NLE Renal & Urinary Nursing Reviewer 2026

Answer: B. Serum creatinine

Step 1 – Understand what 'specific' means here: a specific indicator changes mainly because of kidney problems, not other reasons. Step 2 – Serum creatinine is produced at a steady rate from muscle breakdown and is excreted almost entirely by the kidneys. It is NOT affected by diet or hydration status in the way BUN is. Step 3 – BUN is incorrect because it can rise due to dehydration, high-protein intake, GI bleeding, or catabolism even when the kidneys are working normally. Step 4 – Sodium and potassium are electrolytes affected by many factors beyond renal function (diet, hormones, medications). Step 5 – Therefore, a rising serum creatinine reliably points to decreased kidney clearance, making it the MOST specific renal function test.

Answer: B. 15 mg/dL

Step 1 – Memorize the normal BUN range: 10–20 mg/dL. Step 2 – 5 mg/dL is below normal, which can occur with severe malnutrition or liver disease (less urea is produced). Step 3 – 15 mg/dL falls squarely within 10–20 mg/dL, so this is the correct answer. Step 4 – 25 mg/dL and 35 mg/dL are both above normal, suggesting renal impairment, dehydration, high-protein intake, or GI bleeding. Step 5 – Remember: BUN is non-specific, so an elevated BUN alone does not confirm kidney disease — always interpret alongside creatinine.

Answer: C. Oliguria

Step 1 – Know the urine output definitions: Anuria = <100 mL/day; Oliguria = <400 mL/day; Normal = ~1,500 mL/day (or 1–2 mL/kg/hr); Polyuria = excessive urine output. Step 2 – 320 mL/day is less than 400 mL/day but more than 100 mL/day, so it fits oliguria. Step 3 – Anuria (< 100 mL) is ruled out because the output is 320 mL, which is above the anuria threshold. Step 4 – Normal urine output is around 1,500 mL/day — 320 mL is far below normal. Step 5 – Polyuria means excess output, which is the opposite of what is described here.

Answer: B. Daily weight measurement

Step 1 – Daily weight is the gold standard for fluid monitoring because 1 kg of body weight change = approximately 1 liter of fluid gained or lost. Step 2 – The key nursing standard is: weigh the patient at the same time each day, using the same scale, with the same amount of clothing. Step 3 – Intake and output (I&O) monitoring is important but less precise because not all fluid losses (insensible losses like sweating and breathing) are captured. Step 4 – Blood pressure and skin turgor are useful clues but are indirect and can be affected by many factors beyond fluid status. Step 5 – For the NLE, when asked about the MOST reliable or BEST indicator of fluid status, always choose daily weight.

Answer: B. Specific gravity of 1.020

Step 1 – Know the normal urinalysis values: specific gravity 1.005–1.030; protein = negative/trace; glucose = negative; RBC casts = abnormal. Step 2 – A specific gravity of 1.020 falls within the normal range of 1.005–1.030, indicating normal urine concentration ability. Step 3 – Protein 2+ is abnormal and suggests glomerular damage (e.g., nephrotic syndrome, diabetic nephropathy). Step 4 – RBC casts are always abnormal and strongly suggest glomerulonephritis — a serious finding that requires immediate follow-up. Step 5 – Glucosuria (glucose in urine) is abnormal; it appears when blood glucose exceeds the renal threshold (~180 mg/dL), as in uncontrolled diabetes mellitus.

Answer: D. Stage 5 CKD (ESRD)

Step 1 – Memorize the GFR stages of CKD: Stage 1 ≥90; Stage 2: 60–89; Stage 3: 30–59; Stage 4: 15–29; Stage 5 (ESRD): <15 mL/min/1.73 m². Step 2 – The patient's eGFR is 12 mL/min/1.73 m², which is below 15 — this places the patient in Stage 5, also known as End-Stage Renal Disease (ESRD). Step 3 – At Stage 5, the kidneys have lost nearly all function, and dialysis or kidney transplant is usually required to sustain life. Step 4 – Stage 4 (GFR 15–29) is ruled out because 12 is below the Stage 4 lower limit of 15. Step 5 – For NLE: remember that dialysis is typically initiated when GFR <15 (Stage 5) and the patient becomes symptomatic or uremic.

