Transcript Test Taking Tips - ANNA Jersey North Chapter 126

Test Taking Tips
Madeline McLoughlin BSN, RN, CNN
Unit Educator, Dialysis Services
Morristown Memorial Hospital
May 7, 2011
The following pages are intended as a review of
test taking tips and practices for you. There are
sample questions, some that illustrate test
taking tips; others are included as examples that
the faculty of this course thought might be of
assistance to you.
In no way is it suggested that these are
questions directly from the exam or from anyone
who has had input into the questions on the
exam that you will, or might be, taking. These
are meant for practice and to alleviate some
anxiety about looking at test questions.
Publications to Review




ANNA’s Standards of Practice and Guidelines of Care
Contemporary Nephrology Nursing: Principles and
Practices text
ANNA’s Core Curriculum for Nephrology Nursing
Chronic Kidney Disease: CD Rom Modules – Available on
ANNA’s Web site
All of the above are available from ANNA and are
valuable resources for more than studying for this exam.
(The ANNA Core Curriculum will have a new edition out in late 2007 or early 2008.)
Other sources that might be of use

Kesselman-Turkel, J. & Peterson, F.
(2004). Test Taking Strategies. Madison:
University of Wisconsin Press.

www.testtakingtips.com
CNN Test Blueprint
The following slides are the ideal
distribution of 200 items in the Nephrology
Nursing Certification Examination (found
on NNCC’s Web site).
Don’t count questions or worry about
whether this is exact. It is your total score
that counts, not how well you do in each
section.
Concepts of Renal Failure
35% of exam
 14 Pathophysiology/Complications
 11 Interventions
 3 Physical/Technical
 7 Teaching
 5 Meds
 3 Interdisciplinary
 7 Psychosocial
 11 Infection
 3 Professional
Total = 70
Hemodialysis
30% of the exam
 13 Path/Comp
 8 Interventions
 7 Phys/Tech
 6 Teaching
 7 Medications
 3 Interdisciplinary
 3 Psychosocial
 10 Infection
 3 Professional
Total = 60
Peritoneal Dialysis
20% of exam
 8 Path/Comp
 6 Interventions
 5 Phys/Tech
 4 Teaching
 5 Medications
 2 Interdisciplinary
 3 Psychosocial
 6 Infection
 1 Professional
Total = 40
Transplant
15% of exam
 5 Path/Comp
 5 Interventions
 3 Phys/Tech
 3 Teaching
 4 Medications
 2 Interdisciplinary
 2 Psychosocial
 5 Infections
 1 Professional
Total = 30
Other resources


ANA’s Code of Ethics
Your nursing experience
The Code of Ethics reminds us of our
professional responsibilities to our patients.
Your nursing experience is extremely valuable
because it is the cornerstone for your
preparation!
Test Taking Tips

Read the questions all the way through.
– There may be a word at the end that impacts
the answer.

Eliminate the obvious wrong answers.
– You may then have only two choices to work
with, not four.
– Sometimes, when you have eliminated all but
two, you have a true/false question.
A patient who is severely dehydrated would most likely be
treated with which of the following IV solutions initially?




A.
B.
C.
D.
Hypertonic
Isotonic
Hypotonic
Colloidal
A patient who is severely dehydrated would most likely be
treated with which of the following IV solutions initially?




A. Hypertonic – Would pull fluid off tissue, perhaps
causing organ failure.
B. Isotonic – Correct because of the need to increase
perfusion to the vital organs.
C. Hypotonic – Incorrect. These would replenish the
tissue which is not an initial concern.
D. Colloidal – Would increase fluid loss to the tissue.
The key word in this question is the last word of the
question, which could be easy to miss.
Kathy White has pyelonephritis. The symptoms you would
expect her to exhibit are:




A.
B.
C.
D.
Burning on urination, fever, and malaise.
Pyuria, proteinuria, and fatigue.
Flank pain, increased WBC, and fever.
Glucosuria, malaise, and positive blood culture.
Kathy White has pyelonephritis. The symptoms you would
expect her to exhibit are:




