RENAL NCLEX 2026 – COMPREHENSIVE
PRACTICE TEST WITH VERIFIED QUESTIONS,
ANSWERS & RATIONALES | HIGH-YIELD
UPDATED EXAM REVIEW & A+ STUDY GUIDE
PART 1: Renal Function and Diagnostic Tests (Questions 1- 15)
1. A nurse is reviewing the results of a client's urinalysis. The findings indicate that
the urine is positive for leukocyte esterase and nitrates. Which of the following
actions should the nurse take?
A. Repeat the test early the next morning
B. Obtain a clean-catch urine sample for culture and sensitivity
C. Start a 24-hour urine collection for creatinine clearance
D. Increase the client's oral fluid intake and reassess in 24 hours
-Answer💜💜-: B. Obtain a clean-catch urine sample for culture and sensitivity
Rationale: Leukocyte esterase and nitrates are indicators of a urinary tract infection (UTI).
Leukocyte esterase indicates the presence of white blood cells, and nitrates indicate
bacterial conversion of nitrates to nitrites. A clean-catch urine sample for culture and
sensitivity is necessary to confirm the diagnosis and identify the specific organism and
appropriate antibiotic therapy.
2. A nurse administered captopril to a client during a renal scan. Which of the
following actions should the nurse take?
A. Assess for hypertension
B. Limit fluid intake
C. Encourage early ambulation
D. Monitor for orthostatic hypotension
-Answer💜💜-: D. Monitor for orthostatic hypotension
Rationale: Captopril is an ACE inhibitor that can cause vasodilation and lead to
orthostatic hypotension, especially when administered during a renal scan. The nurse
should monitor blood pressure closely, particularly when the client changes positions.
,3. A nurse is teaching a client who will have an x-ray of the kidneys, ureters, and
bladder (KUB). Which of the following statements should the nurse include in the
teaching?
A. "You will receive contrast dye during the procedure"
B. "An enema is necessary before the procedure"
C. "You will need to lie prone during the procedure"
D. "The procedure determines whether you have a kidney stone"
-Answer💜💜-: D. "The procedure determines whether you have a kidney stone"
Rationale: A KUB x-ray is a plain abdominal film that can detect radiopaque kidney
stones. It does not require contrast dye, enema preparation, or a prone position. The
client typically lies supine during this non-invasive procedure.
4. A nurse reviews the urinalysis results of a patient and notes a urine osmolality of
1200 mOsm/kg (1200 mmol/kg). Which action should the nurse take?
A. Contact the provider and recommend a low-sodium diet
B. Prepare to administer an intravenous diuretic
C. Obtain a suction device and implement seizure precautions
D. Encourage the patient to drink more fluids
-Answer💜💜-: D. Encourage the patient to drink more fluids
Rationale: Normal urine osmolality ranges from 300 to 900 mOsm/kg. This patient's
urine is highly concentrated, indicating dehydration. The nurse should encourage
increased fluid intake to correct the fluid volume deficit.
5. A nurse contacts the healthcare provider after reviewing a patient's laboratory
results and noting a blood urea nitrogen (BUN) of 35 mg/dL and a creatinine of
1.0 mg/dL. What collaborative care measure does the nurse consult the provider
about?
A. Intravenous fluids
B. Hemodialysis
C. Fluid restriction
D. Urine culture and sensitivity
-Answer💜💜-: A. Intravenous fluids
Rationale: Normal BUN is 10-20 mg/dL, and normal creatinine is 0.6-1.2 mg/dL. The
elevated BUN with normal creatinine suggests a non-renal cause, most commonly
dehydration. The nurse should anticipate administering IV fluids to correct the
dehydration rather than fluid restriction or dialysis.
,6. A nurse is caring for a client with type 2 diabetes mellitus who will have
excretory urography. Prior to the procedure, which actions should the nurse take?
(Select all that apply)
A. Identify an allergy to seafood
B. Withhold metformin for 24 hours
C. Administer an enema
D. Assess for asthma
E. Obtain blood coagulation profile
-Answer💜💜-: A, B, C, D. Identify an allergy to seafood; Withhold metformin for 24
hours; Administer an enema; Assess for asthma
Rationale: Excretory urography uses IV contrast dye. The nurse should assess for
iodine/shellfish allergies and asthma (increased allergy risk). Metformin is held for 24-48
hours before and after contrast administration due to risk of lactic acidosis. An enema
may be ordered to clear bowel contents for better visualization. Coagulation studies are
not typically required for this procedure.
