Renal: AKI, CKD, dialysis and electrolytes

26 AIIMS NORCET (Nursing Officer) practice questions on Renal: AKI, CKD, dialysis and electrolytes, part of Medical-Surgical Nursing. The first 25 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

1. Question 1 · Medium

   Which instruction is most important for a patient being treated for renal colic from a ureteric stone?

   1. AAvoid all calcium in the diet
   2. BStrain all urine and save any stone passed
   3. CRestrict fluids to 1 litre a day
   4. DStay in bed until the pain has gone

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   Answer: B · Strain all urine and save any stone passed

   Straining all urine catches the stone so it can be analysed, and its type guides diet and drug prevention. Small stones often pass on their own with pain relief and adequate fluids. Walking is encouraged, as it may help passage. Fever with renal colic suggests an infected, obstructed kidney and needs urgent review.

   • A: Cutting out dietary calcium increases oxalate absorption and stone risk.
   • C: Restricting fluids concentrates the urine and promotes stone growth.
   • D: Activity may help the stone pass; bed rest is not needed.

2. Question 2 · Medium

   Calcium carbonate prescribed as a phosphate binder in CKD is most effective when taken:

   1. AWith the morning iron tablet
   2. BAt bedtime on an empty stomach
   3. CTwo hours after meals
   4. DWith meals

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   Answer: D · With meals

   Phosphate binders work by combining with phosphate from food in the gut so that it is passed in the stool. They must be in the gut at the same time as the food, so they are taken with meals. Controlling phosphate helps prevent secondary hyperparathyroidism and renal bone disease. Calcium reduces iron absorption, so the two are taken at different times.

   • A: Calcium reduces iron absorption, so they should be separated.
   • B: On an empty stomach there is no dietary phosphate to bind.
   • C: Two hours after a meal much of the phosphate has already been absorbed.

3. Question 3 · Easy

   Which fluid is used for continuous bladder irrigation after transurethral resection of the prostate (TURP)?

   1. A5% dextrose in water
   2. BSterile distilled water
   3. CSterile 0.9% sodium chloride
   4. DRinger lactate with potassium

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   Answer: C · Sterile 0.9% sodium chloride

   Isotonic sterile normal saline is used for continuous bladder irrigation after TURP because it is not hypotonic and is safe if some is absorbed. It flows in through a three-way catheter and keeps clots from forming and blocking the catheter. The rate is adjusted to keep the drainage light pink. Output minus irrigation input gives the true urine output.

   • A: Dextrose is not used for bladder irrigation and supports bacterial growth.
   • B: Water is hypotonic and can cause haemolysis and hyponatraemia if absorbed.
   • D: Potassium-containing fluid has no place in bladder irrigation.

4. Question 4 · Easy

   In a patient on peritoneal dialysis, cloudy dialysate outflow is an early sign of:

   1. AFluid overload
   2. BCatheter blockage
   3. CHypoglycaemia
   4. DPeritonitis

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   Answer: D · Peritonitis

   Normal peritoneal dialysate drains clear and pale yellow. A cloudy outflow, often with abdominal pain and fever, is the earliest sign of peritonitis, the main complication of peritoneal dialysis. The bag is sent for cell count, Gram stain and culture, and antibiotics are often given into the dialysate. Strict aseptic technique at every exchange prevents it.

   • A: Fluid overload causes oedema and breathlessness, not cloudy fluid.
   • B: A blocked catheter slows the outflow; it does not make it cloudy.
   • C: The dialysate contains glucose; cloudiness does not mean hypoglycaemia.

5. Question 5 · Hard

   A patient's pre-dialysis weight is 72.6 kg and her dry weight is 70.0 kg. During the session she will drink 200 mL, and 300 mL of saline will be returned at rinse-back. What total ultrafiltration volume should be set to reach dry weight?

   1. A2.9 L
   2. B2.1 L
   3. C3.1 L
   4. D2.6 L

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   Answer: C · 3.1 L

   The fluid to remove is the excess weight, 72.6 - 70.0 = 2.6 kg, which is about 2.6 L. Fluid that enters during the session must also be removed: 0.2 L drunk and 0.3 L of rinse-back saline. The total is 2.6 + 0.2 + 0.3 = 3.1 L. Removing too much too fast causes cramps and hypotension, so the nurse watches the BP during the session.

   • A: Two point nine litres adds the rinse-back but forgets the drink.
   • B: Two point one litres subtracts the session intake instead of adding it.
   • D: Two point six litres ignores the fluid taken in during the session.

6. Question 6 · Easy

   Twitching of the facial muscles when the facial nerve is tapped in front of the ear (Chvostek's sign) suggests:

   1. AHyperkalaemia
   2. BHypernatraemia
   3. CHypercalcaemia
   4. DHypocalcaemia

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7. Question 7 · Hard

   A 58-year-old on haemodialysis missed two sessions. Serum K+ is 7.2 mEq/L (normal 3.5-5.0), and the ECG shows peaked T waves and a widening QRS. The doctor orders IV calcium gluconate, IV insulin with dextrose, salbutamol nebulisation and sodium polystyrene sulphonate. Which should the nurse give first?

   1. ASodium polystyrene sulphonate
   2. BIV regular insulin with dextrose
   3. CSalbutamol by nebuliser
   4. DIV calcium gluconate 10%

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8. Question 8 · Easy

   How does the nurse confirm that an arteriovenous fistula is patent?

