HESI EXAM vc
Exam Solution vc
HESI CASE STUDIES 2026 A+ GRADE ASSURED COMPLE
vc vc vc vc vc vc vc
TE SOLUTIONS AND VERIFIED ANSWERS (C49B5)
vc vc vc vc vc
QUESTION 1 vc
What additional information in Judy's history may be related to the onset of ESRD?
vc vc vc vc vc vc vc vc vc vc vc vc vc
A) Hypertension
vc
B) Polycystic Kidney Disease
vc vc vc
C) Hysterectomy at age 35
vc vc vc vc
D) Female gender
vc vc
E) African-American ethnicity F) Hypertension
vc vc vc vc
ANSWER
E + F African American ethnicity = African American clients are more likely to develop ESKD and have h
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc
ypertensive ESKD Hypertension Polycystic Kidney Disease = Polycystic kidney disease gene mutation wi
vc vc vc vc vc vc vc vc vc vc vc vc
ll develop kidney cysts by age 30 half of these people develop CKD by age 50 -
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc
hysterectomy at age 35 = this is not a risk factor for CKD -
vc vc vc vc vc vc vc vc vc vc vc vc vc
Female gender = CKD does not seem to be more common in either gender -
vc vc vc vc vc vc vc vc vc vc vc vc vc vc
HTN = hypertension is one of the primary causes of CKD the vast majority of clients with CKD have hyp
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc
ertension which may be either the cause or the result of CKD
vc vc vc vc vc vc vc vc vc vc vc
QUESTION 2 vc
Which lab value is likely to be decreased in a client with chronic kidney disease? -
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc
Serum K+ -Serum BUN and Creatinine -Serum Ca+ -Serum Phosphorous
vc vc vc vc vc vc vc vc vc
ANSWER
Serum calcium = Serum calcium is decreased in CKD in response to an increase in serum phosphorus -
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc
serum potassium levels are increased in CKD as the kidney loses the ability to remove potassium from t
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc
he body clients with CKD should be assessed carefully for symptoms of hyperkalemia -
vc vc vc vc vc vc vc vc vc vc vc vc vc
serum creatinine and BUN are tests which evaluate the removal of nitrogenous wastes by the kidney. B
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc
oth are increased in CKD although BUN levels are directly impacted by protein intake hydration status a
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc
nd other factors - serum phosphorus is increased as less phosphorus is excreted by the kidney
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc
QUESTION 3 vc
,Judy's hemoglobin level is 7.8. Which underlying pathology does the nurse recognize as t
vc vc vc vc vc vc vc vc vc vc vc vc vc
he cause of this abnormal lab value? -Fewer red blood cells are being formed -
vc vc vc vc vc vc vc vc vc vc vc vc vc vc
hematuria results in blood loss -renal waste products destroy red blood cells -
vc vc vc vc vc vc vc vc vc vc vc vc
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
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc
roduce erythropoietin necessary for the formation of red blood cells -
vc vc vc vc vc vc vc vc vc vc
hematuria results in blood loss = CKD does not result in hematuria -
vc vc vc vc vc vc vc vc vc vc vc vc
renal waste products destroy red blood cells = this does not occur in CKD -
vc vc vc vc vc vc vc vc vc vc vc vc vc vc
dehydration causes dilutional anemia = if dehydration occurred it would be likely to result in a high he
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc
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
vc vc vc vc vc vc vc vc vc vc vc
iratory alkalosis (compensated) metabolic alkalosis (compensated) respiratory acidosis
vc vc vc vc vc vc vc vc
(compensated)
ANSWER
Metabolic acidosis (compensated) = an excessive bicarbonate is excreted, the HCO3 level decreases caus
vc vc vc vc vc vc vc vc vc vc vc vc vc
ing metabolic acidosis (decreased pH). compensation occurs when an increased rate and depth of respir
vc vc vc vc vc vc vc vc vc vc vc vc vc vc
ations reduce the CO2 levels returning the pH to low normal -
vc vc vc vc vc vc vc vc vc vc vc
alkalosis would be indicated by an increased pH rather than decreased pH -
vc vc vc vc vc vc vc vc vc vc vc vc vc
respiratory acidosis (compensated) = this is a compensated acidosis but if it were respiratory in nature
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc
the CO2, would be elevated rather than decreased
vc vc vc vc vc vc vc
QUESTION 5 vc
Which additional assessment finding is consistent with ESRD?
