NUR 257 CHRONIC ILLNESS MANAGEMENT EXAM 3
2026/2027 | 45 Actual Questions | Galen College | 100%
Correct Answers | Pass Guaranteed - A+ Graded
SECTION 1: CHRONIC KIDNEY DISEASE (CKD) & DIALYSIS
MANAGEMENT (Q1-10)
Q1. A 68-year-old male with CKD Stage 4 has a serum creatinine of 3.2 mg/dL, eGFR
of 24 mL/min/1.73m², and urine albumin-to-creatinine ratio (UACR) of 350 mg/g.
Which CKD staging and albuminuria category best describes this patient?
A. G3bA2 (moderately to severely decreased eGFR, moderately increased
albuminuria)
B. G4A2 (severely decreased eGFR, moderately increased albuminuria)
C. G4A3 (severely decreased eGFR, severely increased albuminuria)
D. G3bA3 (moderately to severely decreased eGFR, severely increased albuminuria)
Correct Answer: B. G4A2 (severely decreased eGFR, moderately increased
albuminuria) [CORRECT]
Rationale: KDIGO 2024 CKD classification uses GFR categories (G1 ≥90, G2 60-89,
G3a 45-59, G3b 30-44, G4 15-29, G5 <15) and albuminuria categories (A1 <30, A2
30-300, A3 >300 mg/g). An eGFR of 24 = G4 (15-29), and UACR of 350 = A2 (30-300,
moderately increased). UACR >300 would be A3, but 350 mg/g is borderline A2/A3;
however, standard classification uses 30-300 for A2. G3b (30-44) is incorrect for eGFR
24. G4A3 would require UACR >300, but 350 is often classified as high A2.
Q2. A 55-year-old female on hemodialysis three times weekly receives epoetin alfa
for anemia of CKD. Her hemoglobin is 9.8 g/dL, ferritin is 45 ng/mL, and TSAT is 18%.
What is the priority intervention?
,A. Increase epoetin alfa dose to achieve hemoglobin >13 g/dL
B. Administer IV iron supplementation to replete iron stores before adjusting ESA
C. Discontinue epoetin alfa and transfuse packed RBCs
D. Switch to darbepoetin alfa with no change in iron management
Correct Answer: B. Administer IV iron supplementation to replete iron stores
before adjusting ESA [CORRECT]
Rationale: KDIGO guidelines recommend maintaining ferritin >100-500 ng/mL and
TSAT >20% for optimal ESA response. This patient's ferritin (45) and TSAT (18%)
indicate absolute iron deficiency, which will limit ESA effectiveness regardless of dose
escalation. IV iron is preferred over oral iron in dialysis patients due to poor oral
absorption and need for rapid repletion. Target hemoglobin is 10-11.5 g/dL;
exceeding 13 g/dL increases cardiovascular risk. RBC transfusion is reserved for acute
symptomatic anemia or hemoglobin <7-8 g/dL.
Q3. A 62-year-old male with CKD Stage 5D on hemodialysis has a serum phosphorus
of 6.8 mg/dL (goal <5.5), calcium of 8.2 mg/dL, and PTH of 580 pg/mL (goal 150-
300). Which medication combination is most appropriate?
A. Calcium carbonate with meals + sevelamer with meals + calcitriol
B. Calcium acetate with meals + lanthanum carbonate + cinacalcet
C. Aluminum hydroxide with every meal + vitamin D3 (cholecalciferol)
D. Sevelamer only + no phosphate binder with snacks
Correct Answer: B. Calcium acetate with meals + lanthanum carbonate +
cinacalcet [CORRECT]
Rationale: This patient has severe hyperphosphatemia (6.8) with elevated PTH (580),
indicating secondary hyperparathyroidism. Management requires: 1) Phosphate
binders with every meal AND snacks (calcium acetate or sevelamer); 2) Calcimimetic
(cinacalcet) to suppress PTH secretion by activating calcium-sensing receptors on the
parathyroid gland; 3) Active vitamin D (calcitriol or paricalcitol) may be added but
requires careful monitoring. Calcium-based binders alone are insufficient for this
severity. Aluminum hydroxide is avoided long-term due to aluminum toxicity.
