NSG RENAL NURSING EXAM QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS) PLUS RATIONALES 2026 Q&A |
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,Core Domains
Acute Kidney Injury (AKI) Pathophysiology and Management
Chronic Kidney Disease (CKD) Staging and Progression
Hemodialysis and Peritoneal Dialysis Care
Kidney Transplantation and Immunosuppression
Electrolyte and Fluid Balance in Renal Failure
Renal Pharmacology and Medication Safety
Ethical, Legal, and Regulatory Compliance in Renal Nursing
Nutritional Management for Renal Patients
Urinary Tract Infections and Kidney Stones
Critical Care Nephrology and Emergency Interventions
Introduction
,This comprehensive renal nursing exam assesses critical knowledge and clinical decision-making skills essential for safe, effective practice in
nephrology nursing. The assessment evaluates foundational theory, applied professional knowledge, regulatory and legal compliance, ethical
standards, and real-world scenario-based decision-making. Through 200 multiple-choice and scenario-based questions, candidates demonstrate
mastery in acute and chronic kidney disease management, dialysis care, transplantation, electrolyte balance, pharmacology, and emergency
interventions. Emphasis is placed on clinical judgment, patient safety, evidence-based practice, and professional accountability in diverse renal care
settings.
SECTION ONE: QUESTIONS 1–100
Question 1
A patient with acute kidney injury (AKI) has a serum potassium level of 6.8 mEq/L. Which intervention should the nurse prioritize?
A. Administer sodium polystyrene sulfonate orally
B. Administer IV insulin and dextrose
C. Encourage high-potassium foods
D. Prepare for immediate hemodialysis
🟢 B. Administer IV insulin and dextrose
🔴 RATIONALE: Hyperkalemia >6.5 mEq/L is a medical emergency. IV insulin with dextrose shifts potassium intracellularly rapidly (within 15–30
minutes), making it the priority intervention to prevent cardiac arrhythmias. Sodium polystyrene sulfonate acts too slowly, and dialysis is reserved
for refractory cases.
Question 2
Which stage of chronic kidney disease (CKD) is characterized by a glomerular filtration rate (GFR) of 25 mL/min/1.73 m²?
A. Stage 2
B. Stage 3a
C. Stage 3b
D. Stage 4
🟢 D. Stage 4
🔴 RATIONALE: CKD Stage 4 is defined by GFR 15–29 mL/min/1.73 m², indicating severe kidney dysfunction. Stage 3b is GFR 30–44, Stage 3a is
45–59, and Stage 2 is 60–89.
, Question 3
A hemodialysis patient development hypotension during treatment. What is the FIRST nursing action?
A. Stop ultrafiltration and place patient in Trendelenburg position
B. Administer 500 mL normal saline bolus
C. Decrease blood flow rate through the dialyzer
D. Notify the nephrologist immediately
🟢 A. Stop ultrafiltration and place patient in Trendelenburg position
🔴 RATIONALE: Hypotension during hemodialysis is most commonly due to rapid fluid removal. Stopping ultrafiltration immediately prevents
further volume loss, and Trendelenburg position improves cerebral perfusion. Fluid bolus may follow but is not the first action.
Question 4
Which laboratory finding is MOST indicative of glomerulonephritis?
A. Elevated serum creatinine only
B. Proteinuria with hematuria and RBC casts
C. Hyperkalemia with metabolic acidosis
D. Elevated BUN with normal urinalysis
🟢 B. Proteinuria with hematuria and RBC casts
🔴 RATIONALE: RBC casts in urine are pathognomonic for glomerulonephritis, indicating glomerular inflammation. Proteinuria and hematuria
also support this diagnosis. Elevated creatinine and BUN are nonspecific.
Question 5
A patient on peritoneal dialysis reports cloudy dialysate output. What condition should the nurse suspect?
