NCLEX Renal and Urinary
(#1) A client with acute kidney injury has a serum potassium level of 7.0 mEq/L (7.0 mmol/L). The
nurse should plan which actions as a priority? Select all that apply.
1. Place the client on a cardiac monitor.
2. Notify the health care provider (HCP).
3. Put the client on NPO (nothing by mouth) status except for ice chips.
4. Review the client's medications to determine if any contain or retain potassium.
5. Allow an extra 500 mL of intravenous fluid intake to dilute the electrolyte concentration. -
✅1, 2, 4
R: NPO is unnecessary. Adding extra fluid may worsen the situation and lead to fluid overload.
Excess K can cause heart dysrhythmias, so 1&4 are appropriate. Calling the HCP is also necessary
for further orders.
(#2) A client arrives at the emergency department with complaints of low abdominal pain and
hematuria. The client is afebrile. The nurse next assesses the client to determine a history of which
condition?
1. Pyelonephritis
2. Glomerulonephritis
3. Trauma to the bladder or abdomen
4. Renal cancer in the client's family -
✅3
R: 1& 2 are similar/alike, and they would involve a fever. 4 would have flank pain instead of low
abd pain.
(# 3) The nurse discusses plans for future treatment options with a client with symptomatic
polycystic kidney disease. Which treatment should be included in this discussion? Select all that
apply.
1. Hemodialysis
2. Peritoneal dialysis
3. Kidney transplant
4. Bilateral nephrectomy
5. Intense immunosuppression therapy -
✅1,3,4
R: Polycystic KD involves cysts that eventually rupture and damage the kidneys, leading to end-
stage renal disease. This requires options 1, 3, or 4. 2 is contraindicated r/t infection. 5 won't help
the pt's condition.
A client is admitted to the emergency department following a fall from a horse and the health care
provider (HCP) prescribes insertion of a urinary catheter. While preparing for the procedure, the
nurse notes blood at the urinary meatus. The nurse should take which action?
1. Notify the HCP before performing the catheterization.
2. Use a small-sized catheter and an anesthetic gel as a lubricant.
1
,3. Administer parenteral pain medication before inserting the catheter.
4. Clean the meatus with soap and water before opening the catheterization kit. -
✅1
R: blood may = urethral trauma, so you need to notify the HCP first so you can identify the true
cause of blood before catheterization.
Since there's blood from an unknown cause, you need to assess first before doing anything that can
worsen it.
The nurse is assessing the patency of a client's left arm arteriovenous fistula prior to initiating
hemodialysis. Which finding indicates that the fistula is patent?
1. Palpation of a thrill over the fistula
2. Presence of a radial pulse in the left wrist
3. Visualization of enlarged blood vessels at the fistula site
4. Capillary refill less than 3 seconds in the nail beds of the fingers on the left hand -
✅1.
R: listen for a thrill or bruit over AV fistula site. All other options don't REALLY show if the AV
fistula is patent, just that there's perfusion to the hand.
A male client has a tentative diagnosis of urethritis. The nurse should assess the client for which
manifestation of the disorder?
1. Hematuria and pyuria
2. Dysuria and proteinuria
3. Hematuria and urgency
4. Dysuria and penile discharge -
✅4.
R: Urethritis usually involves dysuria, so 1&3 are incorrect. Proteinuria is r/t kidney dysfunction, so
option 2 is also incorrect. Urethritis is also associated with chlamydia, so discharge is expected.
Hematuria is not assoc. with urethritis.
The nurse is assessing a client with epididymitis. The nurse anticipates which findings on physical
examination?
1. Fever, diarrhea, groin pain, and ecchymosis
2. Nausea, painful scrotal edema, and ecchymosis
3. Fever, nausea, vomiting, and painful scrotal edema
4. Diarrhea, groin pain, testicular torsion, and scrotal edema -
✅3
R: -itis is associated w/ fever, so you can narrow it down to 1&3. Epididymitis does not involve
bleeding so ecchymosis (option 1) is irrelevant.
Typical signs and symptoms of epididymitis include scrotal pain and edema, which often are
accompanied by fever, nausea and vomiting, and chills.
A client complains of fever, perineal pain, and urinary urgency, frequency, and dysuria. To assess
whether the client's problem is related to bacterial prostatitis, the nurse reviews the results of the
prostate examination for which characteristic of this disorder?
