Renal and Urological Nursing Examination Questions
and Verified Answers 2026-2027
Comprehensive Practice Test Bank & Clinical Assessment Guide for Nephrology and
Urology Nursing
1. A client with chronic kidney disease (CKD) Stage 5 presents with confusion, lethargy,
pericardial friction rub, and a blood urea nitrogen (BUN) level of 112 mg/dL. What
immediate intervention is indicated to manage these uremic manifestations?
A. Increase daily dietary protein intake to 1.5 g/kg.
B. Prepare the client for emergency hemodialysis.
C. Administer high-dose oral loop diuretics.
D. Restrict intravenous crystalloid fluids to keep-vein-open rates.
Rationale: Uremic symptoms such as pericarditis, encephalopathy, and severe azotemia
represent clear indications for urgent renal replacement therapy (hemodialysis) to clear
uremic toxins.
2. A nurse is evaluating a client undergoing continuous ambulatory peritoneal dialysis
(CAPD). The effluent drainage collected in the drainage bag appears cloudy and dark
yellow. The client reports mild diffuse abdominal pain. What complication should the
nurse suspect first?
A. Peritonitis
B. Catheter exit-site infection
C. Bowel perforation
D. Normal fibrin accumulation in dialysate
Rationale: Cloudy dialysate outflow is the hallmark sign of peritoneal dialysis-associated
peritonitis, often accompanied by abdominal pain, fever, and elevated dialysate white blood
cell count.
3. A client with acute kidney injury (AKI) secondary to severe hypovolemic shock enters
the oliguric phase. Which laboratory finding aligns with prerenal acute kidney injury?
A. Fractional Excretion of Sodium (FENa) greater than 2%
B. Fractional Excretion of Sodium (FENa) less than 1% and high urine specific gravity
(>1.020)
C. Low urine osmolality (<300 mOsm/kg)
D. Presence of muddy brown granular casts in urine microscopy
Rationale: Prerenal AKI reflects intact tubular function responding to renal hypoperfusion.
Tubules avidly reabsorb sodium and water, resulting in FENa <1% and concentrated urine.
Muddy brown casts and high FENa indicate intrinsic tubular necrosis.
,4. A client who underwent creation of an arteriovenous (AV) fistula in the left forearm 6
weeks ago is assessed in the clinic. Which physical exam finding confirms functional
patency of the vascular access?
A. Presence of a strong, bounding radial pulse distal to the graft
B. Palpation of a continuous thrill and auscultation of a soft bruit over the anastomosis
site
C. Absence of localized edema in the left hand
D. Capillary refill time less than 2 seconds in all left fingers
Rationale: Functional AV fistulas exhibit a palpable vibration (thrill) and a continuous turbulent
vascular murmur (bruit) caused by high-pressure arterial flow entering the low-pressure
venous system.
5. A client diagnosed with acute post-streptococcal glomerulonephritis (APSGN)
presents with dark cola-colored urine, facial edema, and hypertension. What primary
pathophysiological mechanism drives fluid retention and hypertension in nephritic
syndrome?
A. Immune-complex deposition in glomeruli causing reduced glomerular filtration rate
(GFR) and renal sodium/water retention
B. Severe hypoalbuminemia secondary to massive immunoglobulin loss
C. Direct bacterial infection of renal medullary collecting ducts
D. Obstructive uropathy at the ureteropelvic junction
Rationale: Antigen-antibody immune complexes deposit in glomerular capillaries, triggering
inflammatory injury, basement membrane disruption, decreased GFR, and subsequent renal
sodium and water retention.
6. A client with end-stage renal disease (ESRD) takes sevelamer carbonate with meals.
How should the nurse explain the therapeutic purpose of this drug to the client?
A. "It stimulates red blood cell production in the bone marrow."
B. "It binds dietary phosphorus in your intestines to lower serum phosphate levels."
C. "It replaces potassium lost during daily dialysis treatments."
D. "It lowers systemic blood pressure by relaxing renal blood vessels."
Rationale: Sevelamer is a non-calcium phosphate binder that binds dietary phosphate in the
gastrointestinal tract, preventing its absorption and controlling hyperphosphatemia in CKD.
7. A client with nephrotic syndrome exhibits 4+ generalized pitting edema (anasarca),
serum albumin of 1.8 g/dL, and severe proteinuria (>3.5 g/24 hours). What causes the
profound peripheral edema in nephrotic syndrome?
A. Elevated plasma oncotic pressure driving fluid into arterioles
B. Decreased plasma oncotic pressure resulting from massive urinary loss of albumin
C. Primary rightsided heart failure causing systemic venous stasis
D. Mechanical obstruction of pelvic lymphatic drainage channels
Rationale: Glomerular podocyte effacement leads to heavy proteinuria and hypoalbuminemia.
Reduced plasma proteins lower intravascular oncotic pressure, driving fluid shift into
, interstitial spaces.
