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HESI CASE STUDIES EXAM 2024/2025 QUESTIONS WITH COMPLETED & VERIFIED SOLUTIONS.
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HESI CASE STUDIES EXAM 2024/2025 QUESTIONS WITH COMPLETED & VERIFIED SOLUTIONS.
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HESI CASE STUDIESJudy Harrison is a 38-year-old African American female with a long history of diabetes mellitus
type 2 and hypertension. She has experienced renal insufficiency for the last two years. Her
current medications include an angiotensin converting enzyme inhibitor (ACEI), a diuretic, and
an oral hypoglycemic agent. She reports to the nurse at the clinic that she has lost her appetite
and is very fatigued. She adds that she has to get up to go to the bathroom several times during
the night and has trouble catching her breath at times. Her current weight is 114 lbs (51.7 kg).
She is scheduled for diagnostic studies to evaluate for the onset of end-stage renal disease
(ESRD). - ANS Background for Chronic Kidney Disease HESI Case Study
Which explanation by the nurse is an accurate description of CKD?
-There are frequent exacerbations since half of all nephrons are damaged
-It is a fatal disorder unless renal replacement therapy is received.
-The condition has a rapid onset with frequent remissions
-symptoms are reversible with lifelong medication - ANS It is a fatal disorder unless renal
replacement therapy is received.
CKD is fatal unless some form of renal replacement therapy dialysis or organ transplant is done
whereas acute renal failure has a good prognosis for the return of kidney function if appropriate
supportive care is provided during the acute.
-symptoms are reversible with lifelong medication = chronic kidney disease is progressive
irreversible kidney injury acute renal failure may be reversible with adequate supportive care
during the acute episode
-The condition has a rapid onset with frequent remissions = acute renal failure has a rapid onset
but chronic kidney disease has a gradual onset occurring over months or years neither form of
renal failure has frequent periods of remission
-There are frequent exacerbations since half of all nephrons are damaged =
half of all nephrons are often damaged in acute renal failure in CKD about 90% of nephrons are
typically involved
What additional information in Judy's history may be related to the onset of ESRD?
A) Hypertension
B) Polycystic Kidney Disease
C) Hysterectomy at age 35
D) Female gender
E) African-American ethnicity
F) Hypertension - ANS E + F
,African American ethnicity = African American clients are more likely to develop ESKD and have
hypertensive ESKD
Hypertension
Polycystic Kidney Disease = Polycystic kidney disease gene mutation will develop kidney cysts
by age 30 half of these people develop CKD by age 50
-hysterectomy at age 35 =
this is not a risk factor for CKD
-Female gender = CKD does not seem to be more common in either gender
-HTN = hypertension is one of the primary causes of CKD the vast majority of clients with CKD
have hypertension which may be either the cause or the result of CKD
Which lab value is likely to be decreased in a client with chronic kidney disease?
-Serum K+
-Serum BUN and Creatinine
-Serum Ca+
-Serum Phosphorous - ANS Serum calcium = Serum calcium is decreased in CKD in response
to an increase in serum phosphorus
-serum potassium levels are increased in CKD as the kidney loses the ability to remove
potassium from the body clients with CKD should be assessed carefully for symptoms of
hyperkalemia
- serum creatinine and BUN are tests which evaluate the removal of nitrogenous wastes by the
kidney. Both are increased in CKD although BUN levels are directly impacted by protein intake
hydration status and other factors
- serum phosphorus is increased as less phosphorus is excreted by the kidney
Judy's hemoglobin level is 7.8. Which underlying pathology does the nurse recognize as the
cause of this abnormal lab value?
-Fewer red blood cells are being formed
-hematuria results in blood loss
-renal waste products destroy red blood cells
-dehydration causes dilutional anemia - ANS Fewer red blood cells are being formed =
hemoglobin is decreased as the kidneys become less able to produce erythropoietin necessary
for the formation of red blood cells
-hematuria results in blood loss = CKD does not result in hematuria
-renal waste products destroy red blood cells = this does not occur in CKD
-dehydration causes dilutional anemia = if dehydration occurred it would be likely to result in a
high hemoglobin level rather than a low level
,What is the correct interpretation of these ABGs?