2
,1. Soft and swollen prostate gland
2. Swollen, and boggy prostate gland
3. Tender and edematous prostate gland
4. Tender, indurated prostate gland that is warm to the touch -
✅4
R: The client with bacterial prostatitis has a swollen and tender prostate gland that is also warm to
the touch, firm, and indurated. Systemic symptoms include fever with chills, perineal and low back
pain, and signs of urinary tract infection, which often accompany the disorder.
*Remember, -itis= inflammation/infection, so tenderness and local warmth is expected. so option 4
is most correct.
The nurse is collecting data from a client. Which symptom described by the client is characteristic
of an early symptom of benign prostatic hyperplasia?
1. Nocturia
2. Scrotal edema
3. Occasional constipation
4. Decreased force in the stream of urine -
✅4
R: Option 1 is a later sign. 2&3 are irrelevant to BPH.
The nurse monitoring a client receiving peritoneal dialysis notes that the client's outflow is less than
the inflow. Which actions should the nurse take? Select all that apply.
1. Check the level of the drainage bag.
2. Reposition the client to his or her side.
3. Contact the health care provider (HCP).
4. Place the client in good body alignment.
5. Check the peritoneal dialysis system for kinks.
6. Increase the flow rate of the peritoneal dialysis solution. -
✅1,2,4,5
R: Try to fix the flow yourself before calling the HCP or messing with the flow rate. Imbalance may
be r/t a kink or improper positioning so fix those first.
A hemodialysis client with a left arm fistula is at risk for arterial steal syndrome. The nurse should
assess for which manifestations of this complication?
1. Warmth, redness, and pain in the left hand
2. Ecchymosis and audible bruit over the fistula
3. Edema and reddish discoloration of the left arm
4. Pallor, diminished pulse, and pain in the left hand -
✅4
R: Arterial STEAL syndrome involves vascular insufficiency (literally stealing the blood that the
hand's tissue needs!). So you'd see pallor and other signs of decr. perfusion.
1&3 sound more like an infection so they're incorrect. Option 2 is a normal finding for a fistula.
3
, The nurse is reviewing a client's record and notes that the health care provider has documented that
the client has chronic renal disease. On review of the laboratory results, the nurse most likely would
expect to note which finding?
1. Elevated creatinine level
2. Decreased hemoglobin level
3. Decreased red blood cell count
4. Increased number of white blood cells in the urine -
✅1
R: Creat is increased only by kidney dysfunction of at least 50% loss. 2&3 are irrelevant. 4 is more
involved w/ UTIs.
A client with chronic kidney disease returns to the nursing unit following a hemodialysis treatment.
On assessment, the nurse notes that the client's temperature is 38.5°C (101.2°F). Which nursing
action is most appropriate?
1. Encourage fluid intake.
2. Notify the health care provider.
3. Continue to monitor vital signs.
4. Monitor the site of the shunt for infection. -
✅2
R: Options 3&4 involve assessment, which is normally good but not for a priority situation like this
so they're incorrect (you'll just watch the pt deteriorate lol). You know that dialysis patients have
fluid restrictions, so option 2 is the best choice since the HCP can order further & treatment.
The nurse is performing an assessment on a client who has returned from the dialysis unit following
hemodialysis. The client is complaining of headache and nausea and is extremely restless. Which is
the priority nursing action?
1. Monitor the client.
2. Elevate the head of the bed.
3. Assess the fistula site and dressing.
4. Notify the health care provider (HCP). -
✅4
R: "Disequilibrium syndrome may be caused by rapid removal of solutes from the body during
hemodialysis. These changes can cause cerebral edema that leads to increased intracranial pressure.
The client is exhibiting early signs and symptoms of disequilibrium syndrome and appropriate
treatments with anticonvulsive medications and barbiturates may be necessary to prevent a life-
threatening situation. The HCP must be notified. Monitoring the client, elevating the head of the
bed, and assessing the fistula site are correct actions, but the priority action is to notify the HCP."
A client with severe back pain and hematuria is found to have hydronephrosis due to urolithiasis.
The nurse anticipates which treatment will be done to relieve the obstruction? Select all that apply.
1. Peritoneal dialysis
2. Analysis of the urinary stone
3. Intravenous opioid analgesics
4. Insertion of a nephrostomy tube
5. Placement of a ureteral stent with ureteroscopy -
4
(#1) A client with acute kidney injury has a serum potassium level of 7.0 mEq/L (7.0 mmol/L). The
nurse should plan which actions as a priority? Select all that apply.
