RENAL NURSING: CLINICAL REASONING AND PRIORITIZATION —
COMPREHENSIVE UNIVERSITY-LEVEL EXAMINATION QUESTIONS,
ANSWERS AND RATIONALES FOR 2026-2027
1. A patient with acute kidney injury has a serum potassium of 6.8 mEq/L and peaked T waves on ECG.
What is the priority nursing action?
A. Administer oral potassium binder
B. Prepare for emergency dialysis
C. Administer IV calcium gluconate as ordered
D. Restrict dietary potassium
Correct Answer:C
Rationale: Severe hyperkalemia with ECG changes requires immediate cardioprotection with IV calcium
gluconate. This stabilizes cardiac membranes and prevents life-threatening arrhythmias. Subsequent
interventions include insulin/glucose, sodium bicarbonate, and dialysis. Oral potassium binders and
dietary restriction are slower interventions .
2. A patient with chronic kidney disease has a hemoglobin of 8.5 g/dL. What is the most likely cause of
anemia in this patient?
A. Iron deficiency
B. Decreased erythropoietin production
C. Blood loss
D. Hemolysis
Correct Answer:B
,Rationale: The kidneys produce erythropoietin, which stimulates red blood cell production. In chronic
kidney disease, erythropoietin production decreases, leading to anemia. Treatment includes
erythropoiesis-stimulating agents (epoetin alfa) and iron supplementation .
3. A patient is 2 hours post-renal biopsy. Which finding requires immediate intervention?
A. Pink-tinged urine
B. Severe flank pain and hypotension
C. Mild discomfort at the biopsy site
D. Blood pressure of 130/80 mmHg
Correct Answer:B
Rationale: Severe flank pain and hypotension after renal biopsy may indicate bleeding or hematoma
formation. This is a life-threatening complication requiring immediate intervention. Pink-tinged urine
and mild discomfort are expected findings. The provider should be notified immediately .
4. A patient with acute kidney injury has a urine output of 15 mL/hr. Which phase of acute kidney injury
is this patient most likely experiencing?
A. Prerenal phase
B. Oliguric phase
C. Diuretic phase
D. Recovery phase
Correct Answer:B
Rationale: The oliguric phase of acute kidney injury is characterized by urine output less than 400
mL/day (or <0.5 mL/kg/hr). This phase typically lasts 1-3 weeks and is associated with fluid overload,
hyperkalemia, and metabolic acidosis. Treatment focuses on managing complications .
,5. A patient with end-stage renal disease is receiving hemodialysis. Which finding indicates the patient is
fluid overloaded?
A. Weight loss of 2 kg
B. Blood pressure of 180/100 mmHg and crackles
C. Flat neck veins
D. Dry mucous membranes
Correct Answer:B
Rationale: Fluid overload in dialysis patients is characterized by hypertension, crackles, edema, weight
gain, and jugular venous distension. Weight loss and flat neck veins suggest fluid removal. Fluid status
should be assessed before and after dialysis .
6. A patient with chronic kidney disease has a calcium level of 7.8 mg/dL and a phosphate level of 6.5
mg/dL. What is the most likely cause?
A. Hyperparathyroidism
B. Decreased vitamin D activation
C. Increased calcium intake
D. Hyperphosphatemia
Correct Answer:B
Rationale: In chronic kidney disease, the kidneys cannot convert vitamin D to its active form (calcitriol),
leading to decreased calcium absorption and hypocalcemia. Hyperphosphatemia occurs due to
decreased renal excretion. Treatment includes phosphate binders and active vitamin D .
, 7. A patient with acute kidney injury is receiving continuous renal replacement therapy (CRRT). Which
finding requires immediate intervention?
A. Blood pressure of 110/70 mmHg
B. Filter pressure alarm
C. Urine output of 30 mL/hr
D. Temperature of 37.2°C
Correct Answer:B
Rationale: Filter pressure alarms in CRRT may indicate clotting, kinking, or obstruction of the circuit.
This requires immediate assessment and intervention to prevent treatment interruption and blood loss.
Other findings are within normal limits .
8. A patient with nephrotic syndrome has a serum albumin of 2.0 g/dL. What is the most likely cause of
edema in this patient?
A. Increased capillary permeability
B. Decreased colloidal osmotic pressure
C. Increased hydrostatic pressure
D. Lymphatic obstruction
Correct Answer:B
Rationale: Nephrotic syndrome causes massive protein loss in the urine, leading to hypoalbuminemia.
Decreased serum albumin reduces colloidal osmotic pressure, causing fluid to shift from the
intravascular space to the interstitial space, resulting in edema. Treatment includes albumin
replacement and diuretics .