Metabolic acidosis (compensated)
respiratory alkalosis (compensated)
metabolic alkalosis (compensated)
respiratory acidosis (compensated) - ANS Metabolic acidosis (compensated) = an excessive
bicarbonate is excreted, the HCO3 level decreases causing metabolic acidosis (decreased pH).
compensation occurs when an increased rate and depth of respirations reduce the CO2 levels
returning the pH to low normal
- alkalosis would be indicated by an increased pH rather than decreased pH
-respiratory acidosis (compensated) = this is a compensated acidosis but if it were respiratory in
nature the CO2, would be elevated rather than decreased
Which additional assessment finding is consistent with ESRD?
A) Clay colored stool
b) tall tented T waves on c) electrocardiogram
d) decrease attention span
e) stridor
f) yellow Gray pallor - ANS B, D, F
Tall tented T waves on electrocardiogram = potassium excretion occurs mainly through the
kidney. any increase in potassium load during the later stages of CKD can lead to hyperkalemia
(high serum potassium levels)
Decreased attention span = problems ranging from lethargy to seizures or coma which may
indicate uremic encephalopathy
Yellow-gray pallor = the client with ESRD often exhibits a yellow Gray pallor as the result of
anemia and uremia. in addition the client with ESRD may exhibit other skin manifestations such
as bruising and uremic frost (a very late manifestation)
- Stridor is a crowing respiratory noise due to bronchoconstriction it is not an expected finding in
ESRD
- Clay-colored stools = not a manifestation seen in ESRD
Which explanation best describes the pathology resulting in her hypertension?
-An increase in the excretion of sodium and water from the kidneys causes hypertension
-activation of the renin angiotensin cycle and excretion of aldosterone causes hypertension
-the increase of uremic waste products in the bloodstream increase the blood pressure
, -irritation of the pericardial lining of the heart due to uremic toxins increases the blood pressure -
ANS Activation of the renin-angiotensin cycle and excretion of aldosterone causes hypertension
= the renin angiotensin cycle causes vasoconstriction of the periphery which increases the
blood pressure. in addition the excretion of aldosterone causes the retention of sodium and
water further increasing the fluid volume which increases the blood pressure
- An increase in the excretion of sodium and water from the kidneys causes hypertension =
hypertension would be caused by an increase in the retention of sodium and water rather than
an increase in the excretion
- the increase of uremic waste products in the bloodstream increase the blood pressure = this is
the probable cause for gastrointestinal manifestations such as anorexia, nausea and vomiting
-irritation of the pericardial lining of the heart due to uremic toxins increases the blood pressure
= explains the cause of pericarditis
Which assessment finding indicates to the nurse that the desired outcome of the calcium
acetate (PhosLo) has been achieved?
Serum hemoglobin of 12 g/dL
serum glucose of 90 mg/dL
serum phosphorus of 4.0 mg/dL
Serum hematocrit of 32% - ANS Serum phosphorous of 4.0 mg/dL = calcium acetate (PhosLo)
acts as a phosphate binder reducing the high serum phosphorus levels commonly found in the
client with CKD
-hemoglobin and hematocrit are not affected by the use of PhosLo
- serum glucose of 90 mg/dL = this normal glucose level is managed with the clients glipizide
(Glucotrol)
Which assessment should the nurse perform to determine if the desired outcome of the
captopril (Capoten) has been achieved?
Blood pressure
Intake and output
apical pulse
finger stick glucose - ANS Blood pressure = captopril (Capoten) is an ACE inhibitor used as an
antihypertensive agent
-Intake and output = this would be an approximate assessment measure for a diuretic such as
furosemide (lasix) but not for captopril
- Apical pulse = this does not provide data as to the desired outcome of the captopril
-finger stick glucose = this would be an appropriate assessment measure for a hypoglycemic
agent such as glipizide (Glucotrol) but not for captopril
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