Medical-Surgical Nursing Renal & Urinary Disorders Practice
Questions and Answers Updated 2026 | Complete Med-Surg Study
Guide with Verified Questions, Detailed Rationales, Kidney Disease,
Acute Kidney Injury (AKI), Chronic Kidney Disease (CKD), Urinary
Tract Infections, Fluid & Electrolyte Imbalance, Dialysis Care,
Bladder Disorders, Lab Interpretation & NCLEX-RN Exam Prep
Question 1: A patient with chronic kidney disease stage 4 is being assessed. Which
laboratory finding is MOST indicative of declining renal function?
A. Serum potassium 3.8 mEq/L
B. Blood urea nitrogen (BUN) 18 mg/dL
C. Glomerular filtration rate (GFR) 22 mL/min/1.73m²
D. Serum creatinine 0.9 mg/dL
CORRECT ANSWER: C. Glomerular filtration rate (GFR) 22 mL/min/1.73m²
Rationale: GFR is the most sensitive and specific indicator of renal function. A GFR of 22
mL/min/1.73m² confirms stage 4 CKD (15-29 mL/min/1.73m²), reflecting severe loss of
nephron mass. BUN and creatinine can fluctuate with hydration, diet, and muscle
mass, while potassium within normal limits does not signal functional decline.
Question 2: A nurse is caring for a patient receiving hemodialysis. Which
assessment finding requires IMMEDIATE intervention?
A. Weight loss of 2 kg post-dialysis
B. Blood pressure 90/60 mmHg with dizziness
C. Mild itching on the arms
D. Fatigue reported after treatment
CORRECT ANSWER: B. Blood pressure 90/60 mmHg with dizziness
Rationale: Intradialytic hypotension with symptomatic dizziness indicates
compromised cerebral perfusion and requires urgent action (e.g., Trendelenburg
position, saline bolus). Weight loss reflects prescribed ultrafiltration; pruritus and
fatigue are common chronic issues but not emergencies.
Question 3: A patient with acute kidney injury (AKI) has a urine output of 200 mL
over 12 hours. Which phase of AKI is the patient MOST likely experiencing?
A. Initiation phase
B. Oliguric phase
C. Diuretic phase
D. Recovery phase
CORRECT ANSWER: B. Oliguric phase
Rationale: The oliguric phase of AKI is characterized by urine output <400 mL/24 hours
(or <20 mL/hr), reflecting severe tubular damage and impaired filtration. The initiation
,phase precedes measurable changes; the diuretic phase features high urine output as
recovery begins; recovery shows normalized output and labs.
Question 4: Which nursing intervention is PRIORITY for a patient with a newly
placed arteriovenous (AV) fistula for hemodialysis?
A. Administer analgesics for incisional pain
B. Assess for thrill and bruit every 4 hours
C. Apply warm compresses to the access site
D. Restrict arm movement for 48 hours
CORRECT ANSWER: B. Assess for thrill and bruit every 4 hours
Rationale: Patency of an AV fistula depends on adequate blood flow; absence of thrill
(palpable vibration) or bruit (audible swish) indicates thrombosis, requiring immediate
intervention. Pain management and activity restrictions are secondary; heat application
is contraindicated due to infection risk.
Question 5: A patient with end-stage renal disease (ESRD) is scheduled for kidney
transplantation. Which preoperative teaching point is MOST critical to prevent
postoperative complications?
A. "Avoid all physical activity for 6 weeks."
B. "Report any fever, pain, or decreased urine output immediately."
C. "Increase dietary potassium to promote healing."
D. "Discontinue all immunosuppressants 24 hours before surgery."
CORRECT ANSWER: B. "Report any fever, pain, or decreased urine output
immediately."
Rationale: Early signs of transplant rejection or infection include fever, graft tenderness,
and oliguria. Prompt reporting enables timely intervention. Immunosuppressants are
initiated perioperatively, not stopped; potassium restriction is typically required post-
transplant; early ambulation is encouraged.
Question 6: A patient with recurrent urinary tract infections (UTIs) is being
discharged. Which statement by the patient indicates understanding of prevention
strategies?
A. "I will take bubble baths to relax the perineal area."
B. "I will void every 4 to 6 hours to avoid bladder distension."
C. "I will wipe from back to front after using the toilet."
D. "I will drink 2 to 3 liters of water daily unless contraindicated."
CORRECT ANSWER: D. "I will drink 2 to 3 liters of water daily unless
contraindicated."
