Renal and Urology Nursing Questions for the Prometric Exam 2026: 20 MCQs with Answers on Acute Kidney Injury, Chronic Kidney Disease, Haemodialysis and Fistula Care, Peritoneal Dialysis, Kidney Transplant, Urinary Catheters, Retention, Stones, Prostate Surgery and Incontinence

Renal and urology nursing supplies 8 to 12 questions on the registered nurse paper, and the Gulf has some of the world's highest rates of dialysis dependence because of diabetes and hypertension, so dialysis units and transplant centres recruit constantly. The exam tests kidney protection, dialysis safety, catheter care and the post-operative urology that every ward nurse meets. This set covers what recurs; dialysis technicians sit a separate paper (dialysis technician questions).

Acute and chronic kidney disease

Question 1

A 70-year-old on an ACE inhibitor, a diuretic and regular ibuprofen is admitted with vomiting and diarrhoea. Her urine output has been 20 mL/h for six hours and creatinine has risen from 90 to 190 micromol/L. The nurse should:

1. Give the scheduled ibuprofen and diuretic
2. Recognise acute kidney injury (oliguria below 0.5 mL/kg/h and a creatinine rise of over 1.5 times baseline), hold the nephrotoxic and haemodynamically active drugs pending review (NSAIDs, ACE inhibitor, diuretic, metformin), ensure fluid resuscitation as prescribed, start strict fluid balance and daily weight, check potassium and blood gas, send urinalysis, review all medication doses for renal function, and escalate; sick-day rules are taught at discharge
3. Restrict fluids to rest the kidneys
4. Insert a catheter and discharge

Answer: B. Pre-renal AKI from dehydration plus the "triple whammy" of ACE inhibitor, diuretic and NSAID is the commonest ward scenario; contrast, aminoglycosides and obstruction are the other tested causes.

Question 2

Which dietary teaching is correct for a patient with stage 4 CKD not yet on dialysis?

1. A high-protein diet to prevent muscle loss
2. Moderate protein restriction (about 0.6 to 0.8 g/kg/day as advised by the dietitian), sodium under 2 g/day, limiting high-potassium foods (bananas, oranges, dates, tomatoes, potatoes, salt substitutes) if potassium is raised, limiting phosphate (processed foods, cola, dairy) with binders if prescribed, adequate but not excessive fluid, avoiding NSAIDs and herbal remedies, and controlling blood pressure and glucose; protein needs increase once on dialysis
3. Unlimited potassium because the kidneys are failing
4. Fluid restriction of 500 mL/day in all CKD patients

Answer: B. Dates are a staple in Gulf diets and are high in potassium; a renal dietitian reviews every patient.

Question 3

A dialysis patient has a potassium of 7.0 mmol/L with peaked T waves on ECG, two hours before the scheduled session. The nurse's immediate actions are:

1. Wait for the scheduled session
2. Continuous cardiac monitoring, stop any potassium-containing fluids or foods, notify the physician urgently, prepare intravenous calcium gluconate to protect the myocardium, insulin with dextrose and nebulised salbutamol to shift potassium into cells as prescribed, and arrange urgent dialysis as the definitive treatment, with repeat potassium and glucose monitoring
3. Give oral potassium binder only
4. Encourage fluids

Answer: B. Missed sessions and dietary indiscretion are the usual causes; the nurse explores barriers to attendance.

Question 4

Which medication teaching is correct for a CKD patient prescribed sevelamer and darbepoetin?

1. Take sevelamer at bedtime on an empty stomach
2. Take sevelamer (a phosphate binder) with meals so it binds dietary phosphate, report constipation; darbepoetin (an erythropoiesis-stimulating agent) is given subcutaneously or intravenously at dialysis to treat renal anaemia, with blood pressure monitored because it can rise, haemoglobin targeted to about 100 to 115 g/L rather than normal, and iron stores corrected first; vitamin D analogues and calcimimetics manage secondary hyperparathyroidism and need calcium monitoring
3. Stop darbepoetin when haemoglobin reaches 100 g/L
4. Take all medications at the same time as the binder

Answer: B. Binders also bind some drugs (levothyroxine, ciprofloxacin), which are spaced from them.

Haemodialysis

Question 5

A patient has a newly created left radiocephalic arteriovenous fistula. Which nursing instruction is correct?

1. Take blood pressure and draw blood from the left arm to spare the right
2. No blood pressure, venepuncture, cannulation, tight clothing, watches or carrying heavy bags on the fistula arm, check the thrill by palpation and the bruit by auscultation every shift and teach the patient to check daily, report loss of thrill, coldness, numbness or pain in the hand (steal syndrome), redness, swelling or bleeding immediately, keep the arm elevated initially, and perform hand exercises as advised to mature the fistula over about six to twelve weeks before first use
3. Apply a tourniquet to make the veins prominent
4. The fistula can be used the day after creation

Answer: B. A fistula is the preferred access; central venous catheters carry the highest infection risk and are used while the fistula matures.

