Ten free renal and genitourinary (GU) NCLEX practice questions with full rationales — AKI vs CKD, hemodialysis AV access care, peritoneal dialysis, UTI and pyelonephritis, kidney stones, BPH and post-TURP care, and glomerulonephritis. Answer each one, then reveal the correct answer and see why every option is right or wrong. No sign-up needed to practice here.
High-Yield Renal & GU Review
Renal and genitourinary content is a heavy hitter on the NCLEX because kidney problems touch fluid, electrolytes, acid-base balance, and cardiovascular stability all at once. Start by separating acute kidney injury (AKI) from chronic kidney disease (CKD). AKI is a sudden, often reversible drop in kidney function, and its causes sort into three buckets: prerenal (poor perfusion from hypovolemia, hemorrhage, or heart failure), intrarenal (direct damage from nephrotoxic drugs, acute tubular necrosis, or glomerulonephritis), and postrenal (obstruction from stones, tumors, or an enlarged prostate). Watch the oliguric phase for fluid overload and rising creatinine (normal 0.6 to 1.2 mg/dL) and BUN (normal 10 to 20 mg/dL). CKD is progressive and generally irreversible (early CKD can often be slowed or stabilized), staged by GFR (normal 90 or higher; stage 5 or end-stage is below 15), and it drives the classic management picture: restrict sodium, potassium, phosphorus, and often protein and fluids; give phosphate binders with meals; and treat anemia with erythropoietin plus iron.
Dialysis shows up in almost every renal question set. For a hemodialysis arteriovenous (AV) fistula or graft, protect that arm: auscultate for a bruit and palpate for a thrill each shift, and never take a blood pressure, draw blood, or start an IV in the access arm. A missing bruit or thrill means possible clotting and must be reported immediately. For peritoneal dialysis, the complication the NCLEX wants you to catch is peritonitis, signaled by cloudy effluent, abdominal pain, and fever. Warm the dialysate, use strict aseptic technique, and ensure proper inflow, dwell, and outflow.
Round out your review with the common GU scenarios. Urinary tract infections are prevented by wiping front to back, voiding after intercourse, hydrating, and completing antibiotics; pyelonephritis adds flank or costovertebral angle pain and fever. For urolithiasis, strain all urine to capture the stone, push fluids, control pain, and adjust diet by stone type. After a transurethral resection of the prostate (TURP) for benign prostatic hyperplasia, maintain continuous bladder irrigation, expect pink-tinged drainage, and treat bright-red output with clots as hemorrhage by titrating the irrigation up and notifying the surgeon.
Renal & Genitourinary (GU) NCLEX Practice Questions
Question 1 · AKI vs CKD
A nurse is teaching a group of new graduates about the causes of acute kidney injury (AKI). Which situation is an example of a PRERENAL cause of AKI?
- A Acute tubular necrosis from a nephrotoxic aminoglycoside antibiotic
- B Poststreptococcal glomerulonephritis damaging the nephrons
- C Profuse vomiting and diarrhea leading to severe hypovolemia
- D A staghorn calculus obstructing the renal pelvis
Show answer & rationale
Correct answer: C
Prerenal AKI results from decreased perfusion to the kidneys. Profuse vomiting and diarrhea cause severe hypovolemia, which drops renal blood flow and glomerular filtration before any structural kidney damage occurs; this type is potentially reversible if perfusion is restored quickly with fluids. Acute tubular necrosis from a nephrotoxic aminoglycoside is an intrarenal cause, because the injury is within the kidney tissue itself. A staghorn calculus obstructing the renal pelvis is a postrenal cause, since urine flow is blocked distal to the kidney. Poststreptococcal glomerulonephritis is also intrarenal, because immune-mediated inflammation directly damages the glomeruli. Clinical pearl: think of the three P's in order along the plumbing. Prerenal equals a perfusion problem (before the kidney), intrarenal equals a parenchymal problem (inside the kidney), and postrenal equals a plumbing obstruction (after the kidney). AKI is often reversible when caught early, unlike chronic kidney disease, which is progressive. Monitor creatinine (normal 0.6 to 1.2 mg/dL) and BUN (normal 10 to 20 mg/dL); both rise as filtration falls. During the oliguric phase, watch closely for fluid overload and hyperkalemia. Restoring circulating volume promptly in prerenal AKI can prevent it from progressing to intrarenal acute tubular necrosis.
Question 2 · Hemodialysis AV access
A client returns to the unit after surgical creation of a left forearm arteriovenous (AV) fistula for future hemodialysis. Which action by the nurse is appropriate?
