Renal and Urological Nursing Examination Questions
and Verified Answers 2026-2027
Comprehensive Clinical Assessment & Test Bank for Nephrology and Urology Nursing
1. A 54-year-old patient with chronic kidney disease (CKD) Stage 4 presents for a routine
follow-up. Laboratory results show a serum potassium level of 6.2 mEq/L and
characteristic tall, peaked T waves on the ECG. Which emergency medication should be
administered first to stabilize the cardiac cellular membrane?
A. Sodium polystyrene sulfonate orally
B. Intravenous calcium gluconate or calcium chloride
C. Regular insulin with 50% dextrose IV
D. Oral sodium bicarbonate tablets
Rationale: Calcium gluconate antagonizes the cardiac membrane excitability caused by
severe hyperkalemia, protecting the heart from fatal dysrhythmias. While insulin and dextrose
drive potassium into cells, calcium acts immediately as a membrane stabilizer.
2. A patient recovering from an arteriovenous (AV) fistula creation in the left forearm is
being assessed by the nurse. Which physical assessment technique confirms functional
patency of the newly created vascular access?
A. Measuring blood pressure in the left arm every 4 hours
B. Palpating a thrashing thrill and auscultating a continuous vascular bruit over the
site
C. Performing a modified Allen's test on the right wrist
D. Applying a tight pressure dressing proximal to the surgical anastomosis
Rationale: A palpable thrill and audible continuous bruit indicate adequate blood flow through
the high-pressure arterial to low-pressure venous anastomosis. Blood pressures and
venipunctures are strictly avoided in the access extremity.
3. A 68-year-old male with benign prostatic hyperplasia (BPH) undergoes a transurethral
resection of the prostate (TURP). Postoperatively, continuous bladder irrigation (CBI) is
running. The nurse notes bright red urinary drainage with frequent large blood clots and
patient complaints of severe bladder spasms. What is the priority nursing action?
A. Increase the flow rate of the continuous bladder irrigation and manually irrigate the
catheter if obstructed
B. Administer an IV bolus of furosemide
C. Stop the irrigation infusion immediately and remove the catheter
D. Place the patient in Trendelenburg position
Rationale: Bright red blood and clots indicate active operative site bleeding. Increasing the
irrigation rate flushes out clots and prevents urinary retention. Manual irrigation with sterile
normal saline clears catheter occlusions causing bladder spasms.
,4. A 28-year-old female presents to the emergency department with severe right flank
pain radiating to her groin, accompanied by hematuria, nausea, and vomiting. A
diagnosis of nephrolithiasis is confirmed. Which nursing action is essential during urine
collection?
A. Collect all urine in a 24-hour dark container with hydrochloric acid preservative
B. Strain all voided urine through a fine mesh strainer to catch passed calculi for
laboratory analysis
C. Restrict fluid intake to less than 1 liter daily
D. Maintain strict bed rest in a supine position
Rationale: Straining urine allows retrieval of passed kidney stones so chemical composition
analysis can determine stone type (e.g., calcium oxalate, uric acid) and guide preventative
dietary therapy.
5. A patient receiving peritoneal dialysis reports cloudy dialysate outflow drainage,
diffuse abdominal pain, and a low-grade fever. What complication should the nurse
suspect first?
A. Peritonitis
B. Catheter site hematoma
C. Inguinal hernia development
D. Encapsulating peritoneal sclerosis
Rationale: Cloudy dialysate effluent is the cardinal early sign of peritoneal dialysis-associated
peritonitis, typically accompanied by abdominal pain, fever, and leukocytosis. Dialysate
effluent must be sent for cell count and culture.
6. A child presents with generalized edema, gross proteinuria (>40 mg/m²/hr),
hypoalbuminemia, and hyperlipidemia. Which primary renal diagnosis is consistent with
this clinical presentation?
A. Acute Post-Streptococcal Glomerulonephritis
B. Nephrotic Syndrome (Minimal Change Disease)
C. Hemolytic Uremic Syndrome
D. Polycystic Kidney Disease
Rationale: The classic triad of nephrotic syndrome includes heavy proteinuria, marked
hypoalbuminemia, and generalized peripheral/periorbital edema. Minimal change disease
accounts for the vast majority of pediatric cases.
7. A patient with acute kidney injury (AKI) enters the oliguric phase. The nurse calculates
the patient's daily fluid restriction allowance. What formula governs fluid replacement in
oliguric renal failure?