COMPREHENSIVE UNIVERSITY-LEVEL EXAMINATION QUESTIONS,
ANSWERS AND RATIONALES FOR 2026-2027
1. A patient with acute kidney injury has a serum potassium of 6.8 mEq/L and peaked T waves on ECG.
What is the priority nursing action?
A. Administer oral potassium binder
B. Prepare for emergency dialysis
C. Administer IV calcium gluconate as ordered
D. Restrict dietary potassium
Correct Answer:C
Rationale: Severe hyperkalemia with ECG changes requires immediate cardioprotection with IV calcium
gluconate. This stabilizes cardiac membranes and prevents life-threatening arrhythmias. Subsequent
interventions include insulin/glucose, sodium bicarbonate, and dialysis. Oral potassium binders and
dietary restriction are slower interventions .
2. A patient with chronic kidney disease has a hemoglobin of 8.5 g/dL. What is the most likely cause of
anemia in this patient?
A. Iron deficiency
B. Decreased erythropoietin production
C. Blood loss
D. Hemolysis
Correct Answer:B
,Rationale: The kidneys produce erythropoietin, which stimulates red blood cell production. In chronic
kidney disease, erythropoietin production decreases, leading to anemia. Treatment includes
erythropoiesis-stimulating agents (epoetin alfa) and iron supplementation .
3. A patient is 2 hours post-renal biopsy. Which finding requires immediate intervention?
A. Pink-tinged urine
B. Severe flank pain and hypotension
C. Mild discomfort at the biopsy site
D. Blood pressure of 130/80 mmHg
Correct Answer:B
Rationale: Severe flank pain and hypotension after renal biopsy may indicate bleeding or hematoma
formation. This is a life-threatening complication requiring immediate intervention. Pink-tinged urine
and mild discomfort are expected findings. The provider should be notified immediately .
4. A patient with acute kidney injury has a urine output of 15 mL/hr. Which phase of acute kidney injury
is this patient most likely experiencing?
A. Prerenal phase
B. Oliguric phase
C. Diuretic phase
D. Recovery phase
Correct Answer:B
Rationale: The oliguric phase of acute kidney injury is characterized by urine output less than 400
mL/day (or <0.5 mL/kg/hr). This phase typically lasts 1-3 weeks and is associated with fluid overload,
hyperkalemia, and metabolic acidosis. Treatment focuses on managing complications .
,5. A patient with end-stage renal disease is receiving hemodialysis. Which finding indicates the patient is
fluid overloaded?
A. Weight loss of 2 kg
B. Blood pressure of 180/100 mmHg and crackles
C. Flat neck veins
D. Dry mucous membranes
Correct Answer:B
Rationale: Fluid overload in dialysis patients is characterized by hypertension, crackles, edema, weight
gain, and jugular venous distension. Weight loss and flat neck veins suggest fluid removal. Fluid status
should be assessed before and after dialysis .
6. A patient with chronic kidney disease has a calcium level of 7.8 mg/dL and a phosphate level of 6.5
mg/dL. What is the most likely cause?
A. Hyperparathyroidism
B. Decreased vitamin D activation
C. Increased calcium intake
D. Hyperphosphatemia
Correct Answer:B
Rationale: In chronic kidney disease, the kidneys cannot convert vitamin D to its active form (calcitriol),
leading to decreased calcium absorption and hypocalcemia. Hyperphosphatemia occurs due to
decreased renal excretion. Treatment includes phosphate binders and active vitamin D .
, 7. A patient with acute kidney injury is receiving continuous renal replacement therapy (CRRT). Which
finding requires immediate intervention?
A. Blood pressure of 110/70 mmHg
B. Filter pressure alarm
C. Urine output of 30 mL/hr
D. Temperature of 37.2°C
Correct Answer:B
Rationale: Filter pressure alarms in CRRT may indicate clotting, kinking, or obstruction of the circuit.
This requires immediate assessment and intervention to prevent treatment interruption and blood loss.
Other findings are within normal limits .
8. A patient with nephrotic syndrome has a serum albumin of 2.0 g/dL. What is the most likely cause of
edema in this patient?
A. Increased capillary permeability
B. Decreased colloidal osmotic pressure
C. Increased hydrostatic pressure
D. Lymphatic obstruction
Correct Answer:B
Rationale: Nephrotic syndrome causes massive protein loss in the urine, leading to hypoalbuminemia.
Decreased serum albumin reduces colloidal osmotic pressure, causing fluid to shift from the
intravascular space to the interstitial space, resulting in edema. Treatment includes albumin
replacement and diuretics .
