CKD/AKI Review

Which of the following is false about the Ottawa Personal Decision Guide?

• a) It can be used for any health-related decisions

• b) It can be used for social decisions

• c) It can only be used by 1 person at a time

• d) It asks for personal opinions and values

Answer explanation

Correct answer: C - It can be used by multiple people at a time to make a collective decision 

If someone with advanced CKD has anorexia, what should the nurse do?

• a) Restrict dietary options

• b) Offer low-bulk low-calorie supplements

• c) Allow the patient to only eat in their room

• d) Try appetite stimulants such as dronabinol

Answer explanation

Correct answer: D 

A: Do not want to restrict dietary options to allow them to create an appetite 

B: Want to offer low-bulk, high-calorie supplements so they’re at least getting calories 

C: We want to increase the social nature to their meals and change the environment 

A patient with advanced CKD presents to the clinic with pruritus. Upon physical examination, there is no rash present and the skin is dry with excoriations. Which of the following interventions would be suitable to treat the pruritus? (Select all that apply).

• a) Low dose gabapentin or pregabalin

• b) Antihistamines such as Benadryl

• c) Referral to dermatology 

• d) Showering with hot water to soothe the itchiness

• e) Applying moisturizers to the skin, such as lotions with pramocaine

Answer explanation

Correct Answers: a, e

a)The pathophysiology of uremic pruritus is not well understood but it is hypothesized that it is neuropathic in nature.

b) The sensation of itchiness is transmitted by myelinated A-delta afferent nerves and unmyelinated C-fibers, which are primarily histamine-independent. Benadryl may help with the itching but it does not treat the underlying pathophysiology of uremic pruritus. 

c) Presence of a rash warrants a dermatology referral, but since there is no rash, and the patient’s skin is dry and excoriated, the likely cause is uremic pruritus. 

d)Extremes of temperature should be avoided as this can further irritate the skin.

d) Moisturizers, particularly lotions with pramoxine help to alleviate pruritus 

​​A patient with chronic kidney disease presents with neuropathic pain. From the medications listed, which of the following is considered first-line pharmacologic treatment?

• a) Ketorolac

• b) Methadone

• c) Gabapentin

• d) Ketamine

Answer explanation

Correct answer = C)

Using the stepwise approach and taking metabolism differences and adverse effects into consideration, calcium channel alpha-2-delta ligands such as gabapentin or pregabalin are first line pharmacologic treatment options for neuropathy in CKD

A) ketorolac has no established role in treating neuropathy

B) Methadone is considered one of the safer opioids  in setting decreased GFR and is used in severe neuropathic pain

D) Ketamine is also used in severe or refractory neuropathic pain

Which of the following are steps to Shared Decision Making for patients with AKI? Select all that apply

• a) Understanding the clinical picture

• b) Assess the renal prognosis

• c) Arrange meeting with patient, family and members of the care team

• d) Align patient goals and values with treatment plan

Answer explanation

Correct answer = A, B, C, D

All of the above are true. These are all domains of kidney supportive care which are used to develop appropriate care plans for the patients. Shared-decision making in specific is a patient- centered approach used to navigate various care options that work for the patient and care team.

What are the three most common causes of death among patients with kidney failure? Select all that apply

• a) Dialysis Withdrawal

• b) Secondary hyperparathyroidism

• c) Diabetes

• d) Cardiovascular Disease

• e) Infection

Answer explanation

Correct Answers: a, d, e (with a being third after d and e)

C- is not correct because while this is a common comorbidity to CKD, it is not one of the top three causes of death for CKD. 

B- is not correct because although it is a result of CKD and creates many nasty complications, it is not the top three causes of death.

Which answer is FALSE when it comes to multidisciplinary care (MDC) for CKD?

• a) MDC slows eGFR

• b) MDC increases annual medical costs

• c) MDC decreases mortality

• d) MDC reduces needs for emergency dialysis

Answer explanation

Correct answer is B - It does not increase annual medical costs, it decreases the costs due to the benefits of the true answers and more, such as decreased renal replacement therapy etc.

Which of the following best describes the nurse’s role in caring for CKD patients in an interdisciplinary team? Select all that apply.

• a) Managing prescription drugs, following up on labs, and determining stage of disease

• b) Providing health education related to CKD including risk factors, understanding disease processes, signs of end-stage renal failure, renal replacement therapy

• c) Guiding lifestyle changes for patients (e.g., smoking cessation, exercise habits)

• d) Obtaining a social history, considering barriers to receiving care, and helping CKD patients obtain needed resources

Answer explanation

Correct answers: b and c

a. This describes the role of the nephrologist

d. This describes the role of the social worker

Regarding dialysis treatment which of the following statements is true?

• a) Dialysis always improves survival advantage for patients with advanced CKD

• b) Dialysis patients with ischemic heart disease have an improved survival advantage compared to without dialysis 

• c) Dialysis patients starting treatment over the age of 80 have an improved survival advantage compared to without dialysis

• d) For patients over 80 or with ischemic heart disease dialysis shows modest or absent improvements in survival advantage 

Answer explanation

Correct answer is D - dialysis doesn’t always improve survival advantage, in patients with ischemic heart disease or starting treatment over the age of 80, studies shown only modest or no advantage at all

Which of the following interventions is NOT used for treating the oral intake symptom of dysgeusia in advanced CKD

• a) Rinse with sodium bicarbonate mouthwash

• b) Avoid metal cutlery

• c) Encourage herbs, spices, and tart flavors to reduce bitter taste

• d) Avoid strong smells 

Answer explanation

Correct answer is D- all others are for treating dysgeusia, however D is for treating nausea/vomiting