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 • 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.)

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 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.

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 • 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!

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: • 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.

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 you’d 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 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?

22. 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.

23. 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.

24. 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!

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 < 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.

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 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.

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 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.

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 patient’s skin may show: • 1. Excessive oiliness. • 2. Dry, scaly skin with excoriations from scratching. • 3. Cyanosis. • 4. Hirsutism.