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ATI RN TARGETED MEDICAL
SURGICAL RENAL & URINARY
PRACTICE EXAM 2026–2027 [QUESTION
1-100] AND ANSWERS UPDATED
2026/2027 | DETAILED RATIONALES –
INSTANT DOWNLOAD
INTRODUCTION
The ATI RN Targeted Medical-Surgical Renal & Urinary Practice Exam focuses on nursing
assessment, clinical judgment, prioritization, safety, and evidence-based management of patients
experiencing renal and urinary disorders. It is designed for RN nursing students preparing for
targeted medical-surgical assessments and for learners who want additional practice applying
renal concepts to realistic clinical situations. Key areas include acute kidney injury, chronic
kidney disease, dialysis, urinary tract infections, nephrolithiasis, urinary obstruction, fluid and
electrolyte disturbances, renal medications, urinary diversions, and patient safety.
This practice bank emphasizes application-level questions rather than simple recall. Each
scenario requires the student to interpret assessment findings, recognize complications, identify
priority interventions, evaluate treatment responses, and determine when escalation of care is
necessary. The rationales explain the clinical reasoning behind the correct answer and distinguish
it from the distractors. The questions are original study materials aligned with common RN
medical-surgical renal and urinary learning objectives; they are not reproduced ATI examination
items or guaranteed representations of future ATI questions.
CONTENT AREA OVERVIEW
STUDY
CONTENT AREA QUESTIONS KEY TOPICS
WEIGHT
Prerenal, intrarenal, postrenal causes,
Acute Kidney Injury 1–12 12%
assessment, treatment
Staging concepts, uremia,
Chronic Kidney Disease 13–24 12%
complications, nutrition, medications
Hemodialysis & Access care, complications, safety,
25–36 12%
Peritoneal Dialysis treatment response
Fluid & Electrolyte Potassium, sodium, acid-base balance,
37–48 12%
Management fluid overload
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STUDY
CONTENT AREA QUESTIONS KEY TOPICS
WEIGHT
UTI, pyelonephritis, cystitis, urinary
Urinary Tract Disorders 49–58 10%
retention
Nephrolithiasis & Stones, hydronephrosis, obstruction,
59–68 10%
Obstruction pain management
Urinary Diversions & Ileal conduits, ostomies, catheters,
69–78 10%
Continence bladder management
Renal Medications & Diuretics, nephrotoxic drugs,
79–88 10%
Safety antihypertensives, antibiotics
Clinical Judgment & Deterioration, delegation, safety,
89–100 12%
Prioritization escalation of care
QUESTIONS 1-100
ACUTE KIDNEY INJURY
Q1:
A client develops acute kidney injury after several days of severe vomiting and diarrhea. The
client's blood pressure is 86/52 mmHg, heart rate is 118/min, and urine output is 15 mL/hr.
Which intervention should the nurse anticipate as the priority?
A) Restrict all IV fluids.
B) Administer a potassium supplement immediately.
C) Restore circulating volume as prescribed and closely monitor renal perfusion.
D) Prepare the client for long-term dialysis.
Rationale: The correct answer is C because severe gastrointestinal losses can cause
hypovolemia and prerenal acute kidney injury. Restoring circulating volume can improve renal
perfusion when hypovolemia is the underlying cause. Option A is incorrect because further fluid
restriction could worsen hypoperfusion. Option B is unsafe because AKI can impair potassium
excretion. Option D is premature because acute kidney injury does not automatically require
long-term dialysis.
Q2:
A client with acute kidney injury has a urine output of 20 mL/hr, potassium 6.4 mEq/L, and
peaked T waves on the ECG. Which action should the nurse take first?
A) Encourage oral fluids.
B) Administer a potassium-rich meal.
C) Notify the provider immediately and initiate emergency treatment for hyperkalemia according
,3|Page
to protocol.
D) Document the ECG findings as an expected consequence of AKI.
Rationale: The correct answer is C because severe hyperkalemia with ECG changes can rapidly
cause life-threatening dysrhythmias. Immediate treatment and continuous cardiac monitoring
are required. Option A is not sufficient and may worsen fluid status. Option B would increase
potassium. Option D dangerously minimizes a potentially fatal complication.
Q3:
A client with AKI has a serum creatinine that increased from 1.0 to 3.2 mg/dL within several
days. Which interpretation is most appropriate?
A) Renal function has improved significantly.
B) The result confirms chronic kidney disease.
C) The client has significant deterioration in renal filtration requiring further assessment.
D) The creatinine level is unrelated to kidney function.
Rationale: The correct answer is C because a substantial rise in serum creatinine indicates
reduced renal filtration and requires evaluation of the cause and complications. Option A is the
opposite of the finding. Option B cannot be concluded solely from this acute change. Option D is
incorrect because creatinine is commonly used as a marker of kidney filtration.
