Cardiac Case Study NGN questions and
answers 2025\2026 A+ Grade
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%.
- correct answer 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
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
- correct answer As evidence by change in POTASSIUM
Rationale
- correct answer 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
Today: 89 mg/dL
Last: 84 mg/dL
GOAL: 74 to 106 mg/dL
Serum creatinine (Scr)
1.0 mg/dL
1.1 mg/dL
0.5 to 1.1 mg/dL
Potassium
answers 2025\2026 A+ Grade
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%.
- correct answer 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
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
- correct answer As evidence by change in POTASSIUM
Rationale
- correct answer 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
Today: 89 mg/dL
Last: 84 mg/dL
GOAL: 74 to 106 mg/dL
Serum creatinine (Scr)
1.0 mg/dL
1.1 mg/dL
0.5 to 1.1 mg/dL
Potassium