Rationale: Adequate hydration dilutes urine and promotes frequent voiding, flushing
bacteria from the urinary tract. Wiping front-to-back (not back-to-front), avoiding
irritants like bubble baths, and voiding every 2-3 hours (not 4-6) are also recommended.
,Question 7: A patient with nephrotic syndrome presents with severe edema. Which
laboratory abnormality is MOST characteristic of this condition?
A. Hyperalbuminemia
B. Hypocholesterolemia
C. Proteinuria >3.5 g/day
D. Hematuria with red blood cell casts
CORRECT ANSWER: C. Proteinuria >3.5 g/day
Rationale: Nephrotic syndrome is defined by heavy proteinuria (>3.5 g/day),
hypoalbuminemia, edema, and hyperlipidemia. Hematuria with RBC casts is typical of
glomerulonephritis, not nephrotic syndrome.
Question 8: A nurse is preparing to administer intravenous pyelogram (IVP) contrast
to a patient with mild renal impairment. Which action is MOST important to prevent
contrast-induced nephropathy?
A. Administer furosemide before the procedure
B. Ensure adequate hydration with IV normal saline
C. Withhold metformin for 24 hours post-procedure
D. Pre-medicate with diphenhydramine
CORRECT ANSWER: B. Ensure adequate hydration with IV normal saline
Rationale: Hydration with isotonic saline before and after contrast exposure is the most
evidence-based strategy to reduce contrast-induced nephropathy risk. Metformin is
withheld due to lactic acidosis risk if AKI occurs, but hydration is primary prevention.
Furosemide may worsen renal perfusion; diphenhydramine addresses allergy, not
nephrotoxicity.
Question 9: A patient with benign prostatic hyperplasia (BPH) is prescribed
tamsulosin. Which side effect should the nurse emphasize in patient teaching?
A. Hypertension
B. Orthostatic hypotension
C. Urinary retention
D. Hyperkalemia
CORRECT ANSWER: B. Orthostatic hypotension
Rationale: Tamsulosin, an alpha-1 blocker, relaxes prostate and bladder neck smooth
muscle but can cause vasodilation leading to orthostatic hypotension. Patients should
rise slowly to prevent falls. It improves urinary flow (does not cause retention);
hypertension and hyperkalemia are not typical side effects.
Question 10: A patient with chronic kidney disease is prescribed erythropoietin-
stimulating agent (ESA). Which parameter should the nurse monitor MOST closely
to evaluate therapeutic effectiveness?
, A. Serum creatinine
B. Hemoglobin level
C. Blood pressure
D. Potassium level
CORRECT ANSWER: B. Hemoglobin level
Rationale: ESAs stimulate red blood cell production to treat anemia of CKD;
hemoglobin target is typically 10-11 g/dL. Overcorrection increases thrombotic risk.
Blood pressure monitoring is important due to ESA-induced hypertension risk, but
hemoglobin directly measures efficacy.
Question 11: A patient with acute pyelonephritis is admitted with fever, flank pain,
and nausea. Which intervention should the nurse implement FIRST?
A. Obtain a clean-catch urine specimen for culture
B. Administer prescribed intravenous antibiotics
C. Encourage oral fluid intake of 3 L/day
D. Apply a heating pad to the flank area
CORRECT ANSWER: B. Administer prescribed intravenous antibiotics
Rationale: Prompt antibiotic administration is critical in pyelonephritis to prevent sepsis
and renal scarring. While cultures should be obtained before antibiotics when possible,
treatment should not be delayed. Hydration and comfort measures are supportive but
secondary to antimicrobial therapy.
Question 12: Which finding in a patient with renal calculi suggests obstruction and
requires urgent urology consultation?
A. Mild hematuria
B. Colicky flank pain radiating to groin
C. Anuria with rising serum creatinine
D. Nausea and vomiting
CORRECT ANSWER: C. Anuria with rising serum creatinine
Rationale: Anuria with worsening renal function indicates bilateral obstruction or
solitary kidney obstruction, a urologic emergency requiring decompression (e.g., stent,
nephrostomy). Hematuria, colicky pain, and GI symptoms are common with stones but
not immediately life-threatening.
Question 13: A patient undergoing peritoneal dialysis reports cloudy dialysate
effluent. Which complication should the nurse suspect FIRST?
