Medical-Surgical Renal & Urinary Disorders Practice Exam | Updated 2026
Complete Study Guide | Verified Questions with Detailed Rationales on Acute &
Chronic Kidney Disease (AKI & CKD), Glomerulonephritis, Nephrotic Syndrome,
Urinary Tract Infections (UTIs), Renal Failure Management, Dialysis & Fluid
Balance, Electrolyte Imbalances, Acid-Base Disorders, Urinary Retention &
Incontinence, and Nursing Interventions for Exam Success
Question 1: A patient with chronic kidney disease stage 4 presents with fatigue,
anorexia, and metallic taste in the mouth. Which laboratory finding is most
consistent with uremia?
A. Serum potassium 3.2 mEq/L
B. Blood urea nitrogen 85 mg/dL
C. Serum calcium 10.1 mg/dL
D. Urine specific gravity 1.025
CORRECT ANSWER: B. Blood urea nitrogen 85 mg/dL
RATIONALE:Uremia occurs when waste products accumulate in the blood due to
impaired kidney function. A markedly elevated blood urea nitrogen (BUN) level, such as
85 mg/dL (normal: 7-20 mg/dL), is a hallmark laboratory finding in uremia. Symptoms
like fatigue, anorexia, and metallic taste result from toxin accumulation. Hypokalemia
(option A) is uncommon in advanced CKD; hyperkalemia is more typical.
Hypercalcemia (option C) is not characteristic; CKD often causes hypocalcemia due to
impaired vitamin D activation. Urine specific gravity (option D) may be fixed around
1.010 in advanced CKD due to loss of concentrating ability, but this does not directly
indicate uremia.
Question 2: Which nursing intervention is priority for a patient immediately
following hemodialysis?
A. Administer prescribed antihypertensive medication
B. Assess vascular access site for bleeding or hematoma
C. Encourage oral fluid intake of 500 mL
D. Obtain a post-dialysis weight in 2 hours
CORRECT ANSWER: B. Assess vascular access site for bleeding or hematoma
RATIONALE:After hemodialysis, the priority is to assess the vascular access site
(fistula, graft, or catheter) for bleeding, hematoma, or signs of infection because
anticoagulants used during dialysis increase bleeding risk. Administering
antihypertensives (option A) may be indicated but is not the immediate priority; blood
pressure often drops post-dialysis. Encouraging fluids (option C) is contraindicated
immediately post-dialysis as patients are typically fluid-restricted. Post-dialysis weight
(option D) should be obtained immediately after treatment to evaluate fluid removal,
not delayed 2 hours.
Question 3: A patient with acute pyelonephritis is prescribed ciprofloxacin. Which
statement by the patient indicates understanding of medication teaching?
,A. "I will take this medication with dairy products to prevent stomach upset."
B. "I should avoid direct sunlight and use sunscreen while taking this drug."
C. "I can stop taking the antibiotic once my fever resolves."
D. "I will increase my intake of vitamin K-rich foods while on this medication."
CORRECT ANSWER: B. "I should avoid direct sunlight and use sunscreen while
taking this drug."
RATIONALE:Ciprofloxacin, a fluoroquinolone antibiotic, can cause photosensitivity
reactions; patients must avoid direct sunlight and use sunscreen. Dairy products
(option A) impair ciprofloxacin absorption and should be avoided within 2 hours of
dosing. Antibiotics must be completed as prescribed (option C) to prevent resistance
and recurrence, even if symptoms improve. Vitamin K intake (option D) is relevant for
warfarin therapy, not ciprofloxacin.
Question 4: Which assessment finding in a patient with nephrotic syndrome
requires immediate nursing intervention?