7. A nurse is monitoring a patient who had a kidney biopsy for postoperative
complications. Which complication should the nurse identify as the greatest risk to
the client?
A. Infection
B. Hemorrhage
C. Hematuria
D. Pain
-Answer💜💜-: B. Hemorrhage
Rationale: Following a kidney biopsy, hemorrhage is the greatest risk because the kidney
is highly vascular. The nurse should monitor for signs of bleeding, including decreasing
blood pressure, increasing pulse, and back/flank pain. While infection, hematuria, and
pain can occur, hemorrhage is immediately life-threatening.
8. A client has been admitted to the hospital with a diagnosis of acute
glomerulonephritis. During history-taking, the nurse first asks the client about a
recent history of:
A. Bleeding ulcer
B. Deep vein thrombosis
C. Myocardial infarction
D. Streptococcal infection
, -Answer💜💜-: D. Streptococcal infection
Rationale: Acute glomerulonephritis often follows a streptococcal infection (usually of
the throat or skin) by 1-3 weeks. The immune response to the infection causes
inflammation of the glomeruli. The nurse should assess for recent strep infections to
help confirm the diagnosis.
9. A client is scheduled for computed tomography (CT) of the kidneys to rule out
renal disease. As an essential preprocedure component of the nursing assessment,
the nurse plans to ask the client about a history of:
A. Familial renal disease
B. Frequent antibiotic use
C. Long-term diuretic therapy
D. Allergy to shellfish or iodine
-Answer💜💜-: D. Allergy to shellfish or iodine
Rationale: CT of the kidneys often requires IV contrast dye, which contains iodine. Clients
with shellfish or iodine allergies are at increased risk for allergic reactions to the
contrast. This is a critical safety assessment before the procedure.
10. A nurse cares for a patient who has elevated levels of antidiuretic hormone
(ADH). Which disorder should the nurse identify as a trigger for the release of this
hormone?
A. Pneumonia
B. Dehydration
C. Renal failure
D. Edema
-Answer💜💜-: B. Dehydration
Rationale: ADH is released in response to increased extracellular fluid osmolarity, which
occurs with dehydration. ADH increases water reabsorption in the kidneys to
concentrate urine and conserve body water. Pneumonia, renal failure, and edema do not
typically trigger ADH release.
PRACTICE TEST WITH VERIFIED QUESTIONS,
ANSWERS & RATIONALES | HIGH-YIELD
UPDATED EXAM REVIEW & A+ STUDY GUIDE
PART 1: Renal Function and Diagnostic Tests (Questions 1- 15)
1. A nurse is reviewing the results of a client's urinalysis. The findings indicate that
the urine is positive for leukocyte esterase and nitrates. Which of the following
actions should the nurse take?
A. Repeat the test early the next morning
B. Obtain a clean-catch urine sample for culture and sensitivity
C. Start a 24-hour urine collection for creatinine clearance
D. Increase the client's oral fluid intake and reassess in 24 hours
-Answer💜💜-: B. Obtain a clean-catch urine sample for culture and sensitivity
Rationale: Leukocyte esterase and nitrates are indicators of a urinary tract infection (UTI).
Leukocyte esterase indicates the presence of white blood cells, and nitrates indicate
bacterial conversion of nitrates to nitrites. A clean-catch urine sample for culture and
sensitivity is necessary to confirm the diagnosis and identify the specific organism and
appropriate antibiotic therapy.
2. A nurse administered captopril to a client during a renal scan. Which of the
following actions should the nurse take?
A. Assess for hypertension
B. Limit fluid intake
C. Encourage early ambulation
D. Monitor for orthostatic hypotension
-Answer💜💜-: D. Monitor for orthostatic hypotension
Rationale: Captopril is an ACE inhibitor that can cause vasodilation and lead to
orthostatic hypotension, especially when administered during a renal scan. The nurse
should monitor blood pressure closely, particularly when the client changes positions.
,3. A nurse is teaching a client who will have an x-ray of the kidneys, ureters, and
bladder (KUB). Which of the following statements should the nurse include in the
teaching?
A. "You will receive contrast dye during the procedure"
B. "An enema is necessary before the procedure"
C. "You will need to lie prone during the procedure"
D. "The procedure determines whether you have a kidney stone"
-Answer💜💜-: D. "The procedure determines whether you have a kidney stone"
Rationale: A KUB x-ray is a plain abdominal film that can detect radiopaque kidney
stones. It does not require contrast dye, enema preparation, or a prone position. The
client typically lies supine during this non-invasive procedure.
