NCLEX Urinary/Renal System
The nurse assesses a patient admitted to the medical-surgical unit who has a diagnosis of type I
diabetes mellitus. The nurse notes that the patient's urine is cloudy and foul-smelling. Which of the
following diagnostic tests does the nurse anticipate will be ordered based on this finding?
1. urine culture and sensitivity (C&S)
2. blood urea nitrogen (BUN)
3. creatinine clearance
4. residual urine -
✅Correct Answer: 1
Rationale: Urine culture and sensitivity (C&S) is correct because cloudy and foul-smelling urine
indicates a urinary tract infection. The diagnostic test to identify the organism responsible is a urine
C&S. Blood urea nitrogen (BUN) measures the amount of urea (end product of protein metabolism)
in the blood plasma. It does not identify infection. Creatinine clearance is a 24-hour urine test used
to identify renal function; it will not identify an infection. Residual urine measures the amount of
urine left in the bladder after voiding, and does not identify an infection.
When preparing a patient for an intravenous pyelogram (IVP), the nurse reviews diagnostic data,
noting all of the following. Which of these findings requires notification of the physician before
proceeding with the test?
1. blood urea nitrogen (BUN) 55 mg/dLdl
2. serum creatinine 1.3 mg/dL
3. urine culture <10,000 organisms/mL
4. residual urine of 80 mL -
✅Correct Answer: 1
Rationale: Blood urea nitrogen (BUN) 55 mg/dL is correct because this level is elevated, indicating
that there might be a problem of renal function. The physician will need to be notified because an
IVP involves the injection of dye that must eventually cleared by the kidney, and if there is already
compromised renal function, the test may not be administered. Serum creatinine 1.3 mg/dL, urine
culture <10,000 organisms/mL, and residual urine of 80 mL are all incorrect because these values
are all within the normal range, and therefore will not require physician notification
A nurse working in a postoperative unit is caring for a patient who states, "I voided a small amount
of urine, but I feel as if I need to void more and am unable to do so." The patient receives a
prescription for a post-voiding residual urine test. The nurse correctly prepares to perform the
procedure by gathering supplies that include which of the following?
1. a urine collecting device and a straight urinary catheter
2. a urine collecting device and a voiding diary
3. an indwelling urinary catheter and an insertion kit
4. a peripheral IV insertion kit and a urine collecting device -
✅Correct Answer: 1
1
,Rationale: To evaluate the amount of urine in bladder post-voiding is correct. This diagnostic test is
ordered to determine urinary retention or incomplete bladder emptying, which could be a
consequence of the operative experience. To correctly perform the procedure, the nurse gathers a
urinary collecting device and asks the patient to void. A straight urinary catheter is inserted and
removed and the amount of urine obtained from the bladder is measured. Voiding diaries,
indwelling urinary catheters, and peripheral IVs are not required for this procedure.
Because of normal changes due to aging, the nurse anticipates that a 75-year-old patient's serum
creatinine level might be which of the following?
1. 0.3 mg/dL
2. 2.4 mg/dL
3. 4.8 mg/dL
4. 6.4 mg/dL -
✅Correct Answer: 1
Rationale: Lower than normal is correct because serum creatinine level reflects the by-product of
muscle breakdown, and an older adult with less muscle mass can be expected to have a lower-than-
normal level. 0.5-1.5 mg/dL is the normal creatinine range for adults. Higher than normal, variable
with fluid status, and within normal range are all incorrect because the question is asking for the
expected change due to the aging process, and that is less muscle mass, and therefore less serum
creatinine.
When assessing a patient who is scheduled to have a CT scan of the kidneys, which of these
findings would prompt the nurse to notify the primary healthcare provider?
1. allergy to iodine and seafood
2. . urinary output of 1,200 mL in 24 hours
3. last bowel movement one day ago
4. height 5'8" and weight 160 pounds -
✅Correct Answer: 1
Rationale: Allergy to iodine and seafood is correct because a CT scan of the kidneys requires the
injection of a radiopaque dye that contains iodine. A patient who is allergic to iodine or seafood will
be unable to have this test. Urinary output of 1,200 mL in 24 hours, last bowel movement one day
ago, and height 5'8" and weight 160 pounds are all incorrect because these are all normal findings,
and therefore do not require that the physician be notified.