- A Auscultate for a bruit and palpate for a thrill over the fistula
- B Place the blood pressure cuff on the fistula arm for accurate readings
- C Start a peripheral IV line in the fistula arm for maintenance fluids
- D Draw the morning laboratory specimens from the fistula arm
Show answer & rationale
Correct answer: A
The nurse should routinely assess patency of the AV fistula by auscultating for a bruit (the swishing sound of turbulent blood flow) and palpating for a thrill (the buzzing vibration). Their presence confirms the access is open and functioning; a missing bruit or thrill suggests clotting and must be reported immediately. Drawing labs from the fistula arm is contraindicated because venipuncture can damage the access and introduce infection. Placing a blood pressure cuff on the fistula arm is unsafe: the compression can occlude the access and cause clotting. Starting an IV in the fistula arm is likewise prohibited for the same reason, and it risks infiltration and infection of a limb with altered vascular flow. Clinical pearl: protect the access arm with the rule 'nothing in the fistula arm' – no BP, no blood draws, no IVs, no restrictive clothing or jewelry, and no lying on it. Post a sign at the bedside. Teach the client to check for the thrill daily and to report coolness, numbness, absence of the thrill, or signs of infection. A patent fistula preserves the client's lifeline for dialysis, and losing it may require surgical revision or a temporary central catheter.
Question 3 · Peritoneal dialysis
A client receiving continuous ambulatory peritoneal dialysis (PD) reports abdominal pain, and the nurse notes that the drained effluent is cloudy. Which action should the nurse take?
- A Reassure the client that cloudy drainage is normal after several exchanges
- B Document the finding as expected and continue the exchanges
- C Increase the dextrose concentration of the next exchange solution
- D Recognize cloudy effluent as a sign of peritonitis and notify the provider
Show answer & rationale
Correct answer: D
Cloudy effluent, abdominal pain, and fever are the hallmark signs of peritonitis, the most common and serious complication of peritoneal dialysis. The nurse must recognize this and notify the provider, who will typically order a culture of the effluent and antibiotics (often given intraperitoneally). Documenting cloudy effluent as expected and continuing exchanges delays treatment of a potentially life-threatening infection. Increasing the dextrose concentration addresses fluid removal, not infection, and does nothing for peritonitis. Reassuring the client that cloudy drainage is normal is inaccurate and dangerous; normal effluent should be clear and pale yellow. Clinical pearl: 'cloudy equals contaminated.' Peritonitis develops when organisms enter through the catheter, so strict aseptic technique during connections is the key prevention strategy. Also remember the mechanics of a proper exchange: instill (inflow), dwell (allow time for diffusion and osmosis), and drain (outflow). Warm the dialysate to body temperature before instilling to promote comfort and dilate peritoneal vessels for better clearance – never use a microwave, and never instill cold solution. If outflow is sluggish, reposition the client, check for kinks, or ensure the drainage bag is below the abdomen. Early recognition and treatment of peritonitis preserves the peritoneal membrane for continued dialysis.
Question 4 · UTI and pyelonephritis
A nurse is teaching a young woman with recurrent urinary tract infections (UTIs) about prevention. Which statement by the client indicates a NEED FOR FURTHER teaching?
- A "I should urinate after sexual intercourse."
- B "I can stop my antibiotic once my symptoms go away."
- C "I will drink plenty of water throughout the day."
- D "I will wipe from front to back after using the bathroom."
Show answer & rationale
Correct answer: B
The statement about stopping the antibiotic once symptoms resolve indicates a need for further teaching. Antibiotics must be taken for the full prescribed course; stopping early allows surviving organisms to regrow and promotes antibiotic resistance and recurrent infection. Wiping from front to back is correct because it prevents dragging bacteria from the perineum and rectum toward the urethra. Voiding after intercourse is correct because it flushes bacteria that may have been introduced into the urethra during sex. Drinking plenty of water is correct because dilute urine and frequent voiding mechanically flush bacteria from the bladder. Clinical pearl: the classic UTI teaching bundle is wipe front to back, void after sex, hydrate well, avoid irritants such as bubble baths and harsh soaps, wear cotton underwear, do not hold urine, and finish every antibiotic. Cystitis (lower UTI) presents with dysuria, urgency, frequency, and suprapubic discomfort. If the infection ascends to the kidneys, it becomes pyelonephritis, which adds flank or costovertebral angle (CVA) tenderness, high fever, chills, and nausea – a more serious infection that often requires systemic antibiotics and sometimes hospitalization. Teaching clients to complete their antibiotics is a frontline defense against both recurrence and progression to pyelonephritis.
