NCLEX-RN Renal and Urinary Nursing Practice Questions with Answers and Rationales (25 Questions)
NCLEX-RN Renal and Urinary Nursing:
Practical Questions with Answers and
Rationales 100% correct 2026.
A single-unit review covering renal assessment, acute kidney injury, chronic kidney
disease, dialysis, urinary tract disorders, glomerular disease, kidney transplant, and fluid
and electrolyte imbalances. Every question has the correct answer and a rationale. Verify
values and protocols against a current reference before relying on them clinically.
How to Use This Guide
Answer each question before reading the rationale. For renal questions, think about three
things: fluid balance, electrolytes (especially potassium), and protecting the kidneys from
further harm. Re-attempt missed questions after 48 hours.
Part 1: Renal Assessment
1. Which laboratory value is the most reliable indicator of kidney function?
A. Blood urea nitrogen (BUN) B. Serum creatinine and estimated glomerular filtration rate
(eGFR) C. Serum sodium D. Urine color
Answer: B. Creatinine is a waste product of muscle metabolism that is filtered by the
kidneys, and it is less affected by diet and hydration than BUN. The eGFR estimates how
well the kidneys filter blood, with a normal value above about 90 mL/min. A normal
creatinine is about 0.6 to 1.2 mg/dL, and a normal BUN is about 10 to 20 mg/dL.
2. A client with an indwelling urinary catheter has had a urine output of 20 mL per hour for
the past 2 hours. What does the nurse do?
A. Document it as normal B. Check the tubing for kinks, assess the client, and notify the
provider C. Increase the oral fluids only D. Remove the catheter
Answer: B. The minimum acceptable urine output is about 30 mL per hour, or about 0.5
mL/kg/hr. Persistently low output (oliguria is under about 400 mL per day) can signal
dehydration, shock, or kidney injury. First rule out a kink or obstruction in the tubing, then
notify the provider.
Page 1 of 8
, NCLEX-RN Renal and Urinary Nursing Practice Questions with Answers and Rationales (25 Questions)
Part 2: Acute Kidney Injury and Chronic Kidney Disease
3. A client in the diuretic phase of acute kidney injury has a urine output of 3,500 mL per
day. Which complication is the nurse most concerned about?
A. Fluid overload B. Dehydration and electrolyte loss, such as low potassium and sodium
C. High blood pressure only D. Constipation
Answer: B. The phases of AKI are onset, oliguric, diuretic, and recovery. In the diuretic
phase the kidneys produce large volumes of dilute urine but cannot yet conserve
electrolytes, so dehydration, hypotension, hypokalemia, and hyponatremia can develop.
Monitor intake and output, daily weights, and electrolytes.
4. Which condition is a prerenal cause of acute kidney injury?
A. Kidney stones blocking the ureters B. Severe hemorrhage causing low blood pressure
C. Glomerulonephritis D. Enlarged prostate
Answer: B. Prerenal causes reduce blood flow to the kidneys, such as hypovolemia,
hemorrhage, heart failure, and shock. Intrarenal causes damage the kidney tissue itself
(glomerulonephritis, nephrotoxic drugs, prolonged ischemia). Postrenal causes obstruct
urine flow (stones, an enlarged prostate, tumors).
5. Which food should the nurse teach a client with chronic kidney disease to limit?
A. Apples and white rice B. Bananas, oranges, potatoes, and tomatoes C. Egg whites D.
Cabbage
Answer: B. These foods are high in potassium, which accumulates when the kidneys fail
and can cause dangerous dysrhythmias. Clients with CKD usually also limit sodium,
phosphorus, and fluids as ordered. Protein is moderately restricted before dialysis begins,
and is often increased once dialysis starts.
6. A client with chronic kidney disease has a potassium level of 6.8 mEq/L and peaked T
waves on the ECG. Which medication does the nurse anticipate first?
A. Intravenous calcium gluconate B. Oral potassium chloride C. Digoxin D. Spironolactone
Answer: A. IV calcium gluconate stabilizes the heart muscle and protects against
dysrhythmias, although it does not lower the potassium. Other treatments lower the
potassium level: regular insulin with dextrose, sodium polystyrene or other potassium
binders, albuterol, and dialysis. Potassium-sparing drugs should be avoided. The normal
potassium range is about 3.5 to 5.0 mEq/L.
