HESI CASE STUDIES EXAM WITH CORRECT ANSWERS
Judy Harrison is a 38-year-old African American female with a long history of diabetes mellitus type 2 and
t t t t t t t t t t t t t t t t t t
hypertension. She has experienced renal insufficiency for the last two years. Her current medications include t t t t t t t t t t t t t t t
an angiotensin converting enzyme inhibitor (ACEI), a diuretic, and an oral hypoglycemic agent. She reports to
t t t t t t t t t t t t t t t t
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
t t t t t t t t t t t t t t t t t t t t t t t t t t
the bathroom several times during the night and has trouble catching her breath at times. Her current weight is
t t t t t t t t t t t t t t t t t t
114 lbs (51.7 kg). She is scheduled for diagnostic studies to evaluate for the onset of end-stage renal disease
t t t t t t t t t t t t t t t t t t t t
(ESRD). - correct answer Background for Chronic Kidney Disease HESI Case Study
t t t t t t t t t t t
Which explanation by the nurse is an accurate description of CKD?
t t t t t t t t t t
-There are frequent exacerbations since half of all nephrons are damaged
t t t t t t t t t t
-It is a fatal disorder unless renal replacement therapy is received.
t t t t t t t t t t
-The condition has a rapid onset with frequent remissions
t t t t t t t t
-symptoms are reversible with lifelong medication - correct answer It is a fatal disorder unless renal
t t t t t t t t t t t t t t t t
replacement therapy is received. t t t
CKD is fatal unless some form of renal replacement therapy dialysis or organ transplant is done whereas acute
t t t t t t t t t t t t t t t t t t
renal failure has a good prognosis for the return of kidney function if appropriate supportive care is provided
t t t t t t t t t t t t t t t t t t
during the acute. t t
-symptoms are reversible with lifelong medication = chronic kidney disease is progressive irreversible kidney
t t t t t t t t t t t t t t
injury acute renal failure may be reversible with adequate supportive care during the acute episode
t t t t t t t t t t t t t t
-The condition has a rapid onset with frequent remissions = acute renal failure has a rapid onset but chronic
t t t t t t t t t t t t t t t t t t t
kidney disease has a gradual onset occurring over months or years neither form of renal failure has frequent
t t t t t t t t t t t t t t t t t t
periods of remission t t
,-There are frequent exacerbations since half of all nephrons are damaged =
t t t t t t t t t t t t
half of all nephrons are often damaged in acute renal failure in CKD about 90% of nephrons are typically
t t t t t t t t t t t t t t t t t t t
involved
What additional information in Judy's history may be related to the onset of ESRD?
t t t t t t t t t t t t t
A) Hypertension
t
B) Polycystic Kidney Disease
t t t
C) Hysterectomy at age 35
t t t t
D) Female gender
t t
E) African-American ethnicity
t t
F) Hypertension - correct answer E + F
t t t t t t t
African American ethnicity = African American clients are more likely to develop ESKD and have hypertensive
t t t t t t t t t t t t t t t t
ESKD
Hypertension
Polycystic Kidney Disease = Polycystic kidney disease gene mutation will develop kidney cysts by age 30 half of
t t t t t t t t t t t t t t t t t t
these people develop CKD by age 50t t t t t t
-hysterectomy at age 35 = t t t t t
this is not a risk factor for CKD
t t t t t t t
-Female gender = CKD does not seem to be more common in either gender
t t t t t t t t t t t t t
-HTN = hypertension is one of the primary causes of CKD the vast majority of clients with CKD have
t t t t t t t t t t t t t t t t t t t
hypertension which may be either the cause or the result of CKD t t t t t t t t t t t
Which lab value is likely to be decreased in a client with chronic kidney disease?