Question 5 · Urolithiasis
A client is admitted with severe, colicky left flank pain and is diagnosed with a ureteral calculus that is expected to pass. In addition to pain management, which nursing intervention is essential?
- A Maintain strict bed rest in the supine position
- B Insert an indwelling urinary catheter to measure hourly output
- C Restrict oral fluids to rest the affected kidney
- D Strain all urine to capture any stone that passes
Show answer & rationale
Correct answer: D
Straining all urine is essential so that any passed stone can be captured and sent for laboratory analysis. Identifying the stone's composition (for example, calcium oxalate, uric acid, or struvite) guides dietary and medical prevention of future stones. Restricting fluids is wrong and harmful; unless contraindicated by kidney or heart failure, clients should increase fluid intake to 2.5 to 3 liters per day to help flush the stone and prevent new ones. Strict supine bed rest is not indicated; ambulation actually helps some stones move down and pass. Inserting an indwelling catheter is unnecessary for a client who is voiding and is not the priority – it also raises infection risk. Clinical pearl: for stones, remember 'strain and drain' – strain every void and push fluids. Pain control is a top priority because renal colic is excruciating; opioids and NSAIDs (such as ketorolac) are commonly used. Diet prevention depends on stone type: for calcium-oxalate stones, limit high-oxalate foods such as spinach, rhubarb, nuts, chocolate, and tea; for uric-acid stones, limit high-purine foods such as organ meats, red meat, and shellfish. Encourage consistent hydration for all stone formers. Teach the client to report fever, which may signal an obstructing stone with infection – a urologic emergency.
Question 6 · BPH and post-TURP care
A client is 6 hours post transurethral resection of the prostate (TURP) with continuous bladder irrigation (CBI) infusing. The nurse notes the drainage has changed from pink-tinged to bright red with numerous clots. Which action should the nurse take FIRST?
- A Increase the irrigation rate and notify the surgeon
- B Deflate the catheter balloon to relieve bladder pressure
- C Stop the continuous bladder irrigation immediately
- D Clamp the catheter and notify the provider in the morning
Show answer & rationale
Correct answer: A
Bright-red drainage with numerous clots signals hemorrhage after TURP. The nurse should increase (titrate up) the continuous bladder irrigation to keep the catheter and bladder clear of clots, then notify the surgeon promptly. CBI is titrated to keep the output the color of light pink lemonade; if bleeding increases, the irrigation rate is increased to prevent clots from obstructing the catheter. Stopping the irrigation is dangerous because clots would accumulate and block outflow, causing painful bladder distention and worsening bleeding. Clamping the catheter and waiting until morning delays care for active hemorrhage and allows clot retention. Deflating the catheter balloon is contraindicated: the inflated balloon often provides tamponade traction against the prostatic bed to control bleeding, and deflating it could worsen hemorrhage. Clinical pearl: after TURP, expect pink-tinged output that gradually clears over the first day; bright-red output with clots equals hemorrhage – speed up the irrigation and call the surgeon. Do not stop CBI while drainage is flowing; only if the catheter fully clots off do you stop the inflow and hand-irrigate per protocol. Also monitor for TURP syndrome (dilutional hyponatremia from irrigation fluid absorption, causing confusion and nausea). When calculating true urine output, subtract the volume of irrigation fluid instilled from the total drainage. BPH itself causes hesitancy, weak stream, dribbling, and urinary retention; TURP relieves the obstruction.
Question 7 · Glomerulonephritis
An adult presents two weeks after a streptococcal throat infection with periorbital edema, tea-colored urine, and a blood pressure of 158/96 mm Hg. The nurse suspects acute poststreptococcal glomerulonephritis. Which additional laboratory or assessment finding does the nurse anticipate?