Vitamin D3 is not active and requires renal conversion, which is impaired in CKD 5D.
, Q4. A 70-year-old female with an arteriovenous fistula (AVF) in her left upper arm for
hemodialysis reports pain, redness, and warmth over the fistula site. Her temperature
is 101.2°F. The fistula has a palpable thrill and audible bruit. What is the priority
nursing intervention?
A. Apply warm compresses and schedule dialysis for the next available slot
B. Obtain blood cultures, initiate empiric antibiotics per protocol, and notify the
nephrologist
C. Cannulate the fistula for immediate dialysis to "flush out" the infection
D. Apply ice packs to reduce inflammation and discontinue anticoagulation
Correct Answer: B. Obtain blood cultures, initiate empiric antibiotics per
protocol, and notify the nephrologist [CORRECT]
Rationale: AVF infection (vascular access infection) is a serious complication
requiring blood cultures, empiric antibiotics (typically vancomycin + gram-negative
coverage), and nephrology consultation. The presence of fever, erythema, and
warmth indicates active infection. Cannulating an infected fistula risks bacteremia
and sepsis. Warm compresses alone are insufficient for suspected bacteremia. Ice
packs and anticoagulation discontinuation are inappropriate and do not address the
infection. The fistula may need temporary abandonment if infection is severe.
Q5. A 58-year-old male on peritoneal dialysis (PD) reports cloudy effluent, abdominal
pain, and fever of 102°F. The PD catheter exit site appears normal. What is the most
likely diagnosis and initial management?
A. Exit site infection; topical antibiotics and exit site care
B. Peritonitis; send effluent for cell count, Gram stain, culture, and initiate empiric
intraperitoneal antibiotics
C. Catheter malfunction; flush the catheter with heparin
D. Constipation; increase dietary fiber and stool softeners
Correct Answer: B. Peritonitis; send effluent for cell count, Gram stain, culture,
and initiate empiric intraperitoneal antibiotics [CORRECT]
2026/2027 | 45 Actual Questions | Galen College | 100%
Correct Answers | Pass Guaranteed - A+ Graded
SECTION 1: CHRONIC KIDNEY DISEASE (CKD) & DIALYSIS
MANAGEMENT (Q1-10)
Q1. A 68-year-old male with CKD Stage 4 has a serum creatinine of 3.2 mg/dL, eGFR
of 24 mL/min/1.73m², and urine albumin-to-creatinine ratio (UACR) of 350 mg/g.
Which CKD staging and albuminuria category best describes this patient?
A. G3bA2 (moderately to severely decreased eGFR, moderately increased
albuminuria)
B. G4A2 (severely decreased eGFR, moderately increased albuminuria)
C. G4A3 (severely decreased eGFR, severely increased albuminuria)
D. G3bA3 (moderately to severely decreased eGFR, severely increased albuminuria)
Correct Answer: B. G4A2 (severely decreased eGFR, moderately increased
albuminuria) [CORRECT]
Rationale: KDIGO 2024 CKD classification uses GFR categories (G1 ≥90, G2 60-89,
G3a 45-59, G3b 30-44, G4 15-29, G5 <15) and albuminuria categories (A1 <30, A2
30-300, A3 >300 mg/g). An eGFR of 24 = G4 (15-29), and UACR of 350 = A2 (30-300,
moderately increased). UACR >300 would be A3, but 350 mg/g is borderline A2/A3;
however, standard classification uses 30-300 for A2. G3b (30-44) is incorrect for eGFR
24. G4A3 would require UACR >300, but 350 is often classified as high A2.
Q2. A 55-year-old female on hemodialysis three times weekly receives epoetin alfa
for anemia of CKD. Her hemoglobin is 9.8 g/dL, ferritin is 45 ng/mL, and TSAT is 18%.
What is the priority intervention?
