1|Page
ATI RN TARGETED MEDICAL
SURGICAL RENAL & URINARY
PRACTICE EXAM 2026–2027 [QUESTION
1-100] AND ANSWERS UPDATED
2026/2027 | ORIGINAL EXAM-STYLE
PRACTICE | DETAILED RATIONALES |
INSTANT DOWNLOAD
INTRODUCTION
The ATI RN Targeted Medical Surgical: Renal & Urinary practice assessment focuses on
nursing care of adult clients experiencing disorders of the kidneys and urinary tract. ATI
identifies Renal and Urinary as a dedicated Targeted Medical-Surgical assessment area, with
content emphasizing application of medical-surgical nursing knowledge and clinical reasoning.
(Main)
This practice bank is designed for RN nursing students preparing for ATI-style medical-
surgical assessments and NCLEX-RN preparation. It emphasizes clinical judgment rather
than simple recall, including assessment findings, prioritization, complications, pharmacology,
fluid and electrolyte balance, urinary disorders, renal replacement therapy, and patient education.
The questions below are original practice questions, not ATI-released examination questions or
reproduced ATI answer keys. They are structured around renal and urinary medical-surgical
concepts and clinical decision-making. ATI's adult medical-surgical resources specifically
include renal and urinary disorders among their core areas and use application-oriented learning
activities and rationales. (Main)
Use each rationale to identify why an intervention is appropriate and why competing actions are
unsafe or lower priority.
CONTENT AREA OVERVIEW
CONTENT AREA QUESTIONS KEY TOPICS WEIGHT*
Acute Kidney Injury Prerenal, intrarenal, postrenal causes; urine
1–12 12%
(AKI) output; labs; complications
Chronic Kidney Disease Staging concepts, uremia, anemia, mineral-
13–25 13%
& ESRD bone disorder, diet, complications
,2|Page
CONTENT AREA QUESTIONS KEY TOPICS WEIGHT*
Hemodialysis & Access care, complications, dialysis safety,
26–38 13%
Peritoneal Dialysis peritonitis, fluid removal
Glomerular & Glomerulonephritis, nephrotic syndrome,
39–48 10%
Nephrotic Disorders proteinuria, edema, hypertension
Urinary Tract Disorders Cystitis, pyelonephritis, complicated UTI,
49–60 12%
& Infection urinary retention, prevention
Stone types, renal colic, obstruction,
Renal Calculi 61–68 8%
hydration, procedures
Urinary Diversions & Ileal conduits, urostomies, catheter
69–77 9%
Catheter Care complications, postoperative care
Renal/Urinary Diuretics, antibiotics, nephrotoxins,
78–87 10%
Pharmacology electrolyte effects, medication safety
Fluid, Electrolyte & Hyperkalemia, metabolic acidosis, fluid
88–94 8%
Acid-Base Effects overload, sodium abnormalities
Clinical Judgment & Deterioration, prioritization, complications,
95–100 5%
Priority Care emergency interventions
*The percentages above are a study-allocation framework for this original practice bank, not
an official ATI item-weighting table. ATI's public materials identify Renal and Urinary as a
targeted medical-surgical assessment area but do not publish a current 2026/2027 question-
weighting table for this specific assessment. (Main)
QUESTIONS 1–100
ACUTE KIDNEY INJURY — QUESTIONS 1–12
Q1:
A client is admitted after several days of severe vomiting and diarrhea. The client has a blood
pressure of 88/52 mm Hg, heart rate of 118/min, dry mucous membranes, and urine output of 15
mL/hr. Which finding is most concerning for worsening renal perfusion?
A) Dry oral mucosa
B) Heart rate of 118/min
C) Urine output of 15 mL/hr
D) Thirst
Rationale: C is correct because urine output of 15 mL/hr in an adult indicates significant
oliguria and may reflect inadequate renal perfusion. A, B, and D support volume depletion but
are less direct indicators of renal function.
Q2:
,3|Page
A client with acute kidney injury has potassium of 6.3 mmol/L and develops muscle weakness.
Which assessment finding requires the nurse's immediate attention?
A) Mild nausea
B) Increased thirst
C) Peaked T waves on the ECG
D) Dry skin
Rationale: C is correct because severe hyperkalemia can produce cardiac conduction
abnormalities and life-threatening dysrhythmias. A, B, and D are less immediately dangerous.
The ECG change indicates that the elevated potassium is already affecting cardiac function.
Q3:
A client with AKI has a urine output of 20 mL/hr for the past 4 hours and increasing peripheral
edema. Which prescription should the nurse question?
A) Daily weight
B) Serum electrolyte monitoring
C) Increase IV fluids to 250 mL/hr
D) Strict intake and output
Rationale: C is correct because aggressive fluid administration in an oliguric client with edema
may worsen fluid overload and pulmonary edema. A, B, and D are appropriate for monitoring
renal and fluid status.