Question 6

During haemodialysis a patient becomes pale, sweaty and nauseated with a blood pressure of 80/45 mmHg. The nurse should:

1. Increase the ultrafiltration rate to finish faster
2. Place the patient in Trendelenburg or lower the head, reduce or stop ultrafiltration and reduce the blood pump speed, give a bolus of 0.9% saline as per protocol, give oxygen if needed, reassess blood pressure and symptoms, and review the dry weight, antihypertensive timing and interdialytic weight gain to prevent recurrence; chest pain or arrhythmia prompts urgent medical review
3. Continue dialysis unchanged
4. Give an antihypertensive

Answer: B. Intradialytic hypotension is the commonest complication; cramps, disequilibrium syndrome (headache, confusion after rapid urea removal), air embolism and access bleeding are the others tested.

Question 7

Which teaching about interdialytic weight gain and fluid restriction is correct?

1. Fluid intake is unlimited between sessions
2. Limit fluid to the prescribed amount (commonly 500 mL plus the previous day's urine output, or about 1 to 1.5 litres), aiming for weight gain under about 2 to 2.5 kg between sessions (no more than 4 to 5% of dry weight), count all liquids including soups, ice and fruit, manage thirst with sugar-free gum, ice chips and low sodium intake, and weigh daily; excessive gains cause hypertension, pulmonary oedema and intradialytic hypotension from aggressive fluid removal
3. Weight gain of 5 kg between sessions is acceptable
4. Salt intake has no effect on thirst

Answer: B. Hot Gulf summers increase insensible losses and thirst, which the renal team adjusts for.

Peritoneal dialysis and transplant

Question 8

A patient on continuous ambulatory peritoneal dialysis reports cloudy effluent, abdominal pain and fever. The nurse should:

1. Reassure that cloudy fluid is normal
2. Suspect PD peritonitis, send the effluent for cell count, Gram stain and culture before antibiotics, assess the exit site and tunnel, notify the renal team for empirical intraperitoneal antibiotics covering Gram-positive and Gram-negative organisms, continue exchanges as directed (often with more frequent rapid exchanges initially), review the patient's technique and retrain, and teach that touch contamination, poor hand hygiene and exit-site infection are the usual causes
3. Stop all exchanges and send the patient home
4. Give oral antibiotics only

Answer: B. Exit-site care uses daily cleaning with an antiseptic and topical antibiotic per protocol, keeping the catheter immobilised; fungal peritonitis requires catheter removal.

Question 9

Which practice is essential during a CAPD exchange?

1. Warming the dialysate in a microwave on high power
2. Thorough hand hygiene and a mask, a clean, draught-free area with doors and windows closed, inspecting the bag for leaks, clarity and expiry, warming dialysate to body temperature by dry heat (never a microwave, which heats unevenly), connecting with aseptic technique, draining by gravity and observing the effluent, infusing the fresh solution, and recording volumes, ultrafiltration, weight and blood pressure; constipation and a full bladder impair drainage
3. Reusing the transfer set for a week
4. Skipping hand hygiene if gloves are worn

Answer: B. Hypertonic (higher glucose) bags remove more fluid and raise glucose in diabetic patients; automated PD uses a cycler overnight.

Question 10

Two weeks after a living-donor kidney transplant, a patient has a fever, reduced urine output, tenderness over the graft, weight gain and a rising creatinine. The nurse should:

1. Reassure; this is normal post-operative recovery
2. Recognise possible acute rejection (or infection or obstruction), report immediately, monitor vital signs, strict fluid balance, daily weight and urine output, prepare for blood tests, drug levels, ultrasound and possible biopsy, administer prescribed pulse steroids or other treatment, and reinforce that immunosuppressants (tacrolimus, mycophenolate, prednisolone) are taken at exact times every day for life with trough levels monitored, avoiding grapefruit and interacting drugs, and that fever, reduced urine, graft pain or weight gain must be reported at once
3. Stop the immunosuppressants because of the fever
4. Give NSAIDs for the graft pain

Answer: B. Transplant patients are taught infection prevention (hand hygiene, avoiding crowds and sick contacts early on, food safety), sun protection because of skin cancer risk, and lifelong follow-up; Gulf states run growing deceased- and living-donor programmes.

Catheters and retention

Question 11

Which practice reduces catheter-associated urinary tract infection?

