Western Governors University D 440
HESI Case Study - Chronic Kidney Disease Questions Verified and
Provided with A+ Graded Answers Latest Updated 2026
Meet the client The client is an older adult with a long history of type 2 diabetes
mellitus and hypertension. The client record notes a family history of
polycystic kidney disease (PKD). The client was diagnosed with stage 4
chronic kidney disease (CKD) two years ago. The client calls the
nephrology office to speak to the clinic nurse. The client reports loss of
appetite, fatigue, nocturia, and occasional shortness of breath.
Etiology The client's current medications include a angiotension receptor
blocker (ARB), a diuretic, and an oral diabetic medication. The
client's most recent lab work (3 months ago) includes:
Hemoglobin: 10.5 g/dL (105 g/L)
Hematocrit: 30.0% (0.3 proportion of 1.0)
Creatinine: 2.25 mg/dL (171.56 mcmol/L)
Blood Urea Nitrogen (BUN): 25 mg/dL (8.92 mmol/L)
Glomerular Filtration Rate (GFR): 28 mL/min/1.73m2
Sodium: 132 mEq/L (132 mmol/L)
Potassium: 3.8 mEq/L (3.8 mmol/L)
Calcium: 8.9 mg/dL (2.23 mmol/L)
Phosphorus: 4.0 mg/dL (1.29 mmol/L)
Parathyroid Hormone (PTH): 98 pg/mL (98 ng/L)
The nurse reviews the client's medical history. What Hypertension.
part of the medical history should the nurse Hypertension is one of the primary causes of CKD. The vast majority
of consider relevant to the client's current history? 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.
Which additional symptoms should the nurse ask Nausea
about? Ammonia is a breakdown product of urea. When ammonia
accumulates in the gastrointestinal tract, it causes irritation, nausea,
vomiting, a
metallic taste in the mouth, and bleeding.
Decreased attention span.
Problems ranging from lethargy to seizures or coma, which may indicate
uremic encephalopathy.
Itching
Calcium phosphate crystals and urea accumulate in the skin,
causing itching.
Based on the client's symptoms, what should the The client has uremia and may need to start dialysis.
nurse suspect? Classic signs of uremia are nausea, vomiting, fatigue, weight loss,
anorexia, muscle cramps, pruritis, and a change in mental status.
, The nurse determines that the client is The client acknowledges that renal replacement therapy will need to be
demonstrating progression of chronic kidney initiated immediately to rid the body of waste and maintain fluid
disease and is uremic. balance.
CKD is fatal unless some form of renal replacement therapy such
as The nurse is teaching the client about progression dialysis or organ transplantation is done.
of chronic kidney disease (CKD). Which
evaluation statement documented by the nurse
indicates the client's understanding of the
disease process?
Diagnostic evaluation The nurse contacts the healthcare provider (HCP) regarding the
client's symptoms. The HCP orders laboratory testing.
The following diagnostic tests are performed and results are as follows:
Hemoglobin: 7.8 g/dL (78 g/L)
Hematocrit: 30% (0.30 proportion of 1.0)
Creatinine: 4.5 mg/dL (397.80 mcmol/L)
Blood urea nitrogen (BUN): 100 mg/dL (35.7 mmol/L)
Glomerular filtration rate (GFR): 9 mL/min/1.73m2
Sodium: 135 mEql/L (135 mmol/L)
Potassium: 5.5 mEq/L (5.5 mmol/L)
Calcium: 9.2 mg/dL (2.3 mmol/L)
Phosphorus: 5.5 mg/dL (1.78 mmol/L)
Parathyroid hormone: 182 pg/mL (182 mg/L)
Arterial blood gases: pH 7.35, PO2 96 mmHg, PCO2 30 mmHg, HCO3
18 mEq/L (18 mmol/L)
Which lab value would the nurse be most Glomerular filtration rate (GFR) of 9 mL/min/1.73m2.
concerned about? Estimated glomerular filtration rate (GFR) is the best test to measure
level of kidney function and determine stage of kidney disease.
The client's hemoglobin level is 7.8 g/dL (78 g/L). Obtain an order to start an erythropoietin stimulating agent (ESA).
What action should the nurse take? Hemoglobin is decreased as the kidneys become less able to produce
erythropoietin necessary for the formation of red blood cells. ESA's will
replace the erythropoietin levels.
The client's arterial blood gas (ABG) results are: Metabolic acidosis (compensated).
pH 7.35 As excessive bicarbonate is excreted, the HCO3 level decreases,
PO2 96.0 mmHg causing metabolic acidosis (decreased pH). Compensation occurs when
PCO2 30.0 mmHg an increased rate and depth of respirations reduce the CO2 levels,
HCO3 18.0 mEq/L (18 mmol/L) returning the pH to low normal.
What is the correct interpretation of these ABGs?
Clinical Manifestation The 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 blood pressure 178/92 mmHg.