vc vc vc vc vc vc vc
A) Clay colored stool
vc vc vc
b) tall tented T waves on
vc vc vc vc vc
c) electrocardiogram
vc
d) decrease attention span
vc vc vc
e) stridor f) yellow Gray pallor
vc vc vc vc vc
ANSWER
B, D, F Tall tented T waves on electrocardiogram = potassium excretion occurs mainly through the kidn
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc
ey. any increase in potassium load during the later stages of CKD can lead to hyperkalemia (high serum
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc
potassium levels) Decreased attention span = problems ranging from lethargy to seizures or coma whic
vc vc vc vc vc vc vc vc vc vc vc vc vc vc
h may indicate uremic encephalopathy Yellow-
vc vc vc vc vc
gray pallor = the client with ESRD often exhibits a yellow Gray pallor as the result of anemia and uremia
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc
. in addition the client with ESRD may exhibit other skin manifestations such as bruising and uremic fro
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc
st (a very late manifestation) -
vc vc vc vc vc
Stridor is a crowing respiratory noise due to bronchoconstriction it is not an expected finding in ESRD -
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc
Clay-colored stools = not a manifestation seen in ESRD
vc vc vc vc vc vc vc vc vc
, QUESTION 6 vc
Which assessment finding indicates to the nurse that the desired outcome of the calcium
vc vc vc vc vc vc vc vc vc vc vc vc vc vc
acetate (PhosLo) has been achieved? Serum hemoglobin of 12 g/dL serum glucose of 90
vc vc vc vc vc vc vc vc vc vc vc vc vc vc
mg/dL serum phosphorus of 4.0 mg/dL Serum hematocrit of 32%
vc vc vc vc vc vc vc vc vc
ANSWER
Serum phosphorous of 4.0 mg/dL = calcium acetate (PhosLo) acts as a phosphate binder reducing the hi
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc
gh serum phosphorus levels commonly found in the client with CKD -
vc vc vc vc vc vc vc vc vc vc vc
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)
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc
QUESTION 7 vc
Which assessment should the nurse perform to determine if the desired outcome of the c
vc vc vc vc vc vc vc vc vc vc vc vc vc vc
aptopril (Capoten) has been achieved? Blood pressure Intake and output apical pulse fin
vc vc vc vc vc vc vc vc vc vc vc vc
ger stick glucose vc vc
ANSWER
Blood pressure = captopril (Capoten) is an ACE inhibitor used as an antihypertensive agent -
vc vc vc vc vc vc vc vc vc vc vc vc vc vc
Intake and output = this would be an approximate assessment measure for a diuretic such as furosemid
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc
e (lasix) but not for captopril -
vc vc vc vc vc vc
Apical pulse = this does not provide data as to the desired outcome of the captopril -
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc
finger stick glucose = this would be an appropriate assessment measure for a hypoglycemic agent such
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc
as glipizide (Glucotrol) but not for captopril
vc vc vc vc vc vc
QUESTION 8 vc
Which assessment data indicates to the nurse that the desired outcome of the epoetin alf
vc vc vc vc vc vc vc vc vc vc vc vc vc vc
a (Epogen) has been achieved? Conjunctival sac returns to a reddish-pink color Normo-
vc vc vc vc vc vc vc vc vc vc vc vc
active bowel sounds no evidence of edema consumed 100% of diet
vc vc vc vc vc vc vc vc vc vc
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
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc
he production of RBCs resulting in an increase in hematocrit it is used to treat the anemia common in cl
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc
ients with CKD -Normo- vc vc vc
active bowel sounds = this is not an indicator for the desired outcome of epogen -
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc
no evidence of edema = this assessment finding is an indicator use to assess the effectiveness of a diure
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc
tic such as a furosemide (Lasix) but not epogen -
vc vc vc vc vc vc vc vc vc
consumed 100% of diet = this is not the best indicator that the desired outcome of a Epoetin has been
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc
achieved although an improvement in dietary intake may be a secondary benefit of a reduction in fatigu
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc
e
Exam Solution vc
HESI CASE STUDIES 2026 A+ GRADE ASSURED COMPLE
vc vc vc vc vc vc vc
TE SOLUTIONS AND VERIFIED ANSWERS (C49B5)
vc vc vc vc vc
QUESTION 1 vc
What additional information in Judy's history may be related to the onset of ESRD?