7. Which medication is used to treat anemia in a client with chronic kidney disease?
A. Epoetin alfa B. Furosemide C. Warfarin D. Prednisone
Page 2 of 8
NCLEX-RN Renal and Urinary Nursing:
Practical Questions with Answers and
Rationales 100% correct 2026.
A single-unit review covering renal assessment, acute kidney injury, chronic kidney
disease, dialysis, urinary tract disorders, glomerular disease, kidney transplant, and fluid
and electrolyte imbalances. Every question has the correct answer and a rationale. Verify
values and protocols against a current reference before relying on them clinically.
How to Use This Guide
Answer each question before reading the rationale. For renal questions, think about three
things: fluid balance, electrolytes (especially potassium), and protecting the kidneys from
further harm. Re-attempt missed questions after 48 hours.
Part 1: Renal Assessment
1. Which laboratory value is the most reliable indicator of kidney function?
A. Blood urea nitrogen (BUN) B. Serum creatinine and estimated glomerular filtration rate
(eGFR) C. Serum sodium D. Urine color
Answer: B. Creatinine is a waste product of muscle metabolism that is filtered by the
kidneys, and it is less affected by diet and hydration than BUN. The eGFR estimates how
well the kidneys filter blood, with a normal value above about 90 mL/min. A normal
creatinine is about 0.6 to 1.2 mg/dL, and a normal BUN is about 10 to 20 mg/dL.
2. A client with an indwelling urinary catheter has had a urine output of 20 mL per hour for
the past 2 hours. What does the nurse do?
A. Document it as normal B. Check the tubing for kinks, assess the client, and notify the
provider C. Increase the oral fluids only D. Remove the catheter
Answer: B. The minimum acceptable urine output is about 30 mL per hour, or about 0.5
mL/kg/hr. Persistently low output (oliguria is under about 400 mL per day) can signal
dehydration, shock, or kidney injury. First rule out a kink or obstruction in the tubing, then
notify the provider.
Page 1 of 8
, NCLEX-RN Renal and Urinary Nursing Practice Questions with Answers and Rationales (25 Questions)
Part 2: Acute Kidney Injury and Chronic Kidney Disease
3. A client in the diuretic phase of acute kidney injury has a urine output of 3,500 mL per
day. Which complication is the nurse most concerned about?
A. Fluid overload B. Dehydration and electrolyte loss, such as low potassium and sodium
C. High blood pressure only D. Constipation
Answer: B. The phases of AKI are onset, oliguric, diuretic, and recovery. In the diuretic
phase the kidneys produce large volumes of dilute urine but cannot yet conserve
electrolytes, so dehydration, hypotension, hypokalemia, and hyponatremia can develop.
Monitor intake and output, daily weights, and electrolytes.
4. Which condition is a prerenal cause of acute kidney injury?
A. Kidney stones blocking the ureters B. Severe hemorrhage causing low blood pressure
C. Glomerulonephritis D. Enlarged prostate
Answer: B. Prerenal causes reduce blood flow to the kidneys, such as hypovolemia,
hemorrhage, heart failure, and shock. Intrarenal causes damage the kidney tissue itself
(glomerulonephritis, nephrotoxic drugs, prolonged ischemia). Postrenal causes obstruct
urine flow (stones, an enlarged prostate, tumors).
5. Which food should the nurse teach a client with chronic kidney disease to limit?
A. Apples and white rice B. Bananas, oranges, potatoes, and tomatoes C. Egg whites D.
Cabbage
Answer: B. These foods are high in potassium, which accumulates when the kidneys fail
and can cause dangerous dysrhythmias. Clients with CKD usually also limit sodium,
phosphorus, and fluids as ordered. Protein is moderately restricted before dialysis begins,
and is often increased once dialysis starts.
6. A client with chronic kidney disease has a potassium level of 6.8 mEq/L and peaked T
waves on the ECG. Which medication does the nurse anticipate first?
A. Intravenous calcium gluconate B. Oral potassium chloride C. Digoxin D. Spironolactone
Answer: A. IV calcium gluconate stabilizes the heart muscle and protects against
dysrhythmias, although it does not lower the potassium. Other treatments lower the
potassium level: regular insulin with dextrose, sodium polystyrene or other potassium
binders, albuterol, and dialysis. Potassium-sparing drugs should be avoided. The normal
potassium range is about 3.5 to 5.0 mEq/L.
7. Which medication is used to treat anemia in a client with chronic kidney disease?
A. Epoetin alfa B. Furosemide C. Warfarin D. Prednisone
Page 2 of 8