A. Bowel perforation
B. Peritonitis
C. Catheter migration
D. Hyperglycemia
Questions and Answers Updated 2026 | Complete Med-Surg Study
Guide with Verified Questions, Detailed Rationales, Kidney Disease,
Acute Kidney Injury (AKI), Chronic Kidney Disease (CKD), Urinary
Tract Infections, Fluid & Electrolyte Imbalance, Dialysis Care,
Bladder Disorders, Lab Interpretation & NCLEX-RN Exam Prep
Question 1: A patient with chronic kidney disease stage 4 is being assessed. Which
laboratory finding is MOST indicative of declining renal function?
A. Serum potassium 3.8 mEq/L
B. Blood urea nitrogen (BUN) 18 mg/dL
C. Glomerular filtration rate (GFR) 22 mL/min/1.73m²
D. Serum creatinine 0.9 mg/dL
CORRECT ANSWER: C. Glomerular filtration rate (GFR) 22 mL/min/1.73m²
Rationale: GFR is the most sensitive and specific indicator of renal function. A GFR of 22
mL/min/1.73m² confirms stage 4 CKD (15-29 mL/min/1.73m²), reflecting severe loss of
nephron mass. BUN and creatinine can fluctuate with hydration, diet, and muscle
mass, while potassium within normal limits does not signal functional decline.
Question 2: A nurse is caring for a patient receiving hemodialysis. Which
assessment finding requires IMMEDIATE intervention?
A. Weight loss of 2 kg post-dialysis
B. Blood pressure 90/60 mmHg with dizziness
C. Mild itching on the arms
D. Fatigue reported after treatment
CORRECT ANSWER: B. Blood pressure 90/60 mmHg with dizziness
Rationale: Intradialytic hypotension with symptomatic dizziness indicates
compromised cerebral perfusion and requires urgent action (e.g., Trendelenburg
position, saline bolus). Weight loss reflects prescribed ultrafiltration; pruritus and
fatigue are common chronic issues but not emergencies.
Question 3: A patient with acute kidney injury (AKI) has a urine output of 200 mL
over 12 hours. Which phase of AKI is the patient MOST likely experiencing?
A. Initiation phase
B. Oliguric phase
C. Diuretic phase
D. Recovery phase
CORRECT ANSWER: B. Oliguric phase
Rationale: The oliguric phase of AKI is characterized by urine output <400 mL/24 hours
(or <20 mL/hr), reflecting severe tubular damage and impaired filtration. The initiation
,phase precedes measurable changes; the diuretic phase features high urine output as
recovery begins; recovery shows normalized output and labs.
Question 4: Which nursing intervention is PRIORITY for a patient with a newly
placed arteriovenous (AV) fistula for hemodialysis?
A. Administer analgesics for incisional pain
B. Assess for thrill and bruit every 4 hours
C. Apply warm compresses to the access site
D. Restrict arm movement for 48 hours
CORRECT ANSWER: B. Assess for thrill and bruit every 4 hours
Rationale: Patency of an AV fistula depends on adequate blood flow; absence of thrill
(palpable vibration) or bruit (audible swish) indicates thrombosis, requiring immediate
intervention. Pain management and activity restrictions are secondary; heat application
is contraindicated due to infection risk.
Question 5: A patient with end-stage renal disease (ESRD) is scheduled for kidney
transplantation. Which preoperative teaching point is MOST critical to prevent
postoperative complications?
A. "Avoid all physical activity for 6 weeks."
B. "Report any fever, pain, or decreased urine output immediately."
C. "Increase dietary potassium to promote healing."
D. "Discontinue all immunosuppressants 24 hours before surgery."
CORRECT ANSWER: B. "Report any fever, pain, or decreased urine output
immediately."
Rationale: Early signs of transplant rejection or infection include fever, graft tenderness,
and oliguria. Prompt reporting enables timely intervention. Immunosuppressants are
initiated perioperatively, not stopped; potassium restriction is typically required post-
transplant; early ambulation is encouraged.
Question 6: A patient with recurrent urinary tract infections (UTIs) is being
discharged. Which statement by the patient indicates understanding of prevention
strategies?
A. "I will take bubble baths to relax the perineal area."
B. "I will void every 4 to 6 hours to avoid bladder distension."
C. "I will wipe from back to front after using the toilet."
D. "I will drink 2 to 3 liters of water daily unless contraindicated."
CORRECT ANSWER: D. "I will drink 2 to 3 liters of water daily unless
contraindicated."
