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Free Renal NCLEX Questions to Boost Your NCLEX Success

Focused studying and regularly answering practice NCLEX questions are your keys to the nursing kingdom. But before you get to wear that coveted badge with your credentials after your name, you’ll need to pass the NCLEX exam. 

If you’ve been on the hunt for renal NCLEX questions or have just been wondering what you need to know regarding the renal system for the NCLEX exam, you’ve come to the right place.

Today, we’re going to cover how the renal system works, common conditions, laboratory tests, and how nurses should manage renal patients. Once you have a good handle on the content to expect, we’ll move onto some sample renal NCLEX questions with answer rationales included. By the time we’re done, you can confidently study for renal questions and be on the road to NCLEX success.

How the Renal System Works

Diagram explaining how the renal system works

A basic knowledge of how the renal system works is mandatory for renal NCLEX questions. To begin, the renal system is composed of two kidneys, two ureters, one bladder, and one urethra. It’s often referred to as the urinary system or the genitourinary system.

And here’s a fun fact for you: Every 30 minutes your kidneys filter your entire blood supply removing poisons, toxins, wastes, and excess fluid. Isn’t that amazing? Urea and creatinine are two waste products that are removed through this process.

Kidneys are a sometimes-forgotten cornerstone of good health. In addition to filtering blood and maintaining electrolyte balance, they also produce important hormones, activate vitamin D, produce erythropoietin, and control blood pressure. Without proper kidney function, dialysis or a kidney transplant may be necessary to avoid end-stage renal disease or even death. 

Each kidney has the following parts that help maintain homeostasis in the body:


  • Renal artery — This supplies blood to the kidney.
  • Medulla — This refers to the inner portion of each kidney. 
  • Renal vein — Filtered blood is pumped back into circulation through this vein and the rest of the blood that contains waste is further processed by the kidney.
  • Renal pyramid — This is responsible for bringing urine to the renal pelvis.
  • Renal pelvis — Urine is collected here after blood containing waste is processed.
  • Renal calyx — This brings urine from the renal pyramid to the renal pelvis.
  • Cortex — The name for the outside of the kidney.
  • Nephrons — Each kidney is made up of about 2 million nephrons
  • Glomeruli — Each nephron has a glomeruli that filters blood and is measured by the glomerular filtration rate (GFR).

For renal NCLEX questions, remember that urine excreted by the kidneys is pushed through the ureters, tubes connected to each kidney that connect to the bladder. The ureters have small values to prevent the backflow of urine into the kidneys. Next, the bladder collects the urine and it is then excreted out of the body by the urethra. 

Hormones and Enzymes Related to the Renal System

There are four endocrine hormones and enzymes that prompt the kidneys that you should know for renal NCLEX questions:

  • Antidiuretic hormone (ADH) — ADH production occurs in the pituitary gland and controls the water in the blood serum and body. 
  • Aldosterone — Secreted by the adrenal glands to regulate sodium and water. This maintains healthy blood pressures.
  • Renin — An enzyme produced by the kidneys to regulate blood pressure, blood volume, and electrolytes. Renin forms angiotensin when it’s converted to angiotensin II. Renin works with angiotensins to form the renin-angiotensin cycle. 
  • Angiotensin II — An enzyme that acts as a vasoconstrictor to increase blood pressure when needed. In addition, it prompts the production of aldosterone. 

You can memorize these endocrine hormones by making connections and drawing out how each hormone works in the renal system. This activates your critical thinking skills and helps with retention.

Conditions Affecting Renal Patients

As you can see, the renal system is a complex network of vessels, organs, hormones, and enzymes that work simultaneously together to perform important bodily functions. Because of this, there are many small areas where things can go awry and lead to bigger problems. 

Here are some renal disorders and conditions you should review for renal NCLEX questions:

  • Acute renal failure
  • Chronic renal failure
  • Nephrotic syndrome
  • Renal calculi
  • Neurogenic bladder
  • Urinary tract infection
  • Renal cysts
  • Acute glomerulonephritis
  • Urolithiasis
  • Nephrolithiasis
  • Ureterolithiasis
  • Acute kidney injury (AKI)

Laboratory Values Related to the Renal System

A vial with laboratory values related to the renal system

There are four specific laboratory tests that measure renal function and tell us how well the kidneys are functioning.

Blood Urea Nitrogen (BUN)

BUN level is a blood draw measuring the amount of urea nitrogen in the blood. Urea nitrogen forms when protein breaks down. BUN measures protein metabolism within the body.


Creatinine is a blood draw to see how well the kidneys are functioning. Chronic, persistent renal impairments cause a rise in creatinine.

Creatinine Clearance

Creatinine clearance is a blood draw to measure GFR. It lets us know how well the kidneys remove creatinine from the blood.

Urine Creatinine

Urine creatinine tells us how well the kidneys are working by measuring the amount of creatinine in the urine. Healthy kidneys should be filtering creatinine out of the blood and expelling it through urination.