,A. Increase epoetin alfa dose to achieve hemoglobin >13 g/dL
B. Administer IV iron supplementation to replete iron stores before adjusting ESA
C. Discontinue epoetin alfa and transfuse packed RBCs
D. Switch to darbepoetin alfa with no change in iron management
Correct Answer: B. Administer IV iron supplementation to replete iron stores
before adjusting ESA [CORRECT]
Rationale: KDIGO guidelines recommend maintaining ferritin >100-500 ng/mL and
TSAT >20% for optimal ESA response. This patient's ferritin (45) and TSAT (18%)
indicate absolute iron deficiency, which will limit ESA effectiveness regardless of dose
escalation. IV iron is preferred over oral iron in dialysis patients due to poor oral
absorption and need for rapid repletion. Target hemoglobin is 10-11.5 g/dL;
exceeding 13 g/dL increases cardiovascular risk. RBC transfusion is reserved for acute
symptomatic anemia or hemoglobin <7-8 g/dL.
Q3. A 62-year-old male with CKD Stage 5D on hemodialysis has a serum phosphorus
of 6.8 mg/dL (goal <5.5), calcium of 8.2 mg/dL, and PTH of 580 pg/mL (goal 150-
300). Which medication combination is most appropriate?
A. Calcium carbonate with meals + sevelamer with meals + calcitriol
B. Calcium acetate with meals + lanthanum carbonate + cinacalcet
C. Aluminum hydroxide with every meal + vitamin D3 (cholecalciferol)
D. Sevelamer only + no phosphate binder with snacks
Correct Answer: B. Calcium acetate with meals + lanthanum carbonate +
cinacalcet [CORRECT]
Rationale: This patient has severe hyperphosphatemia (6.8) with elevated PTH (580),
indicating secondary hyperparathyroidism. Management requires: 1) Phosphate
binders with every meal AND snacks (calcium acetate or sevelamer); 2) Calcimimetic
(cinacalcet) to suppress PTH secretion by activating calcium-sensing receptors on the
parathyroid gland; 3) Active vitamin D (calcitriol or paricalcitol) may be added but
requires careful monitoring. Calcium-based binders alone are insufficient for this
severity. Aluminum hydroxide is avoided long-term due to aluminum toxicity.
Vitamin D3 is not active and requires renal conversion, which is impaired in CKD 5D.
, Q4. A 70-year-old female with an arteriovenous fistula (AVF) in her left upper arm for
hemodialysis reports pain, redness, and warmth over the fistula site. Her temperature
is 101.2°F. The fistula has a palpable thrill and audible bruit. What is the priority
nursing intervention?
A. Apply warm compresses and schedule dialysis for the next available slot
B. Obtain blood cultures, initiate empiric antibiotics per protocol, and notify the
nephrologist
C. Cannulate the fistula for immediate dialysis to "flush out" the infection
D. Apply ice packs to reduce inflammation and discontinue anticoagulation
Correct Answer: B. Obtain blood cultures, initiate empiric antibiotics per
protocol, and notify the nephrologist [CORRECT]
Rationale: AVF infection (vascular access infection) is a serious complication
requiring blood cultures, empiric antibiotics (typically vancomycin + gram-negative
coverage), and nephrology consultation. The presence of fever, erythema, and
warmth indicates active infection. Cannulating an infected fistula risks bacteremia
and sepsis. Warm compresses alone are insufficient for suspected bacteremia. Ice
packs and anticoagulation discontinuation are inappropriate and do not address the
infection. The fistula may need temporary abandonment if infection is severe.
Q5. A 58-year-old male on peritoneal dialysis (PD) reports cloudy effluent, abdominal
pain, and fever of 102°F. The PD catheter exit site appears normal. What is the most
likely diagnosis and initial management?
A. Exit site infection; topical antibiotics and exit site care
B. Peritonitis; send effluent for cell count, Gram stain, culture, and initiate empiric
intraperitoneal antibiotics
C. Catheter malfunction; flush the catheter with heparin
D. Constipation; increase dietary fiber and stool softeners
Correct Answer: B. Peritonitis; send effluent for cell count, Gram stain, culture,
and initiate empiric intraperitoneal antibiotics [CORRECT]
