Study topic

Renal and urinary care

NCLEX renal chapter: AKI phases, CKD diet and overload, hyperkalemia emergencies, dialysis access and peritonitis cues, and bladder medication teaching.

Clesial Editorial TeamReviewed by Clesial Editorial Team, Clinical Content Review1 minUpdated Aug 6, 2026

Renal care on the NCLEX is volume, potassium, access protection, and a short list of urinary drugs that stain the toilet or tip an older adult into confusion.

AKI and CKD: phases and diet

Phase / state	What to expect
Oliguric AKI	Low urine, fluid overload risk, rising K+/BUN/Cr, possible metabolic acidosis
Diuretic / recovery	High urine output; watch hypovolemia and electrolyte wasting
CKD chronic teaching	Limit K+/Phos/Na (and protein if ordered); fluid limits when overload is the problem
Nephrotic pattern	Proteinuria, low albumin, edema, high lipids

Urine under 30 mL/hr for hours: assess bladder, vitals, volume status; notify.
CKD phosphorus teaching often targets dairy, cola, nuts, and processed foods — follow the diet order in front of you.

Hyperkalemia and overload

Potassium above the critical range with peaked T waves, weakness, or bradydysrhythmias is a membrane emergency. Stabilize the heart first when ECG changes are present, then shift and remove potassium per the ordered pathway. Exact drug order and dialysis timing are protocol-specific.

Safety

K+ around 6.8–7.1 with peaked T waves is not a “recheck in the morning” finding. Protect the heart and escalate now.

Fluid overload cues: weight gain, edema, crackles, rising BP, dyspnea.
Kidney stone pain: analgesia, fluids as ordered, strain urine, infection watch.

Dialysis access and sessions

Limb protector sleeve, blood pressure cuff set aside, and stethoscope on clean linen. — Supplies used when protecting and assessing an AV fistula arm.

No BP, IVs, or blood draws on the fistula arm.
Palpate thrill / auscultate bruit each assessment.
Between treatments expect fluid/diet limits and daily weights as taught.

Peritoneal dialysis drain bag, tubing, and sterile gauze on a clean table. — Peritoneal dialysis supplies. Effluent appearance teaching is in the text.

Problem	Action
Cloudy PD effluent, abdominal pain, fever	Peritonitis pathway — culture/notify
First HD: headache, nausea, confusion	Disequilibrium pattern — slow/stop notify per protocol

Renal and bladder medications

Unmarked pill bottle, plain chewable tablets in a dish, and a glass of water. — Mealtime medication setup used when teaching phosphate binders.

Drug	Teaching / watch
Calcium acetate (binder)	Take with meals to bind dietary phosphate
Epoetin alfa	Raises Hgb slowly; report HTN or rapid climb (clot risk)
Sodium polystyrene sulfonate	Monitor bowel function and K+; constipation/impaction risk
Phenazopyridine	Orange-red urine expected; does not cure UTI alone
Oxybutynin	Dry mouth, constipation, blurred vision; confusion/retention in older adults = escalate
Tamsulosin	Orthostatic precautions; take as timed
Bethanechol	Stimulates bladder emptying for retention; watch cholinergic excess

Medication cup, water glass, and clean empty urinal on a bedside table. — Bedside setup for bladder medication and voiding assessment.

Priority map

Picture	First move
K+ 6.9 + peaked T waves	Cardiac protect + hyperK pathway
Cloudy PD drain	Peritonitis escalate
BP cuff heading to fistula arm	Stop — other arm only
Urine <30 mL/hr × hours	Assess and notify
Orange urine on phenazopyridine	Expected teaching, not hemorrhage

Must know

1Oliguric AKI: urine often under about 400 mL/day (or <0.5 mL/kg/hr patterns), rising K+/BUN/creatinine, fluid overload risk. Diuretic/recovery phase: large urine output — watch volume and electrolytes.
2Urine output under 30 mL/hr for several hours: assess and escalate; do not ignore.
3CKD diet: often limit potassium, phosphorus, sodium, and sometimes protein as ordered. Dairy/colas/nuts/processed foods are common phosphorus hits.
4Nephrotic syndrome fingerprint: heavy proteinuria, hypoalbuminemia, edema, hyperlipidemia.
5Hyperkalemia with ECG changes (peaked T waves): cardiac emergency. Anticipate calcium to stabilize membrane, then shift/remove K+ (insulin+glucose, kayexalate/patiromer, dialysis) per order — protocol-specific sequencing.
6AV fistula arm: no BP, no sticks, no tight clothing. Check thrill/bruit. Teach client to protect the access.
7Cloudy peritoneal dialysis effluent: peritonitis until proven otherwise — culture/notify pathway.
8First hemodialysis headache/nausea/confusion: think dialysis disequilibrium — slow/stop notify per protocol.
9Calcium acetate (phosphate binder): take with meals. Epoetin: report hypertension/rapid Hgb rise (clot/HTN risk).
10Phenazopyridine turns urine orange-red (expected). Oxybutynin anticholinergic effects; acute confusion/urinary retention in older adults is a follow-up. Tamsulosin: orthostatic precautions. Bethanechol for retention: give as ordered, monitor for cholinergic excess.

Memory hooks

No BP on the fistula arm
Protect the AV access: no blood pressures, IVs, or venipuncture in that arm.
Cloudy bag = call
Peritoneal dialysis effluent that turns cloudy is peritonitis until cultures say otherwise.
Peaked T, act for K
Hyperkalemia with ECG changes is a heart emergency, not a wait-for-morning lab.

How it's tested

Stems stack oliguria with rising K+, a cloudy PD drain, a fistula arm BP request, or orange urine on phenazopyridine. Distractors take BP on the access arm, ignore cloudy effluent, or treat peaked T waves as routine.