- A Complete absence of edema
- B Hypotension with rapid weight loss
- C Hematuria and proteinuria
- D Polyuria with clear, dilute urine
Show answer & rationale
Correct answer: C
Acute poststreptococcal glomerulonephritis (PSGN) is an immune-mediated inflammation of the glomeruli that typically appears one to three weeks after a group A streptococcal infection of the throat or skin. Inflamed glomeruli become leaky, so the nurse anticipates hematuria (often tea- or cola-colored urine) and proteinuria. Polyuria with clear, dilute urine is incorrect; PSGN more often reduces filtration and causes oliguria with concentrated, discolored urine. Hypotension with weight loss is incorrect; clients usually develop hypertension and weight gain because sodium and water are retained, producing edema. Complete absence of edema is incorrect; periorbital and dependent edema are classic due to fluid retention and low filtration. Clinical pearl: the PSGN triad is hematuria, edema, and hypertension, with a recent strep infection in the history and elevated antistreptolysin O (ASO) titers. Management is supportive – sodium and fluid restriction, blood pressure control, and monitoring renal function – and most clients recover. Contrast this with nephrotic syndrome, which features massive proteinuria (greater than 3.5 g/day), hypoalbuminemia, generalized edema (anasarca), and hyperlipidemia. Remember: glomeruloNephritis leans toward hematuria and hypertension, while Nephrotic syndrome leans toward heavy proteinuria and profound edema. Monitor creatinine and BUN in both, and watch for signs of fluid overload such as crackles and rising blood pressure.
Question 8 · CKD management
A nurse is teaching a client with stage 4 chronic kidney disease (CKD) about diet and medications. Which instructions are appropriate? Select all that apply.
- A Consume unlimited high-protein red meat every day
- B Take the prescribed phosphate binder with each meal
- C Expect epoetin alfa to be prescribed for anemia of CKD
- D Eat a high-phosphorus diet to strengthen the bones
- E Restrict dietary sodium and monitor daily fluid intake
- F Limit high-potassium foods such as bananas, oranges, and potatoes
Show answer & rationale
Correct answer: B, C, E, F
Chronic kidney disease impairs the kidney's ability to excrete waste, potassium, phosphorus, sodium, and fluid, and to make erythropoietin and activate vitamin D. Phosphate binders must be taken with meals so they bind dietary phosphorus in the gut and prevent its absorption – taking them between meals is ineffective. Limiting high-potassium foods (bananas, oranges, potatoes, tomatoes, salt substitutes) prevents dangerous hyperkalemia, since failing kidneys cannot excrete potassium. Restricting sodium and monitoring fluids helps control the fluid overload and hypertension common in CKD. Epoetin alfa (erythropoietin) is appropriate because damaged kidneys produce less erythropoietin, leading to anemia; supplementing it stimulates red blood cell production. Eating a high-phosphorus diet is wrong: excess phosphorus pulls calcium from bones and causes renal osteodystrophy and vascular calcification, so phosphorus is restricted. Consuming unlimited high-protein red meat is wrong for a client with pre-dialysis stage 4 CKD; protein is often moderately restricted to reduce nitrogenous waste, and red and organ meats also add potassium and phosphorus. Clinical pearl: think 'limit the salty, the sweet potato, and the phosphorus' – restrict sodium, potassium, phosphorus, and often protein and fluid. Give phosphate binders WITH meals, treat anemia with erythropoietin (plus iron), and watch for renal osteodystrophy. CKD is staged by GFR: normal is 90 or above, and stage 5 (end-stage) is below 15, when dialysis or transplant is required.
Question 9 · Fluid balance in renal failure
A client is in the oliguric phase of acute kidney injury. Which assessment findings would the nurse expect that indicate fluid volume overload? Select all that apply.
- A Increased urine output with dilute urine
- B Crackles auscultated in the lung bases
- C Rapid weight gain over the past two days
- D Flat neck veins and poor skin turgor
- E Dependent and periorbital edema
- F Jugular vein distention
Show answer & rationale
Correct answer: B, C, E, F
During the oliguric phase of AKI, the kidneys cannot excrete fluid, so it accumulates and causes volume overload. Rapid weight gain is the most sensitive early indicator; a 1 kg gain roughly equals 1 liter of retained fluid, so daily weights are essential. Dependent and periorbital edema reflects fluid moving into the interstitial space. Crackles in the lung bases signal pulmonary congestion as fluid backs up into the lungs, a warning sign for pulmonary edema. Jugular vein distention reflects increased central venous volume and pressure from the excess fluid. Increased urine output with dilute urine is incorrect for the oliguric phase – oliguria means output is decreased (often less than 400 mL/day); a rise in dilute output would instead herald the later diuretic (recovery) phase. Flat neck veins and poor skin turgor are signs of fluid volume deficit, not overload, so they are incorrect here. Clinical pearl: for overload, look for the 'wet' signs – weight up, edema, crackles, bounding pulses, hypertension, and distended neck veins. Weigh the client daily at the same time on the same scale, monitor strict intake and output, and watch potassium and creatinine closely (normal creatinine 0.6 to 1.2 mg/dL, BUN 10 to 20 mg/dL). Fluid overload during the oliguric phase can precipitate heart failure and pulmonary edema, so early recognition drives fluid restriction and possibly dialysis.
