HESI Case Study - Chronic Kidney Disease:Questions And Answers
- ansThe nurse held the medication. The healthcare provider (HCP) calls and instructs the nurse to discontinue
the potassium chloride. The HCP informs the nurse the client will need to start dialysis and he will be coming in
to discuss this with the client.
A Complication Occurs - ansOne week after surgery, the client is discharged home. Three days later, the client
calls the transplant office to speak to the nurse. The client complains of abdominal pain that has become
unbearable in the last couple of hours.
After the nurse completes the assessment, what findings are most important to report to the healthcare
provider (HCP) ? - ansBlood pressure of 178/92 mmHg.
Blood pressure is elevated. Client may require additional diuretic or antihypertensive therapy to get blood
pressure to normal range.
Respiratory rate of 28 breaths per minute.
Normal respiratory rate is 12-20 breaths per minute. Client has tachypnea and should be reported to the
healthcare provider for further evaluation.
Bibasilar crackles.
Client is experiencing fluid volume overload. Bibasilar crackles are a manifestation of the fluid volume overload.
Edema
Edema is an abnormal finding and should be reported to the physician.
Based on the client's symptoms, what should the nurse suspect? - ansThe client has uremia and may need to
start dialysis.
Classic signs of uremia are nausea, vomiting, fatigue, weight loss, anorexia, muscle cramps, pruritis, and a
change in mental status.
Based on the nurse's assessment, which assessment data supports the decision to administer pain medication
, as the first intervention? - ansPain rating of 6/10.
Pain was 2/10 prior to transport and is now 6/10. Client is experiencing an increase in intensity of the pain.
Heart rate of 102 beats/minute.
Heart rate may elevate when acute pain is present
Blood pressure of 132/76 mmHg.
Blood pressure increased from baseline prior to transfer. May be attributed to acute pain.
Based on these problems, which nursing intervention should be included in the client's plan of care? -
ansEncourage the client to ask questions and discuss fears about diagnosis.
An open atmosphere that allows for discussion can decrease anxiety. Facilitate discussions with family
members about the prognosis and the impact on lifestyle.
Case Outcome - ansThe client's family member is able to share frustration and anger with other family
members. In the meantime, the medical regimen of immunosuppressants is successful in reversing the organ
rejection, the client is discharged home with the support of family and the home care nursing agency.
The client returns to the transplant clinic in one week for follow up. The client expresses gratitude to have a
new kidney. The client plans to take good care of the kidney through careful management of the diabetes and
hypertension as well as taking the immunosuppression medications every day as directed. The client verbalizes
understanding of the need to continue to follow up with the transplant department and nephrologist.
Client Teaching: Dietary Management - ansThe client is tolerating dialysis and discharge is scheduled. The nurse
completes discharge teaching for the goal, "Client will manage diet effectively while receiving hemodialysis
three times a week."
Clinical Manifestation - ansThe client'sdiagnostic tests support the medical diagnosis of end-stage renal disease
(ESRD). The client is brought into the clinic to discuss laboratory results. The nurse assesses the client on arrival
to the clinic. In addition to the client's report of fatigue, anorexia, dyspnea, and nocturia, the nurse's focused
assessment findings include: +3 pedal edema, basilar crackles in both lungs, and clear, pale urine. The client's
vital signs: temperature 98.8° F (37.1° C), heart rate 86 beats/minute, respirations 28 breaths/minute, and
- ansThe nurse held the medication. The healthcare provider (HCP) calls and instructs the nurse to discontinue
the potassium chloride. The HCP informs the nurse the client will need to start dialysis and he will be coming in
to discuss this with the client.
A Complication Occurs - ansOne week after surgery, the client is discharged home. Three days later, the client
calls the transplant office to speak to the nurse. The client complains of abdominal pain that has become
unbearable in the last couple of hours.
After the nurse completes the assessment, what findings are most important to report to the healthcare
provider (HCP) ? - ansBlood pressure of 178/92 mmHg.
Blood pressure is elevated. Client may require additional diuretic or antihypertensive therapy to get blood
pressure to normal range.
Respiratory rate of 28 breaths per minute.
Normal respiratory rate is 12-20 breaths per minute. Client has tachypnea and should be reported to the
healthcare provider for further evaluation.
Bibasilar crackles.
Client is experiencing fluid volume overload. Bibasilar crackles are a manifestation of the fluid volume overload.
Edema
Edema is an abnormal finding and should be reported to the physician.
Based on the client's symptoms, what should the nurse suspect? - ansThe client has uremia and may need to
start dialysis.
Classic signs of uremia are nausea, vomiting, fatigue, weight loss, anorexia, muscle cramps, pruritis, and a
change in mental status.
Based on the nurse's assessment, which assessment data supports the decision to administer pain medication
, as the first intervention? - ansPain rating of 6/10.
Pain was 2/10 prior to transport and is now 6/10. Client is experiencing an increase in intensity of the pain.
Heart rate of 102 beats/minute.
Heart rate may elevate when acute pain is present
Blood pressure of 132/76 mmHg.
Blood pressure increased from baseline prior to transfer. May be attributed to acute pain.
Based on these problems, which nursing intervention should be included in the client's plan of care? -
ansEncourage the client to ask questions and discuss fears about diagnosis.
An open atmosphere that allows for discussion can decrease anxiety. Facilitate discussions with family
members about the prognosis and the impact on lifestyle.
Case Outcome - ansThe client's family member is able to share frustration and anger with other family
members. In the meantime, the medical regimen of immunosuppressants is successful in reversing the organ
rejection, the client is discharged home with the support of family and the home care nursing agency.
The client returns to the transplant clinic in one week for follow up. The client expresses gratitude to have a
new kidney. The client plans to take good care of the kidney through careful management of the diabetes and
hypertension as well as taking the immunosuppression medications every day as directed. The client verbalizes
understanding of the need to continue to follow up with the transplant department and nephrologist.
Client Teaching: Dietary Management - ansThe client is tolerating dialysis and discharge is scheduled. The nurse
completes discharge teaching for the goal, "Client will manage diet effectively while receiving hemodialysis
three times a week."
Clinical Manifestation - ansThe client'sdiagnostic tests support the medical diagnosis of end-stage renal disease
(ESRD). The client is brought into the clinic to discuss laboratory results. The nurse assesses the client on arrival
to the clinic. In addition to the client's report of fatigue, anorexia, dyspnea, and nocturia, the nurse's focused
assessment findings include: +3 pedal edema, basilar crackles in both lungs, and clear, pale urine. The client's
vital signs: temperature 98.8° F (37.1° C), heart rate 86 beats/minute, respirations 28 breaths/minute, and
