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Renal & Urinary NCLEX practice questions

Five NCLEX-style questions on acute kidney injury, chronic kidney disease, dialysis, UTIs and BPH. Pick your answer, then open it to see the right choice and why. New questions every week.

1. Question 1

   A nurse in a long-term care facility is observing an assistant personnel (AP) changing the linen for a client who has fecal incontinence. Which of the following actions indicates that the AP understands the principles of infection control?

   • A.places the soiled linen on the floor before bagging it
   • B.places clean linen that touched the floor in the soiled linen bag
   • C.holds the soiled linen against her body while carrying it to the linen bag
   • D.shakes the soiled linen to remove any toilet paper remnants
   Show answer and rationale ▾Answer and rationale ▴

   Answer: B. places clean linen that touched the floor in the soiled linen bag

   Placing the soiled linen on the floor before bagging it is unsanitary and violates infection control principles. It increases the risk of spreading pathogens to other surfaces, potentially contaminating the environment. Placing clean linen that touched the floor in the soiled linen bag prevents cross-contamination and maintains cleanliness. It adheres to infection control standards by ensuring that only soiled items are disposed of appropriately. Holding the soiled linen against her body while carrying it to the linen bag risks transferring pathogens to the caregiver's clothing and skin, compromising personal hygiene and promoting contamination. Shaking the soiled linen to remove any toilet paper remnants is ineffective and hazardous. It disperses potentially infectious particles, increasing the risk of contamination and compromising infection control efforts.

2. Question 2

   A nurse is caring for a client who has benign prostatic hyperplasia (BPH). The nurse should expect which of the following finding

   • A.Painful urination
   • B.Urge incontinence
   • C.Critically elevated prostate-specific antigen (PSA) level
   • D.Difficulty starting the flow of urine
   Show answer and rationale ▾Answer and rationale ▴

   Answer: D. Difficulty starting the flow of urine

   Painful urination: Painful urination, also known as dysuria, is not a typical symptom of BPH. Dysuria is more commonly associated with conditions such as urinary tract infections (UTIs) or urethritis rather than BPH. Urge incontinence: While BPH can cause lower urinary tract symptoms such as urgency and frequency, urge incontinence (involuntary loss of urine associated with a sudden urge to urinate) is not typically a primary symptom of BPH. Urge incontinence is more commonly associated with overactive bladder (OAB) syndrome. Critically elevated prostate-specific antigen (PSA) level: While BPH can cause an elevation in PSA levels, a critically elevated PSA level alone is not a definitive diagnostic finding for BPH. PSA levels can be elevated in various conditions affecting the prostate gland, including BPH, prostate cancer, and prostatitis. Therefore, PSA levels must be interpreted in conjunction with other clinical findings and diagnostic tests to accurately assess prostate health and diagnose specific prostate conditions. Difficulty starting the flow of urine: Benign prostatic hyperplasia (BPH) is characterized by the enlargement of the prostate gland, which can obstruct the flow of urine through the urethra. This obstruction leads to symptoms such as difficulty starting the flow of urine, weak urinary stream, urinary hesitancy, and incomplete bladder emptying. These symptoms occur due to the mechanical obstruction of the urethra by the enlarged prostate gland. Difficulty starting the flow of urine is a hallmark symptom of BPH and is often one of the earliest manifestations experienced by affected individuals.

3. Question 3

   A nurse is monitoring a client who received epinephrine for angioedema after a first dose of losartan. Which of the following data indicates a therapeutic response to the epinephrine?

   • A.The client tolerates a second dose of medication with no greater than 1 peripheral edema.
   • B.Respirations are unlabored.
   • C.Client reports decreased groin pain of 3 on a 1 to 10 scale.
   • D.The client's blood pressure when arising from resting position is at premedication levels.
   Show answer and rationale ▾Answer and rationale ▴

   Answer: B. Respirations are unlabored.