1. Routine catheter changes every seven days and daily bladder washouts
2. Inserting only for an accepted indication (retention, accurate output monitoring in critical illness, selected surgeries, sacral wounds with incontinence, comfort at end of life), aseptic insertion with the smallest effective size, securing the catheter, keeping the closed drainage bag below bladder level and off the floor, emptying with a clean container per patient, daily meatal hygiene with soap and water, maintaining hydration, taking samples aseptically from the sampling port, reviewing the need daily and removing it as soon as possible, with no routine irrigation or prophylactic antibiotics
3. Disconnecting the bag to collect specimens
4. Using a large catheter to prevent bypassing

Answer: B. Nurse-driven removal protocols reduce catheter days; CAUTI is an International Patient Safety Goal indicator audited in Gulf hospitals.

Question 12

While inserting a urinary catheter in a male patient, the nurse meets resistance at the prostatic urethra and the patient has pain. The correct action is:

1. Push harder to pass the obstruction
2. Stop, do not force, ensure adequate lubricant gel (with lidocaine where used) and a few minutes for it to work, ask the patient to relax and breathe deeply or cough, hold the penis at 90 degrees to the body, try gentle steady pressure, and if resistance persists withdraw and call the medical or urology team for a different approach (coudé catheter, guidewire or suprapubic catheter); never inflate the balloon until urine drains, confirming the balloon is in the bladder
3. Inflate the balloon to anchor the catheter
4. Use a smaller stylet

Answer: B. Forcing creates a false passage, bleeding and stricture; balloon inflation in the urethra causes severe injury.

Question 13

A 68-year-old man with prostatic enlargement has not voided for 12 hours, has a tender suprapubic mass and a bladder scan showing 900 mL. After catheterisation, which nursing precaution applies?

1. Drain the bladder as fast as possible and remove the catheter immediately
2. Drain the bladder, monitoring for hypotension and haematuria (some protocols drain in stages for very large volumes, although rapid complete drainage is generally considered safe with monitoring), record the volume, then observe for post-obstructive diuresis (urine output above about 200 mL/h for several hours) with fluid and electrolyte replacement as prescribed, and keep the catheter in place pending urology review and a trial without catheter after alpha-blocker treatment
3. Clamp the catheter after 200 mL and leave it clamped for an hour
4. Give a diuretic

Answer: B. Chronic retention with renal impairment carries the highest diuresis risk; anticholinergics, alcohol and constipation precipitate acute retention.

Stones and urological surgery

Question 14

A 35-year-old man has sudden severe colicky loin pain radiating to the groin, vomiting, restlessness and microscopic haematuria. Nursing priorities include:

1. Bed rest and fluid restriction
2. Prompt analgesia (NSAIDs such as intramuscular or rectal diclofenac are first line if renal function allows, with opioids as needed), antiemetics, fluids, straining all urine to collect the stone for analysis, monitoring temperature because an infected obstructed kidney is an emergency requiring decompression, preparing for CT KUB, and teaching fluid intake of 2 to 3 litres daily, reduced salt and animal protein and normal calcium intake to prevent recurrence
3. Withholding analgesia until the diagnosis is confirmed
4. Encouraging a low-calcium diet

Answer: B. Heat and dehydration make stone disease very common in the Gulf; stones over about 6 to 7 mm or with obstruction need intervention (ureteroscopy, lithotripsy or stenting).

Question 15

A patient returns from a transurethral resection of the prostate with a three-way catheter and continuous bladder irrigation. The drainage is dark red with clots and the flow has slowed. The nurse should:

1. Stop the irrigation and clamp the catheter
2. Increase the irrigation rate to keep the output pink and free-flowing, check for catheter obstruction by clots and perform manual irrigation with a bladder syringe and sterile saline only if trained and ordered, keep the catheter patent and the bag below bladder level, monitor for bladder spasm (antispasmodics as prescribed), measure true urine output (total output minus irrigant), monitor vital signs and haemoglobin, and report bright red bleeding, persistent clots, abdominal distension, hypotension, confusion or hyponatraemia (TURP syndrome from irrigant absorption)
3. Remove the catheter to relieve the obstruction
4. Encourage straining to pass the clots

Answer: B. After catheter removal the patient is taught that mild haematuria and frequency are expected for weeks, to avoid straining and heavy lifting, to drink well, and that retrograde ejaculation is common.

Question 16

A patient is 24 hours post-right nephrectomy for renal cancer. Which finding most needs reporting?

1. Serous drainage of 30 mL from the wound drain
2. Urine output below 0.5 mL/kg/h, increasing abdominal or flank distension, tachycardia and hypotension suggesting haemorrhage, or breathlessness with reduced air entry suggesting pneumothorax or atelectasis after the flank approach; the remaining kidney must be protected, so nephrotoxins are avoided and output is monitored hourly
3. Mild incisional pain controlled by analgesia
4. Reluctance to mobilise on the first morning

Answer: B. The flank incision is painful and splinted for deep breathing; early mobilisation and incentive spirometry prevent chest complications.

