofiltration (CVVH) is a type of continuous
renal replacement therapy used to treat AKI. Continuous
ambulatory peritoneal dialysis (CAPD) is dialysis that is
done with exchanges of 1.5 to 3 L of dialysate at least four
times daily.
To prevent the most common serious complication of PD, what is important for the nurse to do?
a. Infuse the dialysate slowly.
b. Use strict aseptic technique in the dialysis procedures.
c. Have the patient empty the bowel before the inflow phase.
d. Reposition the patient frequently and promote deep breathing.
b. Peritonitis is a common complication of peritoneal
dialysis (PD) and may require catheter removal
and termination of dialysis. Infection occurs from
contamination of the dialysate or tubing or from
progression of exit-site or tunnel infections and strict
sterile technique must be used by health professionals as
well as the patient to prevent contamination. Too-rapid
infusion may cause shoulder pain and pain may be caused
if the catheter tip touches the bowel. Difficulty breathing,
atelectasis, and pneumonia may occur from pressure of
the fluid on the diaphragm, which may be prevented by
elevating the head of the bed and promoting repositioning
and deep breathing.
COURSE CODE: NURS 3130
COURSE TITLE: Adult Health Nursing II
CNN EXAM – CHRONIC KIDNEY DISEASE (CKD)
(Clinical Nursing Competency Examination)
ACADEMIC YEAR: 2025/2026
SEMESTER: II
EXAM TYPE: Comprehensive Written Examination
TIME ALLOWED: 3 Hours
TOTAL MARKS: 100 Marks
The patient with CKD is receiving dialysis, and the nurse observes excoriations on the patient's
skin. What
pathophysiologic changes in CKD can contribute to this finding (select all that apply)?
a. Dry skin
b. Sensory neuropathy
c. Vascular calcifications
d. Calcium-phosphate skin deposits
e. Uremic crystallization from high BUN
a, b, d. Pruritus is common in patients receiving dialysis.
It causes scratching from dry skin, sensory neuropathy,
,and calcium-phosphate deposition in the skin. Vascular
calcifications contribute to cardiovascular disease, not to
itching skin. Uremic frost rarely occurs without BUN levels
greater than 200 mg/dL, which should not occur in a patient
on dialysis; urea crystallizes on the skin and also causes
pruritus.
What accurately describes the care of the patient with CKD?
a. A nutrient that is commonly supplemented for the patient on dialysis because it is dialyzable
is iron.
b. The syndrome that includes all of the signs and symptoms seen in the various body systems in
CKD is azotemia.
c. The use of morphine is contraindicated in the patient with CKD because accumulation of its
metabolites may
cause seizures.
d. The use of calcium-based phosphate binders in the patient with CKD is contraindicated when
serum calcium
levels are increased.
d. In the patient with CKD, when serum calcium levels
are increased, calcium-based phosphate binders are not
used. The nutrient supplemented for patients on dialysis is
folic acid. The various body system manifestations occur
with uremia, which includes azotemia. Meperidine is
contraindicated in patients with CKD related to possible
seizures.
,The patient with chronic kidney disease is considering whether to use peritoneal dialysis (PD) or
hemodialysis (HD).
What are advantages of PD when compared to HD (select all that apply)?
a. Less protein loss
b. Rapid fluid removal
c. Less cardiovascular stress
d. Decreased hyperlipidemia
e. Requires fewer dietary restrictions
c, e. Peritoneal dialysis is less stressful for the
cardiovascular system and requires fewer dietary
restrictions. Peritoneal dialysis actually contributes to more
protein loss and increased hyperlipidemia. The fluid and
creatinine removal are slower with peritoneal dialysis than
hemodialysis.
In which type of dialysis does the patient dialyze during sleep and leave the fluid in the
abdomen during the day?
a. Long nocturnal hemodialysis
b. Automated peritoneal dialysis (APD)
c. Continuous venovenous hemofiltration (CVVH)
d. Continuous ambulatory peritoneal dialysis (CAPD)
b. Automated peritoneal dialysis (APD) is the type of
dialysis in which the patient dialyzes during sleep and
leaves the fluid in the abdomen during the day. Long
nocturnal hemodialysis occurs while the patient is
, sleeping and is done up to six times per week. Continuous
venovenous hemofiltration (CVVH) is a type of continuous
renal replacement therapy used to treat AKI. Continuous
ambulatory peritoneal dialysis (CAPD) is dialysis that is
done with exchanges of 1.5 to 3 L of dialysate at least four
times daily.
To prevent the most common serious complication of PD, what is important for the nurse to do?
a. Infuse the dialysate slowly.
b. Use strict aseptic technique in the dialysis procedures.
c. Have the patient empty the bowel before the inflow phase.
d. Reposition the patient frequently and promote deep breathing.
b. Peritonitis is a common complication of peritoneal
dialysis (PD) and may require catheter removal
and termination of dialysis. Infection occurs from
contamination of the dialysate or tubing or from
progression of exit-site or tunnel infections and strict
sterile technique must be used by health professionals as
well as the patient to prevent contamination. Too-rapid
infusion may cause shoulder pain and pain may be caused
if the catheter tip touches the bowel. Difficulty breathing,
atelectasis, and pneumonia may occur from pressure of
the fluid on the diaphragm, which may be prevented by
elevating the head of the bed and promoting repositioning
and deep breathing.
