Chronic Kidney Disease (CKD) is a progressive public health epidemic with major implications for medication management. Pharmacists play a critical and multifaceted role, as detailed in the Patient Care 4 curriculum, from slowing disease progression with blood pressure and glucose control to managing complex complications like anemia and mineral and bone disorder. This quiz will test your comprehensive knowledge of the staging, pathophysiology, and evidence-based pharmacotherapy used in the long-term management of CKD.
1. Chronic Kidney Disease (CKD) is defined as abnormalities of kidney structure or function, present for how long?
- a. > 1 week
- b. > 1 month
- c. > 3 months
- d. > 1 year
Answer: c. > 3 months
2. What are the two most common causes of CKD in the United States?
- a. Polycystic kidney disease and glomerulonephritis
- b. Hypertension and diabetes
- c. Recurrent kidney infections and kidney stones
- d. Smoking and hyperlipidemia
Answer: b. Hypertension and diabetes
3. According to KDIGO guidelines, CKD is staged based on GFR and which other marker of kidney damage?
- a. Serum potassium
- b. Albuminuria
- c. Hemoglobin
- d. Serum phosphate
Answer: b. Albuminuria
4. A patient with a GFR of 25 mL/min/1.73m² is in which stage of CKD?
- a. Stage 2
- b. Stage 3b
- c. Stage 4
- d. Stage 5
Answer: c. Stage 4
5. Which class of medications is considered first-line for slowing the progression of diabetic kidney disease, especially in patients with albuminuria?
- a. Loop diuretics
- b. Beta-blockers
- c. ACE inhibitors or ARBs
- d. Calcium channel blockers
Answer: c. ACE inhibitors or ARBs
6. The “Pathophysiology and Management of Chronic Kidney Disease (CKD)” is a specific learning module in which course?
- a. PHA5784C Patient Care 4
- b. PHA5104 Sterile Compounding
- c. PHA5703 Pharmacy Law and Ethics
- d. PHA5878C Patient Care 3
Answer: a. PHA5784C Patient Care 4
7. Anemia of CKD is primarily caused by a deficiency in which hormone?
- a. Erythropoietin (EPO)
- b. Aldosterone
- c. Calcitriol
- d. Renin
Answer: a. Erythropoietin (EPO)
8. Before initiating therapy with an erythropoiesis-stimulating agent (ESA) for anemia of CKD, what must a pharmacist ensure?
- a. The patient’s blood pressure is uncontrolled.
- b. The patient has adequate iron stores.
- c. The patient’s hemoglobin is > 12 g/dL.
- d. The patient has low serum potassium.
Answer: b. The patient has adequate iron stores.
9. The pathophysiology of CKD-Mineral and Bone Disorder (CKD-MBD) is initiated by:
- a. Low serum phosphate and high serum calcium.
- b. High serum phosphate and decreased activation of Vitamin D by the kidneys.
- c. Overproduction of erythropoietin.
- d. Low parathyroid hormone (PTH) levels.
Answer: b. High serum phosphate and decreased activation of Vitamin D by the kidneys.
10. A patient with CKD and hyperphosphatemia is prescribed calcium acetate. The pharmacist should counsel the patient to take this medication:
- a. On an empty stomach.
- b. At bedtime.
- c. With meals to bind dietary phosphate.
- d. Once weekly.
Answer: c. With meals to bind dietary phosphate.
11. The management of anemia is a topic within the Patient Care 4 curriculum.
- a. True
- b. False
Answer: a. True
12. A patient with CKD has a blood pressure of 145/92 mmHg and albuminuria. According to guidelines, what is an appropriate first-line antihypertensive?
- a. Hydrochlorothiazide
- b. Amlodipine
- c. Lisinopril
- d. Metoprolol
Answer: c. Lisinopril
13. What is the primary reason for the development of secondary hyperparathyroidism in CKD?
- a. High serum calcium levels.
- b. Low serum phosphate levels.
- c. A compensatory response to low serum calcium and high serum phosphate.
- d. Direct stimulation of the parathyroid gland by uremic toxins.
Answer: c. A compensatory response to low serum calcium and high serum phosphate.
14. Which class of diabetes medications has shown significant benefit in slowing the progression of CKD in patients with and without diabetes?
- a. Sulfonylureas
- b. DPP-4 inhibitors
- c. SGLT2 inhibitors
- d. Meglitinides
Answer: c. SGLT2 inhibitors
15. End-Stage Renal Disease (ESRD), or CKD Stage 5, is defined by a GFR of:
- a. < 60 mL/min/1.73m²
- b. < 45 mL/min/1.73m²
- c. < 30 mL/min/1.73m²
- d. < 15 mL/min/1.73m² or the need for dialysis.
