The renal system plays a vital role in maintaining homeostasis and is the primary route of elimination for countless medications. As such, the management of renal disease and the principles of dosing in renal dysfunction are critical skills for every pharmacist. The Patient Care 4 curriculum dedicates a major module to the renal system, covering the pathophysiology of Acute Kidney Injury (AKI) and Chronic Kidney Disease (CKD), the management of complex electrolyte abnormalities, and the crucial science of estimating renal function. This quiz will test your knowledge on the pathophysiology, therapeutics, and pharmacokinetic considerations essential for providing safe and effective care to patients with renal disorders.
1. The Cockcroft-Gault equation is commonly used to estimate:
- a. Glomerular Filtration Rate (GFR)
- b. Creatinine Clearance (CrCl)
- c. Liver function
- d. Body Mass Index (BMI)
Answer: b. Creatinine Clearance (CrCl)
2. Which of the following medications is a common cause of drug-induced kidney disease via vasoconstriction of the afferent arteriole?
- a. Lisinopril
- b. Losartan
- c. Ibuprofen (an NSAID)
- d. Metformin
Answer: c. Ibuprofen (an NSAID)
3. Anemia of Chronic Kidney Disease (CKD) is primarily caused by a deficiency of which hormone produced by the kidneys?
- a. Aldosterone
- b. Renin
- c. Calcitriol
- d. Erythropoietin (EPO)
Answer: d. Erythropoietin (EPO)
4. A patient with CKD has hyperphosphatemia. Which of the following is a first-line treatment?
- a. A high-phosphate diet.
- b. An oral phosphate binder, such as calcium carbonate or sevelamer, taken with meals.
- c. An erythropoiesis-stimulating agent (ESA).
- d. A potassium supplement.
Answer: b. An oral phosphate binder, such as calcium carbonate or sevelamer, taken with meals.
5. Which of the following is a life-threatening electrolyte abnormality that can cause fatal cardiac arrhythmias and must be treated emergently?
- a. Mild hyponatremia
- b. Severe hyperkalemia
- c. Mild hypocalcemia
- d. Mild hyperphosphatemia
Answer: b. Severe hyperkalemia
6. The “Management of Electrolyte Abnormalities” 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. A patient presents with dehydration and hypotension. Their subsequent rise in serum creatinine is most likely due to which type of Acute Kidney Injury (AKI)?
- a. Prerenal AKI
- b. Intrinsic AKI
- c. Postrenal AKI
- d. Chronic AKI
Answer: a. Prerenal AKI
8. ACE inhibitors and ARBs can cause an acute rise in serum creatinine upon initiation by:
- a. Causing direct tubular necrosis.
- b. Vasoconstricting the afferent arteriole.
- c. Vasodilating the efferent arteriole, which decreases intraglomerular pressure.
- d. Obstructing the ureter.
Answer: c. Vasodilating the efferent arteriole, which decreases intraglomerular pressure.
9. What is the primary role of Vitamin D analogs (e.g., calcitriol) and calcimimetics (e.g., cinacalcet) in managing CKD-Mineral and Bone Disorder (CKD-MBD)?
- a. To lower serum phosphate.
- b. To treat the anemia of CKD.
- c. To manage secondary hyperparathyroidism.
- d. To lower blood pressure.
Answer: c. To manage secondary hyperparathyroidism.
10. Before initiating an Erythropoiesis-Stimulating Agent (ESA) for anemia of CKD, it is essential to ensure the patient has:
- a. Uncontrolled hypertension.
- b. Adequate iron stores.
- c. A low serum potassium level.
- d. A very high hemoglobin level.
Answer: b. Adequate iron stores.
11. The “Pathophysiology and Management of Acute Kidney Injury (AKI)” is a specific topic within the Patient Care 4 curriculum.
- a. True
- b. False
Answer: a. True
12. Kayexalate (sodium polystyrene sulfonate) is used to treat:
- a. Hyperphosphatemia
- b. Hyperkalemia
- c. Hypercalcemia
- d. Hyponatremia
Answer: b. Hyperkalemia
13. A patient with severe hyponatremia requires correction with hypertonic saline. What is a major risk if the sodium level is corrected too rapidly?
- a. Cerebral edema
- b. Osmotic demyelination syndrome
- c. Acute liver failure
- d. A hypertensive crisis
Answer: b. Osmotic demyelination syndrome
14. Phosphate binders should be administered:
- a. On an empty stomach.
- b. At bedtime.
- c. With meals to bind dietary phosphate.
- d. Once a week.
Answer: c. With meals to bind dietary phosphate.
15. Which of the following is NOT a primary function of the kidneys?
- a. Regulation of blood pressure.