A. Previous 24-hour total fluid output plus 500 to 600 mL for insensible losses
B. Fixed 2,000 mL daily regardless of output
C. Double the previous day's urinary output
, D. Previous 24-hour total fluid output minus 300 mL
Rationale: Fluid restriction during the oliguric phase of AKI prevents fluid overload and
pulmonary edema. It is calculated by adding estimated insensible losses (500–600 mL) to the
total measured fluid output from the preceding 24 hours.
8. A 42-year-old male with a history of recurrent uric acid kidney stones receives a
prescription for Allopurinol. What dietary modification should the nurse recommend to
reduce uric acid formation?
A. Avoid calcium-fortified dairy products
B. Limit intake of purine-rich foods such as organ meats, sardines, and red meat
C. Avoid citrus fruits and green leafy vegetables
D. Increase consumption of high-sodium canned soups
Rationale: Uric acid is an end product of purine metabolism. Restricting purine-dense foods
(organ meats, anchovies, sardines, red meat, shellfish) decreases uric acid production and
stone recurrence.
9. An elderly female client presents with acute confusion, dysuria, urinary frequency, and
a low-grade fever. Urinalysis reveals leukocyte esterase and nitrites. What condition is
present?
A. Urinary Tract Infection (UTI) / Cystitis
B. Acute Pyelonephritis
C. Neurogenic bladder
D. Interstitial Cystitis
Rationale: In older adults, classic localized UTI symptoms may be absent or subtle. Acute
onset confusion (altered mental status) is a frequent primary manifestation of urinary tract
infection in the elderly population.
10. A nurse is caring for a patient who underwent a left radical nephrectomy for renal cell
carcinoma. Which postoperative assessment finding requires immediate notification of
the surgeon?
A. Small amount of serosanguinous drainage on the abdominal dressing
B. Hourly urine output of 15 mL/hr for two consecutive hours
C. Hypoactive bowel sounds in all four quadrants
D. Incisional pain rated 6 out of 10 on a visual scale
Rationale: Following nephrectomy, monitoring remaining renal function is vital. Urine output
under 30 mL/hr signals renal hypoperfusion, fluid deficit, or acute failure of the solitary
remaining kidney, requiring immediate evaluation.
11. A 35-year-old client with autosomal dominant polycystic kidney disease (ADPKD)
receives genetic counseling. What key pathophysiological feature should the nurse
explain to the client regarding ADPKD progression?
A. Fluid-filled cysts enlarge progressively, compressing and destroying surrounding
and Verified Answers 2026-2027
Comprehensive Clinical Assessment & Test Bank for Nephrology and Urology Nursing
1. A 54-year-old patient with chronic kidney disease (CKD) Stage 4 presents for a routine
follow-up. Laboratory results show a serum potassium level of 6.2 mEq/L and
characteristic tall, peaked T waves on the ECG. Which emergency medication should be
administered first to stabilize the cardiac cellular membrane?
A. Sodium polystyrene sulfonate orally
B. Intravenous calcium gluconate or calcium chloride
C. Regular insulin with 50% dextrose IV
D. Oral sodium bicarbonate tablets
Rationale: Calcium gluconate antagonizes the cardiac membrane excitability caused by
severe hyperkalemia, protecting the heart from fatal dysrhythmias. While insulin and dextrose
drive potassium into cells, calcium acts immediately as a membrane stabilizer.
2. A patient recovering from an arteriovenous (AV) fistula creation in the left forearm is
being assessed by the nurse. Which physical assessment technique confirms functional
patency of the newly created vascular access?
A. Measuring blood pressure in the left arm every 4 hours
B. Palpating a thrashing thrill and auscultating a continuous vascular bruit over the
site
C. Performing a modified Allen's test on the right wrist
D. Applying a tight pressure dressing proximal to the surgical anastomosis
Rationale: A palpable thrill and audible continuous bruit indicate adequate blood flow through
the high-pressure arterial to low-pressure venous anastomosis. Blood pressures and
venipunctures are strictly avoided in the access extremity.
3. A 68-year-old male with benign prostatic hyperplasia (BPH) undergoes a transurethral
resection of the prostate (TURP). Postoperatively, continuous bladder irrigation (CBI) is
running. The nurse notes bright red urinary drainage with frequent large blood clots and
patient complaints of severe bladder spasms. What is the priority nursing action?
A. Increase the flow rate of the continuous bladder irrigation and manually irrigate the
catheter if obstructed
B. Administer an IV bolus of furosemide
C. Stop the irrigation infusion immediately and remove the catheter
D. Place the patient in Trendelenburg position
Rationale: Bright red blood and clots indicate active operative site bleeding. Increasing the
irrigation rate flushes out clots and prevents urinary retention. Manual irrigation with sterile
normal saline clears catheter occlusions causing bladder spasms.