A nurse is assessing a 68-year-old female patient who states, "I am having episodes of urinary
incontinence." The nurse should recognize this statement as indicating which of the following?
1. an abnormal finding requiring further testing
2. an indication of the presence of a urinary infection
3. a normal outcome of the aging process
4. the result of having several children -
✅Correct Answer: 1
Rationale: An abnormal finding requiring further testing is correct because incontinence is not a
normal part of the aging process, and therefore will require further investigation to identify the
cause. An indication of the presence of a urinary infection is incorrect because although frequency
2
,and urgency can be symptoms of a urinary tract infection, a culture and sensitivity test is necessary
in order to determine infection. A normal outcome of the aging process and a result of having
several children are incorrect because incontinence is not normal, and is it not necessarily the result
of having had several children.
A nurse is caring for a patient who has a diagnosis of peritonitis related to a ruptured appendix. The
patient states, "I hope I don't get a kidney infection from this with my kidneys being so close to my
appendix. I had a kidney infection before and I felt terrible." Which explanation would be most
appropriate for the nurse to give the patient?
1. "Your kidneys are located outside the peritoneum, the sack that encloses the appendix."
2. "Good thinking. Infections in the abdomen can spread to other organs."
3. "You need to speak with your primary healthcare provider about your concern."
4. "We can check your urine daily to assure the infection is not spreading." -
✅Correct Answer: 1
The nurse is caring for patient who has been diagnosed with an altered mycogenic mechanism of
the renal blood vessels. The patient asks, "Why is it so important that I treat my hypertension and
keep my blood pressure within normal limits?" The nurse's best response is which of the following?
1. "Your kidneys may have difficulty protecting themselves from high blood pressure."
2. "Your blood pressure medication is toxic to your kidneys in high doses."
3. "If not controlled, the condition will require an indwelling urinary catheter."
4. "High blood pressure increases your risk for kidney stones." -
✅Correct Answer: 1
Rationale: The myogenic mechanism, which responds to pressure changes in the renal blood
vessels, controls the diameter of the afferent arterioles to achieve autoregulation. An increase in
systemic blood pressure causes the renal vessels to constrict, whereas a decrease in blood pressure
causes the afferent arterioles to dilate. These changes adjust the glomerular hydrostatic pressure
and, indirectly, maintain the GFR. An alteration in this system exposes the kidneys to pressures that
are too high for proper long term kidney function. Option 2 does not address the patient's question.
Option 3 and 4 are incorrect.
A nurse is teaching a nursing student about the effects of a sustained drop in systemic blood
pressure on the juxtaglomerular cells of the distal tubules in the kidneys. The nurse knows teaching
has been effective when the student states, "This juxtaglomerular cell response to low blood
pressure is utilized with the medication
1. captopril (Capoten)."
2. digoxin (Lanoxin)."
3. furosemide (Lasix)."
4. adenosine (Adenocard)." -
✅Correct Answer: 1
Rationale: A sustained drop in systemic blood pressure triggers the juxtaglomerular cells to release
renin. Renin acts on a plasma globulin, angiotensinogen, to release angiotensin I, which is in turn
converted to angiotensin II. As a vasoconstrictor, angiotensin II activates vascular smooth muscle
throughout the body, causing systemic blood pressure to rise. Captopril (Capoten) is an ACE
3
, inhibitor, which blocks the conversion of angiotensin I to the vasodilator angiotensin II. The other
drugs are not ACE inhibitors.
A nurse is teaching a nursing student about kidney function. The nurse states, "In healthy kidneys,
almost all organic nutrients such as glucose and amino acids are reabsorbed." The nurse knows the
student understands teaching when the student states, "Your comment means that
1. the nutrients move from blood to filtrate to blood, then back to the blood."
