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WorksheetsKidney Disease and Dietary Management Worksheet
Total questions: 75
Worksheet time: 40mins
A patient's basic metabolic panel reports potassium 6.4 mEq/L. Which immediate cardiovascular intervention from the guide is appropriate to stabilize the cardiac membrane?
IV calcium gluconate
Oral phosphate binders
IV furosemide only
Sodium polystyrene sulfonate if bowels are not moving
A client with CKD stage 4 is told to take phosphate binders with meals. Which is the correct rationale?
Phosphate binders increase kidney excretion of phosphate.
Phosphate binders bind dietary phosphate in the gut so it is excreted in stool.
Phosphate binders raise serum calcium so phosphate decreases in blood.
Taking with meals increases urinary excretion of phosphate.
A patient has GFR 55 mL/min for 4 months. According to the guide, this finding indicates:
Normal kidney function.
Acute kidney injury.
Chronic kidney disease (CKD).
End stage renal disease.
Which diet restriction is most appropriate for a patient with CKD to limit daily potassium intake?
2–3 grams potassium per day
40 mEq potassium per day
No restriction; only phosphorus is restricted
Potassium supplements only in dialysis
A patient with AKI is oliguric (<400 mL/day) and labs show rising BUN and creatinine. This scenario most likely represents which AKI stage?
Diuretic phase
Oliguric phase
Recovery phase
Chronic stable phase
A nurse teaches a patient with end-stage kidney disease about foods to limit for phosphate restriction (1 g/day). Which food choice requires correction?
Cheese and milk
Lean chicken breast
Processed deli meat
Yogurt
A patient on hemodialysis is scheduled for treatment. Which medication category should usually be held prior to dialysis because it could cause excessive hypotension with fluid removal?
ACE inhibitors and ARBs
Phosphate binders
Erythropoietin
Oral iron supplements
A patient with CKD is prescribed erythropoietin (epoetin alfa). What is a primary nursing concern?
Risk for thromboembolic events and increased BP
Severe hypokalemia
Immediate correction of anemia without monitoring
Increased risk of hypercalcemia
A patient with AKI due to rhabdomyolysis has hyperkalemia and peaked T waves. Which immediate treatment combination from the guide gives rapid shift of potassium into cells?
IV calcium gluconate alone
IV insulin with glucose
Sodium polystyrene sulfonate with lactulose
Oral phosphate binders with vitamin D
Which statement about urine osmolarity and specific gravity is correct per the guide?
Dilute urine has high specific gravity (1.030).
Concentrated urine has specific gravity 1.005.
Normal urine specific gravity ranges approximately 1.005–1.030.
Urine osmolarity is not reflected by specific gravity.
A client with CKD has an albumin of 2.8 g/dL. According to the guide, this most likely indicates:
Normal nutritional and oncotic status.
Hypoalbuminemia related to protein loss.
Excess dietary protein.
Overhydration only.
A 68-year-old with CKD presents with absent deep tendon reflexes, decreased mental status, and shallow respirations. Which electrolyte abnormality aligns with these signs?
Hypokalemia
Hypermagnesemia
Hypocalcemia
Hyponatremia
A post-op patient becomes oliguric and has MAP <65 mm Hg. This prerenal cause of AKI most likely results from:
Intrarenal tubular necrosis.
Decreased renal perfusion due to hypovolemia.
Obstruction from kidney stone.
Glomerulonephritis.
A patient with AKI and hyperkalemia is given IV insulin with glucose. Per the guide, what is the primary purpose of that therapy?
To increase renal excretion immediately.
To shift potassium into cells, lowering serum potassium quickly.
To bind potassium in the GI tract.
To permanently remove potassium from the body.
A patient’s creatinine increases from baseline. According to the guide, which is an appropriate interpretation?
Kidneys are excreting more creatinine (improved).
Kidneys are not filtering creatinine well (worse function).
This always indicates dehydration only.
Creatinine is unaffected by muscle mass.
A patient with CKD reports constipation, stomatitis, and a metallic taste. These GI symptoms are most consistent with which condition?
Hypercalcemia
Uremia from accumulating waste products
Hypoglycemia
Acute appendicitis
Which statement about GFR in the guide is accurate?
GFR >90 always means CKD.
GFR <60 mL/min for >3 months indicates CKD.
GFR cannot indicate hyperfiltration.
GFR values are not influenced by hypertension or diabetes.
A patient with CKD is instructed to avoid which OTC medication class because it is harmful to kidneys?
NSAIDs
Antacids without magnesium
Laxatives containing fiber
Vitamin C supplements
A patient with AKI due to urinary obstruction from BPH is categorized as which cause?
