HESI CASE STUDIES UPDATED EXAMS WITH
CORRECT ANSWERS
Judy Harrison is a 38-year-old African American female with a long history of
diabetes mellitus type 2 and hypertension. She has experienced renal
insufficiency for the last two years. Her current medications include an
angiotensin converting enzyme inhibitor (ACEI), a diuretic, and an oral
hypoglycemic agent. She reports to the nurse at the clinic that she has lost
her appetite and is very fatigued. She adds that she has to get up to go to
the bathroom several times during the night and has trouble catching her
breath at times. Her current weight is 114 lbs (51.7 kg). She is scheduled for
diagnostic studies to evaluate for the onset of end-stage renal disease
(ESRD). - ANSWER-Background for Chronic Kidney Disease HESI Case Study
Which explanation by the nurse is an accurate description of CKD?
-There are frequent exacerbations since half of all nephrons are damaged
-It is a fatal disorder unless renal replacement therapy is received.
-The condition has a rapid onset with frequent remissions
-symptoms are reversible with lifelong medication - ANSWER-It is a fatal
disorder unless renal replacement therapy is received.
CKD is fatal unless some form of renal replacement therapy dialysis or organ
transplant is done whereas acute renal failure has a good prognosis for the
return of kidney function if appropriate supportive care is provided during the
acute.
-symptoms are reversible with lifelong medication = chronic kidney disease
is progressive irreversible kidney injury acute renal failure may be reversible
with adequate supportive care during the acute episode
-The condition has a rapid onset with frequent remissions = acute renal
failure has a rapid onset but chronic kidney disease has a gradual onset
,occurring over months or years neither form of renal failure has frequent
periods of remission
-There are frequent exacerbations since half of all nephrons are damaged =
half of all nephrons are often damaged in acute renal failure in CKD about
90% of nephrons are typically involved
What additional information in Judy's history may be related to the onset of
ESRD?
A) Hypertension
B) Polycystic Kidney Disease
C) Hysterectomy at age 35
D) Female gender
E) African-American ethnicity
F) Hypertension - ANSWER-E + F
African American ethnicity = African American clients are more likely to
develop ESKD and have hypertensive ESKD
Hypertension
Polycystic Kidney Disease = Polycystic kidney disease gene mutation will
develop kidney cysts by age 30 half of these people develop CKD by age 50
-hysterectomy at age 35 =
this is not a risk factor for CKD
-Female gender = CKD does not seem to be more common in either gender
,-HTN = 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
Which lab value is likely to be decreased in a client with chronic kidney
disease?
-Serum K+
-Serum BUN and Creatinine
-Serum Ca+
-Serum Phosphorous - ANSWER-Serum calcium = Serum calcium is
decreased in CKD in response to an increase in serum phosphorus
-serum potassium levels are increased in CKD as the kidney loses the ability
to remove potassium from the body clients with CKD should be assessed
carefully for symptoms of hyperkalemia
- serum creatinine and BUN are tests which evaluate the removal of
nitrogenous wastes by the kidney. Both are increased in CKD although BUN
levels are directly impacted by protein intake hydration status and other
factors
- serum phosphorus is increased as less phosphorus is excreted by the
kidney
Judy's hemoglobin level is 7.8. Which underlying pathology does the nurse
recognize as the cause of this abnormal lab value?
-Fewer red blood cells are being formed
-hematuria results in blood loss
-renal waste products destroy red blood cells
, -dehydration causes dilutional anemia - ANSWER-Fewer red blood cells are
being formed = hemoglobin is decreased as the kidneys become less able to
produce erythropoietin necessary for the formation of red blood cells
-hematuria results in blood loss = CKD does not result in hematuria
-renal waste products destroy red blood cells = this does not occur in CKD
-dehydration causes dilutional anemia = if dehydration occurred it would be
likely to result in a high hemoglobin level rather than a low level
What is the correct interpretation of these ABGs?
Metabolic acidosis (compensated)
respiratory alkalosis (compensated)
metabolic alkalosis (compensated)
respiratory acidosis (compensated) - ANSWER-Metabolic acidosis
(compensated) = an 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
- alkalosis would be indicated by an increased pH rather than decreased pH
-respiratory acidosis (compensated) = this is a compensated acidosis but if it
were respiratory in nature the CO2, would be elevated rather than decreased
Which additional assessment finding is consistent with ESRD?