Q4:
A client develops AKI after receiving a nephrotoxic medication. Which laboratory trend should
the nurse expect?
A) Decreasing serum creatinine
B) Increasing estimated renal clearance
C) Increasing serum creatinine and BUN
D) Increasing hemoglobin concentration
Rationale: C is correct because impaired renal filtration commonly causes accumulation of
nitrogenous waste products, including BUN and creatinine. A and B indicate improving renal
function. D does not specifically reflect renal filtration.
Q5:
A client with severe dehydration develops AKI. Which intervention should the nurse anticipate if
the cause is primarily prerenal and there is no evidence of fluid overload?
, 4|Page
A) Strict fluid restriction
B) Immediate dialysis for every case
C) Restoration of circulating volume as prescribed
D) High-dose potassium supplementation
Rationale: C is correct because prerenal AKI results from inadequate renal perfusion, and
restoring effective circulating volume can improve kidney perfusion when clinically appropriate.
A may worsen hypoperfusion. Dialysis is not automatically required. D could be dangerous if
renal potassium excretion is impaired.
Q6:
A client with AKI has crackles, dyspnea, oxygen saturation of 86%, and rapidly increasing
weight. Which complication should the nurse suspect?
A) Hypovolemia
B) Improved kidney function
C) Acute fluid overload with pulmonary edema
D) Uncomplicated urinary retention
Rationale: C is correct because reduced renal excretion can produce fluid accumulation,
resulting in pulmonary edema. A does not explain the weight gain and crackles. B is inconsistent
with the findings. D does not explain the respiratory deterioration.
Q7:
A client with AKI has a serum bicarbonate of 17 mmol/L and increasing respiratory rate. Which
complication should the nurse recognize?
A) Metabolic alkalosis
B) Respiratory alkalosis as the primary disorder
C) Metabolic acidosis with respiratory compensation
D) Normal renal adaptation
Rationale: C is correct because impaired renal acid excretion can cause metabolic acidosis.
Increased respiratory rate may represent compensatory elimination of carbon dioxide. A is the
opposite acid-base disturbance. B does not explain the low bicarbonate.
Q8:
A client with AKI asks why daily weights are being obtained at the same time every morning.
Which response is most appropriate?
A) “It helps determine whether you are eating enough.”
B) “It measures your muscle strength.”
ATI RN TARGETED MEDICAL
SURGICAL RENAL & URINARY
PRACTICE EXAM 2026–2027 [QUESTION
1-100] AND ANSWERS UPDATED
2026/2027 | ORIGINAL EXAM-STYLE
PRACTICE | DETAILED RATIONALES |
INSTANT DOWNLOAD
INTRODUCTION
The ATI RN Targeted Medical Surgical: Renal & Urinary practice assessment focuses on
nursing care of adult clients experiencing disorders of the kidneys and urinary tract. ATI
identifies Renal and Urinary as a dedicated Targeted Medical-Surgical assessment area, with
content emphasizing application of medical-surgical nursing knowledge and clinical reasoning.
(Main)
This practice bank is designed for RN nursing students preparing for ATI-style medical-
surgical assessments and NCLEX-RN preparation. It emphasizes clinical judgment rather
than simple recall, including assessment findings, prioritization, complications, pharmacology,
fluid and electrolyte balance, urinary disorders, renal replacement therapy, and patient education.
The questions below are original practice questions, not ATI-released examination questions or
reproduced ATI answer keys. They are structured around renal and urinary medical-surgical
concepts and clinical decision-making. ATI's adult medical-surgical resources specifically
include renal and urinary disorders among their core areas and use application-oriented learning
activities and rationales. (Main)
Use each rationale to identify why an intervention is appropriate and why competing actions are
unsafe or lower priority.