A. Periorbital edema noted in the morning
B. Weight gain of 1 kg over 2 days
C. Crackles auscultated in bilateral lung bases
D. Frothy, amber-colored urine
CORRECT ANSWER: C. Crackles auscultated in bilateral lung bases
RATIONALE:Crackles in bilateral lung bases indicate pulmonary edema, a life-
threatening complication of nephrotic syndrome due to severe hypoalbuminemia and
fluid shift into interstitial spaces. This requires immediate intervention such as oxygen,
diuretics, and notifying the provider. Periorbital edema (option A) and weight gain
(option B) are expected findings in nephrotic syndrome requiring monitoring but not
emergency action. Frothy urine (option D) reflects proteinuria, a diagnostic feature, but
is not an acute emergency.
Question 5: A patient with end-stage renal disease is scheduled for peritoneal
dialysis. Which instruction should the nurse include in pre-procedure teaching?
A. "You will need to remain NPO for 8 hours before the procedure."
B. "Report any cloudy drainage from the catheter exit site immediately."
C. "You may experience severe abdominal pain during fluid infusion."
D. "The dialysate solution should be warmed to body temperature in a microwave."
CORRECT ANSWER: B. "Report any cloudy drainage from the catheter exit site
immediately."
RATIONALE:Cloudy drainage from the peritoneal dialysis catheter suggests peritonitis,
a serious infection requiring prompt treatment. Patients must be taught to recognize
and report this sign. NPO status (option A) is not required for routine peritoneal dialysis
exchanges. Mild abdominal discomfort may occur during infusion, but severe pain
(option C) is abnormal and should be reported. Dialysate should be warmed using a
,commercial warmer or by allowing it to reach room temperature; microwaving (option
D) can cause uneven heating and burns.
Question 6: Which electrolyte imbalance is most likely to occur in a patient with
acute kidney injury during the oliguric phase?
A. Hypokalemia
B. Hypernatremia
C. Hyperkalemia
D. Hypophosphatemia
CORRECT ANSWER: C. Hyperkalemia
RATIONALE:During the oliguric phase of acute kidney injury, urine output decreases
significantly, impairing potassium excretion and leading to hyperkalemia, which can
cause life-threatening cardiac dysrhythmias. Hypokalemia (option A) is more common
in the diuretic phase. Hypernatremia (option B) is less typical; hyponatremia may occur
due to fluid overload. Hypophosphatemia (option D) is not characteristic;
hyperphosphatemia is common in AKI due to reduced excretion.
Question 7: A nurse is caring for a patient with a newly created arteriovenous
fistula for hemodialysis. Which action by the nurse is contraindicated?
A. Palpating for a thrill over the fistula site
B. Auscultating for a bruit every 8 hours
C. Taking blood pressure on the arm with the fistula
D. Assessing distal pulses in the affected extremity
CORRECT ANSWER: C. Taking blood pressure on the arm with the fistula
RATIONALE:Blood pressure measurement, venipuncture, or IV insertion on the arm
with an arteriovenous fistula is contraindicated because compression can compromise
blood flow, leading to thrombosis and fistula failure. Palpating for a thrill (option A) and
auscultating for a bruit (option B) are essential assessments to confirm fistula patency.
Assessing distal pulses (option D) evaluates adequate perfusion beyond the fistula site.
Question 8: Which clinical manifestation is most indicative of acute
glomerulonephritis?
A. Polyuria and nocturia
B. Cola-colored urine and periorbital edema
C. Flank pain radiating to the groin
D. Dysuria and urinary frequency
CORRECT ANSWER: B. Cola-colored urine and periorbital edema
RATIONALE:Acute glomerulonephritis typically presents with hematuria (cola-colored
urine), proteinuria, hypertension, and edema (especially periorbital) due to
inflammation of the glomeruli and impaired filtration. Polyuria and nocturia (option A)
are more characteristic of chronic kidney disease or diabetes insipidus. Flank pain
, radiating to the groin (option C) suggests nephrolithiasis. Dysuria and frequency (option
D) indicate lower urinary tract infection.
Question 9: A patient with chronic kidney disease is prescribed epoetin alfa. Which
laboratory value should the nurse monitor to evaluate therapeutic effectiveness?
