🎯 High-Yield Points
- AKI: sudden onset, potentially reversible; causes = pre-renal (decreased perfusion), renal (nephrotoxins), post-renal (obstruction)
- CKD: gradual, irreversible; watch for hyperkalaemia, metabolic acidosis, anaemia, hypertension
- Haemodialysis: assess AV fistula — palpate thrill, auscultate bruit; never take BP in fistula arm
- UTI: burning, frequency, urgency, cloudy urine; E. coli most common cause
- Renal calculi: most common = calcium oxalate; encourage 3L fluid/day; strain all urine
[Concept Map: Renal & Urinary NCLEX Questions — Clinical Manifestations, Nursing Interventions, Priority Actions]
Practice Questions
Question 1
A client with chronic kidney disease has a serum potassium of 6.4 mEq/L. Which food does the nurse instruct the client to AVOID?
✓ Correct: Bananas and oranges
Hyperkalaemia is a life-threatening complication of CKD because damaged kidneys cannot excrete potassium. Bananas and oranges are high-potassium foods (420mg and 237mg respectively) that must be avoided. High-potassium foods to avoid: bananas, oranges, potatoes, tomatoes, avocados, and dried fruits. Low-potassium safe choices include white rice, pasta, white bread, apples, and chicken.
Hyperkalaemia is a life-threatening complication of CKD because damaged kidneys cannot excrete potassium. Bananas and oranges are high-potassium foods (420mg and 237mg respectively) that must be avoided. High-potassium foods to avoid: bananas, oranges, potatoes, tomatoes, avocados, and dried fruits. Low-potassium safe choices include white rice, pasta, white bread, apples, and chicken.
Question 2
A client is admitted with acute kidney injury (AKI) and has a urine output of 15 mL/hour. Which medication does the nurse question giving?
✓ Correct: IV gentamicin (aminoglycoside)
Aminoglycoside antibiotics (gentamicin, tobramycin, amikacin) are nephrotoxic. In a client already experiencing AKI with severely reduced urine output (normal is >30 mL/hour), administering a nephrotoxic antibiotic will worsen renal damage. The nurse should question this order and discuss an alternative antibiotic with the provider. This is a critical medication safety issue.
Aminoglycoside antibiotics (gentamicin, tobramycin, amikacin) are nephrotoxic. In a client already experiencing AKI with severely reduced urine output (normal is >30 mL/hour), administering a nephrotoxic antibiotic will worsen renal damage. The nurse should question this order and discuss an alternative antibiotic with the provider. This is a critical medication safety issue.
Question 3
A nurse is assessing a client who has an arteriovenous (AV) fistula in the left arm for haemodialysis. Which assessment is ESSENTIAL?
✓ Correct: Assess for a thrill and bruit in the fistula
The AV fistula must be assessed for patency by palpating for a thrill (vibration) and auscultating for a bruit (swooshing sound). Absence of thrill or bruit indicates thrombosis and requires immediate notification of the dialysis team. NEVER: take blood pressure, draw blood, start IV, or apply tourniquet on the fistula arm. These actions can cause fistula clotting.
The AV fistula must be assessed for patency by palpating for a thrill (vibration) and auscultating for a bruit (swooshing sound). Absence of thrill or bruit indicates thrombosis and requires immediate notification of the dialysis team. NEVER: take blood pressure, draw blood, start IV, or apply tourniquet on the fistula arm. These actions can cause fistula clotting.
Question 4
A client passes a kidney stone at home and is instructed to strain urine. Which instruction explains the reason for this?
✓ Correct: To capture the stone for laboratory analysis to guide dietary modification
Straining all urine to capture the passed stone allows laboratory analysis to identify the stone composition (calcium oxalate, uric acid, struvite, cystine). This guides specific dietary and medication interventions to prevent recurrence. For calcium oxalate stones: reduce oxalate foods, maintain adequate calcium intake, increase fluids. For uric acid stones: reduce purines, alkalinise urine. Stone analysis is essential for personalised prevention.
Straining all urine to capture the passed stone allows laboratory analysis to identify the stone composition (calcium oxalate, uric acid, struvite, cystine). This guides specific dietary and medication interventions to prevent recurrence. For calcium oxalate stones: reduce oxalate foods, maintain adequate calcium intake, increase fluids. For uric acid stones: reduce purines, alkalinise urine. Stone analysis is essential for personalised prevention.
Question 5
A post-renal transplant client develops fever, decreased urine output, and tenderness over the transplant site on day 3. Which complication does the nurse suspect?
✓ Correct: Acute transplant rejection
The classic triad of acute transplant rejection (days to weeks post-transplant) is: fever, decreased urine output (rising creatinine), and tenderness/swelling over the transplant site. This is an emergency requiring immediate notification of the transplant team and likely high-dose immunosuppression (pulse steroids). Cyclosporine toxicity presents similarly but without the tenderness. Acute rejection occurring within the first week is called hyperacute; within months is called acute cellular rejection.
The classic triad of acute transplant rejection (days to weeks post-transplant) is: fever, decreased urine output (rising creatinine), and tenderness/swelling over the transplant site. This is an emergency requiring immediate notification of the transplant team and likely high-dose immunosuppression (pulse steroids). Cyclosporine toxicity presents similarly but without the tenderness. Acute rejection occurring within the first week is called hyperacute; within months is called acute cellular rejection.
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