Answer: d. < 15 mL/min/1.73m² or the need for dialysis.
16. Which of the following is NOT a complication of CKD?
- a. Anemia
- b. Cardiovascular disease
- c. Metabolic alkalosis
- d. Mineral and Bone Disorder
Answer: c. Metabolic alkalosis
17. The “Renal System” is a module within the Patient Care 4 curriculum.
- a. True
- b. False
Answer: a. True
18. Sevelamer is what type of phosphate binder?
- a. Calcium-based
- b. Aluminum-based
- c. Non-calcium, non-aluminum based polymer
- d. Iron-based
Answer: c. Non-calcium, non-aluminum based polymer
19. A patient with CKD and hyperkalemia should be counseled to avoid:
- a. Salt substitutes containing potassium chloride.
- b. High-potassium foods like bananas and potatoes.
- c. NSAIDs.
- d. All of the above.
Answer: d. All of the above.
20. An active learning session on CKD is part of the Patient Care 4 curriculum.
- a. True
- b. False
Answer: a. True
21. What is the role of calcitriol in the body?
- a. It is the active form of Vitamin D that increases calcium absorption from the gut.
- b. It is a hormone that stimulates red blood cell production.
- c. It is a potent diuretic.
- d. It is a phosphate binder.
Answer: a. It is the active form of Vitamin D that increases calcium absorption from the gut.
22. A major risk associated with ESA therapy is:
- a. Severe anemia
- b. Hypertension and thromboembolic events
- c. Hypokalemia
- d. Liver failure
Answer: b. Hypertension and thromboembolic events
23. A patient with CKD on hemodialysis should receive their dose of a dialyzable medication:
- a. Right before dialysis.
- b. During dialysis.
- c. After dialysis.
- d. The timing does not matter.
Answer: c. After dialysis.
24. The “Intact Nephron Hypothesis” suggests that in CKD:
- a. All nephrons fail simultaneously.
- b. Damaged nephrons can fully regenerate.
- c. The remaining healthy nephrons hyperfiltrate to compensate for lost nephrons, leading to further damage over time.
- d. Only the glomeruli are damaged, while the tubules remain intact.
Answer: c. The remaining healthy nephrons hyperfiltrate to compensate for lost nephrons, leading to further damage over time.
25. Which of the following is a symptom of uremia?
- a. Increased energy
- b. Fatigue, nausea, and a metallic taste
- c. Sharpened mental acuity
- d. Increased appetite
Answer: b. Fatigue, nausea, and a metallic taste
26. The primary role of the pharmacist in CKD management is:
- a. Adjusting medication doses based on renal function.
- b. Managing the pharmacotherapy for CKD complications.
- c. Counseling patients on diet and medications.
- d. All of the above.
Answer: d. All of the above.
27. Cinacalcet is a calcimimetic that works by:
- a. Binding phosphate in the gut.
- b. Increasing the sensitivity of the calcium-sensing receptor on the parathyroid gland to calcium.
- c. Acting as a Vitamin D analog.
- d. Stimulating the bone marrow.
Answer: b. Increasing the sensitivity of the calcium-sensing receptor on the parathyroid gland to calcium.
28. An active learning session on the renal system is part of which course?
- a. PHA5784C Patient Care 4
- b. PHA5163L Professional Skills Lab 3
- c. PHA5781 Patient Care I
- d. PHA5782C Patient Care 2
Answer: a. PHA5784C Patient Care 4
29. Why should aluminum-based phosphate binders be avoided for long-term use?
- a. They are not effective.
- b. Due to the risk of aluminum accumulation and toxicity (e.g., bone disease, encephalopathy).
- c. They are too expensive.
- d. They cause severe diarrhea.
Answer: b. Due to the risk of aluminum accumulation and toxicity (e.g., bone disease, encephalopathy).
30. The “Dosing in Renal Dysfunction” transcending concept is part of the Patient Care 4 curriculum.
- a. True
- b. False
Answer: a. True
31. What is the first step in managing anemia of CKD?
- a. Starting an ESA.
- b. Assessing and repleting iron stores.
- c. A blood transfusion.
- d. Starting a folic acid supplement.
Answer: b. Assessing and repleting iron stores.
32. The leading cause of death in patients with CKD is:
- a. Kidney failure itself.
- b. Cardiovascular disease.
- c. Infections.
- d. Anemia.
Answer: b. Cardiovascular disease.
33. Patients with CKD often require dose adjustments for which common antibiotic class?
- a. Macrolides
- b. Beta-lactams
- c. Tetracyclines
- d. All antibiotics are safe.