2. the nutrients move from filtrate to blood, then back to the filtrate."
3. the nutrients remain in the kidneys at all times."
4. the nutrients are large molecules and remain in the blood at all times." -
✅Correct Answer: 1
Rationale: Reabsorption may be active or passive. Substances move from the blood into the filtrate,
then are reclaimed into the blood.
The nurse is caring for a patient who states, "I need to micturate." The nurse's best response is
which of the following?
1. "There is a restroom at the end of the hallway."
2. "Have you been taking your medication on a daily basis?"
3. "Do you have a supply of sterile catheters?"
4. "Do you have someone who can drive you home?" -
✅Correct Answer: 1
Rationale: Micturation is the acting of urinating or voiding. The best response is to direct the patient
to a restroom.
A nurse is caring for a patient who asks the nurse why females are more likely than males to
contract bladder infections. The nurse knows teaching has been effective when the patient identifies
which of the following as a female risk factor for bladder infections?
1. The urinary meatus is closer to the bladder than in most males.
2. The urinary meatus is farther from the anus than most males.
3. The pH of the female urethra is more conducive to infection.
4. Females urinate more frequently than males, increasing risk. -
✅Correct Answer: 1
Rationale: In females, the urethra is approximately 1.5 inches (3 to 5 cm) long, and the urinary
meatus is anterior to the vaginal orifice. In males, the urethra is approximately 8 inches (20 cm)
long. The shorter distance of the female urethra creates a mechanism by which more females than
males contract bladder infections. The female urinary meatus is closer, not farther from the anus
than in most males, also increasing risk for bladder infections. The pH of the female urethra is not
more conducive to infection. Frequent urination decreases the risk of bladder infection making this
choice incorrect.
The nurse working on a nephrology unit is providing telephone triage to a patient who states, "I am
worried that my child may be genetically at risk for kidney problems in adulthood." The nurse
should recognize that which of these comments by the patient best indicates that the patient's child
may be at future risk for manifesting a genetic kidney disorder?
4
The nurse assesses a patient admitted to the medical-surgical unit who has a diagnosis of type I
diabetes mellitus. The nurse notes that the patient's urine is cloudy and foul-smelling. Which of the
following diagnostic tests does the nurse anticipate will be ordered based on this finding?
1. urine culture and sensitivity (C&S)
2. blood urea nitrogen (BUN)
3. creatinine clearance
4. residual urine -
✅Correct Answer: 1
Rationale: Urine culture and sensitivity (C&S) is correct because cloudy and foul-smelling urine
indicates a urinary tract infection. The diagnostic test to identify the organism responsible is a urine
C&S. Blood urea nitrogen (BUN) measures the amount of urea (end product of protein metabolism)
in the blood plasma. It does not identify infection. Creatinine clearance is a 24-hour urine test used
to identify renal function; it will not identify an infection. Residual urine measures the amount of
urine left in the bladder after voiding, and does not identify an infection.
When preparing a patient for an intravenous pyelogram (IVP), the nurse reviews diagnostic data,
noting all of the following. Which of these findings requires notification of the physician before
proceeding with the test?
1. blood urea nitrogen (BUN) 55 mg/dLdl
2. serum creatinine 1.3 mg/dL
3. urine culture <10,000 organisms/mL
4. residual urine of 80 mL -
✅Correct Answer: 1
Rationale: Blood urea nitrogen (BUN) 55 mg/dL is correct because this level is elevated, indicating
that there might be a problem of renal function. The physician will need to be notified because an
IVP involves the injection of dye that must eventually cleared by the kidney, and if there is already
compromised renal function, the test may not be administered. Serum creatinine 1.3 mg/dL, urine
culture <10,000 organisms/mL, and residual urine of 80 mL are all incorrect because these values
are all within the normal range, and therefore will not require physician notification
A nurse working in a postoperative unit is caring for a patient who states, "I voided a small amount
of urine, but I feel as if I need to void more and am unable to do so." The patient receives a
prescription for a post-voiding residual urine test. The nurse correctly prepares to perform the
procedure by gathering supplies that include which of the following?