   The client tolerates a second dose of medication with no greater than 1 peripheral edema:This does not directly indicate a therapeutic response to epinephrine for angioedema. Angioedema primarily involves swelling of deeper layers of the skin, often around the eyes and lips, and sometimes the throat, which can cause breathing difficulties. Tolerating a second dose of medication with minimal peripheral edema does not specifically address the acute respiratory effects of angioedema. Respirations are unlabored:This is the correct answer. Angioedema can cause swelling in the airways, leading to difficulty breathing. Epinephrine is used to reduce this swelling and improve airway patency. Unlabored respirations indicate that the airway is not obstructed, which means the epinephrine has successfully alleviated the swelling causing the angioedema. Client reports decreased groin pain of 3 on a 1 to 10 scale:Decreased groin pain is not relevant to the treatment of angioedema with epinephrine. Pain relief in the groin area does not indicate a therapeutic response to epinephrine, which is primarily used to address airway and anaphylactic symptoms. The client's blood pressure when arising from resting position is at premedication levels:While epinephrine can affect blood pressure, the main concern with angioedema is airway obstruction rather than blood pressure control. Normalizing blood pressure does not specifically indicate that the epinephrine has successfully treated the angioedema and improved the client's respiratory status.

4. Question 4

   A nurse is caring for a client who has end-stage kidney disease (ESKD) and reports having shortness of breath and swelling in his lower extremities. Upon assessment, the nurse notes the client has crackles in his lungs and an elevated blood pressure. The nurse should suspect which of the following based on the client's manifestations?

   • A.Hyponatremia
   • B.Hypervolemia
   • C.Hypovolemia
   • D.Hyperkalemia
   Show answer and rationale ▾Answer and rationale ▴

   Answer: B. Hypervolemia

   Hyponatremia: Hyponatremia is characterized by low sodium levels in the blood and can lead to symptoms such as weakness, confusion, and seizures. While hyponatremia can contribute to fluid imbalance, the client's presentation with shortness of breath, lower extremity swelling, crackles in the lungs, and elevated blood pressure is more indicative of fluid volume excess rather than hyponatremia. Hypervolemia: Hypervolemia, or fluid volume excess, occurs when there is an abnormal increase in the extracellular fluid volume. This can lead to symptoms such as shortness of breath, crackles in the lungs (indicative of pulmonary edema), peripheral edema, and elevated blood pressure. Given the client's reported symptoms and assessment findings, hypervolemia is the most likely diagnosis. Hypovolemia: Hypovolemia, or fluid volume deficit, occurs when there is a decrease in the extracellular fluid volume. This condition is characterized by symptoms such as thirst, dry mucous membranes, decreased urine output, and hypotension. The client in this scenario presents with signs and symptoms consistent with fluid volume excess rather than hypovolemia. Hyperkalemia: Hyperkalemia is characterized by elevated potassium levels in the blood and can lead to symptoms such as muscle weakness, cardiac dysrhythmias, and nausea. While hyperkalemia can occur in clients with end-stage kidney disease, the client's reported symptoms and assessment findings are more suggestive of fluid volume excess rather than hyperkalemia.

5. Question 5

   The nurse is identifying outcomes for a client with the nursing diagnosis of Stress Urinary Incontinence. Which outcome would be related to sphincter incompetence?

   • A.The client will perform four to five isometric squeezes for 5 to 10 seconds.
   • B.The client will empty her bladder completely each time she voids.
   • C.The client will improve her incontinence within one month.
   • D.The client will stop the flow of urine when voiding.
   Show answer and rationale ▾Answer and rationale ▴

   Answer: A. The client will perform four to five isometric squeezes for 5 to 10 seconds.

   Stress urinary incontinence is the involuntary loss of urine during physical activity such as coughing, sneezing, or exercising. It is often caused by weakness of the pelvic floor muscles and/or the urethral sphincter. An appropriate outcome for a client with this condition would be to improve the strength of these muscles. Performing isometric squeezes, also known as Kegel exercises, can help strengthen the pelvic floor muscles and improve sphincter competence. This can help reduce or prevent episodes of incontinence.