CONTENT AREA OVERVIEW
CONTENT AREA QUESTIONS KEY TOPICS WEIGHT*
Acute Kidney Injury Prerenal, intrarenal, postrenal causes; urine
1–12 12%
(AKI) output; labs; complications
Chronic Kidney Disease Staging concepts, uremia, anemia, mineral-
13–25 13%
& ESRD bone disorder, diet, complications
,2|Page
CONTENT AREA QUESTIONS KEY TOPICS WEIGHT*
Hemodialysis & Access care, complications, dialysis safety,
26–38 13%
Peritoneal Dialysis peritonitis, fluid removal
Glomerular & Glomerulonephritis, nephrotic syndrome,
39–48 10%
Nephrotic Disorders proteinuria, edema, hypertension
Urinary Tract Disorders Cystitis, pyelonephritis, complicated UTI,
49–60 12%
& Infection urinary retention, prevention
Stone types, renal colic, obstruction,
Renal Calculi 61–68 8%
hydration, procedures
Urinary Diversions & Ileal conduits, urostomies, catheter
69–77 9%
Catheter Care complications, postoperative care
Renal/Urinary Diuretics, antibiotics, nephrotoxins,
78–87 10%
Pharmacology electrolyte effects, medication safety
Fluid, Electrolyte & Hyperkalemia, metabolic acidosis, fluid
88–94 8%
Acid-Base Effects overload, sodium abnormalities
Clinical Judgment & Deterioration, prioritization, complications,
95–100 5%
Priority Care emergency interventions
*The percentages above are a study-allocation framework for this original practice bank, not
an official ATI item-weighting table. ATI's public materials identify Renal and Urinary as a
targeted medical-surgical assessment area but do not publish a current 2026/2027 question-
weighting table for this specific assessment. (Main)
QUESTIONS 1–100
ACUTE KIDNEY INJURY — QUESTIONS 1–12
Q1:
A client is admitted after several days of severe vomiting and diarrhea. The client has a blood
pressure of 88/52 mm Hg, heart rate of 118/min, dry mucous membranes, and urine output of 15
mL/hr. Which finding is most concerning for worsening renal perfusion?
A) Dry oral mucosa
B) Heart rate of 118/min
C) Urine output of 15 mL/hr
D) Thirst
Rationale: C is correct because urine output of 15 mL/hr in an adult indicates significant
oliguria and may reflect inadequate renal perfusion. A, B, and D support volume depletion but
are less direct indicators of renal function.
Q2:
,3|Page
A client with acute kidney injury has potassium of 6.3 mmol/L and develops muscle weakness.
Which assessment finding requires the nurse's immediate attention?
A) Mild nausea
B) Increased thirst
C) Peaked T waves on the ECG
D) Dry skin
Rationale: C is correct because severe hyperkalemia can produce cardiac conduction
abnormalities and life-threatening dysrhythmias. A, B, and D are less immediately dangerous.
The ECG change indicates that the elevated potassium is already affecting cardiac function.
Q3:
A client with AKI has a urine output of 20 mL/hr for the past 4 hours and increasing peripheral
edema. Which prescription should the nurse question?
A) Daily weight
B) Serum electrolyte monitoring
C) Increase IV fluids to 250 mL/hr
D) Strict intake and output
Rationale: C is correct because aggressive fluid administration in an oliguric client with edema
may worsen fluid overload and pulmonary edema. A, B, and D are appropriate for monitoring
renal and fluid status.
Q4:
A client develops AKI after receiving a nephrotoxic medication. Which laboratory trend should
the nurse expect?
A) Decreasing serum creatinine
B) Increasing estimated renal clearance
C) Increasing serum creatinine and BUN
D) Increasing hemoglobin concentration
Rationale: C is correct because impaired renal filtration commonly causes accumulation of
nitrogenous waste products, including BUN and creatinine. A and B indicate improving renal
function. D does not specifically reflect renal filtration.
Q5:
A client with severe dehydration develops AKI. Which intervention should the nurse anticipate if
the cause is primarily prerenal and there is no evidence of fluid overload?
, 4|Page
A) Strict fluid restriction
B) Immediate dialysis for every case
C) Restoration of circulating volume as prescribed
D) High-dose potassium supplementation
Rationale: C is correct because prerenal AKI results from inadequate renal perfusion, and
restoring effective circulating volume can improve kidney perfusion when clinically appropriate.
A may worsen hypoperfusion. Dialysis is not automatically required. D could be dangerous if
renal potassium excretion is impaired.
Q6:
A client with AKI has crackles, dyspnea, oxygen saturation of 86%, and rapidly increasing
weight. Which complication should the nurse suspect?
A) Hypovolemia
B) Improved kidney function
C) Acute fluid overload with pulmonary edema
D) Uncomplicated urinary retention
Rationale: C is correct because reduced renal excretion can produce fluid accumulation,
resulting in pulmonary edema. A does not explain the weight gain and crackles. B is inconsistent
with the findings. D does not explain the respiratory deterioration.
Q7:
A client with AKI has a serum bicarbonate of 17 mmol/L and increasing respiratory rate. Which
complication should the nurse recognize?
A) Metabolic alkalosis
B) Respiratory alkalosis as the primary disorder
C) Metabolic acidosis with respiratory compensation
D) Normal renal adaptation
Rationale: C is correct because impaired renal acid excretion can cause metabolic acidosis.
Increased respiratory rate may represent compensatory elimination of carbon dioxide. A is the
opposite acid-base disturbance. B does not explain the low bicarbonate.
Q8:
A client with AKI asks why daily weights are being obtained at the same time every morning.
Which response is most appropriate?
A) “It helps determine whether you are eating enough.”
B) “It measures your muscle strength.”