Answer: b. Beta-lactams
34. The goal of using an ACE inhibitor in a patient with diabetic nephropathy is to:
- a. Cure the diabetes.
- b. Reduce albuminuria and slow the progression of kidney disease.
- c. Increase the GFR.
- d. Treat hyperkalemia.
Answer: b. Reduce albuminuria and slow the progression of kidney disease.
35. A patient with CKD Stage 5 (ESRD) requires:
- a. A low-protein diet.
- b. A high-protein diet if on dialysis to account for protein loss.
- c. No dietary modifications.
- d. A gluten-free diet.
Answer: b. A high-protein diet if on dialysis to account for protein loss.
36. A patient is taking metformin. At what eGFR level is this medication generally contraindicated?
- a. < 90 mL/min/1.73m²
- b. < 60 mL/min/1.73m²
- c. < 45 mL/min/1.73m²
- d. < 30 mL/min/1.73m²
Answer: d. < 30 mL/min/1.73m²
37. Which of the following is NOT a form of Renal Replacement Therapy (RRT)?
- a. Hemodialysis
- b. Peritoneal Dialysis
- c. Kidney Transplantation
- d. Loop Diuretics
Answer: d. Loop Diuretics
38. The principle of renal clearance is a major topic in the Drug Therapy Individualization course.
- a. True
- b. False
Answer: a. True
39. A patient is prescribed patiromer for chronic hyperkalemia. The pharmacist should counsel the patient that:
- a. It should be taken with other oral medications.
- b. It should be separated from other oral medications by at least 3 hours.
- c. It will work immediately to lower potassium.
- d. It has no side effects.
Answer: b. It should be separated from other oral medications by at least 3 hours.
40. An active learning session covering CKD is part of which course module?
- a. Module 7: Renal System
- b. Module 1: PUD and GERD
- c. Module 4: Gastrointestinal Infections
- d. Module 5: Nutrition & Weight Management
Answer: a. Module 7: Renal System
41. The primary treatment for metabolic acidosis in CKD is:
- a. A high-protein diet.
- b. Oral sodium bicarbonate supplementation.
- c. IV insulin.
- d. Increased fluid intake.
Answer: b. Oral sodium bicarbonate supplementation.
42. Which of the following is a physical sign of fluid overload in a CKD patient?
- a. Dry mucous membranes
- b. Poor skin turgor
- c. Pitting edema in the lower extremities
- d. Hypotension
Answer: c. Pitting edema in the lower extremities
43. A pharmacist’s role in CKD management is multidisciplinary and involves collaboration with:
- a. Nephrologists
- b. Dietitians
- c. Nurses
- d. All of the above
Answer: d. All of the above.
44. A patient with Stage 3 CKD should avoid which over-the-counter pain medication for chronic use?
- a. Acetaminophen
- b. Ibuprofen
- c. Aspirin
- d. All are safe.
Answer: b. Ibuprofen
45. Which of the following is a symptom of secondary hyperparathyroidism?
- a. Bone pain and fractures
- b. Muscle weakness
- c. Soft tissue calcification
- d. All of the above
Answer: d. All of the above
46. SGLT2 inhibitors help slow CKD progression by:
- a. Increasing blood pressure.
- b. Reducing intraglomerular pressure through afferent arteriole vasoconstriction.
- c. Lowering serum potassium.
- d. Increasing hemoglobin.
Answer: b. Reducing intraglomerular pressure through afferent arteriole vasoconstriction.
47. A patient with CKD is prescribed IV iron. Which formulation is most common for dialysis patients?
- a. Iron dextran
- b. Ferrous sulfate
- c. Iron sucrose
- d. Ferrous fumarate
Answer: c. Iron sucrose
48. An active learning session on CKD is part of which course?
- a. PHA5784C Patient Care 4
- b. PHA5163L Professional Skills Lab 3
- c. PHA5781 Patient Care I
- d. PHA5782C Patient Care 2
Answer: a. PHA5784C Patient Care 4
49. The overall management of CKD focuses on:
- a. A single therapeutic agent.
- b. A multifaceted approach targeting blood pressure, glycemic control, and complication management.
- c. Curing the disease.
- d. Only managing anemia.
Answer: b. A multifaceted approach targeting blood pressure, glycemic control, and complication management.
50. The ultimate goal of a pharmacist’s involvement in CKD management is to:
- a. Ensure all patients are on an ACE inhibitor.
- b. Improve patient outcomes and quality of life by ensuring safe and effective medication use.
- c. Eliminate the need for dialysis.
- d. Only manage the patient’s electrolytes.
Answer: b. Improve patient outcomes and quality of life by ensuring safe and effective medication use.