Answer: B. Assess for allergy to iodine, shellfish, or contrast dye

Step 1 – IVP uses contrast dye (iodine-based) to visualize the urinary tract structures. The dye can cause allergic reactions ranging from mild hives to life-threatening anaphylaxis. Step 2 – Therefore, the PRIORITY nursing action before any contrast study is to assess the patient for allergy to iodine, shellfish, or contrast media. Step 3 – The nurse must also check BUN and serum creatinine before contrast administration because contrast dye is nephrotoxic — it can worsen kidney function. Step 4 – Metformin (a diabetes drug) must be held around the procedure because contrast combined with metformin can cause lactic acidosis, a potentially fatal complication. Step 5 – High-protein meals and furosemide are not appropriate pre-IVP actions; ensuring adequate hydration (to flush the dye post-procedure) is important but comes after the allergy assessment.

Answer: B. Removing the indwelling catheter as early as clinically possible

Step 1 – CAUTI (catheter-associated UTI) is one of the most common healthcare-associated infections in Philippine and global hospital settings. Step 2 – The single biggest risk factor for CAUTI is the DURATION of catheterization — the longer the catheter remains in place, the higher the risk of infection. Step 3 – Therefore, removing the catheter as early as clinically possible is the MOST important preventive action. Step 4 – Routine irrigation is NOT recommended as it breaks the closed system and introduces pathogens. Step 5 – The drainage bag must be kept BELOW the level of the bladder (not at the level) to prevent backflow of urine into the bladder; clamping the tubing every 4 hours is also not a standard CAUTI prevention measure.

Answer: B. Monitoring for signs of bleeding

Step 1 – After a renal biopsy, the PRIORITY concern using Maslow's hierarchy (physiological safety) is hemorrhage because the kidney is a highly vascular organ. Step 2 – Post-biopsy nursing care includes: bed rest, frequent vital sign monitoring, and checking urine for hematuria (blood in urine). Step 3 – The nurse also monitors for flank pain, falling blood pressure, and rising pulse rate — all signs of internal bleeding. Step 4 – The patient should avoid strenuous activity and heavy lifting for approximately 2 weeks after the procedure. Step 5 – Infection is a concern but is a later, secondary priority compared to immediate post-biopsy bleeding risk. Blood glucose and level of consciousness are not the primary concerns after a renal biopsy.

Answer: C. Diffusion

Step 1 – Dialysis uses two main physical principles: diffusion (for solute removal) and osmosis/ultrafiltration (for fluid removal). Step 2 – Diffusion is the movement of solutes from an area of HIGH concentration to an area of LOW concentration across a semipermeable membrane. Step 3 – In dialysis, blood (high in urea, creatinine, potassium) is exposed to dialysate (a solution that contains none or very low amounts of these wastes). The concentration gradient drives these wastes from the blood into the dialysate. Step 4 – Osmosis/ultrafiltration removes EXCESS FLUID — water moves across the membrane driven by a pressure or osmotic gradient (e.g., dextrose added to peritoneal dialysate). Step 5 – Active transport requires energy (ATP) and carrier proteins; this does not describe the dialysis process. Remember: the dialysate is warmed to body temperature and is potassium-free or low-potassium.

Answer: B. Escherichia coli

Step 1: The patient's symptoms (dysuria, frequency, cloudy urine) point to a lower UTI (cystitis). Step 2: The question asks for the MOST COMMON cause of uncomplicated UTI. Step 3: Escherichia coli (E. coli) accounts for approximately 80% of uncomplicated UTIs due to its ability to colonize the perineal area and ascend the short female urethra. Step 4: Staphylococcus aureus is more associated with hematogenous spread, not ascending UTI. Klebsiella and Pseudomonas are common in hospital-acquired or catheter-associated UTIs. Step 5: Therefore, E. coli is the correct answer for a typical community-acquired UTI in a young woman.

Answer: C. More than 100,000 colony-forming units/mL

Step 1: Urine culture is the gold-standard diagnostic test for UTI. Step 2: Not all bacteria found in urine are clinically significant because small amounts can result from contamination during specimen collection. Step 3: The classic threshold for a significant UTI is greater than 100,000 (10⁵) colony-forming units per milliliter (CFU/mL) of a single organism from a clean-catch midstream sample. Step 4: Counts below this threshold may indicate contamination rather than true infection. Step 5: This value is a high-yield NLE fact — memorize 10⁵ CFU/mL as the significant count.