,4. A 28-year-old female presents to the emergency department with severe right flank
pain radiating to her groin, accompanied by hematuria, nausea, and vomiting. A
diagnosis of nephrolithiasis is confirmed. Which nursing action is essential during urine
collection?
A. Collect all urine in a 24-hour dark container with hydrochloric acid preservative
B. Strain all voided urine through a fine mesh strainer to catch passed calculi for
laboratory analysis
C. Restrict fluid intake to less than 1 liter daily
D. Maintain strict bed rest in a supine position
Rationale: Straining urine allows retrieval of passed kidney stones so chemical composition
analysis can determine stone type (e.g., calcium oxalate, uric acid) and guide preventative
dietary therapy.
5. A patient receiving peritoneal dialysis reports cloudy dialysate outflow drainage,
diffuse abdominal pain, and a low-grade fever. What complication should the nurse
suspect first?
A. Peritonitis
B. Catheter site hematoma
C. Inguinal hernia development
D. Encapsulating peritoneal sclerosis
Rationale: Cloudy dialysate effluent is the cardinal early sign of peritoneal dialysis-associated
peritonitis, typically accompanied by abdominal pain, fever, and leukocytosis. Dialysate
effluent must be sent for cell count and culture.
6. A child presents with generalized edema, gross proteinuria (>40 mg/m²/hr),
hypoalbuminemia, and hyperlipidemia. Which primary renal diagnosis is consistent with
this clinical presentation?
A. Acute Post-Streptococcal Glomerulonephritis
B. Nephrotic Syndrome (Minimal Change Disease)
C. Hemolytic Uremic Syndrome
D. Polycystic Kidney Disease
Rationale: The classic triad of nephrotic syndrome includes heavy proteinuria, marked
hypoalbuminemia, and generalized peripheral/periorbital edema. Minimal change disease
accounts for the vast majority of pediatric cases.
7. A patient with acute kidney injury (AKI) enters the oliguric phase. The nurse calculates
the patient's daily fluid restriction allowance. What formula governs fluid replacement in
oliguric renal failure?
A. Previous 24-hour total fluid output plus 500 to 600 mL for insensible losses
B. Fixed 2,000 mL daily regardless of output
C. Double the previous day's urinary output
, D. Previous 24-hour total fluid output minus 300 mL
Rationale: Fluid restriction during the oliguric phase of AKI prevents fluid overload and
pulmonary edema. It is calculated by adding estimated insensible losses (500–600 mL) to the
total measured fluid output from the preceding 24 hours.
8. A 42-year-old male with a history of recurrent uric acid kidney stones receives a
prescription for Allopurinol. What dietary modification should the nurse recommend to
reduce uric acid formation?
A. Avoid calcium-fortified dairy products
B. Limit intake of purine-rich foods such as organ meats, sardines, and red meat
C. Avoid citrus fruits and green leafy vegetables
D. Increase consumption of high-sodium canned soups
Rationale: Uric acid is an end product of purine metabolism. Restricting purine-dense foods
(organ meats, anchovies, sardines, red meat, shellfish) decreases uric acid production and
stone recurrence.
9. An elderly female client presents with acute confusion, dysuria, urinary frequency, and
a low-grade fever. Urinalysis reveals leukocyte esterase and nitrites. What condition is
present?
A. Urinary Tract Infection (UTI) / Cystitis
B. Acute Pyelonephritis
C. Neurogenic bladder
D. Interstitial Cystitis
Rationale: In older adults, classic localized UTI symptoms may be absent or subtle. Acute
onset confusion (altered mental status) is a frequent primary manifestation of urinary tract
infection in the elderly population.
10. A nurse is caring for a patient who underwent a left radical nephrectomy for renal cell
carcinoma. Which postoperative assessment finding requires immediate notification of
the surgeon?
A. Small amount of serosanguinous drainage on the abdominal dressing
B. Hourly urine output of 15 mL/hr for two consecutive hours
C. Hypoactive bowel sounds in all four quadrants
D. Incisional pain rated 6 out of 10 on a visual scale
Rationale: Following nephrectomy, monitoring remaining renal function is vital. Urine output
under 30 mL/hr signals renal hypoperfusion, fluid deficit, or acute failure of the solitary
remaining kidney, requiring immediate evaluation.
11. A 35-year-old client with autosomal dominant polycystic kidney disease (ADPKD)
receives genetic counseling. What key pathophysiological feature should the nurse
explain to the client regarding ADPKD progression?
A. Fluid-filled cysts enlarge progressively, compressing and destroying surrounding
