CARDIAC CASE STUDY NGN EXAM
QUESTIONS WITH 100% CORRECT
ANSWERS | LATEST VERSION 2025/2026.
A 49-year-old client is seen in clinic for a follow-up visit since starting enalapril for primary
hypertension at her last visit 1 month ago. She reports nausea and diarrhea for the past few
weeks and is not sure what is causing these symptoms because she has implemented various
lifestyle changes. She has a medical history significant for dyslipidemia, which is treated with
simvastatin, and type 2 diabetes mellitus, which is managed with insulin. Since her last visit, she
has increased exercise, uses potassium supplements instead of sodium when cooking, and has
eliminated alcohol. Vital signs are temperature of 98.6°F (37°C), heart rate of 80 beats per
minute, respiratory rate of 20 breaths per minute, blood pressure of 126/78, and pulse
oximetry reading of 97%. - ANS Laboratory Value
Today's Result
Result From 1 Month Ago
Reference Range
Alanine aminotransferase (ALT)
17 U/L
19 U/L
4 to 36 U/L
Aspartate aminotransferase (AST)
20 U/L
21 U/L
1 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED
, 0 to 35 U/L
Serum creatinine (Scr)
0.9 mg/dL
1.0 mg/dL
0.5 to 1.1 mg/dL
Potassium
5.2 mEq/L
4.9 mEq/L
3.5 to 5.0 mEq/L
The patient developed HYPERKALEMIA - ANS As evidence by change in POTASSIUM
Rationale - ANS Angiotensin-converting enzyme (ACE) inhibitors, such as enalapril, may
cause hyperkalemia or elevated potassium levels secondary to suppression of aldosterone
release. This client has developed hyperkalemia, as noted by the increase in the client's
potassium level (i.e., from 4.9 mEq/L to 5.2 mEq/L), which is now above the upper limit of
normal (i.e., 5.0 mEq/L). Additionally, the client has reported nausea and diarrhea, symptoms
suggestive of hyperkalemia, within the time frame of initiating enalapril and lifestyle changes.
Notably, the client reports using potassium supplements instead of sodium for cooking as a
means of reducing her sodium intake. Clients who are started on ACE inhibitors should be
advised to avoid salt substitutes that contain potassium in order to reduce the risk for
hyperkalemia. In addition to her current symptoms, hyperkalemia may cause cardiovascular
effects, such as abnormal heart rhythms, which can potentially be fatal. The client does not
have evidence of liver dysfunction because her AST and ALT values are within normal limits. The
client also does not have evidence of renal impairment. Her serum creatinine remains within
the normal range. The client does not have uncontrolled hypertension because her blood
pressure reading is not elevated according to the various evidence-based blood pressure goals.
Patient 2
Glucose
2 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED
QUESTIONS WITH 100% CORRECT
ANSWERS | LATEST VERSION 2025/2026.
A 49-year-old client is seen in clinic for a follow-up visit since starting enalapril for primary
hypertension at her last visit 1 month ago. She reports nausea and diarrhea for the past few
weeks and is not sure what is causing these symptoms because she has implemented various
lifestyle changes. She has a medical history significant for dyslipidemia, which is treated with
simvastatin, and type 2 diabetes mellitus, which is managed with insulin. Since her last visit, she
has increased exercise, uses potassium supplements instead of sodium when cooking, and has
eliminated alcohol. Vital signs are temperature of 98.6°F (37°C), heart rate of 80 beats per
minute, respiratory rate of 20 breaths per minute, blood pressure of 126/78, and pulse
oximetry reading of 97%. - ANS Laboratory Value
Today's Result
Result From 1 Month Ago
Reference Range
Alanine aminotransferase (ALT)
17 U/L
19 U/L
4 to 36 U/L
Aspartate aminotransferase (AST)
20 U/L
21 U/L
1 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED
, 0 to 35 U/L
Serum creatinine (Scr)
0.9 mg/dL
1.0 mg/dL
0.5 to 1.1 mg/dL
Potassium
5.2 mEq/L
4.9 mEq/L
3.5 to 5.0 mEq/L
The patient developed HYPERKALEMIA - ANS As evidence by change in POTASSIUM
Rationale - ANS Angiotensin-converting enzyme (ACE) inhibitors, such as enalapril, may
cause hyperkalemia or elevated potassium levels secondary to suppression of aldosterone
release. This client has developed hyperkalemia, as noted by the increase in the client's
potassium level (i.e., from 4.9 mEq/L to 5.2 mEq/L), which is now above the upper limit of
normal (i.e., 5.0 mEq/L). Additionally, the client has reported nausea and diarrhea, symptoms
suggestive of hyperkalemia, within the time frame of initiating enalapril and lifestyle changes.
Notably, the client reports using potassium supplements instead of sodium for cooking as a
means of reducing her sodium intake. Clients who are started on ACE inhibitors should be
advised to avoid salt substitutes that contain potassium in order to reduce the risk for
hyperkalemia. In addition to her current symptoms, hyperkalemia may cause cardiovascular
effects, such as abnormal heart rhythms, which can potentially be fatal. The client does not
have evidence of liver dysfunction because her AST and ALT values are within normal limits. The
client also does not have evidence of renal impairment. Her serum creatinine remains within
the normal range. The client does not have uncontrolled hypertension because her blood
pressure reading is not elevated according to the various evidence-based blood pressure goals.
Patient 2
Glucose
2 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED
