NCLEX RENAL – Exam Review & Practice Questions | 2026/2027
Comprehensive Renal Nursing Examination with Verified Answers |
Latest Updated High-Yield Study Guide
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.
Comprehensive Renal Nursing Examination with Verified Answers |
Latest Updated High-Yield Study Guide
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.