Rationale: Adequate hydration dilutes urine and promotes frequent voiding, flushing
bacteria from the urinary tract. Wiping front-to-back (not back-to-front), avoiding
irritants like bubble baths, and voiding every 2-3 hours (not 4-6) are also recommended.
,Question 7: A patient with nephrotic syndrome presents with severe edema. Which
laboratory abnormality is MOST characteristic of this condition?
A. Hyperalbuminemia
B. Hypocholesterolemia
C. Proteinuria >3.5 g/day
D. Hematuria with red blood cell casts
CORRECT ANSWER: C. Proteinuria >3.5 g/day
Rationale: Nephrotic syndrome is defined by heavy proteinuria (>3.5 g/day),
hypoalbuminemia, edema, and hyperlipidemia. Hematuria with RBC casts is typical of
glomerulonephritis, not nephrotic syndrome.
Question 8: A nurse is preparing to administer intravenous pyelogram (IVP) contrast
to a patient with mild renal impairment. Which action is MOST important to prevent
contrast-induced nephropathy?
A. Administer furosemide before the procedure
B. Ensure adequate hydration with IV normal saline
C. Withhold metformin for 24 hours post-procedure
D. Pre-medicate with diphenhydramine
CORRECT ANSWER: B. Ensure adequate hydration with IV normal saline
Rationale: Hydration with isotonic saline before and after contrast exposure is the most
evidence-based strategy to reduce contrast-induced nephropathy risk. Metformin is
withheld due to lactic acidosis risk if AKI occurs, but hydration is primary prevention.
Furosemide may worsen renal perfusion; diphenhydramine addresses allergy, not
nephrotoxicity.
Question 9: A patient with benign prostatic hyperplasia (BPH) is prescribed
tamsulosin. Which side effect should the nurse emphasize in patient teaching?
A. Hypertension
B. Orthostatic hypotension
C. Urinary retention
D. Hyperkalemia
CORRECT ANSWER: B. Orthostatic hypotension
Rationale: Tamsulosin, an alpha-1 blocker, relaxes prostate and bladder neck smooth
muscle but can cause vasodilation leading to orthostatic hypotension. Patients should
rise slowly to prevent falls. It improves urinary flow (does not cause retention);
hypertension and hyperkalemia are not typical side effects.
Question 10: A patient with chronic kidney disease is prescribed erythropoietin-
stimulating agent (ESA). Which parameter should the nurse monitor MOST closely
to evaluate therapeutic effectiveness?
, A. Serum creatinine
B. Hemoglobin level
C. Blood pressure
D. Potassium level
CORRECT ANSWER: B. Hemoglobin level
Rationale: ESAs stimulate red blood cell production to treat anemia of CKD;
hemoglobin target is typically 10-11 g/dL. Overcorrection increases thrombotic risk.
Blood pressure monitoring is important due to ESA-induced hypertension risk, but
hemoglobin directly measures efficacy.
Question 11: A patient with acute pyelonephritis is admitted with fever, flank pain,
and nausea. Which intervention should the nurse implement FIRST?
A. Obtain a clean-catch urine specimen for culture
B. Administer prescribed intravenous antibiotics
C. Encourage oral fluid intake of 3 L/day
D. Apply a heating pad to the flank area
CORRECT ANSWER: B. Administer prescribed intravenous antibiotics
Rationale: Prompt antibiotic administration is critical in pyelonephritis to prevent sepsis
and renal scarring. While cultures should be obtained before antibiotics when possible,
treatment should not be delayed. Hydration and comfort measures are supportive but
secondary to antimicrobial therapy.
Question 12: Which finding in a patient with renal calculi suggests obstruction and
requires urgent urology consultation?
A. Mild hematuria
B. Colicky flank pain radiating to groin
C. Anuria with rising serum creatinine
D. Nausea and vomiting
CORRECT ANSWER: C. Anuria with rising serum creatinine
Rationale: Anuria with worsening renal function indicates bilateral obstruction or
solitary kidney obstruction, a urologic emergency requiring decompression (e.g., stent,
nephrostomy). Hematuria, colicky pain, and GI symptoms are common with stones but
not immediately life-threatening.
Question 13: A patient undergoing peritoneal dialysis reports cloudy dialysate
effluent. Which complication should the nurse suspect FIRST?
A. Bowel perforation
B. Peritonitis
C. Catheter migration
D. Hyperglycemia