1. a urine collecting device and a straight urinary catheter
2. a urine collecting device and a voiding diary
3. an indwelling urinary catheter and an insertion kit
4. a peripheral IV insertion kit and a urine collecting device -
✅Correct Answer: 1
1
,Rationale: To evaluate the amount of urine in bladder post-voiding is correct. This diagnostic test is
ordered to determine urinary retention or incomplete bladder emptying, which could be a
consequence of the operative experience. To correctly perform the procedure, the nurse gathers a
urinary collecting device and asks the patient to void. A straight urinary catheter is inserted and
removed and the amount of urine obtained from the bladder is measured. Voiding diaries,
indwelling urinary catheters, and peripheral IVs are not required for this procedure.
Because of normal changes due to aging, the nurse anticipates that a 75-year-old patient's serum
creatinine level might be which of the following?
1. 0.3 mg/dL
2. 2.4 mg/dL
3. 4.8 mg/dL
4. 6.4 mg/dL -
✅Correct Answer: 1
Rationale: Lower than normal is correct because serum creatinine level reflects the by-product of
muscle breakdown, and an older adult with less muscle mass can be expected to have a lower-than-
normal level. 0.5-1.5 mg/dL is the normal creatinine range for adults. Higher than normal, variable
with fluid status, and within normal range are all incorrect because the question is asking for the
expected change due to the aging process, and that is less muscle mass, and therefore less serum
creatinine.
When assessing a patient who is scheduled to have a CT scan of the kidneys, which of these
findings would prompt the nurse to notify the primary healthcare provider?
1. allergy to iodine and seafood
2. . urinary output of 1,200 mL in 24 hours
3. last bowel movement one day ago
4. height 5'8" and weight 160 pounds -
✅Correct Answer: 1
Rationale: Allergy to iodine and seafood is correct because a CT scan of the kidneys requires the
injection of a radiopaque dye that contains iodine. A patient who is allergic to iodine or seafood will
be unable to have this test. Urinary output of 1,200 mL in 24 hours, last bowel movement one day
ago, and height 5'8" and weight 160 pounds are all incorrect because these are all normal findings,
and therefore do not require that the physician be notified.
A nurse is assessing a 68-year-old female patient who states, "I am having episodes of urinary
incontinence." The nurse should recognize this statement as indicating which of the following?
1. an abnormal finding requiring further testing
2. an indication of the presence of a urinary infection
3. a normal outcome of the aging process
4. the result of having several children -
✅Correct Answer: 1
Rationale: An abnormal finding requiring further testing is correct because incontinence is not a
normal part of the aging process, and therefore will require further investigation to identify the
cause. An indication of the presence of a urinary infection is incorrect because although frequency
2
,and urgency can be symptoms of a urinary tract infection, a culture and sensitivity test is necessary
in order to determine infection. A normal outcome of the aging process and a result of having
several children are incorrect because incontinence is not normal, and is it not necessarily the result
of having had several children.
A nurse is caring for a patient who has a diagnosis of peritonitis related to a ruptured appendix. The
patient states, "I hope I don't get a kidney infection from this with my kidneys being so close to my
appendix. I had a kidney infection before and I felt terrible." Which explanation would be most
appropriate for the nurse to give the patient?
1. "Your kidneys are located outside the peritoneum, the sack that encloses the appendix."
2. "Good thinking. Infections in the abdomen can spread to other organs."
3. "You need to speak with your primary healthcare provider about your concern."
4. "We can check your urine daily to assure the infection is not spreading." -
✅Correct Answer: 1
The nurse is caring for patient who has been diagnosed with an altered mycogenic mechanism of
the renal blood vessels. The patient asks, "Why is it so important that I treat my hypertension and
keep my blood pressure within normal limits?" The nurse's best response is which of the following?
1. "Your kidneys may have difficulty protecting themselves from high blood pressure."
2. "Your blood pressure medication is toxic to your kidneys in high doses."
