RENAL NCLEX PRACTICE EXAM 2026 –
QUESTIONS WITH VERIFIED ANSWERS &
DETAILED RATIONALES | LATEST HIGH-
YIELD STUDY GUIDE FOR A+ EXAM PREP
Renal Diagnostics and Laboratory Values
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.
Correct -Answer💜💜-: B. Leukocyte esterase and nitrates are indicators of a urinary
tract infection (UTI). A positive finding warrants a culture and sensitivity test to identify
the specific pathogen and determine the most effective antibiotic.
2. A client is scheduled for a computed tomography (CT) scan of the kidneys with
intravenous contrast. Which question is most important for the nurse to ask
before the procedure?
A. "Have you ever had a reaction to shellfish or iodine?"
B. "When did you last eat or drink anything?"
C. "Do you have any metal implants or a pacemaker?"
D. "Are you currently experiencing any pain?"
,Correct -Answer💜💜-: A. Intravenous contrast dye used in CT scans contains iodine. A
client with an allergy to iodine or shellfish is at high risk for a severe allergic reaction.
While checking for metal is crucial for MRIs, it is not the primary concern for a CT scan
with contrast.
3. A client with type 2 diabetes mellitus is scheduled for an excretory urography.
Which nursing action is most appropriate regarding the client's metformin
(Glucophage)?
A. Administer the metformin as usual with a sip of water.
B. Hold the metformin for 24 hours before and 48 hours after the procedure.
C. Increase the dose of metformin to account for contrast excretion.
D. Hold the metformin only on the morning of the procedure.
Correct -Answer💜💜-: B. Metformin can interact with the contrast dye, leading to a
rare but serious condition called lactic acidosis, especially in clients with reduced kidney
function. The medication should be withheld before and after the procedure as
prescribed.
4. A nurse is teaching a client about a scheduled serum creatinine test. Which
statement by the client indicates an understanding of the teaching?
A. "This test will show if I have a urinary tract infection."
B. "This test will check my blood for the level of waste products from muscle
breakdown."
C. "This test will measure the concentration of my urine."
D. "This test will determine the amount of protein I am losing in my urine."
Correct -Answer💜💜-: B. Serum creatinine is a breakdown product of creatine
phosphate from muscle metabolism. It is filtered out of the blood by the kidneys and is
,a more specific and sensitive indicator of renal function than blood urea nitrogen
(BUN).
5. A client with hypertension is being screened for chronic kidney disease. The
nurse knows that which laboratory value is the best indicator for staging the
severity of the disease?
A. Blood Urea Nitrogen (BUN)
B. Serum Potassium
C. Urine Specific Gravity
D. Glomerular Filtration Rate (GFR)
Correct -Answer💜💜-: D. The GFR is the gold standard for evaluating kidney function
and staging chronic kidney disease (CKD). It estimates the amount of blood that passes
through the glomeruli each minute. A declining GFR indicates progressive kidney
damage.
6. The nurse reviews the health history of a patient with an over secretion of renin.
Which disorder should the nurse correlate with this assessment finding?
A. Alzheimer's disease
B. Hypertension
C. Diabetes mellitus
D. Viral hepatitis
Correct -Answer💜💜-: B. Renin is an enzyme released by the kidneys in response to
low blood volume or pressure. It initiates the renin-angiotensin-aldosterone system
(RAAS), leading to vasoconstriction and sodium and water retention. Over secretion of
renin is a major cause of persistent hypertension.
, 7. 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.
Correct -Answer💜💜-: D. Normal urine osmolality ranges from 300 to 900 mOsm/kg. A
value of 1200 indicates highly concentrated urine, suggesting dehydration. The nurse
should encourage the patient to increase fluid intake to correct the fluid volume deficit.
8. A nurse contacts the healthcare provider after reviewing a patient's laboratory
results and noting a blood urea nitrogen (BUN) of 35 mg/dL (12.5 mmol/L) and a
creatinine of 1.0 mg/dL (88.4 mcmol/L). What collaborative care measure does the
nurse consult the provider about?
A. Intravenous fluids
B. Hemodialysis
C. Fluid restriction
D. Urine culture and sensitivity
Correct -Answer💜💜-: A. The BUN is elevated, but the creatinine is normal. Creatinine
is more specific for kidney function, while BUN can be elevated by non-renal factors
such as dehydration, high-protein diet, or catabolism. The most likely cause here is
dehydration, so the nurse should anticipate an order for IV fluids.
9. A nurse is providing post-procedure care for a client who had a kidney biopsy.
Which intervention should the nurse include in the plan of care?