A. Serum creatinine
B. Hemoglobin level
C. Blood urea nitrogen
D. Serum potassium
CORRECT ANSWER: B. Hemoglobin level
RATIONALE:Epoetin alfa stimulates red blood cell production to treat anemia of chronic
kidney disease. Hemoglobin level is the primary indicator of therapeutic response;
target is typically 10-11 g/dL. Serum creatinine (option A) and BUN (option C) assess
kidney function, not erythropoietin efficacy. Serum potassium (option D) is monitored
for electrolyte balance but is unrelated to epoetin alfa effectiveness.
Question 10: Which statement by a patient with recurrent calcium oxalate kidney
stones indicates a need for further teaching?
A. "I will limit my intake of spinach, rhubarb, and nuts."
B. "I should drink at least 3 liters of fluid daily."
C. "I will take my calcium supplement with meals."
D. "I can increase my vitamin C supplementation to prevent stones."
CORRECT ANSWER: D. "I can increase my vitamin C supplementation to prevent
stones."
RATIONALE:High-dose vitamin C (ascorbic acid) can be metabolized to oxalate,
increasing the risk of calcium oxalate stone formation; patients should avoid excessive
supplementation. Limiting oxalate-rich foods (option A), maintaining high fluid intake
(option B), and taking calcium supplements with meals (option C) to bind dietary
oxalate in the gut are appropriate preventive measures.
Question 11: A patient with acute kidney injury has a serum potassium level of 6.8
mEq/L. Which intervention should the nurse anticipate administering first?
A. Sodium polystyrene sulfonate enema
B. Intravenous calcium gluconate
C. Oral potassium-binding resin
D. Restrict dietary potassium
CORRECT ANSWER: B. Intravenous calcium gluconate
RATIONALE:For severe hyperkalemia (K+ >6.5 mEq/L) with ECG changes or high risk, IV
calcium gluconate is administered first to stabilize the cardiac membrane and prevent
dysrhythmias. This is a temporizing measure. Sodium polystyrene sulfonate (options A
Complete Study Guide | Verified Questions with Detailed Rationales on Acute &
Chronic Kidney Disease (AKI & CKD), Glomerulonephritis, Nephrotic Syndrome,
Urinary Tract Infections (UTIs), Renal Failure Management, Dialysis & Fluid
Balance, Electrolyte Imbalances, Acid-Base Disorders, Urinary Retention &
Incontinence, and Nursing Interventions for Exam Success
Question 1: A patient with chronic kidney disease stage 4 presents with fatigue,
anorexia, and metallic taste in the mouth. Which laboratory finding is most
consistent with uremia?
A. Serum potassium 3.2 mEq/L
B. Blood urea nitrogen 85 mg/dL
C. Serum calcium 10.1 mg/dL
D. Urine specific gravity 1.025
CORRECT ANSWER: B. Blood urea nitrogen 85 mg/dL
RATIONALE:Uremia occurs when waste products accumulate in the blood due to
impaired kidney function. A markedly elevated blood urea nitrogen (BUN) level, such as
85 mg/dL (normal: 7-20 mg/dL), is a hallmark laboratory finding in uremia. Symptoms
like fatigue, anorexia, and metallic taste result from toxin accumulation. Hypokalemia
(option A) is uncommon in advanced CKD; hyperkalemia is more typical.
Hypercalcemia (option C) is not characteristic; CKD often causes hypocalcemia due to
impaired vitamin D activation. Urine specific gravity (option D) may be fixed around
1.010 in advanced CKD due to loss of concentrating ability, but this does not directly
indicate uremia.
Question 2: Which nursing intervention is priority for a patient immediately
following hemodialysis?