1. Place the client on a cardiac monitor.
2. Notify the health care provider (HCP).
3. Put the client on NPO (nothing by mouth) status except for ice chips.
4. Review the client's medications to determine if any contain or retain potassium.
5. Allow an extra 500 mL of intravenous fluid intake to dilute the electrolyte concentration. -
✅1, 2, 4
R: NPO is unnecessary. Adding extra fluid may worsen the situation and lead to fluid overload.
Excess K can cause heart dysrhythmias, so 1&4 are appropriate. Calling the HCP is also necessary
for further orders.
(#2) A client arrives at the emergency department with complaints of low abdominal pain and
hematuria. The client is afebrile. The nurse next assesses the client to determine a history of which
condition?
1. Pyelonephritis
2. Glomerulonephritis
3. Trauma to the bladder or abdomen
4. Renal cancer in the client's family -
✅3
R: 1& 2 are similar/alike, and they would involve a fever. 4 would have flank pain instead of low
abd pain.
(# 3) The nurse discusses plans for future treatment options with a client with symptomatic
polycystic kidney disease. Which treatment should be included in this discussion? Select all that
apply.
1. Hemodialysis
2. Peritoneal dialysis
3. Kidney transplant
4. Bilateral nephrectomy
5. Intense immunosuppression therapy -
✅1,3,4
R: Polycystic KD involves cysts that eventually rupture and damage the kidneys, leading to end-
stage renal disease. This requires options 1, 3, or 4. 2 is contraindicated r/t infection. 5 won't help
the pt's condition.
A client is admitted to the emergency department following a fall from a horse and the health care
provider (HCP) prescribes insertion of a urinary catheter. While preparing for the procedure, the
nurse notes blood at the urinary meatus. The nurse should take which action?
1. Notify the HCP before performing the catheterization.
2. Use a small-sized catheter and an anesthetic gel as a lubricant.
1
,3. Administer parenteral pain medication before inserting the catheter.
4. Clean the meatus with soap and water before opening the catheterization kit. -
✅1
R: blood may = urethral trauma, so you need to notify the HCP first so you can identify the true
cause of blood before catheterization.
Since there's blood from an unknown cause, you need to assess first before doing anything that can
worsen it.
The nurse is assessing the patency of a client's left arm arteriovenous fistula prior to initiating
hemodialysis. Which finding indicates that the fistula is patent?
1. Palpation of a thrill over the fistula
2. Presence of a radial pulse in the left wrist
3. Visualization of enlarged blood vessels at the fistula site
4. Capillary refill less than 3 seconds in the nail beds of the fingers on the left hand -
✅1.
R: listen for a thrill or bruit over AV fistula site. All other options don't REALLY show if the AV
fistula is patent, just that there's perfusion to the hand.
A male client has a tentative diagnosis of urethritis. The nurse should assess the client for which
manifestation of the disorder?
1. Hematuria and pyuria
2. Dysuria and proteinuria
3. Hematuria and urgency
4. Dysuria and penile discharge -
✅4.
R: Urethritis usually involves dysuria, so 1&3 are incorrect. Proteinuria is r/t kidney dysfunction, so
option 2 is also incorrect. Urethritis is also associated with chlamydia, so discharge is expected.
Hematuria is not assoc. with urethritis.
The nurse is assessing a client with epididymitis. The nurse anticipates which findings on physical
examination?
1. Fever, diarrhea, groin pain, and ecchymosis
2. Nausea, painful scrotal edema, and ecchymosis
3. Fever, nausea, vomiting, and painful scrotal edema
4. Diarrhea, groin pain, testicular torsion, and scrotal edema -
✅3
R: -itis is associated w/ fever, so you can narrow it down to 1&3. Epididymitis does not involve
bleeding so ecchymosis (option 1) is irrelevant.
Typical signs and symptoms of epididymitis include scrotal pain and edema, which often are
accompanied by fever, nausea and vomiting, and chills.
A client complains of fever, perineal pain, and urinary urgency, frequency, and dysuria. To assess
whether the client's problem is related to bacterial prostatitis, the nurse reviews the results of the
prostate examination for which characteristic of this disorder?