Q4:
A client with AKI develops increasing dyspnea, crackles, peripheral edema, and oxygen
saturation of 88%. Which complication should the nurse suspect?
A) Dehydration.
B) Hypoglycemia.
C) Fluid volume excess with pulmonary edema.
D) Uncomplicated cystitis.
Rationale: The correct answer is C because impaired renal excretion can cause fluid retention,
resulting in pulmonary edema and impaired oxygenation. Option A would not explain edema and
crackles. Option B does not account for the respiratory findings. Option D does not cause this
pattern of acute fluid overload.
Q5:
A client with AKI is receiving a nephrotoxic medication. Which laboratory trend should cause
the nurse to question continuation of therapy?
A) Decreasing creatinine.
B) Stable urine output.
, 4|Page
C) Progressively increasing serum creatinine.
D) Stable sodium level.
Rationale: The correct answer is C because increasing creatinine indicates worsening renal
filtration and may signal medication-related nephrotoxicity. A and B suggest stable or improving
renal status. D does not specifically demonstrate worsening filtration.
Q6:
A client with AKI has oliguria. Which assessment finding requires the most immediate attention?
A) Mild fatigue.
B) Poor appetite.
C) New confusion with an irregular cardiac rhythm.
D) Dry skin.
Rationale: The correct answer is C because confusion may indicate uremia or metabolic
disturbance, while an irregular rhythm may indicate dangerous electrolyte abnormalities such as
hyperkalemia. A, B, and D are less immediately threatening.
Q7:
A client develops AKI after receiving a nephrotoxic contrast agent. Which nursing action is
appropriate?
A) Assume renal function will remain normal.
B) Encourage additional nephrotoxic medications.
C) Monitor renal function, urine output, fluid status, and prescribed preventive measures.
D) Avoid obtaining any further laboratory tests.
Rationale: The correct answer is C because contrast-associated renal injury requires close
monitoring of renal function and fluid status. Options A, B, and D are unsafe because they fail to
detect or prevent worsening renal impairment.
Q8:
A client with AKI has a urine output of 10 mL/hr for 4 consecutive hours. Which action is most
appropriate?
A) Document the finding as expected.
B) Encourage the client to drink unlimited water.
C) Assess the client and promptly report persistent oliguria according to clinical protocol.
D) Administer potassium without laboratory confirmation.
ATI RN TARGETED MEDICAL
SURGICAL RENAL & URINARY
PRACTICE EXAM 2026–2027 [QUESTION
1-100] AND ANSWERS UPDATED
2026/2027 | DETAILED RATIONALES –
INSTANT DOWNLOAD
INTRODUCTION
The ATI RN Targeted Medical-Surgical Renal & Urinary Practice Exam focuses on nursing
assessment, clinical judgment, prioritization, safety, and evidence-based management of patients
experiencing renal and urinary disorders. It is designed for RN nursing students preparing for
targeted medical-surgical assessments and for learners who want additional practice applying
renal concepts to realistic clinical situations. Key areas include acute kidney injury, chronic
kidney disease, dialysis, urinary tract infections, nephrolithiasis, urinary obstruction, fluid and
electrolyte disturbances, renal medications, urinary diversions, and patient safety.
This practice bank emphasizes application-level questions rather than simple recall. Each
scenario requires the student to interpret assessment findings, recognize complications, identify
priority interventions, evaluate treatment responses, and determine when escalation of care is
necessary. The rationales explain the clinical reasoning behind the correct answer and distinguish
it from the distractors. The questions are original study materials aligned with common RN
medical-surgical renal and urinary learning objectives; they are not reproduced ATI examination
items or guaranteed representations of future ATI questions.
CONTENT AREA OVERVIEW
STUDY
CONTENT AREA QUESTIONS KEY TOPICS
WEIGHT
Prerenal, intrarenal, postrenal causes,
Acute Kidney Injury 1–12 12%
assessment, treatment
Staging concepts, uremia,
Chronic Kidney Disease 13–24 12%
complications, nutrition, medications
Hemodialysis & Access care, complications, safety,
25–36 12%
Peritoneal Dialysis treatment response
Fluid & Electrolyte Potassium, sodium, acid-base balance,
37–48 12%
Management fluid overload
,2|Page
STUDY
CONTENT AREA QUESTIONS KEY TOPICS
WEIGHT
UTI, pyelonephritis, cystitis, urinary
Urinary Tract Disorders 49–58 10%
retention
Nephrolithiasis & Stones, hydronephrosis, obstruction,
59–68 10%
Obstruction pain management
Urinary Diversions & Ileal conduits, ostomies, catheters,
69–78 10%
Continence bladder management
Renal Medications & Diuretics, nephrotoxic drugs,
79–88 10%
Safety antihypertensives, antibiotics
Clinical Judgment & Deterioration, delegation, safety,
89–100 12%
Prioritization escalation of care
QUESTIONS 1-100
ACUTE KIDNEY INJURY
Q1:
A client develops acute kidney injury after several days of severe vomiting and diarrhea. The
client's blood pressure is 86/52 mmHg, heart rate is 118/min, and urine output is 15 mL/hr.
