HESI Case Study - Chronic Kidney Disease
Questions and Answers
Question 1
The client's arterial blood gas (ABG) results are:
pH 7.35
PO2 96.0 mmHg
PCO2 30.0 mmHg
HCO3 18.0 mEq/L (18 mmol/L)
What is the correct interpretation of these ABGs?
Correct Answer
Metabolic acidosis (compensated).
As 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.
Question 2
Nursing Diagnoses and Interventions
Correct Answer
The client is admitted to an acute care facility for management of end-stage renal
disease (ESRD). The nursing plan of care includes these nursing problems:
Excess fluid volume
Inpaired gas exchange
Decreased cardiac output
Inadequate nutrition
Risk for infection
Risk for injury
Fatigue
Anxiety
Constipation
Knowledge deficit
Page 1 of 19
,Question 3
The nurse determines that the client is demonstrating progression of chronic kidney
disease and is uremic.
The nurse is teaching the client about progression of chronic kidney disease (CKD).
Which evaluation statement documented by the nurse indicates the client's
understanding of the disease process?
Correct Answer
The client acknowledges that renal replacement therapy will need to be initiated
immediately to rid the body of waste and maintain fluid balance.
CKD is fatal unless some form of renal replacement therapy such as dialysis or
organ transplantation is done.
Question 4
The nurse reviews the client's medical history. What part of the medical history should
the nurse consider relevant to the client's current history?
Correct Answer
Hypertension.
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.
Polycystic kidney disease.
PKD gene mutation will develop kidney cysts by age 30. Half of these people
develop chronic kidney disease (CKD) by age 50 years.
Diabetes Mellitus.
Uncontrolled diabetes is a leading causative factor in renal disease.
Question 5
Which action can be assigned to the unlicensed assistive personnel (UAP)?
Correct Answer
Measure the client's urinary output.
This task may be assigned to the UAP.
Page 2 of 19
, Question 6
The nurse recognizes that client's family member is grieving with their expression of
anger.
What is the best nursing intervention for the family member's anger?
Correct Answer
Encourage the family member to share frustration regarding the loss of the kidney
Allowing the family member the opportunity to verbalize anger will help to work
through the anger.
Question 7
Vascular Access Devices
Correct Answer
The client decides that hemodialysis is the preferred modality of renal replacement
therapy. An arteriovenous (AV) graft is surgically placed in the right forearm, and a
dual-lumen hemodialysis catheter is placed for temporary use until the permanent
AV graft site heals.
While assessing the client's AV graft site, the nurse palpates a buzzing sensation
directly over the graft.
Question 8
Pharmacologic Management
Correct Answer
The client receives prescriptions for the following medications:
Calcium acetate: 2 gelcaps (667 mg each) by mouth with each meal.
Ferrous sulfate: 1 tablet (65 mg) by mouth daily.
Epoetin alfa: 3900 units subcutaneously 3 times per week (dosed at 75 U/kg three
times a week).
Glipizide: 10 mg by mouthdaily 30 minutes before breakfast.
Furosemide: 40 mg by mouth twice daily.
Losartan: 50 mg by mouth twice daily.
Potassium chloride elixir: 40 mEq by mouth three times daily.
Page 3 of 19
Questions and Answers
Question 1
The client's arterial blood gas (ABG) results are:
pH 7.35
PO2 96.0 mmHg
PCO2 30.0 mmHg
HCO3 18.0 mEq/L (18 mmol/L)
What is the correct interpretation of these ABGs?
Correct Answer
Metabolic acidosis (compensated).
As 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.
Question 2
Nursing Diagnoses and Interventions
Correct Answer
The client is admitted to an acute care facility for management of end-stage renal
disease (ESRD). The nursing plan of care includes these nursing problems:
Excess fluid volume
Inpaired gas exchange
Decreased cardiac output
Inadequate nutrition
Risk for infection
Risk for injury
Fatigue
Anxiety
Constipation
Knowledge deficit
Page 1 of 19
,Question 3
The nurse determines that the client is demonstrating progression of chronic kidney
disease and is uremic.
The nurse is teaching the client about progression of chronic kidney disease (CKD).
Which evaluation statement documented by the nurse indicates the client's
understanding of the disease process?
Correct Answer
The client acknowledges that renal replacement therapy will need to be initiated
immediately to rid the body of waste and maintain fluid balance.
CKD is fatal unless some form of renal replacement therapy such as dialysis or
organ transplantation is done.
Question 4
The nurse reviews the client's medical history. What part of the medical history should
the nurse consider relevant to the client's current history?
Correct Answer
Hypertension.
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.
Polycystic kidney disease.
PKD gene mutation will develop kidney cysts by age 30. Half of these people
develop chronic kidney disease (CKD) by age 50 years.
Diabetes Mellitus.
Uncontrolled diabetes is a leading causative factor in renal disease.
Question 5
Which action can be assigned to the unlicensed assistive personnel (UAP)?
Correct Answer
Measure the client's urinary output.
This task may be assigned to the UAP.
Page 2 of 19
, Question 6
The nurse recognizes that client's family member is grieving with their expression of
anger.
What is the best nursing intervention for the family member's anger?
Correct Answer
Encourage the family member to share frustration regarding the loss of the kidney
Allowing the family member the opportunity to verbalize anger will help to work
through the anger.
Question 7
Vascular Access Devices
Correct Answer
The client decides that hemodialysis is the preferred modality of renal replacement
therapy. An arteriovenous (AV) graft is surgically placed in the right forearm, and a
dual-lumen hemodialysis catheter is placed for temporary use until the permanent
AV graft site heals.
While assessing the client's AV graft site, the nurse palpates a buzzing sensation
directly over the graft.
Question 8
Pharmacologic Management
Correct Answer
The client receives prescriptions for the following medications:
Calcium acetate: 2 gelcaps (667 mg each) by mouth with each meal.
Ferrous sulfate: 1 tablet (65 mg) by mouth daily.
Epoetin alfa: 3900 units subcutaneously 3 times per week (dosed at 75 U/kg three
times a week).
Glipizide: 10 mg by mouthdaily 30 minutes before breakfast.
Furosemide: 40 mg by mouth twice daily.
Losartan: 50 mg by mouth twice daily.
Potassium chloride elixir: 40 mEq by mouth three times daily.
Page 3 of 19