Prerenal
Intrarenal
A client with CKD has metabolic acidosis. Which lab from the guide supports that diagnosis?
Bicarbonate (CO2) 24 mEq/L
Bicarbonate (CO2) 20 mEq/L
Potassium 3.8 mEq/L
Sodium 140 mEq/L
A patient on peritoneal dialysis is advised to increase what in the diet compared to hemodialysis patients?
Protein
Sodium
Potassium
Phosphorus binders
A patient with suspected ATN (acute tubular necrosis) most likely had which preceding event per the guide?
Chronic NSAID use only
Recent ischemia or exposure to nephrotoxic agents or sepsis
Gradual long-term hypertension only
Dietary phosphate excess
A patient with CKD develops uremic fetor (urine breath) and pruritus with uremic frost. These findings are most likely to occur when GFR is:
>90 mL/min
60–89 mL/min
Around 30–59 mL/min
<15 mL/min (end stage kidney disease)
Which assessment finding is expected for a newly created AV fistula?
Absence of bruit or thrill is normal.
Palpable thrill and audible bruit indicate patency.
Use that arm immediately for blood pressure.
It may be used immediately after surgery.
A patient with CKD is being counseled about medications to avoid. Which drug in the list below is explicitly contraindicated per the guide?
Metformin
ACE inhibitor for proteinuria control
Sevelamer for phosphate binding
Oral iron supplement
A CKD patient’s lab shows hemoglobin low. Which supplement is commonly used per the guide to treat anemia because dialysis removes it?
Vitamin D only
Folic acid supplementation
Phosphate binder
Calcium carbonate
A patient with AKI has fluid overload, BUN >120, and K+ rising. According to the renal replacement therapy indications in the guide, what is indicated?
Conservative oral therapy only
Start renal replacement therapy (hemodialysis)
Start peritoneal dialysis as first choice in AKI
Wait for spontaneous recovery
A patient on hemodialysis should avoid which action on the arm with the AV fistula?
Palpating for thrills
Taking blood pressure measurements
Listening for bruit with stethoscope
Checking distal pulses
For a client with AKI and suspected hyperkalemia causing dysrhythmias, which medication is listed as SECOND-line therapy to stabilize cardiac membranes if dysrhythmias occur?
IV calcium gluconate
Oral phosphate binder
IV glucose and insulin
Kayexalate only
A patient with CKD needs control of dyslipidemia. Which drug class from the guide is recommended?
Statins
Thiazide diuretics
High dose NSAIDs
Aminoglycosides
In a client with ulcerative colitis, which stool characteristic is most characteristic?
Steatorrhea without blood
Bloody stool with mucus
Fecal incontinence with no mucus
Ribbon stool only
A patient with Crohn’s disease reports weight loss, visible abdominal peristalsis, and crampy abdominal pain. Which complication should the nurse be alert for based on the guide?
Intestinal obstruction
Peptic ulcer disease
Cholecystitis
Diverticulosis
Which dietary advice is most appropriate during an IBD flare per the guide?
Increase raw vegetables and whole grains
Increase lean proteins, cooked vegetables, low-fiber grains
Follow a high-fiber diet to reduce inflammation
Increase dairy and spicy foods
A patient with UC has severe fever, tachycardia, hypotension, and profuse bloody diarrhea. Which of the following complications is a priority concern?
Protein malnutrition only
GI bleed and dehydration with electrolyte loss
Hypermagnesemia
Hypercalcemia
A patient with Crohn’s disease develops an enterocutaneous fistula. Which nursing concern is most directly related?
Increased risk of peritonitis from bowel leakage
Reduced stool output only
Increased bone density
Decreased need for nutrition support
A client with IBS is given teaching to manage symptoms. Which is an appropriate recommendation from the guide?
Increase short-chain fermentable carbs (FODMAPs) such as apples and onions
Increase soluble fiber to 30–40 g/day and probiotics
Avoid fluids to decrease stool frequency
Increase fried and fatty foods
A patient with IBS-constipation predominant should be counseled to:
Reduce soluble fiber intake to less than 5 g/day
Increase soluble fiber sources (oats, rice) and fluids
Avoid bananas and oats
Increase artificial sweeteners
A patient with CKD stage 5 (GFR <15) may require strict monitoring of which electrolytes per the guide?
Potassium and phosphorus only, with possible vitamin D and calcium supplementation
Sodium only, no other monitoring needed
Potassium is not a concern in stage 5 CKD
Which medication for hyperkalemia works in the bowel to remove potassium but must NOT be given if the patient has paralytic ileus due to risk of bowel necrosis?