HESI Case Study - Chronic Kidney Disease Questions Verified and
Provided with A+ Graded Answers Latest Updated 2026
Meet the client The client is an older adult with a long history of type 2 diabetes
mellitus and hypertension. The client record notes a family history of
polycystic kidney disease (PKD). The client was diagnosed with stage 4
chronic kidney disease (CKD) two years ago. The client calls the
nephrology office to speak to the clinic nurse. The client reports loss of
appetite, fatigue, nocturia, and occasional shortness of breath.
Etiology The client's current medications include a angiotension receptor
blocker (ARB), a diuretic, and an oral diabetic medication. The
client's most recent lab work (3 months ago) includes:
Hemoglobin: 10.5 g/dL (105 g/L)
Hematocrit: 30.0% (0.3 proportion of 1.0)
Creatinine: 2.25 mg/dL (171.56 mcmol/L)
Blood Urea Nitrogen (BUN): 25 mg/dL (8.92 mmol/L)
Glomerular Filtration Rate (GFR): 28 mL/min/1.73m2
Sodium: 132 mEq/L (132 mmol/L)
Potassium: 3.8 mEq/L (3.8 mmol/L)
Calcium: 8.9 mg/dL (2.23 mmol/L)
Phosphorus: 4.0 mg/dL (1.29 mmol/L)
Parathyroid Hormone (PTH): 98 pg/mL (98 ng/L)
The nurse reviews the client's medical history. What Hypertension.
part of the medical history should the nurse Hypertension is one of the primary causes of CKD. The vast majority
of consider relevant to the client's current history? 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.
Which additional symptoms should the nurse ask Nausea
about? Ammonia is a breakdown product of urea. When ammonia
accumulates in the gastrointestinal tract, it causes irritation, nausea,
vomiting, a
metallic taste in the mouth, and bleeding.
Decreased attention span.
Problems ranging from lethargy to seizures or coma, which may indicate
uremic encephalopathy.
Itching
Calcium phosphate crystals and urea accumulate in the skin,
causing itching.
Based on the client's symptoms, what should the The client has uremia and may need to start dialysis.
nurse suspect? Classic signs of uremia are nausea, vomiting, fatigue, weight loss,
anorexia, muscle cramps, pruritis, and a change in mental status.
, The nurse determines that the client is The client acknowledges that renal replacement therapy will need to be
demonstrating progression of chronic kidney initiated immediately to rid the body of waste and maintain fluid
disease and is uremic. balance.
CKD is fatal unless some form of renal replacement therapy such
as The nurse is teaching the client about progression dialysis or organ transplantation is done.
of chronic kidney disease (CKD). Which
evaluation statement documented by the nurse
indicates the client's understanding of the
disease process?
Diagnostic evaluation The nurse contacts the healthcare provider (HCP) regarding the
client's symptoms. The HCP orders laboratory testing.
The following diagnostic tests are performed and results are as follows:
Hemoglobin: 7.8 g/dL (78 g/L)
Hematocrit: 30% (0.30 proportion of 1.0)
Creatinine: 4.5 mg/dL (397.80 mcmol/L)
Blood urea nitrogen (BUN): 100 mg/dL (35.7 mmol/L)
Glomerular filtration rate (GFR): 9 mL/min/1.73m2
Sodium: 135 mEql/L (135 mmol/L)
Potassium: 5.5 mEq/L (5.5 mmol/L)
Calcium: 9.2 mg/dL (2.3 mmol/L)
Phosphorus: 5.5 mg/dL (1.78 mmol/L)
Parathyroid hormone: 182 pg/mL (182 mg/L)
Arterial blood gases: pH 7.35, PO2 96 mmHg, PCO2 30 mmHg, HCO3
18 mEq/L (18 mmol/L)
Which lab value would the nurse be most Glomerular filtration rate (GFR) of 9 mL/min/1.73m2.
concerned about? Estimated glomerular filtration rate (GFR) is the best test to measure
level of kidney function and determine stage of kidney disease.
The client's hemoglobin level is 7.8 g/dL (78 g/L). Obtain an order to start an erythropoietin stimulating agent (ESA).
What action should the nurse take? Hemoglobin is decreased as the kidneys become less able to produce
erythropoietin necessary for the formation of red blood cells. ESA's will
replace the erythropoietin levels.
The client's arterial blood gas (ABG) results are: Metabolic acidosis (compensated).
pH 7.35 As excessive bicarbonate is excreted, the HCO3 level decreases,
PO2 96.0 mmHg causing metabolic acidosis (decreased pH). Compensation occurs when
PCO2 30.0 mmHg an increased rate and depth of respirations reduce the CO2 levels,
HCO3 18.0 mEq/L (18 mmol/L) returning the pH to low normal.
What is the correct interpretation of these ABGs?
Clinical Manifestation The 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 blood pressure 178/92 mmHg.
