Medical-Surgical Nursing: Renal (Medical-Surgical Nursing) Practice Questions
Test yourself on Renal (Medical-Surgical Nursing) with 12 original NCLEX-RN practice questions. Pick an answer to see instant feedback and a full explanation.
Free original practice questions for study purposes. Open Exam Prep is an independent study resource and is not affiliated with, endorsed by, or sponsored by the makers of NCLEX-RN.
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Answer the questions below — you get instant feedback and a full explanation for each.
1. A client with acute kidney injury (AKI) has a serum potassium level of 6.8 mEq/L and peaked T waves on the ECG. Which medication should the nurse anticipate administering FIRST?
Explanation. With a critically high potassium and ECG changes, the immediate priority is to protect the heart. IV calcium gluconate stabilizes the cardiac membrane within minutes (it does not lower potassium). Insulin/dextrose and sodium polystyrene shift or remove potassium but act more slowly, so cardiac stabilization comes first.
2. The nurse is teaching a client about a low-potassium diet for chronic kidney disease. Which food selection indicates the teaching was effective?
Explanation. Applesauce is low in potassium and appropriate for a restricted diet. Potatoes, bananas, and orange juice are all high in potassium and should be limited in CKD to prevent hyperkalemia.
3. A client returns from surgery with a newly created arteriovenous (AV) fistula for hemodialysis. Which nursing action is essential to maintain fistula patency?
Explanation. A palpable thrill and audible bruit indicate the fistula is patent with adequate blood flow; these should be checked each shift. Blood pressures, venipunctures, IVs, and tight/constrictive dressings on the fistula arm are contraindicated because they can occlude the access.
4. A client receiving peritoneal dialysis reports cloudy effluent (outflow). Which complication should the nurse suspect?
Explanation. Cloudy outflow is the hallmark sign of peritonitis, the most common complication of peritoneal dialysis. The nurse should obtain a culture of the effluent and notify the provider. Clear/straw-colored effluent is normal.
5. A nurse is caring for a client with chronic kidney disease who is prescribed epoetin alfa. What is the primary therapeutic purpose of this medication?
Explanation. Failing kidneys produce less erythropoietin, causing anemia. Epoetin alfa is a synthetic erythropoietin that stimulates the bone marrow to make red blood cells. Phosphate binders, diuretics, and active vitamin D address other CKD problems.
6. A client with nephrotic syndrome has 3+ pitting edema and proteinuria. Which laboratory finding does the nurse expect?
Explanation. Nephrotic syndrome causes massive urinary protein loss, leading to low serum albumin (hypoalbuminemia). The drop in oncotic pressure causes generalized edema, and the liver compensates by increasing lipid synthesis (hyperlipidemia). So albumin is low, not high.
7. A client is admitted with suspected acute glomerulonephritis. Which assessment finding is most consistent with this diagnosis?
Explanation. Acute glomerulonephritis classically presents with hematuria (smoky/cola-colored urine), proteinuria, edema, and hypertension, often after a streptococcal infection. Burning and cloudy urine suggest a UTI; painless hematuria with weight loss suggests malignancy.
8. The nurse is monitoring a client immediately after hemodialysis. Which finding requires immediate intervention?
Explanation. Hypotension is a common but serious complication of hemodialysis due to rapid fluid removal. A BP of 88/52 with dizziness signals hypovolemia and needs immediate action. Weight loss is expected, and mild fatigue and a small bruise are common, non-urgent findings.
9. A client with chronic kidney disease asks why they must take sevelamer with meals. What is the nurse's best response?
Explanation. Sevelamer is a phosphate binder that must be taken with food so it can bind phosphate in the gut and prevent its absorption, lowering serum phosphorus. This helps prevent the secondary hyperparathyroidism and bone disease of CKD.
10. A client with a kidney transplant 2 weeks ago reports fever, decreased urine output, and tenderness over the graft site. The nurse recognizes these as signs of which complication?
Explanation. Fever, decreased urine output, graft tenderness, weight gain, and elevated creatinine are classic signs of acute transplant rejection. The provider must be notified promptly so immunosuppressive therapy can be adjusted to salvage the graft.
11. A nurse is reviewing lab values for a client with AKI. Which set of findings best indicates worsening renal function?
Explanation. Rising BUN and creatinine combined with oliguria indicate the kidneys are filtering less and waste is accumulating—worsening AKI. Decreasing BUN/creatinine and increasing urine output reflect recovery.
12. A client with chronic kidney disease is on a fluid restriction of 1000 mL/day. The nurse would intervene if the client did which of the following?
Explanation. An 8-ounce (240 mL) glass at one meal uses nearly a quarter of the daily limit and may lead to overload if not planned. Counting ice chips, rinsing without swallowing, and spacing fluids throughout the day are all correct fluid-restriction strategies, so those need no intervention.
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FAQ
How do I keep AKI and CKD straight on the NCLEX?
AKI is sudden and potentially reversible, often from prerenal causes (hypovolemia), intrarenal damage, or postrenal obstruction—watch the urine output phases and rising BUN/creatinine. CKD is gradual, progressive, and irreversible, requiring long-term diet management, phosphate binders, erythropoietin, and eventually dialysis or transplant. The NCLEX loves contrasting onset, reversibility, and management.
What renal lab values should I memorize?
Know normal potassium (3.5–5.0 mEq/L), creatinine (0.6–1.2 mg/dL), BUN (10–20 mg/dL), and GFR (>90 normal). For exams, focus on recognizing hyperkalemia emergencies (peaked T waves, calcium gluconate first), elevated BUN/creatinine signaling decreased function, and the relationship of phosphate, calcium, and PTH in CKD.
How are dialysis questions typically tested?
Expect priority and safety questions: protect AV fistulas (no BP/IV/blood draws on that arm; check thrill and bruit), recognize hypotension during/after hemodialysis, and identify peritonitis (cloudy effluent) in peritoneal dialysis. Also know that many medications are held before dialysis because they would be removed.