Kayexalate (sodium polystyrene sulfonate)
IV insulin and glucose
IV calcium gluconate
Loop diuretics
A 45-year-old with Crohn’s disease had ileal resection and now has megaloblastic anemia. Which vitamin deficiency is most likely per the guide?
Vitamin C
Vitamin B12
Vitamin K
Vitamin A
A patient with ulcerative colitis is being treated with sulfasalazine. Which patient teaching point from the guide is appropriate?
Take in the morning only on an empty stomach.
Use sunscreen because photosensitivity can occur.
Expect immediate cure of disease.
Avoid all dairy products permanently.
Which type of colostomy typically produces liquid stool and requires increased fluid intake per the guide?
Sigmoid colostomy
Transverse colostomy
Ileostomy
Descending colostomy
A patient on peritoneal dialysis develops cloudy dialysate and abdominal tenderness. What is the most likely problem?
Fluid overload only
Peritonitis
Pulmonary embolism
Aneurysm of AV fistula
Which of the following is an example of a postrenal cause of AKI listed in the guide?
Sepsis causing low MAP
Acute tubular necrosis from nephrotoxin
Prostatic hypertrophy causing urinary obstruction
Hypovolemia from burns
A client with CKD is prescribed calcium carbonate to be taken with meals. The primary purpose is to:
Lower blood pressure by binding sodium.
Bind intestinal phosphate to lower serum phosphate.
Increase GI absorption of potassium.
Act as a stool softener.
A patient with CKD is taking an iron supplement for anemia. Which important interaction should the nurse remember from the guide?
Give iron with phosphate binders for best absorption.
Avoid giving iron at the same time as phosphate binders because absorption is decreased.
Iron causes no GI effects and can be taken anytime.
Iron use prevents need for erythropoietin.
A patient with AKI has metabolic acidosis and hyperkalemia. Which treatment from the guide can both lower potassium and help correct acidosis?
IV sodium bicarbonate
Calcium gluconate alone
Oral phosphate binder
Loop diuretic alone
Which presenting lab pattern is most consistent with ulcerative colitis during an exacerbation per the guide?
Increased Hct and Hgb; decreased WBC
Decreased Hct and Hgb; increased WBC, CRP, and ESR
Normal inflammatory markers only
Hypocalcemia only
A patient with CKD on hemodialysis is recommended to maintain what level of protein intake relative to peritoneal dialysis?
Hemodialysis: normal protein; Peritoneal: increased protein
Hemodialysis: decreased protein; Peritoneal: decreased protein
Both need very low protein diets
Hemodialysis needs increased protein only if anuric
A hospitalized patient with AKI is receiving loop diuretics to increase urine output. According to the guide, what is a potential intended effect?
Increase potassium retention
Increase potassium excretion via urine
Cause metabolic alkalosis only
Bind phosphate in the bowel
A patient with CKD has an order for patiromer. According to the guide, what is the primary purpose?
Increase serum potassium
Decrease potassium by exchanging ions in the gut
Provide additional calcium for bones
Act as a phosphate binder
A client with IBD is advised to avoid which of the following during flare-ups per the guide?
Cooked vegetables and low-fiber grains
Raw vegetables, whole grains, dairy, fatty and fried foods
Lean proteins such as chicken and fish
Probiotics
A nurse is teaching a patient with CKD about foods high in potassium that should be limited. Which food should be included?
Applesauce (small portion)
Bananas and melons
White rice and white bread
Olive oil
Which statement is true about IBS versus IBD from the guide?
IBS causes structural damage visible on imaging.
IBD is a functional disorder with no visible inflammation.
IBS is a functional disorder without visible inflammation on tests; IBD shows structural inflammation.
Both IBS and IBD always present with bloody stools.
A patient with CKD is taking an ACE inhibitor and develops hyperkalemia. Which effect of ACE inhibitors explains this per the guide?
ACE inhibitors increase potassium retention.
ACE inhibitors directly cause hypokalemia.
ACE inhibitors increase GFR to dangerously high levels.
ACE inhibitors decrease serum creatinine always.
A patient with Crohn’s disease has a small-bowel resection and now requires specialized nutrition. Which complication described in the guide may result from extensive resection?
Short bowel syndrome causing malabsorption and malnutrition
Increased bile salt absorption
Decreased risk of diarrhea
Reduced need for vitamin supplements
A patient with ESRD is being taught fluid restrictions before hemodialysis. Which of the following is the best rationale from the guide?