vc vc vc vc vc vc vc vc vc vc vc vc vc
A) Hypertension
vc
B) Polycystic Kidney Disease
vc vc vc
C) Hysterectomy at age 35
vc vc vc vc
D) Female gender
vc vc
E) African-American ethnicity F) Hypertension
vc vc vc vc
ANSWER
E + F African American ethnicity = African American clients are more likely to develop ESKD and have h
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc
ypertensive ESKD Hypertension Polycystic Kidney Disease = Polycystic kidney disease gene mutation wi
vc vc vc vc vc vc vc vc vc vc vc vc
ll develop kidney cysts by age 30 half of these people develop CKD by age 50 -
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc
hysterectomy at age 35 = this is not a risk factor for CKD -
vc vc vc vc vc vc vc vc vc vc vc vc vc
Female gender = CKD does not seem to be more common in either gender -
vc vc vc vc vc vc vc vc vc vc vc vc vc vc
HTN = hypertension is one of the primary causes of CKD the vast majority of clients with CKD have hyp
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc
ertension which may be either the cause or the result of CKD
vc vc vc vc vc vc vc vc vc vc vc
QUESTION 2 vc
Which lab value is likely to be decreased in a client with chronic kidney disease? -
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc
Serum K+ -Serum BUN and Creatinine -Serum Ca+ -Serum Phosphorous
vc vc vc vc vc vc vc vc vc
ANSWER
Serum calcium = Serum calcium is decreased in CKD in response to an increase in serum phosphorus -
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc
serum potassium levels are increased in CKD as the kidney loses the ability to remove potassium from t
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc
he body clients with CKD should be assessed carefully for symptoms of hyperkalemia -
vc vc vc vc vc vc vc vc vc vc vc vc vc
serum creatinine and BUN are tests which evaluate the removal of nitrogenous wastes by the kidney. B
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc
oth are increased in CKD although BUN levels are directly impacted by protein intake hydration status a
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc
nd other factors - serum phosphorus is increased as less phosphorus is excreted by the kidney
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc
QUESTION 3 vc
,Judy's hemoglobin level is 7.8. Which underlying pathology does the nurse recognize as t
vc vc vc vc vc vc vc vc vc vc vc vc vc
he cause of this abnormal lab value? -Fewer red blood cells are being formed -
vc vc vc vc vc vc vc vc vc vc vc vc vc vc
hematuria results in blood loss -renal waste products destroy red blood cells -
vc vc vc vc vc vc vc vc vc vc vc vc
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
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc
roduce erythropoietin necessary for the formation of red blood cells -
vc vc vc vc vc vc vc vc vc vc
hematuria results in blood loss = CKD does not result in hematuria -
vc vc vc vc vc vc vc vc vc vc vc vc
renal waste products destroy red blood cells = this does not occur in CKD -
vc vc vc vc vc vc vc vc vc vc vc vc vc vc
dehydration causes dilutional anemia = if dehydration occurred it would be likely to result in a high he
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc
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
vc vc vc vc vc vc vc vc vc vc vc
iratory alkalosis (compensated) metabolic alkalosis (compensated) respiratory acidosis
vc vc vc vc vc vc vc vc
(compensated)
ANSWER
Metabolic acidosis (compensated) = an excessive bicarbonate is excreted, the HCO3 level decreases caus
vc vc vc vc vc vc vc vc vc vc vc vc vc
ing metabolic acidosis (decreased pH). compensation occurs when an increased rate and depth of respir
vc vc vc vc vc vc vc vc vc vc vc vc vc vc
ations reduce the CO2 levels returning the pH to low normal -
vc vc vc vc vc vc vc vc vc vc vc
alkalosis would be indicated by an increased pH rather than decreased pH -
vc vc vc vc vc vc vc vc vc vc vc vc vc
respiratory acidosis (compensated) = this is a compensated acidosis but if it were respiratory in nature
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc
the CO2, would be elevated rather than decreased
vc vc vc vc vc vc vc
QUESTION 5 vc
Which additional assessment finding is consistent with ESRD?
