NURSING 101 - HESI RN Case Studies: Altered Nutrition, Constipation & Urinary Patterns 2026-2027 Edition
NURSING 101 — HESI RN Case Studies Examination
Altered Nutrition, Constipation & Urinary Patterns
Comprehensive 55-Question Case Study Examination Aligned with 2026–2027 HESI RN Testing Standards
Total Questions: 55 | Cognitive Distribution: 25% Recall · 50% Application · 25% Analysis | Format: HESI RN Case Study
Section Topic Question Range
1 Altered Nutrition Case Studies (Assessment, Interventions, & Evaluation) Q1 - Q25
2 Constipation Case Studies (Assessment, Interventions, & Evaluation) Q26 - Q40
3 Urinary Patterns Case Studies (Assessment, Interventions, & Evaluation) Q41 - Q50
4 Integrated Case Studies (Complex Scenarios Combining Multiple Systems) Q51 - Q55
Instructions to the Candidate: Each question presents a clinical case scenario followed by four options (A–D). Select
the single best answer based on HESI RN clinical judgment, evidence-based nursing practice, and current
NCLEX/HESI 2026–2027 standards. Rationales explaining the pathophysiologic basis and nursing reasoning are
provided immediately after each question for self-evaluation and remediation.
SECTION 1 — Altered Nutrition Case Studies (Q1–Q25)
Assessment, Interventions, & Evaluation
Case Scenario: Mrs. Eleanor Hayes, a 78-year-old widow, is admitted to the medical unit with a
3-week history of poor oral intake and a 12-lb unintentional weight loss. She reports living alone
since her husband’s death and eats "mostly tea and toast." Her current weight is 102 lb, height
5'4".
Q1: Using the HESI-recommended screening tool for older adults, which validated instrument should the
nurse use FIRST to identify Mrs. Hayes’s nutritional risk? [Application]
A. Body Mass Index (BMI) calculation alone
B. Mini Nutritional Assessment (MNA) [CORRECT]
C. Subjective Global Assessment (SGA)
D. Malnutrition Universal Screening Tool (MUST)
Correct Answer: B — Mini Nutritional Assessment (MNA)
Rationale
The Mini Nutritional Assessment (MNA) is the HESI-preferred, validated screening tool for adults 65+ because it
incorporates BMI, weight loss, mobility, psychological stress, dementia, and dietary intake into a single rapid
score. BMI alone does not detect sarcopenia or micronutrient deficits. SGA and MUST are valid but were
validated primarily in younger adults and inpatient populations; the MNA is the gold standard for
community-dwelling and hospitalized older adults.
Confidential - For NURSING 101 HESI Preparation Only Page 1
,NURSING 101 - HESI RN Case Studies: Altered Nutrition, Constipation & Urinary Patterns 2026-2027 Edition
Case Scenario: Mr. David Okafor, 54, is admitted for evaluation of progressive muscle wasting.
He weighs 145 lb and is 6'0" tall. He reports a 15% weight loss over 4 months without trying.
Q2: Calculate Mr. Okafor’s BMI and identify the correct HESI interpretation. [Analysis]
A. BMI 19.7 kg/m² - normal weight; weight loss is unrelated to nutrition
B. BMI 18.6 kg/m² - underweight; high risk for malnutrition
C. BMI 21.4 kg/m² - normal weight, but significant unintentional weight loss indicates malnutrition risk
[CORRECT]
D. BMI 24.1 kg/m² - overweight; weight loss is beneficial
Correct Answer: C — BMI 21.4 kg/m² - normal weight, but significant unintentional weight loss
indicates malnutrition risk
Rationale
BMI = weight (kg) / height (m)² = (.2046) / (1.83)² = 65..35 = 19.6 kg/m². Although the numeric value
falls at the lower end of the "normal" range (18.5–24.9), HESI emphasizes that an unintentional weight loss ≥
10% in 6 months is a hallmark indicator of malnutrition regardless of BMI. Option C captures both the calculation
and the clinical interpretation. Dismissing risk based on a normal BMI (option A) and misreading the value
(options B and D) reflect common calculation and reasoning errors.
Case Scenario: A nurse is completing a 24-hour dietary recall for Mrs. Yolanda Perez, 67, who
has type 2 diabetes. She reports: black coffee and a pastry for breakfast, a half sandwich and tea
for lunch, and a bowl of cereal with milk for dinner.
Q3: Which nursing analysis of the 24-hour recall is MOST accurate per HESI standards? [Analysis]
A. Adequate caloric intake but deficient in micronutrients
B. Caloric, protein, fiber, and micronutrient intake are all inadequate [CORRECT]
C. Adequate protein intake; deficient only in carbohydrates
D. Adequate caloric intake; only fluid intake needs improvement
Correct Answer: B — Caloric, protein, fiber, and micronutrient intake are all inadequate
Rationale
Mrs. Perez’s recall reveals inadequate calories, minimal protein (only milk and a half sandwich), negligible fiber
(no fruits, vegetables, or whole grains), and inadequate micronutrients. HESI emphasizes that a 24-hour recall
must be evaluated for total calories, macronutrient distribution, fiber, fluids, and micronutrient density. A single
recall is also a snapshot—the nurse should validate with a 3-day food diary before finalizing the plan of care.