A. Burning on urination, fever, and malaise – Incorrect
because burning on urination would be a sign of a
bladder infection, not a kidney infection.
B. Pyuria, proteinuria, and fatigue – Incorrect because
proteinuria would not be an expectation (would
indicate severe damage has occurred).
C. Flank pain, increased WBC, and fever – Correct.
D. Glucosuria, malaise, and positive blood culture –
Incorrect because glucosuria is not a normal finding.
This an example of needing to rule out information that
is incorrect from each choice.
Test Taking Tips

Have a good reason to change your
answers:
– Don’t want to change right answers to wrong.
– Statistically, there are more chances to
change from a right to a wrong than the other
way around.
– If you didn’t read the whole question, etc.
Test Taking Tips

Choose answers based on nephrology
nursing principles.
Mr. Mendez returns from the operating room
with a new AVF. You would check for the
presence of:
 1. Resonance.
 2. Crepitus.
 3. Fremitus.
 4. Bruit.
Mr. Mendez returns from the operating room
with a new AVF. You would check for the
presence of:
 1. Resonance.
 2. Crepitus.
 3. Fremitus.
 4. Bruit – Correct.
Test Taking Tips

Choose answers that are therapeutic in
nature (even if you’d like to choose
another one!).





Mrs. Nameonly comes into your clinic today and
says, “If you would have called me back
yesterday like I asked you to, I wouldn’t have to
be in here today.” Your response would be:
A. What do you mean? I talked to you for an
hour yesterday on the phone!
B. I had a clinic full of patients who were quite
time-consuming.
C. Mrs. Jones came in bleeding from her fistula,
so I didn’t have time.
D. What can I do for you today, Mrs.
Nameonly?





Mrs. Nameonly comes into your clinic today and says, “If you would have called me
back yesterday like I asked you to, I wouldn’t have to be in here today.” Your
response would be:
A. What do you mean? I talked to you for an hour yesterday on the phone!
B. I had a clinic full of patients who were quite time consuming.
C. Mrs. Jones came in bleeding from her fistula, so I didn’t have time.
D. What can I do for you today, Mrs. Nameonly?
Although you might like to choose A, it’s not a therapeutic response! She
doesn’t care that you had a clinic full of patients, so B is also incorrect. C is
incorrect for two reasons – it doesn’t respond to Mrs. Nameonly’s concern,
and you’ve just violated patient confidentiality. So, D would be the most
therapeutic response for this question.

Don’t choose answers based solely on what you do in
your practice setting.
– Make sure answers are based on evidence-based practice
throughout the country.
– Even though your own practice will be good, at times standing
orders aren’t those done by other physicians.

Don’t take the entire test a second time when you finish!
– Leave questions you don’t know blank and then only look at
those questions when you go back through.
– It has been found that when you review questions again, you
start reading material into an exam question that isn’t relevant.
Stress reduction techniques
Review prior to the exam, but don’t “cram” the
night before (raises stress levels).
 Take time during the exam to take deep breaths
and relax.

– Because you do actually have time to do this, promise
yourself you will take 3 deep breath each time you
turn the page to a new question. You’ll be surprised
at how tense your shoulders have gotten. After all,
we’re putting our ego on the line by taking a test like
this!
Test questions
Answers and some rationales are
on slides following this series of
questions.
NKF K/DOQI guidelines define
chronic kidney disease as:
1. GFR < 60ml/min/1.732 for greater than
3 months and kidney damage.
 2. GFR < 60ml/min/1.732 for any time
period regardless of kidney damage.
 3. GFR < 60ml/min/1.732 for greater than
3 months or kidney damage.
 4. GFR 60-89ml/min/1.732 in the elderly
regardless of kidney damage.

The most frequent sign or
symptom of kidney damage is:
1.
 2.
 3.
 4.