Which intervention should the nurse anticipate as the priority?
A) Restrict all IV fluids.
B) Administer a potassium supplement immediately.
C) Restore circulating volume as prescribed and closely monitor renal perfusion.
D) Prepare the client for long-term dialysis.
Rationale: The correct answer is C because severe gastrointestinal losses can cause
hypovolemia and prerenal acute kidney injury. Restoring circulating volume can improve renal
perfusion when hypovolemia is the underlying cause. Option A is incorrect because further fluid
restriction could worsen hypoperfusion. Option B is unsafe because AKI can impair potassium
excretion. Option D is premature because acute kidney injury does not automatically require
long-term dialysis.
Q2:
A client with acute kidney injury has a urine output of 20 mL/hr, potassium 6.4 mEq/L, and
peaked T waves on the ECG. Which action should the nurse take first?
A) Encourage oral fluids.
B) Administer a potassium-rich meal.
C) Notify the provider immediately and initiate emergency treatment for hyperkalemia according
,3|Page
to protocol.
D) Document the ECG findings as an expected consequence of AKI.
Rationale: The correct answer is C because severe hyperkalemia with ECG changes can rapidly
cause life-threatening dysrhythmias. Immediate treatment and continuous cardiac monitoring
are required. Option A is not sufficient and may worsen fluid status. Option B would increase
potassium. Option D dangerously minimizes a potentially fatal complication.
Q3:
A client with AKI has a serum creatinine that increased from 1.0 to 3.2 mg/dL within several
days. Which interpretation is most appropriate?
A) Renal function has improved significantly.
B) The result confirms chronic kidney disease.
C) The client has significant deterioration in renal filtration requiring further assessment.
D) The creatinine level is unrelated to kidney function.
Rationale: The correct answer is C because a substantial rise in serum creatinine indicates
reduced renal filtration and requires evaluation of the cause and complications. Option A is the
opposite of the finding. Option B cannot be concluded solely from this acute change. Option D is
incorrect because creatinine is commonly used as a marker of kidney filtration.
Q4:
A client with AKI develops increasing dyspnea, crackles, peripheral edema, and oxygen
saturation of 88%. Which complication should the nurse suspect?
A) Dehydration.
B) Hypoglycemia.
C) Fluid volume excess with pulmonary edema.
D) Uncomplicated cystitis.
Rationale: The correct answer is C because impaired renal excretion can cause fluid retention,
resulting in pulmonary edema and impaired oxygenation. Option A would not explain edema and
crackles. Option B does not account for the respiratory findings. Option D does not cause this
pattern of acute fluid overload.
Q5:
A client with AKI is receiving a nephrotoxic medication. Which laboratory trend should cause
the nurse to question continuation of therapy?
A) Decreasing creatinine.
B) Stable urine output.
, 4|Page
C) Progressively increasing serum creatinine.
D) Stable sodium level.
Rationale: The correct answer is C because increasing creatinine indicates worsening renal
filtration and may signal medication-related nephrotoxicity. A and B suggest stable or improving
renal status. D does not specifically demonstrate worsening filtration.
Q6:
A client with AKI has oliguria. Which assessment finding requires the most immediate attention?
A) Mild fatigue.
B) Poor appetite.
C) New confusion with an irregular cardiac rhythm.
D) Dry skin.
Rationale: The correct answer is C because confusion may indicate uremia or metabolic
disturbance, while an irregular rhythm may indicate dangerous electrolyte abnormalities such as
hyperkalemia. A, B, and D are less immediately threatening.
Q7:
A client develops AKI after receiving a nephrotoxic contrast agent. Which nursing action is
appropriate?
A) Assume renal function will remain normal.
B) Encourage additional nephrotoxic medications.
C) Monitor renal function, urine output, fluid status, and prescribed preventive measures.
D) Avoid obtaining any further laboratory tests.
Rationale: The correct answer is C because contrast-associated renal injury requires close
monitoring of renal function and fluid status. Options A, B, and D are unsafe because they fail to
detect or prevent worsening renal impairment.
Q8:
A client with AKI has a urine output of 10 mL/hr for 4 consecutive hours. Which action is most
appropriate?
A) Document the finding as expected.
B) Encourage the client to drink unlimited water.
C) Assess the client and promptly report persistent oliguria according to clinical protocol.
D) Administer potassium without laboratory confirmation.
