Renal & Genitourinary Nursing for the NCLEX-RN Exam

Common failure modes

These are the patterns that cause most candidates to lose marks on this topic. Recognising them in advance is half the work.

• !Missing peaked T-waves on ECG as a sign of hyperkalemia (K+ > 6.0)
• !Confusing AV-fistula assessment (palpate thrill, auscultate bruit) with central-line assessment
• !Not holding ACE inhibitors or ARBs the morning of dialysis
• !Forgetting that CKD patients need phosphate binders WITH meals, not on an empty stomach

Study tips

• 1Memorize hyperkalemia treatment order: calcium gluconate (cardiac membrane stabilization), insulin/D50 (intracellular shift), kayexalate or dialysis (removal).
• 2Know AV fistula nursing: no BP, no IVs, no venipuncture in the fistula arm. Assess thrill and bruit every shift.
• 3Drill the difference between pre-renal AKI (BUN:Cr > 20:1, hypovolemia) vs. intrinsic AKI (BUN:Cr ~10:1, ATN).
• 4Catheter care: secure to inner thigh in females, abdomen or thigh in males; keep collection bag below bladder; assess every 2 hours.

Sample NCLEX-RN Renal & Genitourinary Nursing questions

These sample items mirror the format and difficulty of real NCLEX-RN questions. Practice with thousands more on the free Koydo question bank.

1. 1

   A client with CKD has serum K+ of 6.5 mEq/L and peaked T-waves on ECG. Which medication should the nurse prepare to administer first?

   • ASodium polystyrene sulfonate (Kayexalate)
   • BIV insulin and dextrose
   • CIV calcium gluconateCorrect
   • DIV sodium bicarbonate
   Why this answer?

   IV calcium gluconate is given first because it stabilizes the cardiac membrane and prevents life-threatening dysrhythmias. It does not lower potassium. After cardiac stabilization, insulin/dextrose shifts K+ intracellularly, and Kayexalate or dialysis removes it from the body.