A. Normal finding after 3 exchanges
B. Peritonitis
C. Catheter obstruction
D. Hyperglycemia
🟢 B. Peritonitis
INSTANT DOWNLOAD PDF
,Core Domains
Acute Kidney Injury (AKI) Pathophysiology and Management
Chronic Kidney Disease (CKD) Staging and Progression
Hemodialysis and Peritoneal Dialysis Care
Kidney Transplantation and Immunosuppression
Electrolyte and Fluid Balance in Renal Failure
Renal Pharmacology and Medication Safety
Ethical, Legal, and Regulatory Compliance in Renal Nursing
Nutritional Management for Renal Patients
Urinary Tract Infections and Kidney Stones
Critical Care Nephrology and Emergency Interventions
Introduction
,This comprehensive renal nursing exam assesses critical knowledge and clinical decision-making skills essential for safe, effective practice in
nephrology nursing. The assessment evaluates foundational theory, applied professional knowledge, regulatory and legal compliance, ethical
standards, and real-world scenario-based decision-making. Through 200 multiple-choice and scenario-based questions, candidates demonstrate
mastery in acute and chronic kidney disease management, dialysis care, transplantation, electrolyte balance, pharmacology, and emergency
interventions. Emphasis is placed on clinical judgment, patient safety, evidence-based practice, and professional accountability in diverse renal care
settings.
SECTION ONE: QUESTIONS 1–100
Question 1
A patient with acute kidney injury (AKI) has a serum potassium level of 6.8 mEq/L. Which intervention should the nurse prioritize?
A. Administer sodium polystyrene sulfonate orally
B. Administer IV insulin and dextrose
C. Encourage high-potassium foods
D. Prepare for immediate hemodialysis
🟢 B. Administer IV insulin and dextrose
🔴 RATIONALE: Hyperkalemia >6.5 mEq/L is a medical emergency. IV insulin with dextrose shifts potassium intracellularly rapidly (within 15–30
minutes), making it the priority intervention to prevent cardiac arrhythmias. Sodium polystyrene sulfonate acts too slowly, and dialysis is reserved
for refractory cases.
Question 2
Which stage of chronic kidney disease (CKD) is characterized by a glomerular filtration rate (GFR) of 25 mL/min/1.73 m²?
A. Stage 2
B. Stage 3a
C. Stage 3b
D. Stage 4
🟢 D. Stage 4
🔴 RATIONALE: CKD Stage 4 is defined by GFR 15–29 mL/min/1.73 m², indicating severe kidney dysfunction. Stage 3b is GFR 30–44, Stage 3a is
45–59, and Stage 2 is 60–89.
, Question 3
A hemodialysis patient development hypotension during treatment. What is the FIRST nursing action?
A. Stop ultrafiltration and place patient in Trendelenburg position
B. Administer 500 mL normal saline bolus
C. Decrease blood flow rate through the dialyzer
D. Notify the nephrologist immediately
🟢 A. Stop ultrafiltration and place patient in Trendelenburg position
🔴 RATIONALE: Hypotension during hemodialysis is most commonly due to rapid fluid removal. Stopping ultrafiltration immediately prevents
further volume loss, and Trendelenburg position improves cerebral perfusion. Fluid bolus may follow but is not the first action.
Question 4
Which laboratory finding is MOST indicative of glomerulonephritis?
A. Elevated serum creatinine only
B. Proteinuria with hematuria and RBC casts
C. Hyperkalemia with metabolic acidosis
D. Elevated BUN with normal urinalysis
🟢 B. Proteinuria with hematuria and RBC casts
🔴 RATIONALE: RBC casts in urine are pathognomonic for glomerulonephritis, indicating glomerular inflammation. Proteinuria and hematuria
also support this diagnosis. Elevated creatinine and BUN are nonspecific.
Question 5
A patient on peritoneal dialysis reports cloudy dialysate output. What condition should the nurse suspect?
A. Normal finding after 3 exchanges
B. Peritonitis
C. Catheter obstruction
D. Hyperglycemia
🟢 B. Peritonitis