A. Ambulate the client in the room and hall for short distances.
B. Encourage fluids to at least 3 L in the first 24 hours.
QUESTIONS WITH VERIFIED ANSWERS &
DETAILED RATIONALES | LATEST HIGH-
YIELD STUDY GUIDE FOR A+ EXAM PREP
Renal Diagnostics and Laboratory Values
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.
Correct -Answer💜💜-: B. Leukocyte esterase and nitrates are indicators of a urinary
tract infection (UTI). A positive finding warrants a culture and sensitivity test to identify
the specific pathogen and determine the most effective antibiotic.
2. A client is scheduled for a computed tomography (CT) scan of the kidneys with
intravenous contrast. Which question is most important for the nurse to ask
before the procedure?
A. "Have you ever had a reaction to shellfish or iodine?"
B. "When did you last eat or drink anything?"
C. "Do you have any metal implants or a pacemaker?"
D. "Are you currently experiencing any pain?"
,Correct -Answer💜💜-: A. Intravenous contrast dye used in CT scans contains iodine. A
client with an allergy to iodine or shellfish is at high risk for a severe allergic reaction.
While checking for metal is crucial for MRIs, it is not the primary concern for a CT scan
with contrast.
3. A client with type 2 diabetes mellitus is scheduled for an excretory urography.
Which nursing action is most appropriate regarding the client's metformin
(Glucophage)?
A. Administer the metformin as usual with a sip of water.
B. Hold the metformin for 24 hours before and 48 hours after the procedure.
C. Increase the dose of metformin to account for contrast excretion.
D. Hold the metformin only on the morning of the procedure.
Correct -Answer💜💜-: B. Metformin can interact with the contrast dye, leading to a
rare but serious condition called lactic acidosis, especially in clients with reduced kidney
function. The medication should be withheld before and after the procedure as
prescribed.
4. A nurse is teaching a client about a scheduled serum creatinine test. Which
statement by the client indicates an understanding of the teaching?
A. "This test will show if I have a urinary tract infection."
B. "This test will check my blood for the level of waste products from muscle
breakdown."
C. "This test will measure the concentration of my urine."
D. "This test will determine the amount of protein I am losing in my urine."
Correct -Answer💜💜-: B. Serum creatinine is a breakdown product of creatine
phosphate from muscle metabolism. It is filtered out of the blood by the kidneys and is
,a more specific and sensitive indicator of renal function than blood urea nitrogen
(BUN).
5. A client with hypertension is being screened for chronic kidney disease. The
nurse knows that which laboratory value is the best indicator for staging the
severity of the disease?
A. Blood Urea Nitrogen (BUN)
B. Serum Potassium
C. Urine Specific Gravity
D. Glomerular Filtration Rate (GFR)
Correct -Answer💜💜-: D. The GFR is the gold standard for evaluating kidney function
and staging chronic kidney disease (CKD). It estimates the amount of blood that passes
through the glomeruli each minute. A declining GFR indicates progressive kidney
damage.
6. The nurse reviews the health history of a patient with an over secretion of renin.
Which disorder should the nurse correlate with this assessment finding?
A. Alzheimer's disease
B. Hypertension
C. Diabetes mellitus
D. Viral hepatitis
Correct -Answer💜💜-: B. Renin is an enzyme released by the kidneys in response to
low blood volume or pressure. It initiates the renin-angiotensin-aldosterone system
(RAAS), leading to vasoconstriction and sodium and water retention. Over secretion of
renin is a major cause of persistent hypertension.
, 7. 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.
Correct -Answer💜💜-: D. Normal urine osmolality ranges from 300 to 900 mOsm/kg. A
value of 1200 indicates highly concentrated urine, suggesting dehydration. The nurse
should encourage the patient to increase fluid intake to correct the fluid volume deficit.
8. A nurse contacts the healthcare provider after reviewing a patient's laboratory
results and noting a blood urea nitrogen (BUN) of 35 mg/dL (12.5 mmol/L) and a
creatinine of 1.0 mg/dL (88.4 mcmol/L). What collaborative care measure does the
nurse consult the provider about?
A. Intravenous fluids
B. Hemodialysis
C. Fluid restriction
D. Urine culture and sensitivity
Correct -Answer💜💜-: A. The BUN is elevated, but the creatinine is normal. Creatinine
is more specific for kidney function, while BUN can be elevated by non-renal factors
such as dehydration, high-protein diet, or catabolism. The most likely cause here is
dehydration, so the nurse should anticipate an order for IV fluids.
9. A nurse is providing post-procedure care for a client who had a kidney biopsy.
Which intervention should the nurse include in the plan of care?
A. Ambulate the client in the room and hall for short distances.
B. Encourage fluids to at least 3 L in the first 24 hours.