Urinary frequency.
Asymptomatic.
Dark urine.
Shortness of breath.
The primary diagnosis for the
etiology of chronic kidney disease
in the US is:
1.
 2.
 3.
 4.

Hypertension.
Glomerulonephritis.
Renal stones (nephrolithiasis).
Diabetes.
Which of the following is a
modifiable risk factor for CKD?
1.
 2.
 3.
 4.

Smoking.
Family history.
Ethnicity.
Gender.
One of the most common
contributing factors in anemia of
CKD is:
1.
 2.
 3.
 4.

Folate deficiency.
Vitamin B12 deficiency.
Iron deficiency.
Homocystiene deficiency.
Which of the following classes of
antihypertensive medications does
not decrease proteinuria?
1. Nondihydropyridine calcium channel
blockers.
 2. Diuretics.
 3. Beta blockers.
 4. Angiotensin converting enzyme
inhibitors.

Exclusion criteria for patient
selection of peritoneal dialysis
includes all of the following except:
1. Large abdominal aortic aneurysm
(AAA).
 2. Delivery of a son by caesarian section
14 years ago.
 3. Colostomy.
 4. Psoriasis of the abdominal wall.

Your CAPD patient calls to inform you that she has blood in
her drain bags. Through phone triage, you learn that she
has her menses. Blood in the effluent is common in premenopausal woman because:
1. Ovaries and fallopian tubes are outside
of the peritoneal cavity.
 2. Menses causes the peritoneal
membrane to bleed.
 3. Ovaries and fallopian tubes are inside
the peritoneal cavity.
 4. All of the above.

An early post-op complication
of PD is:
1.
 2.
 3.
 4.

Migration of the drain bag.
Migration of the catheter tip.
Cuff extrusion.
Chronic exit site infection.
Post op teaching for a new PD
patient includes:
1. Secure catheter to abdomen.
 2. Primary dressing will be removed after
5-7 days.
 3. Constipation is common post-PD
catheter placement.
 4. All of the above.

An established CAPD patient is hospitalized with a broken tibia. While
recovering from surgery, the in-patient nurses complete his CAPD
exchanges. As the patient’s home CAPD unit, you receive a call from
the hospital informing you that the patient’s body weight is down 7 lbs,
he has hypotension, and the nurse reports that he is only returning
2,400 ml of dark yellow effluent of his past exchange of 2,500 ml. You
encourage the nurse to:
 1.
Keep following MD orders and increase from 4 exchanges per
day to 5 exchanges per day.
 2.
Call the covering MD and report these changes.
Anticipate changing PD fluid from all 2.5% concentration of
dextrose to all 4.25% concentration of dextrose.
 3.
Call the covering MD and report these changes. Anticipate
changing PD fluid from all 2.5% concentration of dextrose to
all 1.5% concentration of dextrose.
 4.
Continue CAPD as ordered and wish her luck.
During a training session with a new CAPD patient, you
realize that he is falling asleep during every other sentence
you speak. Which is the least likely reason for this patient’s
sleepiness:
1. You’ve talked for the past 3 hours, and he
wants to stay awake but now has
information over load.
 2. He has not achieved readiness to learn.
 3. He has uremia and cognitively can’t
focus due to metabolic changes.
 4. He slept well last night and wants to
continue.

The pre-transplant evaluation
process for a potential recipient:
1. Is basically the same for all potential
recipients.
 2. Cannot begin until the patient has begun
dialysis.
 3. Explores only living, related donors as live
donor options, as well as deceased donors.
 4. Varies based upon the individual potential
recipient diagnosis and co-morbidities.

The dialysis unit is expected to send monthly blood
samples to the transplant center monthly. This
sample is immunogolically screened once and
discarded.
1. True.
 2. False.

Post operative management of the recipient of a kidney
transplant includes monitoring urine output. Low urine
output, less than 50 mL/hour, suggests which of the
following except:
1. Delayed graft function.
 2. Preoperative dialysis rendered the patient
too “dry” despite hydration in the OR.
 3. Urine leak at the ureteral anastamosis in the
bladder.
 4. Clot occluding the ureter or the Foley
catheter.