   1. AFeel a thrill and hear a bruit over it
   2. BLook for redness along the vein
   3. CCheck capillary refill in the fingers
   4. DMeasure the blood pressure in that arm

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9. Question 9 · Easy

   To prevent backflow of urine in a patient with an indwelling catheter, the drainage bag should be kept:

   1. ABelow the level of the bladder
   2. BOn the bed beside the patient's hip
   3. CAbove the bladder while the patient walks
   4. DAt the level of the patient's heart

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10. Question 10 · Hard

    Three peritoneal dialysis exchanges of 2000 mL each drained 2150 mL, 1900 mL and 2250 mL. What is the net fluid balance for these exchanges?

    1. A300 mL removed from the patient
    2. B6300 mL removed from the patient
    3. C400 mL removed from the patient
    4. D300 mL retained by the patient

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11. Question 11 · Hard

    A 70-kg patient after major surgery has passed 150 mL of urine over the last 6 hours. Using the KDIGO oliguria threshold (less than 0.5 mL/kg/h for 6 hours or more), what is the output and what does it mean?

    1. A0.36 mL/kg/h, below the oliguria threshold
    2. B2.1 mL/kg/h, an adequate output
    3. C0.5 mL/kg/h, exactly at the threshold
    4. D25 mL/kg/h, a high output

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12. Question 12 · Medium

    Which method of giving intravenous potassium chloride is safe?

    1. AAdded to a hanging bag without mixing it
    2. BUndiluted as a slow IV push over 2 minutes
    3. CDiluted in a bag and infused by pump
    4. DDiluted in 10 mL of water as an IV bolus

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13. Question 13 · Medium

    During TURP, a patient under spinal anaesthesia becomes confused and restless, with bradycardia and a rising BP. Which electrolyte disturbance is most likely?

    1. AHypernatraemia
    2. BHypocalcaemia
    3. CHyponatraemia
    4. DHyperkalaemia

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14. Question 14 · Easy

    The normal range of serum sodium in adults is:

    1. A135 to 145 mEq/L
    2. B150 to 160 mEq/L
    3. C95 to 105 mEq/L
    4. D120 to 130 mEq/L

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15. Question 15 · Easy

    In a patient taking digoxin, a low serum potassium increases the risk of:

    1. ADigoxin toxicity
    2. BHypoglycaemia
    3. CA bleeding tendency
    4. DReduced digoxin effect

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16. Question 16 · Medium

    A nurse sees a colleague about to measure the blood pressure on the arm with a patient's AV fistula. The most appropriate response is to:

    1. AStop the colleague and use the other arm
    2. BAllow it if the fistula is more than a year old
    3. CAsk the colleague to use a larger cuff
    4. DAllow it if the cuff is inflated only briefly

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17. Question 17 · Hard

    A 72-year-old with chronic hyponatraemia (Na+ 116 mmol/L) is on 3% saline. Twelve hours later the Na+ is 128 mmol/L. The unit's limit is a rise of no more than 10 mmol/L in 24 hours. What should the nurse do?

    1. AStop the infusion and report the over-rapid rise
    2. BContinue, because the sodium is still below normal
    3. CContinue, because the limit applies only after 24 hours
    4. DIncrease the rate to reach 135 mmol/L sooner

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18. Question 18 · Medium

    In a patient with hyperkalaemia, which treatment actually removes potassium from the body?

    1. AInsulin with dextrose
    2. BIV calcium gluconate
    3. CNebulised salbutamol
    4. DSodium polystyrene sulphonate

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19. Question 19 · Medium

    In the diuretic (recovery) phase of acute kidney injury, the nurse should watch especially for:

    1. ADehydration and hypokalaemia
    2. BHyperkalaemia and fluid overload
    3. CMetabolic alkalosis and seizures
    4. DHypernatraemia and oedema

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20. Question 20 · Medium

    Which is the most reliable bedside indicator of fluid gain in a patient with CKD?

    1. ASkin turgor over the forearm
    2. BThirst reported by the patient
    3. CUrine colour at each void
    4. DDaily weight on the same scale

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21. Question 21 · Medium

    During or soon after the first haemodialysis session, a patient with a very high blood urea develops headache, vomiting, restlessness and confusion. The most likely cause is:

    1. AAir embolism through the circuit
    2. BDialysis disequilibrium syndrome
    3. CAllergy to the dialyser membrane
    4. DHyperkalaemia from the dialysate

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22. Question 22 · Hard

    A patient with CKD stage 5 has pH 7.28, PaCO2 30 mmHg and HCO3- 14 mEq/L (normal pH 7.35-7.45, PaCO2 35-45 mmHg, HCO3- 22-26 mEq/L). This ABG shows:

    1. AMetabolic alkalosis, partly compensated
    2. BRespiratory acidosis, uncompensated
    3. CRespiratory alkalosis, fully compensated
    4. DMetabolic acidosis, partly compensated

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23. Question 23 · Medium

    On the first day after TURP, the urine in the drainage bag turns bright red with small clots, and the patient has bladder spasms. The continuous bladder irrigation should be:

    1. AStopped until the bleeding settles
    2. BDecreased so the clots can pass
    3. CChanged to sterile distilled water
    4. DIncreased to keep the drainage light pink

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24. Question 24 · Medium

    During a peritoneal dialysis exchange, the dialysate drains very slowly. The nurse should first:

    1. AClamp the catheter and call the surgeon
    2. BCheck the tubing for kinks and turn the patient
    3. CFlush the catheter forcefully with saline
    4. DIncrease the volume of the next inflow

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25. Question 25 · Medium

    A patient with CKD and a serum potassium of 5.8 mEq/L asks what to drink on a hot day. Which drink should the nurse advise the patient to avoid?

    1. ALemon water without salt
    2. BTender coconut water
    3. CWeak tea without milk
    4. DBoiled and cooled water

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