Confidential - For NURSING 101 HESI Preparation Only Page 2
, NURSING 101 - HESI RN Case Studies: Altered Nutrition, Constipation & Urinary Patterns 2026-2027 Edition
Q4: Which clinical manifestation is the MOST reliable early indicator of protein-energy malnutrition
(PEM) in an adult patient? [Recall]
A. Decreased serum albumin level
B. Visible muscle wasting of temporalis and interosseous muscles [CORRECT]
C. Decreased transferrin level
D. Edema of the lower extremities
Correct Answer: B — Visible muscle wasting of temporalis and interosseous muscles
Rationale
HESI prioritizes physical assessment findings over serum markers for early malnutrition. Albumin has a long
half-life (~20 days) and is falsely lowered by inflammation, hydration, and liver disease; transferrin is similarly
affected. Edema reflects kwashiorkor-like late-stage PEM. Visible wasting of the temporalis, interosseous,
deltoid, and quadriceps muscles is the earliest reliable bedside indicator of protein-energy deficit. A focused
physical assessment—not a lab value—is the HESI gold standard for early identification.
Case Scenario: Mrs. Grace Nakamura, 82, is admitted with pneumonia. Her admission weight is
88 lb (a 14-lb loss in 2 months). She is confused, has a pressure ulcer on her sacrum, and her
oral intake is <50% of meals.
Q5: Which finding should the nurse recognize as placing Mrs. Nakamura at HIGHEST risk for
malnutrition per the HESI case-study risk profile? [Analysis]
A. Age greater than 80
B. Altered mental status with poor oral intake [CORRECT]
C. Presence of a pressure ulcer
D. Acute infection requiring antibiotics
Correct Answer: B — Altered mental status with poor oral intake
Rationale
While all four factors increase risk, HESI case-study logic requires the nurse to identify the factor with the
greatest immediate impact on nutritional intake and safety. Altered mental status combined with poor oral intake
directly threatens caloric and protein delivery, increases aspiration risk, and impairs the patient’s ability to
self-feed—an immediate, modifiable risk. Advanced age, infection, and pressure ulcers all raise metabolic
demand, but they are secondary to the direct inability to safely consume adequate nutrition.
Confidential - For NURSING 101 HESI Preparation Only Page 3
NURSING 101 — HESI RN Case Studies Examination
Altered Nutrition, Constipation & Urinary Patterns
Comprehensive 55-Question Case Study Examination Aligned with 2026–2027 HESI RN Testing Standards
Total Questions: 55 | Cognitive Distribution: 25% Recall · 50% Application · 25% Analysis | Format: HESI RN Case Study
Section Topic Question Range
1 Altered Nutrition Case Studies (Assessment, Interventions, & Evaluation) Q1 - Q25
2 Constipation Case Studies (Assessment, Interventions, & Evaluation) Q26 - Q40
3 Urinary Patterns Case Studies (Assessment, Interventions, & Evaluation) Q41 - Q50
4 Integrated Case Studies (Complex Scenarios Combining Multiple Systems) Q51 - Q55
Instructions to the Candidate: Each question presents a clinical case scenario followed by four options (A–D). Select
the single best answer based on HESI RN clinical judgment, evidence-based nursing practice, and current
NCLEX/HESI 2026–2027 standards. Rationales explaining the pathophysiologic basis and nursing reasoning are
provided immediately after each question for self-evaluation and remediation.
SECTION 1 — Altered Nutrition Case Studies (Q1–Q25)
Assessment, Interventions, & Evaluation
Case Scenario: Mrs. Eleanor Hayes, a 78-year-old widow, is admitted to the medical unit with a
3-week history of poor oral intake and a 12-lb unintentional weight loss. She reports living alone
since her husband’s death and eats "mostly tea and toast." Her current weight is 102 lb, height
5'4".
Q1: Using the HESI-recommended screening tool for older adults, which validated instrument should the
nurse use FIRST to identify Mrs. Hayes’s nutritional risk? [Application]
A. Body Mass Index (BMI) calculation alone
B. Mini Nutritional Assessment (MNA) [CORRECT]
C. Subjective Global Assessment (SGA)
D. Malnutrition Universal Screening Tool (MUST)
Correct Answer: B — Mini Nutritional Assessment (MNA)
Rationale
The Mini Nutritional Assessment (MNA) is the HESI-preferred, validated screening tool for adults 65+ because it
incorporates BMI, weight loss, mobility, psychological stress, dementia, and dietary intake into a single rapid
score. BMI alone does not detect sarcopenia or micronutrient deficits. SGA and MUST are valid but were
validated primarily in younger adults and inpatient populations; the MNA is the gold standard for
community-dwelling and hospitalized older adults.
