Renal & Urinary
NCLEX® practice.

Free practice set · 4 questions

4 more free renal & urinary NCLEX-RN® practice questions

Real questions from the same bank the app serves. Pick an answer in your head, then open the rationale to see why the correct option holds and why each other option falls short. No account needed for these.

1. Question 1 of 4 · Renal Dialysis & Urinary Elimination

   A 22-year-old man with stage 4 chronic kidney disease is on a medical-surgical unit awaiting prescribed hemodialysis for fluid overload and uremia. His daily medication regimen was started yesterday. Compared with 2 hours ago, BP is 138/78 from 146/86 mm Hg, HR 112 from 88/min, RR 22 from 16/min, temperature 38.1°C from 37.2°C, and SpO2 95% from 98% on room air. He has nausea, new difficulty concentrating, 80 mL urine in 4 hours, and peaked T waves with an irregular rhythm; potassium is 6.2 mEq/L. Which action should the nurse take first?

   1. APlace the client on continuous cardiac monitoring, obtain an ECG, and notify the provider using SBAR for emergent dialysis preparation.
   2. BRecheck vital signs in 4 hours because the fever and tachycardia may represent an early infection.
   3. CDocument the new difficulty concentrating as an expected response to hospitalization in a young adult.
   4. DPage the health care provider about the peaked T waves and wait for instructions before initiating cardiac monitoring.
   Show the answer and rationale

   Correct answer: A. Place the client on continuous cardiac monitoring, obtain an ECG, and notify the provider using SBAR for emergent dialysis preparation.

   The nurse should immediately place the client on continuous cardiac monitoring, obtain an ECG, and communicate the change through SBAR while preparing for emergent dialysis. The cluster of rising heart rate and respirations, falling oxygen saturation, nausea, decreased urine output, peaked T waves, and an irregular rhythm in severe renal failure identifies life-threatening hyperkalemia with impending dysrhythmia. Acting on these early changes prevents overt cardiovascular collapse. Waiting four hours misses a time-critical trend; new concentration difficulty is not an age-related normal finding; and reporting the ECG change without starting supportive monitoring delays protection from a potentially fatal rhythm.

   A. Place the client on continuous cardiac monitoring, obtain an ECG, and notify the provider using SBAR for emergent dialysis preparation.

   This action recognizes the early deterioration and treats the circulation threat first while breathing remains adequate. Continuous monitoring and ECG assessment support immediate nursing action, and SBAR communicates the finding, trend, baseline, and needed emergent dialysis response.

   B. Recheck vital signs in 4 hours because the fever and tachycardia may represent an early infection.

   A fever and tachycardia deserve evaluation, but waiting four hours is unsafe when the client also has peaked T waves, an irregular rhythm, oliguria, and severe renal disease. The pattern indicates an immediate hyperkalemia-related dysrhythmia risk rather than a routine recheck interval.

   C. Document the new difficulty concentrating as an expected response to hospitalization in a young adult.

   New difficulty concentrating is an acute mental-status change, not an expected response to being hospitalized or a normal feature of this client’s age. It may reflect uremia or worsening physiologic instability and should increase urgency rather than be dismissed in documentation.

   D. Page the health care provider about the peaked T waves and wait for instructions before initiating cardiac monitoring.

   The nurse should notify the health care provider promptly, but waiting for a callback before applying cardiac monitoring delays an ABC-focused safety intervention. Monitoring and ECG assessment must begin while the nurse communicates the urgent trend and prepares for definitive treatment.

2. Question 2 of 4 · Renal Dialysis & Urinary Elimination

   A 34-year-old woman with acute glomerulonephritis after streptococcal pharyngitis is on a medical-surgical unit. Before treatment, BP was 168/98 mm Hg, weight 72.0 kg, urine output 900 mL/day, creatinine 2.1 mg/dL, and potassium 4.7 mEq/L. Goals are BP below 140/90, weight loss 0.5 kg/day, and urine output at least 800 mL/day. She receives furosemide 40 mg IV every 12 hours, sodium restriction, and 1,000 mL/day fluids. After 48 hours, BP is 158/94, weight is 72.1 kg, urine output is 350 mL/day, creatinine is 3.0 mg/dL, and potassium is 5.8 mEq/L. Which action should the nurse take?