An early post transplant
complication is:
1. Cholecystitis.
 2. Graft dysfunction secondary to
nephrotoxic drugs.
 3. Lymphocele.
 4. Post-transplant lymphoproliferative
disorder (PTLD).

An immunosuppressive agent that
is used for induction therapy is:
1.
 2.
 3.
 4.
Cyclosporine.
Methylprednisolone (Solu-Medrol®).
Mycophenolate mofetil (Cellcept®).
Polyclonal antibodies (Atgam®,
Thymoglobin®).
 5. Tacrolimus (Prograf®).

An example of a medication that
may be used post transplant to
prevent cytomegalovirus (CMV) is:
1.
 2.
 3.
 4.

Acyclovir (Zovirax®).
Fluconazole (Diflucan®).
Nystatin (Mycostatin®, Nilstat®).
Trimepthoprim/sulfamethoxazole
(Bactrim®, Septra®).
The nurse assessing the patient for possible
acute rejection should observe for what
symptoms indicative of this most common
type of rejection?
1.
2.
3.
4.
Fever, malaise, tenderness over the
graft.
Hematuria.
No symptoms.
Proteinuria.
As renal function significantly
decreases, laboratory data reflect
all of the following except:
1. An increased serum creatinine.
 2. An increased BUN.
 3. An increased hematocrit and red blood
cell count.
 4. A decreased creatinine clearance.

You instruct Mrs. Smith that she will begin
exercising her fistula to facilitate maturation
of the blood vessel. This process includes:
1.
 2.
 3.
 4.

Dilation and hypertrophy.
Constriction and atrophy.
Dilation and atrophy.
Constriction and hypertrophy.
You explain to your patient that a creatinine
clearance test determines:
1. The number of milligrams of creatinine
excreted in the urine per hour.
 2. The ratio of serum creatinine to blood
urea nitrogen.
 3. Urine flow in milliliters per minute.
 4. The rate at which the kidneys remove
creatinine from the plasma.

Mrs. Johnson had a graft placed in her left upper
arm. She complains of pain in her left hand that
increases in intensity during hemodialysis.
Management of this syndrome would include:
1. Keeping the
 2. Keeping the
elevated.
 3. Keeping the
dependent.
 4. Keeping the
dependent.

hand warm and elevated.
arm extended and
hand warm and
arm extended and
To calculate the percent recirculation, the
nurse draws arterial, venous, and systemic
blood samples:
1.
 2.
 3.
 4.

Randomly.
Simultaneously.
Alternately.
Sequentially.
Assessment of your patient’s skin
may show:
1. Excessive oiliness.
 2. Dry, scaly skin with excoriations from
scratching.
 3. Cyanosis.
 4. Hirsutism.

Answers/Rationales to
Test Questions
NKF K/DOQI Guidelines define
chronic kidney disease as:

1. GFR < 60ml/min/1.732 for greater than 3 months and
kidney damage. – Incorrect because it states both
criteria must be met.

2. GFR < 60ml/min/1.732 for any time period regardless
of kidney damage. – Incorrect because no time period is
specified and kidney damage is not confirmed.


3. GFR < 60ml/min/1.732 for greater than 3 months or
kidney damage. – Correct. Only one criterion is needed if
GFR < 60 more than 3 months.
4. GFR 60-89ml/min/1.732 in the elderly regardless of
kidney damage. – Incorrect because decreased damage
to this level may be normal aging. Need evidence of
kidney damage to label with CKD.
The most frequent sign or
symptom of kidney damage is:
1.
 2.
 3.
 4.

