Renal & Urology NCLEX Practice Questions

Key values: BUN (normal 8-20 mg/dL), serum creatinine (normal 0.6-1.2 mg/dL), GFR (normal >60 mL/min/1.73m2), urine specific gravity (normal 1.005-1.030), and serum potassium (critical in CKD — hyperkalemia risk). Elevated BUN and creatinine with decreased GFR indicate decreased kidney function.

NCLEX tests pre- and post-dialysis assessment, AV fistula and graft care (no blood pressure or venipuncture in that arm, auscultate for bruit, palpate for thrill), recognizing dialysis complications (disequilibrium syndrome, hypotension, infection), and electrolyte and fluid management between sessions.

Prerenal: decreased blood flow to kidneys (hypovolemia, shock, heart failure). BUN:creatinine ratio >20:1. Treat the underlying cause, restore perfusion. Intrarenal: direct kidney damage (nephrotoxic drugs like aminoglycosides, contrast dye, acute tubular necrosis). Postrenal: urinary obstruction (kidney stones, BPH, tumors). Treat by relieving the obstruction. All types present with decreased urine output, rising BUN/creatinine, and fluid/electrolyte disturbances.

Restrict: potassium (avoid bananas, oranges, tomatoes, potatoes, spinach), phosphorus (avoid dairy, cola, processed meats), sodium (limit to 2g/day), and fluid intake as prescribed. Protein may be restricted in pre-dialysis CKD but increased once on dialysis to compensate for protein losses. Monitor calcium levels — CKD patients often need calcium and vitamin D supplements. Phosphate binders (taken with meals) reduce phosphorus absorption.

Signs: peaked T waves on ECG, muscle weakness, paresthesias, cardiac arrhythmias, and potentially cardiac arrest. Treatment hierarchy: calcium gluconate IV (stabilizes cardiac membrane first), regular insulin + dextrose IV (shifts potassium intracellularly), sodium bicarbonate (if acidotic), kayexalate (removes potassium from body), and dialysis for severe or refractory cases. Continuous cardiac monitoring is essential. Potassium >6.5 mEq/L is a medical emergency.

Key principles: maintain a closed drainage system, keep the collection bag below the bladder level at all times, secure the catheter to prevent traction, perform perineal hygiene regularly, empty the bag when two-thirds full using a clean technique, and remove the catheter as soon as clinically possible. Signs of CAUTI: cloudy or foul-smelling urine, fever, suprapubic tenderness, and new-onset confusion in elderly clients. NCLEX emphasizes catheter removal protocols to prevent hospital-acquired infections.