8. A 52-year-old male presents to the emergency department with sudden severe,
agonizing right flank pain radiating down to his groin and testicle, accompanied by
nausea and hematuria. What initial imaging modality is the gold standard for diagnosing
nephrolithiasis?
A. Non-contrast Computed Tomography (CT) of the abdomen and pelvis
B. Plain abdominal X-ray (KUB) alone
C. Intravenous Pyelogram (IVP) with iodinated contrast
D. Retrograde Pyelography
Rationale: Non-contrast CT of the abdomen and pelvis is the gold standard diagnostic test for
urolithiasis, detecting radiopaque and radiolucent stones, stone size, and urinary tract
obstruction.
9. A client receiving continuous hemodialysis via a temporary dual-lumen subclavian
catheter develops sudden hypotension, restlessness, severe headache, and muscle
cramps near the end of the treatment session. What condition is developing?
A. Air embolism
B. Dialysis Disequilibrium Syndrome (DDS)
C. Septic shock from catheter infection
D. Hypercalcemic crisis
Rationale: Dialysis Disequilibrium Syndrome results from rapid removal of urea from the
blood while brain urea levels drop slowly. The osmotic gradient draws water into brain tissue,
causing cerebral edema, headache, and confusion.
10. An older adult male client presents with urinary frequency, hesitancy, weak stream,
post-void dribbling, and nocturia. Digital rectal exam reveals a smooth, symmetrically
enlarged, non-tender prostate. What medication class shrinks prostatic tissue by
blocking testosterone conversion?
A. Alpha-1 adrenergic blockers (e.g., Tamsulosin)
B. 5-Alpha reductase inhibitors (e.g., Finasteride)
C. Anticholinergic bladder relaxants (e.g., Oxybutynin)
D. Phosphodiesterase-5 inhibitors (e.g., Sildenafil)
Rationale: 5-Alpha reductase inhibitors (Finasteride, Dutasteride) inhibit conversion of
testosterone to dihydrotestosterone (DHT), gradually reducing prostate epithelial volume.
Alpha-blockers relax smooth muscle without shrinking prostate size.
11. Following a transurethral resection of the prostate (TURP), a client has a 3-way Foley
catheter connected to continuous bladder irrigation (CBI). The nurse notes dark red
drainage with large blood clots in the collection bag, and the client reports severe
bladder spasms. What action should the nurse take first?
A. Increase the flow rate of the continuous bladder irrigation and manually irrigate the
and Verified Answers 2026-2027
Comprehensive Practice Test Bank & Clinical Assessment Guide for Nephrology and
Urology Nursing
1. A client with chronic kidney disease (CKD) Stage 5 presents with confusion, lethargy,
pericardial friction rub, and a blood urea nitrogen (BUN) level of 112 mg/dL. What
immediate intervention is indicated to manage these uremic manifestations?
A. Increase daily dietary protein intake to 1.5 g/kg.
B. Prepare the client for emergency hemodialysis.
C. Administer high-dose oral loop diuretics.
D. Restrict intravenous crystalloid fluids to keep-vein-open rates.
Rationale: Uremic symptoms such as pericarditis, encephalopathy, and severe azotemia
represent clear indications for urgent renal replacement therapy (hemodialysis) to clear
uremic toxins.
2. A nurse is evaluating a client undergoing continuous ambulatory peritoneal dialysis
(CAPD). The effluent drainage collected in the drainage bag appears cloudy and dark
yellow. The client reports mild diffuse abdominal pain. What complication should the
nurse suspect first?
A. Peritonitis
B. Catheter exit-site infection
C. Bowel perforation
D. Normal fibrin accumulation in dialysate
Rationale: Cloudy dialysate outflow is the hallmark sign of peritoneal dialysis-associated
peritonitis, often accompanied by abdominal pain, fever, and elevated dialysate white blood
cell count.
3. A client with acute kidney injury (AKI) secondary to severe hypovolemic shock enters
the oliguric phase. Which laboratory finding aligns with prerenal acute kidney injury?
A. Fractional Excretion of Sodium (FENa) greater than 2%
B. Fractional Excretion of Sodium (FENa) less than 1% and high urine specific gravity
(>1.020)
C. Low urine osmolality (<300 mOsm/kg)
D. Presence of muddy brown granular casts in urine microscopy
Rationale: Prerenal AKI reflects intact tubular function responding to renal hypoperfusion.
Tubules avidly reabsorb sodium and water, resulting in FENa <1% and concentrated urine.
Muddy brown casts and high FENa indicate intrinsic tubular necrosis.
,4. A client who underwent creation of an arteriovenous (AV) fistula in the left forearm 6
weeks ago is assessed in the clinic. Which physical exam finding confirms functional
patency of the vascular access?