Urinary frequency.
Asymptomatic. – Correct
Dark urine.
Shortness of breath.
The other symptoms may occur but are
not common primary symptoms,
The primary diagnosis for the
etiology of chronic kidney disease
in the U.S. is:

1. Hypertension. – Incorrect. Accounts

2. Glomerulonephritis – Incorrect.

3. Renal stones (nephrolithiasis) –
for about 30% CKD.
Accounts for about 15% CKD.
Incorrect. Accounts for <10% CKD.
 4. Diabetes – Correct. Diabetes accounts
for about 50% of CKD.
Which of the following is a
modifiable risk factor for CKD?
1.
 2.
 3.
 4.

Smoking. – Correct.
Family history.
Ethnicity.
Gender.
The other risk factors cannot be changed
by the patient or the health care provider.
One of the most common
contributing factors in anemia of
CKD is:

1. Folate deficiency. – Incorrect as it is
not usually the primary contributor.
 2. Vitamin B12 deficiency. – Incorrect as
it is not usually the primary contributor
 3. Iron deficiency. – Correct.
 4. Homocystiene deficiency. – Incorrect.
It is not a part of the usual workup.
Which of the following classes of
antihypertensive medications does
not decrease proteinuria?
1.
 2.
 3.
 4.

Nondihydropyridine calcium channel blockers.
Diuretics. – Correct
Beta blockers.
Angiotensin converting enzyme inhibitors.
The other classes have all shown benefit in
decreasing proteinuria. Dihydropyridine CCB
(such as amlodipine [Norvasc®]) have not been
shown to decrease proteinuria.
Exclusion criteria for patient
selection of peritoneal dialysis
includes all of the following except?
1. Large abdominal aortic aneurysm
(AAA).
 2. Delivery of a son by caesarian section
14 years ago. – Correct.
 3. Colostomy.
 4. Psoriasis of the abdominal wall.

Your CAPD patient calls to inform you that she has blood in
her drain bags. Through phone triage, you learn that she
has her menses. Blood in the effluent is common in premenopausal woman because:
1. Ovaries and fallopian tubes are outside of the
peritoneal cavity. – Incorrect.
 2. Menses causes the peritoneal membrane to
bleed. – Incorrect. This only occurs if

endometrial tissue has entered the
peritoneal cavity.

3. Ovaries and fallopian tubes are inside the
peritoneal cavity. – Correct ,which means
that retrograde reflux is not uncommon.

4. All of the above.
An early post-op complication
of PD is:
1. Migration of the drain bag. – Incorrect
 2. Migration of the catheter tip. – Correct
 3. Cuff extrusion. – Incorrect. The


primary cause is placement of the cuff too
close to the exit site so that anchoring too
tightly will increase the risk of extrusion.
4. Chronic exit site infection. – Incorrect
because looking for an acute complication
that is not chronic.
Post-op teaching for a new PD
patient includes:
1. Secure catheter to abdomen.
 2. Primary dressing will be removed after
5-7 days.
 3. Constipation is common post PD
catheter placement.
 4. All of the above – Correct.

An established CAPD patient is hospitalized with a broken tibia. While
recovering from surgery, the in-patient nurses completes his CAPD
exchanges. As the patient’s home CAPD unit, you receive a call from
the hospital informing you that the patient’s body weight is down 7 lbs,
he has hypotension and the nurse reports that he is only returning
2,400 ml of dark yellow effluent of his past exchange of 2,500 ml. You
encourage the nurse to:
 1.
Keep following MD orders and increase from 4 exchanges per
day to 5 exchanges per day. – Incorrect.
 2.
Call the covering MD and report these changes. Anticipate
changing PD fluid from all 2.5% concentration of dextrose to
all 4.25% concentration of dextrose. – Incorrect. Would pull

3.

4.
even more fluid.
Call the covering MD and report these changes. Anticipate
changing PD fluid from all 2.5% concentration of dextrose to
all 1.5% concentration of dextrose – Correct.
Continue CAPD as ordered and wish her luck. – Incorrect.
During a training session with a new CAPD patient, you
realize that he is falling asleep during every other sentence
you speak. Which is the least likely reason for this patient’s
sleepiness:
1. You’ve talked for the past 3 hours and he
wants to stay awake but now has
information over load.
 2. He has not achieved readiness to learn.
 3. He has uremia and cognitively can’t
focus due to metabolic changes.
 4. He slept well last night and wants to
continue. – Correct.