A) Clay colored stool
b) tall tented T waves on c) electrocardiogram
d) decrease attention span
CORRECT ANSWERS
Judy Harrison is a 38-year-old African American female with a long history of
diabetes mellitus type 2 and hypertension. She has experienced renal
insufficiency for the last two years. Her current medications include an
angiotensin converting enzyme inhibitor (ACEI), a diuretic, and an oral
hypoglycemic agent. She reports to the nurse at the clinic that she has lost
her appetite and is very fatigued. She adds that she has to get up to go to
the bathroom several times during the night and has trouble catching her
breath at times. Her current weight is 114 lbs (51.7 kg). She is scheduled for
diagnostic studies to evaluate for the onset of end-stage renal disease
(ESRD). - ANSWER-Background for Chronic Kidney Disease HESI Case Study
Which explanation by the nurse is an accurate description of CKD?
-There are frequent exacerbations since half of all nephrons are damaged
-It is a fatal disorder unless renal replacement therapy is received.
-The condition has a rapid onset with frequent remissions
-symptoms are reversible with lifelong medication - ANSWER-It is a fatal
disorder unless renal replacement therapy is received.
CKD is fatal unless some form of renal replacement therapy dialysis or organ
transplant is done whereas acute renal failure has a good prognosis for the
return of kidney function if appropriate supportive care is provided during the
acute.
-symptoms are reversible with lifelong medication = chronic kidney disease
is progressive irreversible kidney injury acute renal failure may be reversible
with adequate supportive care during the acute episode
-The condition has a rapid onset with frequent remissions = acute renal
failure has a rapid onset but chronic kidney disease has a gradual onset
,occurring over months or years neither form of renal failure has frequent
periods of remission
-There are frequent exacerbations since half of all nephrons are damaged =
half of all nephrons are often damaged in acute renal failure in CKD about
90% of nephrons are typically involved
What additional information in Judy's history may be related to the onset of
ESRD?
A) Hypertension
B) Polycystic Kidney Disease
C) Hysterectomy at age 35
D) Female gender
E) African-American ethnicity
F) Hypertension - ANSWER-E + F
African American ethnicity = African American clients are more likely to
develop ESKD and have hypertensive ESKD
Hypertension
Polycystic Kidney Disease = Polycystic kidney disease gene mutation will
develop kidney cysts by age 30 half of these people develop CKD by age 50
-hysterectomy at age 35 =
this is not a risk factor for CKD
-Female gender = CKD does not seem to be more common in either gender
,-HTN = 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
Which lab value is likely to be decreased in a client with chronic kidney
disease?
-Serum K+
-Serum BUN and Creatinine
-Serum Ca+
-Serum Phosphorous - ANSWER-Serum calcium = Serum calcium is
decreased in CKD in response to an increase in serum phosphorus
-serum potassium levels are increased in CKD as the kidney loses the ability
to remove potassium from the body clients with CKD should be assessed
carefully for symptoms of hyperkalemia
- serum creatinine and BUN are tests which evaluate the removal of
nitrogenous wastes by the kidney. Both are increased in CKD although BUN
levels are directly impacted by protein intake hydration status and other
factors
- serum phosphorus is increased as less phosphorus is excreted by the
kidney
Judy's hemoglobin level is 7.8. Which underlying pathology does the nurse
recognize as the cause of this abnormal lab value?
-Fewer red blood cells are being formed
-hematuria results in blood loss
-renal waste products destroy red blood cells
, -dehydration causes dilutional anemia - ANSWER-Fewer red blood cells are
being formed = hemoglobin is decreased as the kidneys become less able to
produce erythropoietin necessary for the formation of red blood cells
-hematuria results in blood loss = CKD does not result in hematuria
-renal waste products destroy red blood cells = this does not occur in CKD
-dehydration causes dilutional anemia = if dehydration occurred it would be
likely to result in a high hemoglobin level rather than a low level
What is the correct interpretation of these ABGs?
Metabolic acidosis (compensated)
respiratory alkalosis (compensated)
metabolic alkalosis (compensated)
respiratory acidosis (compensated) - ANSWER-Metabolic acidosis
(compensated) = an 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
- alkalosis would be indicated by an increased pH rather than decreased pH
-respiratory acidosis (compensated) = this is a compensated acidosis but if it
were respiratory in nature the CO2, would be elevated rather than decreased
Which additional assessment finding is consistent with ESRD?
A) Clay colored stool
b) tall tented T waves on c) electrocardiogram
d) decrease attention span