- b. Production of albumin.
- c. Removal of metabolic waste products.
- d. Regulation of acid-base balance.
Answer: b. Production of albumin.
16. The “Pathophysiology and Management of Chronic Kidney Disease (CKD)” is a topic covered in the Patient Care 4 course.
- a. True
- b. False
Answer: a. True
17. Which of the following drugs is highly nephrotoxic and requires therapeutic drug monitoring to prevent acute tubular necrosis?
- a. Penicillin
- b. Amoxicillin
- c. Aminoglycosides (e.g., gentamicin) and Vancomycin
- d. Doxycycline
Answer: c. Aminoglycosides (e.g., gentamicin) and Vancomycin
18. What are the two most common causes of Chronic Kidney Disease in the United States?
- a. Polycystic kidney disease and glomerulonephritis.
- b. Smoking and high cholesterol.
- c. Diabetes and hypertension.
- d. Autoimmune disease and infections.
Answer: c. Diabetes and hypertension.
19. In the Cockcroft-Gault equation, if a patient’s actual body weight is less than their ideal body weight, which weight should be used?
- a. Ideal body weight
- b. Adjusted body weight
- c. Actual body weight
- d. Lean body weight
Answer: c. Actual body weight
20. The “Transcending Concept – Pharmacokinetics: Estimating Renal Function” is a module in 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
21. A patient with CKD has a GFR of 25 mL/min/1.73m². This patient is in which stage of CKD?
- a. Stage 2
- b. Stage 3
- c. Stage 4
- d. Stage 5
Answer: c. Stage 4
22. Which of the following is an appropriate emergent treatment for severe hyperkalemia with ECG changes?
- a. Oral potassium supplement
- b. A non-selective beta-blocker
- c. Intravenous calcium gluconate or calcium chloride
- d. A sodium phosphate enema
Answer: c. Intravenous calcium gluconate or calcium chloride
23. The purpose of giving IV calcium in severe hyperkalemia is to:
- a. Lower the serum potassium level.
- b. Stabilize the cardiac membrane to prevent arrhythmias.
- c. Increase the renal excretion of potassium.
- d. Shift potassium into the cells.
Answer: b. Stabilize the cardiac membrane to prevent arrhythmias.
24. The “Management of Drug-Induced Kidney Disease” is an active learning session in the Patient Care 4 course.
- a. True
- b. False
Answer: a. True
25. A key counseling point for a patient starting a loop diuretic like furosemide is:
- a. It may cause hyperkalemia.
- b. It should be taken at bedtime.
- c. It will increase urination and may cause dizziness.
- d. It will turn the urine orange.
Answer: c. It will increase urination and may cause dizziness.
26. Which of the following is NOT a treatment strategy for hyperkalemia?
- a. Administering insulin and dextrose.
- b. Administering a sodium bicarbonate infusion.
- c. Administering IV potassium chloride.
- d. Using a beta-2 agonist like albuterol.
Answer: c. Administering IV potassium chloride.
27. Sevelamer is what type of phosphate binder?
- a. A calcium-based binder.
- b. An aluminum-based binder.
- c. A non-calcium, non-aluminum-based polymer binder.
- d. An iron-based binder.
Answer: c. A non-calcium, non-aluminum-based polymer binder.
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. The Cockcroft-Gault equation is known to be less accurate in which populations?
- a. Patients with very high or very low muscle mass.
- b. The elderly.
- c. Patients with unstable renal function.
- d. All of the above.
Answer: d. All of the above.
30. The “Transcending Concept – Pharmacokinetics: Dosing in Renal Dysfunction” is covered in the Patient Care 4 curriculum.
- a. True
- b. False
Answer: a. True
31. What is the primary role of the pharmacist in managing renal disease?
- a. To perform kidney biopsies.
- b. To recommend and manage dose adjustments for renally cleared medications.
- c. To place dialysis catheters.
- d. To diagnose the cause of AKI.
Answer: b. To recommend and manage dose adjustments for renally cleared medications.
32. What is the main cause of postrenal AKI?
- a. Dehydration
- b. Sepsis
- c. A nephrotoxic drug
- d. An obstruction in the urinary tract (e.g., kidney stone, enlarged prostate).
Answer: d. An obstruction in the urinary tract (e.g., kidney stone, enlarged prostate).
33. In a patient with CKD, secondary hyperparathyroidism develops because:
- a. The parathyroid gland shrinks.
- b. The kidneys fail to excrete parathyroid hormone (PTH).
- c. High phosphate and low active Vitamin D levels lead to low calcium, which stimulates the parathyroid gland to release more PTH.