   1. ADocument that the treatment is effective because the client has tolerated the doses without reported discomfort.
   2. BAdminister the next furosemide dose unchanged because controlling fluid overload remains the treatment priority.
   3. CReport the failed goals and worsening renal indicators to the health care provider, requesting prompt reevaluation of the regimen.
   4. DContinue the prescribed furosemide dose for 72 hours before communicating the unchanged weight and reduced urine output.
   Show the answer and rationale

   Correct answer: C. Report the failed goals and worsening renal indicators to the health care provider, requesting prompt reevaluation of the regimen.

   The nurse should report the ineffective and potentially harmful response for prompt treatment-plan reevaluation. After 48 hours, the client weighs 72.1 kg rather than meeting the goal of losing 0.5 kg/day, has urine output of 350 mL/day rather than at least 800 mL/day, and has BP 158/94 rather than below 140/90. Creatinine increased to 3.0 mg/dL and potassium to 5.8 mEq/L, indicating a worsening safety margin. Continuing ineffective therapy violates outcome evaluation; documenting tolerance lacks a measurable comparison; ignoring adverse effects disregards safety. Therapy must not be judged too early, and the current admission baseline, not an unrelated older value, should guide comparison. The nurse should not independently alter the dose outside the prescription.

   A. Document that the treatment is effective because the client has tolerated the doses without reported discomfort.

   This documents tolerance, not effectiveness. Evaluation requires comparing measurable findings, such as the 72.1-kg weight and 350-mL urine output, with the stated goals; absence of discomfort does not establish that therapy is working.

   B. Administer the next furosemide dose unchanged because controlling fluid overload remains the treatment priority.

   The increased creatinine to 3.0 mg/dL and potassium to 5.8 mEq/L are emerging safety concerns. Preserving the fluid-overload plan without addressing harm ignores the benefit-risk balance and could worsen renal dysfunction or dysrhythmia risk.

   C. Report the failed goals and worsening renal indicators to the health care provider, requesting prompt reevaluation of the regimen.

   This compares current measurable outcomes with explicit goals after an appropriate 48-hour interval and escalates the failure safely. The nurse identifies worsening renal findings and requests collaborative adjustment rather than independently changing therapy.

   D. Continue the prescribed furosemide dose for 72 hours before communicating the unchanged weight and reduced urine output.

   Waiting another 72 hours silently continues an intervention that has not met its goals. The weight, urine output, blood pressure, creatinine, and potassium require timely reassessment and provider collaboration rather than indefinite continuation.

3. Question 3 of 4 · Renal Dialysis & Urinary Elimination

   An 80-year-old woman in a rehabilitation unit is recovering on postoperative day 3 from abdominal surgery complicated by septic-shock-associated acute kidney injury. Her creatinine is 4.2 mg/dL (baseline 1.0), and urine output has been 15 mL/hr for 6 hours. BP is 108/64, HR 108, RR 24, temperature 37.4°C, and SpO₂ 91% on room air; 2 hours ago they were 124/72, 88, 18, 37.0°C, and 96%. She has new bibasilar crackles, mild jugular venous distention, and restlessness. Which action should the nurse take first?

   1. APlace the client upright, apply oxygen per protocol, and notify the health care provider using SBAR.
   2. BRepeat the vital signs in 4 hours before notifying the health care provider about the changing condition.
   3. CPage the health care provider about the new hypoxia and wait for instructions before positioning or applying oxygen.
   4. DReassure the client that the tachycardia and dyspnea are anxiety related, then encourage slow breathing.
   Show the answer and rationale

   Correct answer: A. Place the client upright, apply oxygen per protocol, and notify the health care provider using SBAR.

   The nurse should position the client upright, provide oxygen according to protocol, and promptly communicate the change with SBAR. The cluster of worsening tachycardia, tachypnea, narrowing pulse pressure, hypoxia, oliguria, crackles, jugular venous distention, and restlessness identifies early deterioration from fluid overload and impaired renal adaptation after intrinsic acute kidney injury. Airway and breathing support precede circulation-focused management, and the nurse should act on the trend rather than wait for collapse. SBAR should include the current findings, baseline comparison, urine output and creatinine, and a recommendation for urgent evaluation and treatment.