Confidential - For NURSING 101 HESI Preparation Only Page 1
,NURSING 101 - HESI RN Case Studies: Altered Nutrition, Constipation & Urinary Patterns 2026-2027 Edition
Case Scenario: Mr. David Okafor, 54, is admitted for evaluation of progressive muscle wasting.
He weighs 145 lb and is 6'0" tall. He reports a 15% weight loss over 4 months without trying.
Q2: Calculate Mr. Okafor’s BMI and identify the correct HESI interpretation. [Analysis]
A. BMI 19.7 kg/m² - normal weight; weight loss is unrelated to nutrition
B. BMI 18.6 kg/m² - underweight; high risk for malnutrition
C. BMI 21.4 kg/m² - normal weight, but significant unintentional weight loss indicates malnutrition risk
[CORRECT]
D. BMI 24.1 kg/m² - overweight; weight loss is beneficial
Correct Answer: C — BMI 21.4 kg/m² - normal weight, but significant unintentional weight loss
indicates malnutrition risk
Rationale
BMI = weight (kg) / height (m)² = (.2046) / (1.83)² = 65..35 = 19.6 kg/m². Although the numeric value
falls at the lower end of the "normal" range (18.5–24.9), HESI emphasizes that an unintentional weight loss ≥
10% in 6 months is a hallmark indicator of malnutrition regardless of BMI. Option C captures both the calculation
and the clinical interpretation. Dismissing risk based on a normal BMI (option A) and misreading the value
(options B and D) reflect common calculation and reasoning errors.
Case Scenario: A nurse is completing a 24-hour dietary recall for Mrs. Yolanda Perez, 67, who
has type 2 diabetes. She reports: black coffee and a pastry for breakfast, a half sandwich and tea
for lunch, and a bowl of cereal with milk for dinner.
Q3: Which nursing analysis of the 24-hour recall is MOST accurate per HESI standards? [Analysis]
A. Adequate caloric intake but deficient in micronutrients
B. Caloric, protein, fiber, and micronutrient intake are all inadequate [CORRECT]
C. Adequate protein intake; deficient only in carbohydrates
D. Adequate caloric intake; only fluid intake needs improvement
Correct Answer: B — Caloric, protein, fiber, and micronutrient intake are all inadequate
Rationale
Mrs. Perez’s recall reveals inadequate calories, minimal protein (only milk and a half sandwich), negligible fiber
(no fruits, vegetables, or whole grains), and inadequate micronutrients. HESI emphasizes that a 24-hour recall
must be evaluated for total calories, macronutrient distribution, fiber, fluids, and micronutrient density. A single
recall is also a snapshot—the nurse should validate with a 3-day food diary before finalizing the plan of care.
Confidential - For NURSING 101 HESI Preparation Only Page 2
, NURSING 101 - HESI RN Case Studies: Altered Nutrition, Constipation & Urinary Patterns 2026-2027 Edition
Q4: Which clinical manifestation is the MOST reliable early indicator of protein-energy malnutrition
(PEM) in an adult patient? [Recall]
A. Decreased serum albumin level
B. Visible muscle wasting of temporalis and interosseous muscles [CORRECT]
C. Decreased transferrin level
D. Edema of the lower extremities
Correct Answer: B — Visible muscle wasting of temporalis and interosseous muscles
Rationale
HESI prioritizes physical assessment findings over serum markers for early malnutrition. Albumin has a long
half-life (~20 days) and is falsely lowered by inflammation, hydration, and liver disease; transferrin is similarly
affected. Edema reflects kwashiorkor-like late-stage PEM. Visible wasting of the temporalis, interosseous,
deltoid, and quadriceps muscles is the earliest reliable bedside indicator of protein-energy deficit. A focused
physical assessment—not a lab value—is the HESI gold standard for early identification.
Case Scenario: Mrs. Grace Nakamura, 82, is admitted with pneumonia. Her admission weight is
88 lb (a 14-lb loss in 2 months). She is confused, has a pressure ulcer on her sacrum, and her
oral intake is <50% of meals.
Q5: Which finding should the nurse recognize as placing Mrs. Nakamura at HIGHEST risk for
malnutrition per the HESI case-study risk profile? [Analysis]
A. Age greater than 80
B. Altered mental status with poor oral intake [CORRECT]
C. Presence of a pressure ulcer
D. Acute infection requiring antibiotics
Correct Answer: B — Altered mental status with poor oral intake
Rationale
While all four factors increase risk, HESI case-study logic requires the nurse to identify the factor with the
greatest immediate impact on nutritional intake and safety. Altered mental status combined with poor oral intake
directly threatens caloric and protein delivery, increases aspiration risk, and impairs the patient’s ability to
self-feed—an immediate, modifiable risk. Advanced age, infection, and pressure ulcers all raise metabolic
demand, but they are secondary to the direct inability to safely consume adequate nutrition.
Confidential - For NURSING 101 HESI Preparation Only Page 3