Infection and continence

Question 17

A pregnant woman at 24 weeks has asymptomatic bacteriuria on a routine urine culture. The nurse understands that:

1. No treatment is needed because she has no symptoms
2. Asymptomatic bacteriuria in pregnancy is treated with a pregnancy-safe antibiotic (for example nitrofurantoin avoiding term, cephalexin or amoxicillin per sensitivity) because up to a third progress to pyelonephritis, which increases preterm labour and low birth weight; a test of cure follows, and fever with loin pain in pregnancy is admitted for intravenous antibiotics
3. Fluoroquinolones are the first choice in pregnancy
4. Screening in pregnancy is unnecessary

Answer: B. Outside pregnancy, asymptomatic bacteriuria is generally not treated, especially in the elderly and catheterised patients, to avoid resistance.

Question 18

An 82-year-old woman is brought in with new confusion and a fall. Her urine dipstick is positive for leukocytes and nitrites. Which approach is correct?

1. Diagnose urinary tract infection from the dipstick and start antibiotics
2. Recognise that dipsticks are unreliable in older adults because of high rates of asymptomatic bacteriuria; assess for genuine urinary symptoms (dysuria, frequency, new incontinence, suprapubic or loin pain, fever, rigors) and for other causes of confusion and falls (dehydration, medications, pneumonia, constipation, hypoglycaemia), send a culture only if infection is clinically suspected, and treat according to culture and local guidelines, with hydration and delirium prevention measures
3. Insert a catheter to monitor output
4. Give cranberry juice only

Answer: B. Over-treatment of bacteriuria in the elderly drives resistance and C. difficile; antibiotic stewardship is tested across Gulf papers.

Question 19

A 55-year-old woman leaks urine when she coughs, sneezes or lifts, with no urgency. The first-line management the nurse teaches is:

1. An indwelling catheter
2. Pelvic floor muscle training (at least eight contractions three times a day for at least three months, ideally supervised by a continence physiotherapist), weight loss if overweight, treating chronic cough and constipation, reducing caffeine, timed voiding, appropriate continence products meanwhile, and referral for surgical options (mid-urethral sling or colposuspension) only if conservative measures fail; urge incontinence, by contrast, is managed with bladder training and antimuscarinic or beta-3 agonist drugs
3. Fluid restriction to under 500 mL a day
4. Antimuscarinic medication as first line

Answer: B. Mixed incontinence is treated according to the predominant symptom; overflow incontinence from retention needs catheterisation and treatment of the cause.

Question 20

A patient with a new ileal conduit urostomy after cystectomy asks about care. The nurse teaches:

1. The stoma should be pale and dry
2. That the stoma should be pink or red, moist and slightly raised, with mucus in the urine expected because the conduit is bowel; to empty the pouch when one third full, use a night drainage bag, change the appliance every three to five days or if leaking, cut the barrier to fit the stoma to protect the skin, drink two litres or more daily, report a dusky, pale or black stoma, bleeding, skin breakdown, fever, flank pain or cloudy foul urine (urine from a conduit normally contains mucus but should not be cloudy or offensive), and that stoma size reduces over the first six to eight weeks; psychological support and the stoma nurse are involved early
3. Appliances are changed every day
4. Fluids are restricted to reduce output

Answer: B. Urine pH and crystal formation are monitored; some patients are taught to acidify urine to prevent encrustation per the stoma nurse's advice.

How to practise

• Learn AKI recognition and the nephrotoxin list, and the CKD diet and medication rules.
• Know dialysis safety: fistula protection, intradialytic complications and their management, PD peritonitis, fluid and weight limits.
• Know transplant teaching: immunosuppressant timing, rejection and infection signs.
• Practise the procedures and precautions: catheter insertion and CAUTI bundle, retention and post-obstructive diuresis, continuous bladder irrigation, stoma care.

Renal chapters with explanations are in the Registered Nurse bank; related sets are the fluid and electrolyte questions, medical-surgical questions, fundamentals questions and geriatric questions. Nephrologists have their own set (nephrology questions) and the dialysis career route is in the OT and dialysis technician guide.

Frequently asked questions

How many renal and urology questions are in the Prometric nursing exam?

About 8 to 12 of 150, within the medical-surgical domain, with dialysis and transplant items appearing in critical care and pharmacology as well.

Which renal nursing topics come up most?

Acute kidney injury and nephrotoxins, hyperkalaemia, fistula care and intradialytic hypotension, PD peritonitis, catheter care and CAUTI prevention, retention and post-TURP irrigation.

Do ward nurses need dialysis knowledge for the exam?

Yes, at the level of access protection, complications and patient teaching; machine operation is for dialysis nurses and technicians.

Which guidelines does the exam follow?

KDIGO for AKI and CKD, ISPD for peritoneal dialysis, and standard CAUTI prevention bundles, as reflected in nursing textbooks.

Are these real exam questions?

No. They are original practice questions written to the published blueprint. Real exam content is confidential.