A. Administer prescribed antihypertensive medication
B. Assess vascular access site for bleeding or hematoma
C. Encourage oral fluid intake of 500 mL
D. Obtain a post-dialysis weight in 2 hours
CORRECT ANSWER: B. Assess vascular access site for bleeding or hematoma
RATIONALE:After hemodialysis, the priority is to assess the vascular access site
(fistula, graft, or catheter) for bleeding, hematoma, or signs of infection because
anticoagulants used during dialysis increase bleeding risk. Administering
antihypertensives (option A) may be indicated but is not the immediate priority; blood
pressure often drops post-dialysis. Encouraging fluids (option C) is contraindicated
immediately post-dialysis as patients are typically fluid-restricted. Post-dialysis weight
(option D) should be obtained immediately after treatment to evaluate fluid removal,
not delayed 2 hours.
Question 3: A patient with acute pyelonephritis is prescribed ciprofloxacin. Which
statement by the patient indicates understanding of medication teaching?
,A. "I will take this medication with dairy products to prevent stomach upset."
B. "I should avoid direct sunlight and use sunscreen while taking this drug."
C. "I can stop taking the antibiotic once my fever resolves."
D. "I will increase my intake of vitamin K-rich foods while on this medication."
CORRECT ANSWER: B. "I should avoid direct sunlight and use sunscreen while
taking this drug."
RATIONALE:Ciprofloxacin, a fluoroquinolone antibiotic, can cause photosensitivity
reactions; patients must avoid direct sunlight and use sunscreen. Dairy products
(option A) impair ciprofloxacin absorption and should be avoided within 2 hours of
dosing. Antibiotics must be completed as prescribed (option C) to prevent resistance
and recurrence, even if symptoms improve. Vitamin K intake (option D) is relevant for
warfarin therapy, not ciprofloxacin.
Question 4: Which assessment finding in a patient with nephrotic syndrome
requires immediate nursing intervention?
A. Periorbital edema noted in the morning
B. Weight gain of 1 kg over 2 days
C. Crackles auscultated in bilateral lung bases
D. Frothy, amber-colored urine
CORRECT ANSWER: C. Crackles auscultated in bilateral lung bases
RATIONALE:Crackles in bilateral lung bases indicate pulmonary edema, a life-
threatening complication of nephrotic syndrome due to severe hypoalbuminemia and
fluid shift into interstitial spaces. This requires immediate intervention such as oxygen,
diuretics, and notifying the provider. Periorbital edema (option A) and weight gain
(option B) are expected findings in nephrotic syndrome requiring monitoring but not
emergency action. Frothy urine (option D) reflects proteinuria, a diagnostic feature, but
is not an acute emergency.
Question 5: A patient with end-stage renal disease is scheduled for peritoneal
dialysis. Which instruction should the nurse include in pre-procedure teaching?
A. "You will need to remain NPO for 8 hours before the procedure."
B. "Report any cloudy drainage from the catheter exit site immediately."
C. "You may experience severe abdominal pain during fluid infusion."
D. "The dialysate solution should be warmed to body temperature in a microwave."
CORRECT ANSWER: B. "Report any cloudy drainage from the catheter exit site
immediately."
RATIONALE:Cloudy drainage from the peritoneal dialysis catheter suggests peritonitis,
a serious infection requiring prompt treatment. Patients must be taught to recognize
and report this sign. NPO status (option A) is not required for routine peritoneal dialysis
exchanges. Mild abdominal discomfort may occur during infusion, but severe pain
(option C) is abnormal and should be reported. Dialysate should be warmed using a
,commercial warmer or by allowing it to reach room temperature; microwaving (option
D) can cause uneven heating and burns.
Question 6: Which electrolyte imbalance is most likely to occur in a patient with
acute kidney injury during the oliguric phase?
A. Hypokalemia
B. Hypernatremia
C. Hyperkalemia
D. Hypophosphatemia
CORRECT ANSWER: C. Hyperkalemia
RATIONALE:During the oliguric phase of acute kidney injury, urine output decreases
significantly, impairing potassium excretion and leading to hyperkalemia, which can
cause life-threatening cardiac dysrhythmias. Hypokalemia (option A) is more common
in the diuretic phase. Hypernatremia (option B) is less typical; hyponatremia may occur
due to fluid overload. Hypophosphatemia (option D) is not characteristic;
hyperphosphatemia is common in AKI due to reduced excretion.
