Free CSR Practice Questions

Question 1

Despite taking calcium acetate with meals, an adult receiving maintenance hemodialysis has serum phosphorus of 6.7 mg/dL on three consecutive monthly measurements. Ionized calcium is 1.40 mmol/L (reference 1.15-1.30), and intact PTH is 48 pg/mL (assay upper limit 65). Delivered dialysis is adequate, and protein intake meets the prescription. Which phosphate-lowering strategy best fits this mineral pattern?

Accepted Answer

Replace calcium acetate with a non-calcium phosphate binder.

Answer

Increase calcium acetate at each meal to bind more phosphorus.

Answer

Add calcitriol to reduce PTH secretion.

Answer

Add cinacalcet to lower calcium while continuing calcium acetate.

Question 2

At follow-up, a 74-year-old hemodialysis patient has unchanged predialysis weights and serum albumin of 3.8 g/dL. Leg edema has increased, however, and examination shows new clavicular and thigh muscle loss. The same trained dietitian assigns a global score of 4 on the seven-point Subjective Global Assessment, compared with 7 three months earlier. How should the combined findings be interpreted?

Accepted Answer

Mild-to-moderate malnutrition is present; fluid retention can conceal tissue loss.

Answer

The patient remains well nourished; stable weight and albumin outweigh the change in SGA.

Answer

Severe malnutrition is present; a three-point decline in SGA defines the severe category.

Answer

Nutrition status is improving; lower SGA scores indicate a lower burden of nutritional problems.

Question 3

The prescription for a stable adult receiving peritoneal dialysis is 2,100 kcal/day from all sources and 84 g protein/day. A complete 24-hour dialysate balance study records 250 g of dextrose instilled and 150 g recovered in effluent; the abdomen is fully drained at both endpoints. Using 3.4 kcal per gram of absorbed dextrose, which daily oral prescription preserves both prescribed targets?

Accepted Answer

1,760 kcal and 84 g protein.

Answer

1,250 kcal and 84 g protein.

Answer

1,590 kcal and 84 g protein.

Answer

1,760 kcal and 70 g protein.

Question 4

Ten weeks after an erythropoiesis-stimulating agent is started, a hemodialysis patient's hemoglobin rises from 8.9 to 10.7 g/dL and HbA1c falls from 8.0% to 6.2%. Diabetes medications and food intake have not changed. Continuous glucose records before and after treatment show an unchanged mean near 190 mg/dL, without hypoglycemia on dialysis or nondialysis days; sensor readings agree with blood glucose measurements. What best explains the disagreement between the glycemic measures?

Accepted Answer

ESA-stimulated erythropoiesis has shortened the average time available for hemoglobin glycation.

Answer

Reduced renal insulin clearance has improved glycemia despite the unchanged glucose profile.

Answer

Correction of anemia has made HbA1c more reliable than the corroborated glucose measurements.

Answer

Unrecognized dialysis-day hypoglycemia has lowered average glucose enough to explain the HbA1c.

Question 5

A new outpatient hemodialysis patient will have completed 10 treatments by day 30 after the first outpatient dialysis session. The thirteenth treatment is scheduled for day 38. For the initial comprehensive assessment, which completion deadline is the latest permitted under the CMS ESRD Conditions for Coverage?

Accepted Answer

Day 38 after the first outpatient dialysis session.

Answer

Day 15 after the first outpatient dialysis session.

Answer

Day 30 after the first outpatient dialysis session.

Answer

Day 90 after the first outpatient dialysis session.

Question 6

An ICU team proposes reducing protein because a patient with sepsis-associated AKI has a rising BUN. The patient is hemodynamically stable on continuous kidney replacement therapy and tolerates enteral feeding that supplies the prescribed 1.6 g protein/kg/day. After several days of phosphate-free replacement fluid and a low-electrolyte formula, phosphorus is 1.8 mg/dL and potassium is 3.2 mmol/L. There was no preceding period of starvation. The nutrition recommendation at today's rounds should be to:

Accepted Answer

Maintain the protein prescription, coordinate electrolyte replacement, and reassess the formula's mineral content.

Answer

Reduce protein to 0.6 g/kg/day and retain the low-electrolyte formula to limit urea generation.

Answer

Stop enteral nutrition until phosphorus normalizes, then resume the same formula at the prescribed rate.

Answer

Replace part of the protein with dextrose while retaining the current formula's electrolyte restrictions.

Question 7

"Why do I need kidney nutrition counseling when my filtration result is nearly normal?" asks a 57-year-old with hypertension. Results four months apart show eGFR values of 78 and 80 mL/min/1.73 m² and urine albumin-to-creatinine ratios of 440 and 510 mg/g. Neither sample was obtained during acute illness or a urinary tract infection. Which explanation accurately classifies these findings?

Accepted Answer

Persistent albuminuria establishes CKD G2 A3 despite the relatively preserved eGFR.

Answer

The eGFR establishes CKD G2 A2 because filtration remains above 60 mL/min/1.73 m².

Answer

The albuminuria advances the GFR classification to CKD G3a A3 despite the measured eGFR.

Answer

CKD is not established because the eGFR has not remained below 60 mL/min/1.73 m².

Question 8

The parents of a 4-year-old with CKD from renal dysplasia have eliminated added salt and limited drinks because they believe kidney disease always requires both restrictions. Weight gain and height velocity have slowed despite documented age-appropriate energy and protein intake. The child is persistently polyuric, has no edema or hypertension, and the nephrologist documents renal sodium wasting. Which revision addresses a likely contributor to the growth problem?

Accepted Answer

Individualize sodium and fluid replacement to the child's urinary losses and clinical response.

Answer

Keep the sodium and fluid limits, but increase nonprotein calories to promote catch-up growth.

Answer

Keep the sodium limit and increase protein above age-based needs to stimulate tissue growth.

Answer

Reduce protein to 0.6 g/kg/day while increasing calorie density to protect remaining kidney function.

Question 9

During a nutrition review, an anuric adult receiving thrice-weekly hemodialysis reports worsening appetite. Correctly collected predialysis and postdialysis BUN values are 80 and 30 mg/dL. The treatment record shows that transportation pickup repeatedly ends a prescribed four-hour session after three hours. Protein intake is 1.1 g/kg/day. Select the urea reduction ratio (URR) and response that belong in the care plan.

Accepted Answer

URR 62.5%; coordinate restoration of the prescribed treatment time.

Answer

URR 37.5%; address the transportation problem that is shortening dialysis sessions.

Answer

URR 62.5%; reduce protein to lower BUN.

Answer

URR 50.0%; request more weekly sessions before addressing the shortened treatments.

Question 10

A dialysis facility pilots counseling that helps patients replace phosphate-additive-containing foods. Its primary outcome is the percentage of patients whose serum phosphorus reaches the agreed treatment target. The dietitian is concerned that some patients may instead avoid protein foods altogether. Which additional measure would best detect this nutritional tradeoff early?

Accepted Answer

Percentage of patients whose intake falls below individualized energy or protein prescriptions.

Answer

Percentage of patients who correctly identify phosphate additives on ingredient lists.

Answer

Percentage of patients who report taking prescribed phosphate binders with meals.

Answer

Percentage of patients whose serum phosphorus falls within the laboratory reference interval.

Free CSR Practice Questions

Domain 1: Nutrition Assessment and Diagnosis

Question 1

Question 2

Question 3

Question 4

Domain 2: Intervention and Care Coordination

Question 5

Question 6

Question 7

Question 8

Domain 3: Quality Management and Evidence-Based Practice

Question 9

Question 10

That's 10 of 1,030