3. "If not controlled, the condition will require an indwelling urinary catheter."
4. "High blood pressure increases your risk for kidney stones." -
✅Correct Answer: 1
Rationale: The myogenic mechanism, which responds to pressure changes in the renal blood
vessels, controls the diameter of the afferent arterioles to achieve autoregulation. An increase in
systemic blood pressure causes the renal vessels to constrict, whereas a decrease in blood pressure
causes the afferent arterioles to dilate. These changes adjust the glomerular hydrostatic pressure
and, indirectly, maintain the GFR. An alteration in this system exposes the kidneys to pressures that
are too high for proper long term kidney function. Option 2 does not address the patient's question.
Option 3 and 4 are incorrect.
A nurse is teaching a nursing student about the effects of a sustained drop in systemic blood
pressure on the juxtaglomerular cells of the distal tubules in the kidneys. The nurse knows teaching
has been effective when the student states, "This juxtaglomerular cell response to low blood
pressure is utilized with the medication
1. captopril (Capoten)."
2. digoxin (Lanoxin)."
3. furosemide (Lasix)."
4. adenosine (Adenocard)." -
✅Correct Answer: 1
Rationale: A sustained drop in systemic blood pressure triggers the juxtaglomerular cells to release
renin. Renin acts on a plasma globulin, angiotensinogen, to release angiotensin I, which is in turn
converted to angiotensin II. As a vasoconstrictor, angiotensin II activates vascular smooth muscle
throughout the body, causing systemic blood pressure to rise. Captopril (Capoten) is an ACE
3
, inhibitor, which blocks the conversion of angiotensin I to the vasodilator angiotensin II. The other
drugs are not ACE inhibitors.
A nurse is teaching a nursing student about kidney function. The nurse states, "In healthy kidneys,
almost all organic nutrients such as glucose and amino acids are reabsorbed." The nurse knows the
student understands teaching when the student states, "Your comment means that
1. the nutrients move from blood to filtrate to blood, then back to the blood."
2. the nutrients move from filtrate to blood, then back to the filtrate."
3. the nutrients remain in the kidneys at all times."
4. the nutrients are large molecules and remain in the blood at all times." -
✅Correct Answer: 1
Rationale: Reabsorption may be active or passive. Substances move from the blood into the filtrate,
then are reclaimed into the blood.
The nurse is caring for a patient who states, "I need to micturate." The nurse's best response is
which of the following?
1. "There is a restroom at the end of the hallway."
2. "Have you been taking your medication on a daily basis?"
3. "Do you have a supply of sterile catheters?"
4. "Do you have someone who can drive you home?" -
✅Correct Answer: 1
Rationale: Micturation is the acting of urinating or voiding. The best response is to direct the patient
to a restroom.
A nurse is caring for a patient who asks the nurse why females are more likely than males to
contract bladder infections. The nurse knows teaching has been effective when the patient identifies
which of the following as a female risk factor for bladder infections?
1. The urinary meatus is closer to the bladder than in most males.
2. The urinary meatus is farther from the anus than most males.
3. The pH of the female urethra is more conducive to infection.
4. Females urinate more frequently than males, increasing risk. -
✅Correct Answer: 1
Rationale: In females, the urethra is approximately 1.5 inches (3 to 5 cm) long, and the urinary
meatus is anterior to the vaginal orifice. In males, the urethra is approximately 8 inches (20 cm)
long. The shorter distance of the female urethra creates a mechanism by which more females than
males contract bladder infections. The female urinary meatus is closer, not farther from the anus
than in most males, also increasing risk for bladder infections. The pH of the female urethra is not
more conducive to infection. Frequent urination decreases the risk of bladder infection making this
choice incorrect.
The nurse working on a nephrology unit is providing telephone triage to a patient who states, "I am
worried that my child may be genetically at risk for kidney problems in adulthood." The nurse
should recognize that which of these comments by the patient best indicates that the patient's child
may be at future risk for manifesting a genetic kidney disorder?
4