   A. Place the client upright, apply oxygen per protocol, and notify the health care provider using SBAR.

   This option recognizes several early warning changes, supports breathing immediately, and escalates with the baseline and trend in a structured SBAR report. Upright positioning and oxygen address the immediate ABC priority while the provider evaluates fluid overload and renal failure.

   B. Repeat the vital signs in 4 hours before notifying the health care provider about the changing condition.

   Waiting four hours ignores early deterioration and could allow fluid overload, sepsis recurrence, or respiratory failure to progress. New tachycardia, tachypnea, hypoxia, oliguria, and restlessness require action and timely escalation now.

   C. Page the health care provider about the new hypoxia and wait for instructions before positioning or applying oxygen.

   Communicating the finding is appropriate, but waiting for a callback before positioning and oxygen leaves impaired breathing untreated. ABC priorities require the nurse to begin supportive care while simultaneously seeking urgent provider assistance.

   D. Reassure the client that the tachycardia and dyspnea are anxiety related, then encourage slow breathing.

   Anxiety does not adequately explain new hypoxia, crackles, jugular venous distention, oliguria, and a deteriorating vital-sign trend after severe illness. Reassurance delays oxygenation and evaluation of a potentially serious cardiopulmonary complication.

4. Question 4 of 4 · Renal Dialysis & Urinary Elimination

   A 48-year-old man is in the emergency department 48 hours after a living-donor kidney transplant and uses a new walker. His medications include tacrolimus, mycophenolate, and prednisone. His current BP is 168/94 mm Hg, HR 104/min, RR 22/min, temperature 37.7°C, and SpO2 95%; 4 hours ago, values were 142/82, 88, 18, 37.2°C, and 98%. He has new graft-site tenderness and edema, creatinine has risen from 1.2 to 2.8 mg/dL, and urine output has fallen from 150 to 45 mL/hr. Which action should the nurse take first?

   1. APage the health care provider about the oliguria and rising creatinine, then wait for instructions before assessing or intervening.
   2. BPerform an immediate focused ABC assessment and notify the health care provider with an SBAR recommendation for urgent graft evaluation.
   3. CDocument the findings and recheck vital signs in 4 hours before contacting the transplant team.
   4. DReassure the client that the tachycardia and breathing pattern reflect anxiety, then encourage relaxation.
   Show the answer and rationale

   Correct answer: B. Perform an immediate focused ABC assessment and notify the health care provider with an SBAR recommendation for urgent graft evaluation.

   The nurse should perform a focused ABC assessment and promptly communicate the change using SBAR. New graft tenderness and edema, rising creatinine, hypertension, tachycardia, tachypnea, and a sharp fall in urine output 48 hours after transplantation identify possible acute kidney-allograft rejection with early physiologic deterioration. The trend matters even though oxygen saturation and temperature are not severely abnormal. Reassurance attributes concerning changes to anxiety rather than recognizing a complication. Waiting 4 hours delays evaluation of a time-sensitive deterioration. Calling the provider without first assessing immediate airway, breathing, and circulation omits the nurse’s priority safety actions; the nurse can assess, support, and then escalate with specific findings, baseline comparisons, and a recommendation.

   A. Page the health care provider about the oliguria and rising creatinine, then wait for instructions before assessing or intervening.

   Notification is appropriate, but waiting passively for instructions fails to address immediate ABC safety and assessment. The nurse should assess first, provide indicated support, and communicate a complete SBAR report with a proposed urgent action.

   B. Perform an immediate focused ABC assessment and notify the health care provider with an SBAR recommendation for urgent graft evaluation.

   This option recognizes the early cluster suggesting acute graft rejection, checks airway, breathing, and circulation before deterioration, and escalates promptly. SBAR communicates the findings, trends, relevant transplant history, and recommended urgent evaluation.

   C. Document the findings and recheck vital signs in 4 hours before contacting the transplant team.

   A four-hour delay is unsafe when urine output is falling and renal function is worsening with new abnormal vital-sign trends. Time-sensitive complications require immediate assessment and transplant-team notification, not delayed reassessment.

   D. Reassure the client that the tachycardia and breathing pattern reflect anxiety, then encourage relaxation.

   Anxiety does not adequately explain new graft tenderness, edema, oliguria, creatinine elevation, hypertension, tachycardia, and tachypnea after transplantation. Reassurance alone delays recognition and treatment of a potentially serious complication.