A. Presence of a strong, bounding radial pulse distal to the graft
B. Palpation of a continuous thrill and auscultation of a soft bruit over the anastomosis
site
C. Absence of localized edema in the left hand
D. Capillary refill time less than 2 seconds in all left fingers
Rationale: Functional AV fistulas exhibit a palpable vibration (thrill) and a continuous turbulent
vascular murmur (bruit) caused by high-pressure arterial flow entering the low-pressure
venous system.
5. A client diagnosed with acute post-streptococcal glomerulonephritis (APSGN)
presents with dark cola-colored urine, facial edema, and hypertension. What primary
pathophysiological mechanism drives fluid retention and hypertension in nephritic
syndrome?
A. Immune-complex deposition in glomeruli causing reduced glomerular filtration rate
(GFR) and renal sodium/water retention
B. Severe hypoalbuminemia secondary to massive immunoglobulin loss
C. Direct bacterial infection of renal medullary collecting ducts
D. Obstructive uropathy at the ureteropelvic junction
Rationale: Antigen-antibody immune complexes deposit in glomerular capillaries, triggering
inflammatory injury, basement membrane disruption, decreased GFR, and subsequent renal
sodium and water retention.
6. A client with end-stage renal disease (ESRD) takes sevelamer carbonate with meals.
How should the nurse explain the therapeutic purpose of this drug to the client?
A. "It stimulates red blood cell production in the bone marrow."
B. "It binds dietary phosphorus in your intestines to lower serum phosphate levels."
C. "It replaces potassium lost during daily dialysis treatments."
D. "It lowers systemic blood pressure by relaxing renal blood vessels."
Rationale: Sevelamer is a non-calcium phosphate binder that binds dietary phosphate in the
gastrointestinal tract, preventing its absorption and controlling hyperphosphatemia in CKD.
7. A client with nephrotic syndrome exhibits 4+ generalized pitting edema (anasarca),
serum albumin of 1.8 g/dL, and severe proteinuria (>3.5 g/24 hours). What causes the
profound peripheral edema in nephrotic syndrome?
A. Elevated plasma oncotic pressure driving fluid into arterioles
B. Decreased plasma oncotic pressure resulting from massive urinary loss of albumin
C. Primary rightsided heart failure causing systemic venous stasis
D. Mechanical obstruction of pelvic lymphatic drainage channels
Rationale: Glomerular podocyte effacement leads to heavy proteinuria and hypoalbuminemia.
Reduced plasma proteins lower intravascular oncotic pressure, driving fluid shift into
, interstitial spaces.
8. A 52-year-old male presents to the emergency department with sudden severe,
agonizing right flank pain radiating down to his groin and testicle, accompanied by
nausea and hematuria. What initial imaging modality is the gold standard for diagnosing
nephrolithiasis?
A. Non-contrast Computed Tomography (CT) of the abdomen and pelvis
B. Plain abdominal X-ray (KUB) alone
C. Intravenous Pyelogram (IVP) with iodinated contrast
D. Retrograde Pyelography
Rationale: Non-contrast CT of the abdomen and pelvis is the gold standard diagnostic test for
urolithiasis, detecting radiopaque and radiolucent stones, stone size, and urinary tract
obstruction.
9. A client receiving continuous hemodialysis via a temporary dual-lumen subclavian
catheter develops sudden hypotension, restlessness, severe headache, and muscle
cramps near the end of the treatment session. What condition is developing?
A. Air embolism
B. Dialysis Disequilibrium Syndrome (DDS)
C. Septic shock from catheter infection
D. Hypercalcemic crisis
Rationale: Dialysis Disequilibrium Syndrome results from rapid removal of urea from the
blood while brain urea levels drop slowly. The osmotic gradient draws water into brain tissue,
causing cerebral edema, headache, and confusion.
10. An older adult male client presents with urinary frequency, hesitancy, weak stream,
post-void dribbling, and nocturia. Digital rectal exam reveals a smooth, symmetrically
enlarged, non-tender prostate. What medication class shrinks prostatic tissue by
blocking testosterone conversion?
A. Alpha-1 adrenergic blockers (e.g., Tamsulosin)
B. 5-Alpha reductase inhibitors (e.g., Finasteride)
C. Anticholinergic bladder relaxants (e.g., Oxybutynin)
D. Phosphodiesterase-5 inhibitors (e.g., Sildenafil)
Rationale: 5-Alpha reductase inhibitors (Finasteride, Dutasteride) inhibit conversion of
testosterone to dihydrotestosterone (DHT), gradually reducing prostate epithelial volume.
Alpha-blockers relax smooth muscle without shrinking prostate size.
11. Following a transurethral resection of the prostate (TURP), a client has a 3-way Foley
catheter connected to continuous bladder irrigation (CBI). The nurse notes dark red
drainage with large blood clots in the collection bag, and the client reports severe
bladder spasms. What action should the nurse take first?
A. Increase the flow rate of the continuous bladder irrigation and manually irrigate the