4. A nurse reviews the urinalysis results of a patient and notes a urine osmolality of
1200 mOsm/kg (1200 mmol/kg). Which action should the nurse take?
A. Contact the provider and recommend a low-sodium diet
B. Prepare to administer an intravenous diuretic
C. Obtain a suction device and implement seizure precautions
D. Encourage the patient to drink more fluids
-Answer💜💜-: D. Encourage the patient to drink more fluids
Rationale: Normal urine osmolality ranges from 300 to 900 mOsm/kg. This patient's
urine is highly concentrated, indicating dehydration. The nurse should encourage
increased fluid intake to correct the fluid volume deficit.
5. A nurse contacts the healthcare provider after reviewing a patient's laboratory
results and noting a blood urea nitrogen (BUN) of 35 mg/dL and a creatinine of
1.0 mg/dL. What collaborative care measure does the nurse consult the provider
about?
A. Intravenous fluids
B. Hemodialysis
C. Fluid restriction
D. Urine culture and sensitivity
-Answer💜💜-: A. Intravenous fluids
Rationale: Normal BUN is 10-20 mg/dL, and normal creatinine is 0.6-1.2 mg/dL. The
elevated BUN with normal creatinine suggests a non-renal cause, most commonly
dehydration. The nurse should anticipate administering IV fluids to correct the
dehydration rather than fluid restriction or dialysis.
,6. A nurse is caring for a client with type 2 diabetes mellitus who will have
excretory urography. Prior to the procedure, which actions should the nurse take?
(Select all that apply)
A. Identify an allergy to seafood
B. Withhold metformin for 24 hours
C. Administer an enema
D. Assess for asthma
E. Obtain blood coagulation profile
-Answer💜💜-: A, B, C, D. Identify an allergy to seafood; Withhold metformin for 24
hours; Administer an enema; Assess for asthma
Rationale: Excretory urography uses IV contrast dye. The nurse should assess for
iodine/shellfish allergies and asthma (increased allergy risk). Metformin is held for 24-48
hours before and after contrast administration due to risk of lactic acidosis. An enema
may be ordered to clear bowel contents for better visualization. Coagulation studies are
not typically required for this procedure.
7. A nurse is monitoring a patient who had a kidney biopsy for postoperative
complications. Which complication should the nurse identify as the greatest risk to
the client?
A. Infection
B. Hemorrhage
C. Hematuria
D. Pain
-Answer💜💜-: B. Hemorrhage
Rationale: Following a kidney biopsy, hemorrhage is the greatest risk because the kidney
is highly vascular. The nurse should monitor for signs of bleeding, including decreasing
blood pressure, increasing pulse, and back/flank pain. While infection, hematuria, and
pain can occur, hemorrhage is immediately life-threatening.
8. A client has been admitted to the hospital with a diagnosis of acute
glomerulonephritis. During history-taking, the nurse first asks the client about a
recent history of:
A. Bleeding ulcer
B. Deep vein thrombosis
C. Myocardial infarction
D. Streptococcal infection
, -Answer💜💜-: D. Streptococcal infection
Rationale: Acute glomerulonephritis often follows a streptococcal infection (usually of
the throat or skin) by 1-3 weeks. The immune response to the infection causes
inflammation of the glomeruli. The nurse should assess for recent strep infections to
help confirm the diagnosis.
9. A client is scheduled for computed tomography (CT) of the kidneys to rule out
renal disease. As an essential preprocedure component of the nursing assessment,
the nurse plans to ask the client about a history of:
A. Familial renal disease
B. Frequent antibiotic use
C. Long-term diuretic therapy
D. Allergy to shellfish or iodine
-Answer💜💜-: D. Allergy to shellfish or iodine
Rationale: CT of the kidneys often requires IV contrast dye, which contains iodine. Clients
with shellfish or iodine allergies are at increased risk for allergic reactions to the
contrast. This is a critical safety assessment before the procedure.
10. A nurse cares for a patient who has elevated levels of antidiuretic hormone
(ADH). Which disorder should the nurse identify as a trigger for the release of this
hormone?
A. Pneumonia
B. Dehydration
C. Renal failure
D. Edema
-Answer💜💜-: B. Dehydration
Rationale: ADH is released in response to increased extracellular fluid osmolarity, which
occurs with dehydration. ADH increases water reabsorption in the kidneys to
concentrate urine and conserve body water. Pneumonia, renal failure, and edema do not
typically trigger ADH release.