Question 7: A nurse is caring for a patient with a newly created arteriovenous
fistula for hemodialysis. Which action by the nurse is contraindicated?
A. Palpating for a thrill over the fistula site
B. Auscultating for a bruit every 8 hours
C. Taking blood pressure on the arm with the fistula
D. Assessing distal pulses in the affected extremity
CORRECT ANSWER: C. Taking blood pressure on the arm with the fistula
RATIONALE:Blood pressure measurement, venipuncture, or IV insertion on the arm
with an arteriovenous fistula is contraindicated because compression can compromise
blood flow, leading to thrombosis and fistula failure. Palpating for a thrill (option A) and
auscultating for a bruit (option B) are essential assessments to confirm fistula patency.
Assessing distal pulses (option D) evaluates adequate perfusion beyond the fistula site.
Question 8: Which clinical manifestation is most indicative of acute
glomerulonephritis?
A. Polyuria and nocturia
B. Cola-colored urine and periorbital edema
C. Flank pain radiating to the groin
D. Dysuria and urinary frequency
CORRECT ANSWER: B. Cola-colored urine and periorbital edema
RATIONALE:Acute glomerulonephritis typically presents with hematuria (cola-colored
urine), proteinuria, hypertension, and edema (especially periorbital) due to
inflammation of the glomeruli and impaired filtration. Polyuria and nocturia (option A)
are more characteristic of chronic kidney disease or diabetes insipidus. Flank pain
, radiating to the groin (option C) suggests nephrolithiasis. Dysuria and frequency (option
D) indicate lower urinary tract infection.
Question 9: A patient with chronic kidney disease is prescribed epoetin alfa. Which
laboratory value should the nurse monitor to evaluate therapeutic effectiveness?
A. Serum creatinine
B. Hemoglobin level
C. Blood urea nitrogen
D. Serum potassium
CORRECT ANSWER: B. Hemoglobin level
RATIONALE:Epoetin alfa stimulates red blood cell production to treat anemia of chronic
kidney disease. Hemoglobin level is the primary indicator of therapeutic response;
target is typically 10-11 g/dL. Serum creatinine (option A) and BUN (option C) assess
kidney function, not erythropoietin efficacy. Serum potassium (option D) is monitored
for electrolyte balance but is unrelated to epoetin alfa effectiveness.
Question 10: Which statement by a patient with recurrent calcium oxalate kidney
stones indicates a need for further teaching?
A. "I will limit my intake of spinach, rhubarb, and nuts."
B. "I should drink at least 3 liters of fluid daily."
C. "I will take my calcium supplement with meals."
D. "I can increase my vitamin C supplementation to prevent stones."
CORRECT ANSWER: D. "I can increase my vitamin C supplementation to prevent
stones."
RATIONALE:High-dose vitamin C (ascorbic acid) can be metabolized to oxalate,
increasing the risk of calcium oxalate stone formation; patients should avoid excessive
supplementation. Limiting oxalate-rich foods (option A), maintaining high fluid intake
(option B), and taking calcium supplements with meals (option C) to bind dietary
oxalate in the gut are appropriate preventive measures.
Question 11: A patient with acute kidney injury has a serum potassium level of 6.8
mEq/L. Which intervention should the nurse anticipate administering first?
A. Sodium polystyrene sulfonate enema
B. Intravenous calcium gluconate
C. Oral potassium-binding resin
D. Restrict dietary potassium
CORRECT ANSWER: B. Intravenous calcium gluconate
RATIONALE:For severe hyperkalemia (K+ >6.5 mEq/L) with ECG changes or high risk, IV
calcium gluconate is administered first to stabilize the cardiac membrane and prevent
dysrhythmias. This is a temporizing measure. Sodium polystyrene sulfonate (options A
