Test Taking Tips

1
Test Taking Tips

• Presented by
• Marilyn Eilert RN, CNN

2

• 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.

3
Publications to Review

• ANNAs Standards of Practice and Guidelines of
  Care
• Contemporary Nephrology Nursing Principles and
  Practices text
• ANNAs Core Curriculum for Nephrology Nursing
• Chronic Kidney Disease CD Rom Modules
  Available on ANNAs 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.)

4
Other sources that might be of use

• Kesselman-Turkel, J. Peterson, F. (2004).
  Test Taking Strategies. Madison University of
  Wisconsin Press.
• www.testtakingtips.com

5
CNN Test Blueprint

• The following slides are the ideal distribution
  of 200 items in the Nephrology Nursing
  Certification Examination (found on NNCCs Web
  site).
• Dont count questions or worry about whether
  this is exact. It is your total score that
  counts, not how well you do in each section.

6
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

7
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

8
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

9
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

10
Other resources

• ANAs 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!

11
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.

12
A patient who is severely dehydrated would most
likely be treated with which of the following IV
solutions initially?

• A. Hypertonic
• B. Isotonic
• C. Hypotonic
• D. Colloidal

13
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.

14
Kathy White has pyelonephritis. The symptoms you
would expect her to exhibit are

• A. Burning on urination, fever, and malaise.
• B. Pyuria, proteinuria, and fatigue.
• C. Flank pain, increased WBC, and fever.
• D. Glucosuria, malaise, and positive blood
  culture.

15
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.

16
Test Taking Tips

• Have a good reason to change your answers
• Dont 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 didnt read the whole question, etc.

17
Test Taking Tips

• Choose answers based on nephrology nursing
  principles.

18
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.

19
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.

20
Test Taking Tips

• Choose answers that are therapeutic in nature
  (even if youd like to choose another one!).

21

• Mrs. Nameonly comes into your clinic today and
  says, If you would have called me back yesterday
  like I asked you to, I wouldnt 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 didnt have time.
• D. What can I do for you today, Mrs. Nameonly?

22

• Mrs. Nameonly comes into your clinic today and
  says, If you would have called me back yesterday
  like I asked you to, I wouldnt 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 didnt have time.
• D. What can I do for you today, Mrs. Nameonly?
• Although you might like to choose A, its not a
  therapeutic response! She doesnt care that you
  had a clinic full of patients, so B is also
  incorrect. C is incorrect for two reasons it
  doesnt respond to Mrs. Nameonlys concern, and
  youve just violated patient confidentiality. So,
  D would be the most therapeutic response for this
  question.

23

• Dont 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 arent those done by other
  physicians.
• Dont take the entire test a second time when you
  finish!
• Leave questions you dont 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 isnt relevant.

24
Stress reduction techniques

• Review prior to the exam, but dont 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. Youll
  be surprised at how tense your shoulders have
  gotten. After all, were putting our ego on the
  line by taking a test like this!

25
Test questions

• Answers and some rationales are on slides
  following this series of questions.

26
NKF K/DOQI guidelines define chronic kidney
disease as

• 1. GFR lt 60ml/min/1.732 for greater than 3
  months and kidney damage.
• 2. GFR lt 60ml/min/1.732 for any time period
  regardless of kidney damage.
• 3. GFR lt 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.

27
The most frequent sign or symptom of kidney
damage is

• 1. Urinary frequency.
• 2. Asymptomatic.
• 3. Dark urine.
• 4. Shortness of breath.

28
The primary diagnosis for the etiology of chronic
kidney disease in the US is

• 1. Hypertension.
• 2. Glomerulonephritis.
• 3. Renal stones (nephrolithiasis).
• 4. Diabetes.

29
Which of the following is a modifiable risk
factor for CKD?

• 1. Smoking.
• 2. Family history.
• 3. Ethnicity.
• 4. Gender.

30
One of the most common contributing factors in
anemia of CKD is

• 1. Folate deficiency.
• 2. Vitamin B12 deficiency.
• 3. Iron deficiency.
• 4. Homocystiene deficiency.

31
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.

32
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.

33
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 pre-menopausal 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.

34
An early post-op complication of PD is

• 1. Migration of the drain bag.
• 2. Migration of the catheter tip.
• 3. Cuff extrusion.
• 4. Chronic exit site infection.

35
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.

36
An established CAPD patient is hospitalized with
a broken tibia. While recovering from surgery,
the in-patient nurses complete his CAPD
exchanges. As the patients home CAPD unit, you
receive a call from the hospital informing you
that the patients 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.

37
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 patients
sleepiness

• 1. Youve 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 cant focus
  due to metabolic changes.
• 4. He slept well last night and wants to
  continue.

38
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.

39
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.

40
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.

41
An early post transplant complication is

• 1. Cholecystitis.
• 2. Graft dysfunction secondary to nephrotoxic
  drugs.
• 3. Lymphocele.
• 4. Post-transplant lymphoproliferative disorder
  (PTLD).

42
An immunosuppressive agent that is used for
induction therapy is

• 1. Cyclosporine.
• 2. Methylprednisolone (Solu-Medrol).
• 3. Mycophenolate mofetil (Cellcept).
• 4. Polyclonal antibodies (Atgam,
  Thymoglobin).
• 5. Tacrolimus (Prograf).