Nursing Assessment and Management of Renal Patients

For renal NCLEX questions and for your future role as a licensed nurse, be sure to review how to care for renal patients:

  • Gather history:
    • Ask about urinary urgency, pain, color, difficulty, burning, and retention
    • Find out if the patient has a history of urinary problems and assess fluid intake
    • Obtain medication list
    • Gather a family history and social history
  • Assess skin:
    • Document color, pruritis, distended neck vessels, edema, petechiae, and nail beds
  • Assess the abdomen and chest:
    • Palpate abdomen
    • Percuss kidneys
    • Auscultate for bruit and respiratory edema (crackles)
    • Note fullness, symmetrical/unsymmetrical, or enlargements
  • Assess neurological status:
    • Patients with renal failure may be confused or have slurred speech
  • Monitor for signs and symptoms of renal disease:
    • Decreased or increased blood flow (too little or fluid overload)
    • Oliguria, polyuria, anuria, proteinuria, or hematuria
    • Metabolic acidosis
    • Hyponatremia
    • Hyperkalemia
    • Hyperphosphatemia
    • Weight gain
    • Heart failure
    • Pruritis

Sample Renal NCLEX Questions

A patient being treated for renal related symptoms

It’s time to put your renal nursing knowledge to the test with some practice renal NCLEX questions. Answer rationales follow each question, so be sure to read those for a detailed explanation of why each choice is correct or incorrect.

Renal NCLEX Question #1

You’re caring for a patient with acute renal failure undergoing hemodialysis through an arteriovenous (AV) fistula in the right arm. Which of the following shouldn’t be included in the care plans for this patient?

  1. Assess the AV fistula for a thrill and bruit
  2. Only draw blood from the access arm
  3. Apply gentle pressure to the site if breakthrough bleeding occurs between dialysis treatments
  4. Use two needles for the hemodialysis treatment

Answer: B — Blood should never be drawn from the arm with the AV fistula. In addition, never take a patient’s blood pressure on the access arm. Care plans for this patient should include checking for thrill and bruit to confirm a patent fistula. Applying gentle pressure for breakthrough bleeding for up to 30 minutes is standard, any longer and further interventions are necessary. Also, two needles are used for each hemodialysis treatment — one to remove the blood and one to return filtered blood.

Renal NCLEX Question #2

A renal failure patient undergoing peritoneal dialysis who has kidney disease due to diabetes mellitus. After placing 1200 ml of dialysate, only 400 ml has drained. What should you do next?

  1. Check the catheter for obstruction
  2. Place the patient on his left side
  3. Instill 500 ml of dialysate
  4. Clamp the catheter and palpate the abdomen

Answer: A — Clamp the catheter and observe it for any kinks or obstruction. You may then have the patient reposition to encourage drainage. Do not clamp the catheter or install more dialysate. The patient’s output should be within the ordered parameters before instilling further dialysate. If you try these things and no further dialysate flows out, call the physician for further orders. 

Renal NCLEX Question #3

Which of the following symptoms and/or conditions are associated with disequilibrium syndrome related to a patient with chronic kidney disease beginning his first hemodialysis treatment?

  1. Headache, vomiting, and restlessness
  2. Fever and weakness
  3. Pulmonary edema and difficulty breathing
  4. Peritonitis, tachycardia, and decreased blood pressure

Answer: A — Disequilibrium syndrome is associated with nausea, vomiting, headache, restlessness, mental confusion, and can lead to coma or death. It’s not associated with any of the other choices. 

Renal NCLEX Question #4

You’re caring for a woman with a urinary tract infection who is beginning her first dose of IV antibiotics now. When reading the order, you see you’re also supposed to obtain a urine culture. What order should you proceed in?

  1. Begin to administer the antibiotic then collect a urine culture
  2. Collect a urine culture and administer antibiotic if culture is positive
  3. Administer antibiotic, collect urine culture, then send the culture to the lab if the antibiotic doesn’t relieve symptoms
  4. Collect a urine culture, send to the lab, then hang antibiotic

Answer: D — The urine culture must be collected first before the antibiotic has the ability to alter the bacterial growth in the urine. Then the urine must be immediately sent to the lab. Finally, hang the IV antibiotic. Urine cultures take approximately 48 hours for results and antibiotic therapy shouldn’t be delayed while waiting for results.

Master Renal NCLEX Questions With Consistent Practice Questions

A nursing student studying with practice NCLEX questions

Consistently answering NCLEX practice questions is a surefire way to get you in the NCLEX mindset. And not just for renal NCLEX questions, for all types of NCLEX questions. If you’ve been wondering where to start when it comes to NCLEX practice questions or where to find them, we’ve got good news for you.

Join us at the NCLEX Daily Challenge where each day you get a new practice question sent to your email. No more wondering where to find questions or letting it fall to the bottom of your to-do list. With the challenge, we’ll do that work for you, all you have to do is answer.

You can even kick things up a notch and join the premium version. There you can compete against your friends to work your way up the leaderboard. Each month, the winner gets a prize. Plus, you’ll even have access to a bank of your questions with comprehensive answer rationales. Join us today alongside thousands of other nursing students just like you.

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