Evolve HESI EXAM A+ GRADE ASSURED COMPLETE SOLUTIONS AND VERIFIED ANSWERS

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Exam Solution vc




HESI CASE STUDIES 2026 A+ GRADE ASSURED COMPLE
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TE SOLUTIONS AND VERIFIED ANSWERS (C49B5)
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QUESTION 1 vc




What additional information in Judy's history may be related to the onset of ESRD?
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A) Hypertension
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B) Polycystic Kidney Disease
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C) Hysterectomy at age 35
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D) Female gender
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E) African-American ethnicity F) Hypertension
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ANSWER

E + F African American ethnicity = African American clients are more likely to develop ESKD and have h
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ypertensive ESKD Hypertension Polycystic Kidney Disease = Polycystic kidney disease gene mutation wi
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ll develop kidney cysts by age 30 half of these people develop CKD by age 50 -
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hysterectomy at age 35 = this is not a risk factor for CKD -
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Female gender = CKD does not seem to be more common in either gender -
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HTN = hypertension is one of the primary causes of CKD the vast majority of clients with CKD have hyp
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ertension which may be either the cause or the result of CKD
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QUESTION 2 vc




Which lab value is likely to be decreased in a client with chronic kidney disease? -
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Serum K+ -Serum BUN and Creatinine -Serum Ca+ -Serum Phosphorous
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ANSWER

Serum calcium = Serum calcium is decreased in CKD in response to an increase in serum phosphorus -
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serum potassium levels are increased in CKD as the kidney loses the ability to remove potassium from t
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he body clients with CKD should be assessed carefully for symptoms of hyperkalemia -
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serum creatinine and BUN are tests which evaluate the removal of nitrogenous wastes by the kidney. B
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oth are increased in CKD although BUN levels are directly impacted by protein intake hydration status a
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nd other factors - serum phosphorus is increased as less phosphorus is excreted by the kidney
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QUESTION 3 vc

,Judy's hemoglobin level is 7.8. Which underlying pathology does the nurse recognize as t
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he cause of this abnormal lab value? -Fewer red blood cells are being formed -
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hematuria results in blood loss -renal waste products destroy red blood cells -
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dehydration causes dilutional anemia vc vc vc




ANSWER

Fewer red blood cells are being formed = hemoglobin is decreased as the kidneys become less able to p
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roduce erythropoietin necessary for the formation of red blood cells -
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hematuria results in blood loss = CKD does not result in hematuria -
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renal waste products destroy red blood cells = this does not occur in CKD -
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dehydration causes dilutional anemia = if dehydration occurred it would be likely to result in a high he
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moglobin level rather than a low level vc vc vc vc vc vc




QUESTION 4 vc




What is the correct interpretation of these ABGs? Metabolic acidosis (compensated) resp
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iratory alkalosis (compensated) metabolic alkalosis (compensated) respiratory acidosis
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(compensated)
ANSWER

Metabolic acidosis (compensated) = an excessive bicarbonate is excreted, the HCO3 level decreases caus
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ing metabolic acidosis (decreased pH). compensation occurs when an increased rate and depth of respir
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ations reduce the CO2 levels returning the pH to low normal -
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alkalosis would be indicated by an increased pH rather than decreased pH -
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respiratory acidosis (compensated) = this is a compensated acidosis but if it were respiratory in nature
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the CO2, would be elevated rather than decreased
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QUESTION 5 vc




Which additional assessment finding is consistent with ESRD?
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A) Clay colored stool
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b) tall tented T waves on
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c) electrocardiogram
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d) decrease attention span
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e) stridor f) yellow Gray pallor
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ANSWER

B, D, F Tall tented T waves on electrocardiogram = potassium excretion occurs mainly through the kidn
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ey. any increase in potassium load during the later stages of CKD can lead to hyperkalemia (high serum
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potassium levels) Decreased attention span = problems ranging from lethargy to seizures or coma whic
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h may indicate uremic encephalopathy Yellow-
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gray pallor = the client with ESRD often exhibits a yellow Gray pallor as the result of anemia and uremia
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. in addition the client with ESRD may exhibit other skin manifestations such as bruising and uremic fro
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st (a very late manifestation) -
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Stridor is a crowing respiratory noise due to bronchoconstriction it is not an expected finding in ESRD -
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Clay-colored stools = not a manifestation seen in ESRD
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, QUESTION 6 vc




Which assessment finding indicates to the nurse that the desired outcome of the calcium
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acetate (PhosLo) has been achieved? Serum hemoglobin of 12 g/dL serum glucose of 90
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mg/dL serum phosphorus of 4.0 mg/dL Serum hematocrit of 32%
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ANSWER

Serum phosphorous of 4.0 mg/dL = calcium acetate (PhosLo) acts as a phosphate binder reducing the hi
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gh serum phosphorus levels commonly found in the client with CKD -
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hemoglobin and hematocrit are not affected by the use of PhosLo - vc vc vc vc vc vc vc vc vc vc vc



serum glucose of 90 mg/dL = this normal glucose level is managed with the clients glipizide (Glucotrol)
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QUESTION 7 vc




Which assessment should the nurse perform to determine if the desired outcome of the c
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aptopril (Capoten) has been achieved? Blood pressure Intake and output apical pulse fin
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ger stick glucose vc vc




ANSWER

Blood pressure = captopril (Capoten) is an ACE inhibitor used as an antihypertensive agent -
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Intake and output = this would be an approximate assessment measure for a diuretic such as furosemid
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e (lasix) but not for captopril -
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Apical pulse = this does not provide data as to the desired outcome of the captopril -
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finger stick glucose = this would be an appropriate assessment measure for a hypoglycemic agent such
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as glipizide (Glucotrol) but not for captopril
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QUESTION 8 vc




Which assessment data indicates to the nurse that the desired outcome of the epoetin alf
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a (Epogen) has been achieved? Conjunctival sac returns to a reddish-pink color Normo-
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active bowel sounds no evidence of edema consumed 100% of diet
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ANSWER

Conjunctival sac returns to a reddish- vc vc vc vc vc



pink color = this assessment finding reflects an improvement in the client's anemia. epogen stimulates t
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he production of RBCs resulting in an increase in hematocrit it is used to treat the anemia common in cl
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ients with CKD -Normo- vc vc vc



active bowel sounds = this is not an indicator for the desired outcome of epogen -
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no evidence of edema = this assessment finding is an indicator use to assess the effectiveness of a diure
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tic such as a furosemide (Lasix) but not epogen -
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consumed 100% of diet = this is not the best indicator that the desired outcome of a Epoetin has been
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achieved although an improvement in dietary intake may be a secondary benefit of a reduction in fatigu
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e