Question 10 · Peritoneal dialysis
A nurse is caring for a client receiving peritoneal dialysis. Which nursing actions are appropriate? Select all that apply.
- A Instill cold dialysate to reduce abdominal discomfort
- B Use strict aseptic technique when connecting and disconnecting
- C Report cloudy drained effluent to the provider promptly
- D Ensure the prescribed dwell time is maintained before draining
- E Reuse the drained effluent for the next exchange to conserve fluid
- F Warm the dialysate solution to body temperature before instilling it
Show answer & rationale
Correct answer: B, C, D, F
Peritoneal dialysis uses the peritoneal membrane as a filter, and safe practice centers on infection prevention and correct exchange mechanics. Warming the dialysate to body temperature promotes comfort and dilates peritoneal vessels, improving clearance; use a warmer or heating pad, never a microwave. Reporting cloudy effluent promptly is essential because cloudy drainage is the cardinal sign of peritonitis, the most serious complication, and it requires culture and antibiotics. Using strict aseptic technique at every connection is critical because contamination at the catheter is the main route for peritonitis. Maintaining the prescribed dwell time allows diffusion and osmosis to remove wastes and excess fluid before the drain (outflow) phase; draining too early reduces effectiveness. Instilling cold dialysate is wrong – it causes cramping, discomfort, and vasoconstriction that lowers clearance. Reusing drained effluent is wrong and grossly unsafe: the effluent contains waste products and organisms and must be discarded; each exchange uses fresh sterile solution. Clinical pearl: remember the exchange as inflow, dwell, outflow, and keep everything sterile and warm. If outflow is sluggish, reposition the client, check for tubing kinks or a full colon (constipation is a common cause), and lower the drainage bag below the abdomen. Monitor the effluent color every exchange – it should be clear and pale yellow. Watch for early peritonitis signs of cloudy effluent, abdominal pain, and fever so treatment starts before the infection becomes systemic.
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Renal & GU NCLEX FAQ
What is the difference between acute kidney injury (AKI) and chronic kidney disease (CKD)?
AKI is a sudden, often reversible loss of kidney function caused by prerenal factors (poor perfusion, such as hypovolemia), intrarenal factors (direct damage, such as nephrotoxic drugs or glomerulonephritis), or postrenal factors (obstruction, such as stones or an enlarged prostate). If the cause is corrected early, function can recover. CKD is progressive and generally irreversible (though its progression can often be slowed), staged by glomerular filtration rate (GFR): normal is 90 or higher, and stage 5 (end-stage) is below 15, when dialysis or transplant is needed. In both, watch creatinine (normal 0.6 to 1.2 mg/dL) and BUN (normal 10 to 20 mg/dL) rise, and monitor for fluid overload.
Why can't you take a blood pressure or draw blood from an AV fistula arm?
An arteriovenous fistula or graft is a surgically created connection used for hemodialysis, and it must stay open (patent). Compressing the arm with a blood pressure cuff, drawing blood, starting an IV, or wearing tight clothing can occlude the vessel and cause it to clot, destroying the client's dialysis access. Instead, assess the access every shift by auscultating for a bruit (swishing sound) and palpating for a thrill (buzzing vibration). If the bruit or thrill is absent, the access may be clotting – report it immediately.
What is the most important complication to watch for in peritoneal dialysis?
Peritonitis is the major complication. The classic signs are cloudy drained effluent, abdominal pain, and fever. Normal effluent should be clear and pale yellow, so cloudy drainage should be reported to the provider right away for culture and antibiotics. Prevent peritonitis with strict aseptic technique at every catheter connection. Also warm the dialysate before instilling it, and follow the correct exchange sequence of inflow, dwell, and outflow so that adequate filtration occurs.
Why do you strain urine with kidney stones, and how does diet help prevent them?
You strain all urine to catch any passed stone so it can be analyzed. Knowing the stone type guides prevention. For calcium-oxalate stones, limit high-oxalate foods such as spinach, rhubarb, nuts, chocolate, and tea. For uric-acid stones, limit high-purine foods such as organ meats, red meat, and shellfish. For all stone formers, increase fluids to about 2.5 to 3 liters per day (unless contraindicated) to keep urine dilute. Pain control is a priority during renal colic, and fever with an obstructing stone is an emergency.