- d. The patient’s diet is too high in calcium.
Answer: c. High phosphate and low active Vitamin D levels lead to low calcium, which stimulates the parathyroid gland to release more PTH.
34. A patient is prescribed a renally eliminated drug. Their SCr increases from 1.0 to 2.0 mg/dL. The pharmacist should:
- a. Recommend doubling the drug dose.
- b. Recommend no change to the dose.
- c. Recognize that renal function has significantly declined and recommend a dose adjustment.
- d. Stop all of the patient’s medications.
Answer: c. Recognize that renal function has significantly declined and recommend a dose adjustment.
35. A major side effect of IV iron infusions is:
- a. Hypertension
- b. Hypersensitivity or infusion reactions
- c. Severe constipation
- d. Hyperkalemia
Answer: b. Hypersensitivity or infusion reactions
36. A patient with hypercalcemia might be treated with:
- a. IV fluids and a loop diuretic.
- b. A calcium supplement.
- c. Vitamin D.
- d. A thiazide diuretic.
Answer: a. IV fluids and a loop diuretic.
37. Which of the following is a sign of severe hypomagnesemia?
- a. Hypertension
- b. Bradycardia
- c. Torsades de pointes (a type of arrhythmia)
- d. Constipation
Answer: c. Torsades de pointes (a type of arrhythmia)
38. The principle of renal clearance is a major topic in the Drug Therapy Individualization course.
- a. True
- b. False
Answer: a. True
39. For a drug that is removed by hemodialysis, when should a dose typically be given?
- a. Right before the dialysis session.
- b. During the dialysis session.
- c. After the dialysis session.
- d. The timing does not matter.
Answer: c. After the dialysis session.
40. The functional unit of the kidney responsible for filtration is the:
- a. Loop of Henle
- b. Collecting duct
- c. Proximal tubule
- d. Nephron (glomerulus and tubule)
Answer: d. Nephron (glomerulus and tubule)
41. Which of the following is NOT a primary cause of intrinsic AKI?
- a. Acute tubular necrosis (ATN) from ischemia or toxins.
- b. Acute interstitial nephritis (AIN) from an allergic reaction to a drug.
- c. Glomerulonephritis.
- d. Severe hypotension leading to decreased renal perfusion.
Answer: d. Severe hypotension leading to decreased renal perfusion.
42. The main therapeutic goal for a patient with diabetic nephropathy is:
- a. To stop all diabetes medications.
- b. To control blood glucose and blood pressure, often with an ACE inhibitor or ARB.
- c. To start an ESA immediately.
- d. To increase protein intake.
Answer: b. To control blood glucose and blood pressure, often with an ACE inhibitor or ARB.
43. A patient with severe hyponatremia may present with what symptoms?
- a. Thirst
- a. Seizures, confusion, and coma
- c. Hypertension and tachycardia
- d. A skin rash
Answer: b. Seizures, confusion, and coma
44. Which electrolyte abnormality can cause muscle weakness, respiratory failure, and rhabdomyolysis?
- a. Mild hypercalcemia
- b. Severe hypophosphatemia
- c. Mild hyponatremia
- d. Hypermagnesemia
Answer: b. Severe hypophosphatemia
45. A patient’s medication list is the first place a pharmacist should look when investigating a potential cause of:
- a. Drug-induced kidney disease.
- b. Electrolyte abnormalities.
- c. A drug-drug interaction affecting renal clearance.
- d. All of the above.
Answer: d. All of the above.
46. Which lab value is often used to round up to 0.8 or 1 in the Cockcroft-Gault equation for elderly patients to avoid overestimating CrCl?
- a. Serum creatinine
- b. BUN
- c. Serum albumin
- d. Serum potassium
Answer: a. Serum creatinine
47. A patient with hyperkalemia should be counseled to avoid:
- a. Salt substitutes containing potassium chloride.
- b. Bananas and oranges.
- c. ACE inhibitors and ARBs if not clinically necessary.
- d. All of the above.
Answer: d. All of the above.
48. 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
49. The overall goal of managing a patient with CKD is to:
- a. Cure the kidney disease.
- b. Slow the progression of the disease and manage its complications.
- c. Prepare the patient for immediate transplant.
- d. Stop all of their medications.
Answer: b. Slow the progression of the disease and manage its complications.
50. The ultimate reason for a pharmacist to master the concepts of renal pharmacotherapy is to:
- a. Pass the NAPLEX.
- b. Ensure patient safety by preventing toxicity from improperly dosed medications.
- c. Be able to order lab tests.
- d. Impress physicians with their knowledge of equations.
Answer: b. Ensure patient safety by preventing toxicity from improperly dosed medications.