vc vc vc vc vc vc vc
A) Clay colored stool
vc vc vc
b) tall tented T waves on
vc vc vc vc vc
c) electrocardiogram
vc
d) decrease attention span
vc vc vc
e) stridor f) yellow Gray pallor
vc vc vc vc vc
ANSWER
B, D, F Tall tented T waves on electrocardiogram = potassium excretion occurs mainly through the kidn
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc
ey. any increase in potassium load during the later stages of CKD can lead to hyperkalemia (high serum
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc
potassium levels) Decreased attention span = problems ranging from lethargy to seizures or coma whic
vc vc vc vc vc vc vc vc vc vc vc vc vc vc
h may indicate uremic encephalopathy Yellow-
vc vc vc vc vc
gray pallor = the client with ESRD often exhibits a yellow Gray pallor as the result of anemia and uremia
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc
. in addition the client with ESRD may exhibit other skin manifestations such as bruising and uremic fro
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc
st (a very late manifestation) -
vc vc vc vc vc
Stridor is a crowing respiratory noise due to bronchoconstriction it is not an expected finding in ESRD -
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc
Clay-colored stools = not a manifestation seen in ESRD
vc vc vc vc vc vc vc vc vc
, QUESTION 6 vc
Which assessment finding indicates to the nurse that the desired outcome of the calcium
vc vc vc vc vc vc vc vc vc vc vc vc vc vc
acetate (PhosLo) has been achieved? Serum hemoglobin of 12 g/dL serum glucose of 90
vc vc vc vc vc vc vc vc vc vc vc vc vc vc
mg/dL serum phosphorus of 4.0 mg/dL Serum hematocrit of 32%
vc vc vc vc vc vc vc vc vc
ANSWER
Serum phosphorous of 4.0 mg/dL = calcium acetate (PhosLo) acts as a phosphate binder reducing the hi
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc
gh serum phosphorus levels commonly found in the client with CKD -
vc vc vc vc vc vc vc vc vc vc vc
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)
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc
QUESTION 7 vc
Which assessment should the nurse perform to determine if the desired outcome of the c
vc vc vc vc vc vc vc vc vc vc vc vc vc vc
aptopril (Capoten) has been achieved? Blood pressure Intake and output apical pulse fin
vc vc vc vc vc vc vc vc vc vc vc vc
ger stick glucose vc vc
ANSWER
Blood pressure = captopril (Capoten) is an ACE inhibitor used as an antihypertensive agent -
vc vc vc vc vc vc vc vc vc vc vc vc vc vc
Intake and output = this would be an approximate assessment measure for a diuretic such as furosemid
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc
e (lasix) but not for captopril -
vc vc vc vc vc vc
Apical pulse = this does not provide data as to the desired outcome of the captopril -
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc
finger stick glucose = this would be an appropriate assessment measure for a hypoglycemic agent such
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc
as glipizide (Glucotrol) but not for captopril
vc vc vc vc vc vc
QUESTION 8 vc
Which assessment data indicates to the nurse that the desired outcome of the epoetin alf
vc vc vc vc vc vc vc vc vc vc vc vc vc vc
a (Epogen) has been achieved? Conjunctival sac returns to a reddish-pink color Normo-
vc vc vc vc vc vc vc vc vc vc vc vc
active bowel sounds no evidence of edema consumed 100% of diet
vc vc vc vc vc vc vc vc vc vc
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
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc
he production of RBCs resulting in an increase in hematocrit it is used to treat the anemia common in cl
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc
ients with CKD -Normo- vc vc vc
active bowel sounds = this is not an indicator for the desired outcome of epogen -
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc
no evidence of edema = this assessment finding is an indicator use to assess the effectiveness of a diure
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc
tic such as a furosemide (Lasix) but not epogen -
vc vc vc vc vc vc vc vc vc
consumed 100% of diet = this is not the best indicator that the desired outcome of a Epoetin has been
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc
achieved although an improvement in dietary intake may be a secondary benefit of a reduction in fatigu
vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc vc
e