2
,1. Soft and swollen prostate gland
2. Swollen, and boggy prostate gland
3. Tender and edematous prostate gland
4. Tender, indurated prostate gland that is warm to the touch -
✅4
R: The client with bacterial prostatitis has a swollen and tender prostate gland that is also warm to
the touch, firm, and indurated. Systemic symptoms include fever with chills, perineal and low back
pain, and signs of urinary tract infection, which often accompany the disorder.
*Remember, -itis= inflammation/infection, so tenderness and local warmth is expected. so option 4
is most correct.
The nurse is collecting data from a client. Which symptom described by the client is characteristic
of an early symptom of benign prostatic hyperplasia?
1. Nocturia
2. Scrotal edema
3. Occasional constipation
4. Decreased force in the stream of urine -
✅4
R: Option 1 is a later sign. 2&3 are irrelevant to BPH.
The nurse monitoring a client receiving peritoneal dialysis notes that the client's outflow is less than
the inflow. Which actions should the nurse take? Select all that apply.
1. Check the level of the drainage bag.
2. Reposition the client to his or her side.
3. Contact the health care provider (HCP).
4. Place the client in good body alignment.
5. Check the peritoneal dialysis system for kinks.
6. Increase the flow rate of the peritoneal dialysis solution. -
✅1,2,4,5
R: Try to fix the flow yourself before calling the HCP or messing with the flow rate. Imbalance may
be r/t a kink or improper positioning so fix those first.
A hemodialysis client with a left arm fistula is at risk for arterial steal syndrome. The nurse should
assess for which manifestations of this complication?
1. Warmth, redness, and pain in the left hand
2. Ecchymosis and audible bruit over the fistula
3. Edema and reddish discoloration of the left arm
4. Pallor, diminished pulse, and pain in the left hand -
✅4
R: Arterial STEAL syndrome involves vascular insufficiency (literally stealing the blood that the
hand's tissue needs!). So you'd see pallor and other signs of decr. perfusion.
1&3 sound more like an infection so they're incorrect. Option 2 is a normal finding for a fistula.
3
, The nurse is reviewing a client's record and notes that the health care provider has documented that
the client has chronic renal disease. On review of the laboratory results, the nurse most likely would
expect to note which finding?
1. Elevated creatinine level
2. Decreased hemoglobin level
3. Decreased red blood cell count
4. Increased number of white blood cells in the urine -
✅1
R: Creat is increased only by kidney dysfunction of at least 50% loss. 2&3 are irrelevant. 4 is more
involved w/ UTIs.
A client with chronic kidney disease returns to the nursing unit following a hemodialysis treatment.
On assessment, the nurse notes that the client's temperature is 38.5°C (101.2°F). Which nursing
action is most appropriate?
1. Encourage fluid intake.
2. Notify the health care provider.
3. Continue to monitor vital signs.
4. Monitor the site of the shunt for infection. -
✅2
R: Options 3&4 involve assessment, which is normally good but not for a priority situation like this
so they're incorrect (you'll just watch the pt deteriorate lol). You know that dialysis patients have
fluid restrictions, so option 2 is the best choice since the HCP can order further & treatment.
The nurse is performing an assessment on a client who has returned from the dialysis unit following
hemodialysis. The client is complaining of headache and nausea and is extremely restless. Which is
the priority nursing action?
1. Monitor the client.
2. Elevate the head of the bed.
3. Assess the fistula site and dressing.
4. Notify the health care provider (HCP). -
✅4
R: "Disequilibrium syndrome may be caused by rapid removal of solutes from the body during
hemodialysis. These changes can cause cerebral edema that leads to increased intracranial pressure.
The client is exhibiting early signs and symptoms of disequilibrium syndrome and appropriate
treatments with anticonvulsive medications and barbiturates may be necessary to prevent a life-
threatening situation. The HCP must be notified. Monitoring the client, elevating the head of the
bed, and assessing the fistula site are correct actions, but the priority action is to notify the HCP."
A client with severe back pain and hematuria is found to have hydronephrosis due to urolithiasis.
The nurse anticipates which treatment will be done to relieve the obstruction? Select all that apply.
1. Peritoneal dialysis
2. Analysis of the urinary stone
3. Intravenous opioid analgesics
4. Insertion of a nephrostomy tube
5. Placement of a ureteral stent with ureteroscopy -
4