The pre-transplant evaluation
process for a potential recipient:
1. Is basically the same for all potential
recipients.
 2. Cannot begin until the patient has begun
dialysis.
 3. Explores only living, related donors as live
donor options, as well as deceased donors.
 4. Varies based upon the individual potential
recipient diagnosis and co-morbidities. –

Correct.
The dialysis unit is expected to send monthly blood
samples to the transplant center monthly. This
sample is immunogolically screened once and
discarded.
1. True. – Incorrect.
 2. False. – Correct.

Post-operative management of the recipient of a kidney
transplant includes monitoring urine output. Low urine
output, less than 50 mL/hour, suggests which of the
following except:
1. Delayed graft function.
 2. Pre-operative dialysis rendered the patient
too “dry” despite hydration in the OR. –

Correct.
3. Urine leak at the ureteral anastamosis in the
bladder.
 4. Clot occluding the ureter or the Foley
catheter.

An early post-transplant
complication is:
1. Cholecystitis.
 2. Graft dysfunction secondary to
nephrotoxic drugs.
 3. Lymphocele. – Correct.
 4. Post-transplant lymphoproliferative
disorder (PTLD).

An immunosuppressive agent that
is used for induction therapy is:
1.
 2.
 3.
 4.
Cyclosporine.
Methylprednisolone (Solu-Medrol®)
Mycophenolate mofetil. (Cellcept®)
Polyclonal antibodies (Atgam®,
Thymoglobin®). – Correct.
 5. Tacrolimus (Prograf®).

An example of a medication that
may be used post transplant to
prevent cytomegalovirus (CMV) is:
1.
 2.
 3.
 4.

Acyclovir (Zovirax®). – Correct.
Fluconazole (Diflucan®).
Nystatin (Mycostatin®, Nilstat®).
Trimepthoprim/sulfamethoxazole
(Bactrim®, Septra®).
The nurse assessing the patient for possible
acute rejection should observe for what
symptoms indicative of this most common
type of rejection?
1.
2.
3.
4.
Fever, malaise, tenderness over the
graft. – Correct.
Hematuria.
No symptoms.
Proteinuria.
As renal function significantly
decreases, laboratory data reflect
all of the following except:
1. An increased serum creatinine.
 2. An increased BUN.
 3. An increased hematocrit and red blood
cell count. – Correct.
 4. A decreased creatinine clearance.

You instruct Mrs. Smith that she will begin
exercising her fistula to facilitate maturation
of the blood vessel. This process includes:
1.
 2.
 3.
 4.

Dilation and hypertrophy. – Correct.
Constriction and atrophy.
Dilation and atrophy.
Constriction and hypertrophy.
You explain to your patient that a creatinine
clearance test determines:
1. The number of milligrams of creatinine
excreted in the urine per hour.
 2. The ratio of serum creatinine to blood
urea nitrogen.
 3. Urine flow in milliliters per minute.
 4. The rate at which the kidneys remove
creatinine from the plasma. – Correct.

Mrs. Johnson had a graft placed in her left upper
arm. She complains of pain in her left hand that
increases in intensity during hemodialysis.
Management of this syndrome would include:
1. Keeping the hand warm and elevated.
 2. Keeping the arm extended and
elevated.
 3. Keeping the hand warm and
dependent. – Correct.
 4. Keeping the arm extended and
dependent.

To calculate the percent recirculation, the
nurse draws arterial, venous, and systemic
blood samples:
1.
 2.
 3.
 4.

Randomly.
Simultaneously. – Correct.
Alternately.
Sequentially.
Assessment of your patient’s skin
may show:
1. Excessive oiliness.
 2. Dry, scaly skin with excoriations from
scratching. – Correct.
 3. Cyanosis.
 4. Hirsutism.