43
An example of a medication that may be used post
transplant to prevent cytomegalovirus (CMV) is

• 1. Acyclovir (Zovirax).
• 2. Fluconazole (Diflucan).
• 3. Nystatin (Mycostatin, Nilstat).
• 4. Trimepthoprim/sulfamethoxazole (Bactrim,
  Septra).

44
The nurse assessing the patient for possible
acute rejection should observe for what symptoms
indicative of this most common type of rejection?

• Fever, malaise, tenderness over the graft.
• Hematuria.
• No symptoms.
• Proteinuria.

45
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.

46
You instruct Mrs. Smith that she will begin
exercising her fistula to facilitate maturation
of the blood vessel. This process includes

• 1. Dilation and hypertrophy.
• 2. Constriction and atrophy.
• 3. Dilation and atrophy.
• 4. Constriction and hypertrophy.

47
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.

48
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.
• 4. Keeping the arm extended and dependent.

49
To calculate the percent recirculation, the nurse
draws arterial, venous, and systemic blood
samples

• 1. Randomly.
• 2. Simultaneously.
• 3. Alternately.
• 4. Sequentially.

50
Assessment of your patients skin may show

• 1. Excessive oiliness.
• 2. Dry, scaly skin with excoriations from
  scratching.
• 3. Cyanosis.
• 4. Hirsutism.

51
Answers/Rationales to Test Questions
52
NKF K/DOQI Guidelines define chronic kidney
disease as

• 1. GFR lt 60ml/min/1.732 for greater than 3
  months and kidney damage. Incorrect because it
  states both criteria must be met.
• 2. GFR lt 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 lt 60ml/min/1.732 for greater than 3
  months or kidney damage. Correct. Only one
  criterion is needed if GFR lt 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.

53
The most frequent sign or symptom of kidney
damage is

• 1. Urinary frequency.
• 2. Asymptomatic. Correct
• 3. Dark urine.
• 4. Shortness of breath.
• The other symptoms may occur but are not common
  primary symptoms,

54
The primary diagnosis for the etiology of chronic
kidney disease in the U.S. is

• 1. Hypertension. Incorrect. Accounts for
  about 30 CKD.
• 2. Glomerulonephritis Incorrect. Accounts
  for about 15 CKD.
• 3. Renal stones (nephrolithiasis) Incorrect.
  Accounts for lt10 CKD.
• 4. Diabetes Correct. Diabetes accounts for
  about 50 of CKD.

55
Which of the following is a modifiable risk
factor for CKD?

• 1. Smoking. Correct.
• 2. Family history.
• 3. Ethnicity.
• 4. Gender.
• The other risk factors cannot be changed by the
  patient or the health care provider.

56
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.

57
Which of the following classes of
antihypertensive medications does not decrease
proteinuria?

• 1. Nondihydropyridine calcium channel blockers.
• 2. Diuretics. Correct
• 3. Beta blockers.
• 4. 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.

58
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.

59
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 pre-menopausal 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.

60
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.

61
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.

62
An established CAPD patient is hospitalized with
a broken tibia. While recovering from surgery,
the in-patient nurses completes his CAPD
exchanges. As the patients home CAPD unit, you
receive a call from the hospital informing you
that the patients 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 even more fluid.
• 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 Correct.
• 4. Continue CAPD as ordered and wish her luck.
  Incorrect.

63
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 patients
sleepiness

• 1. Youve 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 cant focus
  due to metabolic changes.
• 4. He slept well last night and wants to
  continue. Correct.

64
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.

65
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.

66
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.

67
An early post-transplant complication is

• 1. Cholecystitis.
• 2. Graft dysfunction secondary to nephrotoxic
  drugs.
• 3. Lymphocele. Correct.
• 4. Post-transplant lymphoproliferative disorder
  (PTLD).

68
An immunosuppressive agent that is used for
induction therapy is

• 1. Cyclosporine.
• 2. Methylprednisolone (Solu-Medrol)
• 3. Mycophenolate mofetil. (Cellcept)
• 4. Polyclonal antibodies (Atgam,
  Thymoglobin). Correct.
• 5. Tacrolimus (Prograf).

69
An example of a medication that may be used post
transplant to prevent cytomegalovirus (CMV) is

• 1. Acyclovir (Zovirax). Correct.
• 2. Fluconazole (Diflucan).
• 3. Nystatin (Mycostatin, Nilstat).
• 4. Trimepthoprim/sulfamethoxazole (Bactrim,
  Septra).

70
The nurse assessing the patient for possible
acute rejection should observe for what symptoms
indicative of this most common type of rejection?

• Fever, malaise, tenderness over the graft.
  Correct.
• Hematuria.
• No symptoms.
• Proteinuria.

71
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.

72
You instruct Mrs. Smith that she will begin
exercising her fistula to facilitate maturation
of the blood vessel. This process includes

• 1. Dilation and hypertrophy. Correct.
• 2. Constriction and atrophy.
• 3. Dilation and atrophy.
• 4. Constriction and hypertrophy.

73
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.

74
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.

75
To calculate the percent recirculation, the nurse
draws arterial, venous, and systemic blood
samples

• 1. Randomly.
• 2. Simultaneously. Correct.
• 3. Alternately.
• 4. Sequentially.

76
Assessment of your patients skin may show

• 1. Excessive oiliness.
• 2. Dry, scaly skin with excoriations from
  scratching. Correct.
• 3. Cyanosis.
• 4. Hirsutism.