To prevent hyponatremia only
To control fluid overload and prevent pulmonary edema and hypertension
To increase protein excretion
To lower creatinine production
A nurse assesses a patient with CKD who takes magnesium-containing antacids. Which concern is supported by the guide?
Magnesium antacids are safe and encouraged.
Magnesium-containing medications should be avoided because magnesium can accumulate and cause serious effects.
Magnesium causes increased GFR and is recommended.
Magnesium corrects hyperkalemia.
A patient being evaluated for IBD has multiple stool tests for occult blood and mucus. According to the guide, how many stool tests may be needed for diagnosis?
One test is sufficient.
Three or more stool tests may be needed.
Testing is not useful for IBD diagnosis.
Stool tests should be avoided in elderly patients.
A patient with CKD stage 3A is instructed to reduce which nutrients per the guide?
Reduce potassium, phosphorus, and sodium intake
Increase potassium and phosphorus only
No dietary changes are needed until stage 5
Increase phosphorus while decreasing sodium
A patient with AKI is given sodium bicarbonate. Which is the intended effect per the guide?
Shift potassium into cells and promote excretion to lower serum potassium
Increase phosphate absorption
Directly dissolve kidney stones
Reduce BUN directly
A client with IBD is prescribed infliximab (Remicade). What is a primary concern with this immunomodulator per the guide?
It causes hyperkalemia.
It increases risk for infection due to immune suppression.
It cures IBD permanently.
It increases phosphate absorption.
Which lab value from the guide indicates low magnesium?
A patient with CKD has prerenal azotemia due to hypovolemia. Which of the following is the most likely immediate lab change?
Decreased BUN and creatinine
Increased BUN with relatively less change in creatinine (prerenal pattern)
Decreased potassium only
Increased GFR
A patient with Crohn’s disease is at risk for which specific nutritional deficiency that can lead to anemia, per the guide?
Vitamin B12 deficiency leading to megaloblastic anemia
Vitamin D excess causing hypercalcemia
Excess folate production
High iron absorption
A nurse notes that a dialysis patient’s dressing is infected at the permacath site. Based on the guide, what is the primary concern?
A permacath has low risk for infection, so no action needed.
Permacaths carry an increased risk for infection and require prompt attention.
Remove the catheter immediately without notifying provider.
Infection is rare with permacaths and can be ignored.
A patient is prescribed sevelamer hydrochloride (Renagel). According to the guide, what additional benefit does it provide besides phosphate binding?
It increases LDL cholesterol.
It lowers cholesterol and LDL levels.
It causes hyperkalemia.
It increases serum phosphate.
A patient with acute tubular necrosis (intrarenal AKI) is likely to have which findings in urinalysis per the guide?
No casts, perfectly clear urine
Casts (muddy brown), RBC and WBC on urinalysis
Only glucose in urine
Only very high specific gravity without cells
A patient with IBS is asked about foods that commonly trigger symptoms and should be avoided. Which of the following is correct per the guide?
Encourage apples, watermelon, and onions.
Avoid short chain carbs (e.g., apples, watermelon, onions, broccoli, beans, dairy) and fatty/fried foods.
A client with CKD is found to have metabolic acidosis. Which bicarbonate (CO2) value from the guide is consistent with acidosis?
26 mEq/L
24 mEq/L
20 mEq/L
28 mEq/L
A patient with ESRD on dialysis should typically restrict daily sodium intake to:
2–4 grams per day
10 grams per day
No restriction on sodium
Less than 0.5 grams per day
A patient with CKD is scheduled for a contrast CT. Which class of drugs or agents from the guide should be avoided because of nephrotoxicity risk?
A. Aminoglycoside antibiotics and contrast dye
B. ACE inhibitors only
C. Phosphate binders only
D. Erythropoietin
Which of the following foods is appropriate to increase for a patient with IBS according to the guide?
Watermelon and beans
Bananas, oranges, spinach, carrots, rice, oats, lean meats
Raw cruciferous vegetables during acute symptoms
Full-fat dairy and fried foods
A patient with CKD and hyperphosphatemia is prescribed calcium carbonate. Which caution from the guide should the nurse mention regarding iron supplements?
Iron supplements should be administered with calcium carbonate for best effect.
Do not give iron at the same time as phosphate binders because it decreases iron absorption.
Iron supplements are unnecessary in CKD.
Iron increases phosphate binding.
A patient with CKD is developing anemia. Which therapy listed in the guide stimulates RBC production but must be used cautiously in uncontrolled hypertension?
Erythropoietin (epoetin alfa)
Oral iron only
Vitamin D