t t t t t t t t t t t t t t
-Serum K+ t
,-Serum BUN and Creatinine t t t
-Serum Ca+ t
-Serum Phosphorous - correct answer Serum calcium = Serum calcium is decreased in CKD in response to an
t t t t t t t t t t t t t t t t t t
increase in serum phosphorus t t t
-serum potassium levels are increased in CKD as the kidney loses the ability to remove potassium from the
t t t t t t t t t t t t t t t t t t
body clients with CKD should be assessed carefully for symptoms of hyperkalemia
t t t t t t t t t t t
- serum creatinine and BUN are tests which evaluate the removal of nitrogenous wastes by the kidney. Both
t t t t t t t t t t t t t t t t t t
are increased in CKD although BUN levels are directly impacted by protein intake hydration status and other
t t t t t t t t t t t t t t t t t
factors
- serum phosphorus is increased as less phosphorus is excreted by the kidney
t t t t t t t t t t t t
Judy's hemoglobin level is 7.8. Which underlying pathology does the nurse recognize as the cause of this
t t t t t t t t t t t t t t t t t
abnormal lab value? t t
-Fewer red blood cells are being formed
t t t t t t
-hematuria results in blood loss t t t t
-renal waste products destroy red blood cells
t t t t t t
-dehydration causes dilutional anemia - correct answer Fewer red blood cells are being formed = hemoglobin
t t t t t t t t t t t t t t t t
is decreased as the kidneys become less able to produce erythropoietin necessary for the formation of red
t t t t t t t t t t t t t t t t t
blood cells t
-hematuria results in blood loss = CKD does not result in hematuria t t t t t t t t t t t
-renal waste products destroy red blood cells = this does not occur in CKD
t t t t t t t t t t t t t
-dehydration causes dilutional anemia = if dehydration occurred it would be likely to result in a high
t t t t t t t t t t t t t t t t t
hemoglobin level rather than a low level t t t t t t
What is the correct interpretation of these ABGs?
t t t t t t t
Metabolic acidosis (compensated) t t
respiratory alkalosis (compensated) t t
metabolic alkalosis (compensated) t t
, respiratory acidosis (compensated) - correct answer Metabolic acidosis (compensated) = an excessive
t t t t t t t t t t t t
bicarbonate is excreted, the HCO3 level decreases causing metabolic acidosis (decreased pH). compensation
t t t t t t t t t t t t t
occurs when an increased rate and depth of respirations reduce the CO2 levels returning the pH to low normal
t t t t t t t t t t t t t t t t t t
- alkalosis would be indicated by an increased pH rather than decreased pH
t t t t t t t t t t t t
-respiratory acidosis (compensated) = this is a compensated acidosis but if it were respiratory in nature the
t t t t t t t t t t t t t t t t t
CO2, would be elevated rather than decreased
t t t t t t
Which additional assessment finding is consistent with ESRD?
t t t t t t t
A) Clay colored stool
t t t
b) tall tented T waves on c) electrocardiogram
t t t t t t t
d) decrease attention span
t t t
e) stridor t
f) yellow Gray pallor - correct answer B, D, F
t t t t t t t t t
Tall tented T waves on electrocardiogram = potassium excretion occurs mainly through the kidney. any
t t t t t t t t t t t t t t t
increase in potassium load during the later stages of CKD can lead to hyperkalemia (high serum potassium
t t t t t t t t t t t t t t t t t
levels)
Decreased attention span = problems ranging from lethargy to seizures or coma which may indicate uremic
t t t t t t t t t t t t t t t t
encephalopathy
Yellow-gray pallor = the client with ESRD often exhibits a yellow Gray pallor as the result of anemia and uremia.
t t t t t t t t t t t t t t t t t t t t
in addition the client with ESRD may exhibit other skin manifestations such as bruising and uremic frost (a very
t t t t t t t t t t t t t t t t t t t
late manifestation) t
- Stridor is a crowing respiratory noise due to bronchoconstriction it is not an expected finding in ESRD
t t t t t t t t t t t t t t t t t
- Clay-colored stools = not a manifestation seen in ESRD
t t t t t t t t t
Which explanation best describes the pathology resulting in her hypertension?
t t t t t t t t t
Judy Harrison is a 38-year-old African American female with a long history of diabetes mellitus type 2 and
t t t t t t t t t t t t t t t t t t
hypertension. She has experienced renal insufficiency for the last two years. Her current medications include t t t t t t t t t t t t t t t
an angiotensin converting enzyme inhibitor (ACEI), a diuretic, and an oral hypoglycemic agent. She reports to
t t t t t t t t t t t t t t t t
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
t t t t t t t t t t t t t t t t t t t t t t t t t t
the bathroom several times during the night and has trouble catching her breath at times. Her current weight is
t t t t t t t t t t t t t t t t t t
114 lbs (51.7 kg). She is scheduled for diagnostic studies to evaluate for the onset of end-stage renal disease
t t t t t t t t t t t t t t t t t t t t
(ESRD). - correct answer Background for Chronic Kidney Disease HESI Case Study
t t t t t t t t t t t
Which explanation by the nurse is an accurate description of CKD?
t t t t t t t t t t
-There are frequent exacerbations since half of all nephrons are damaged
t t t t t t t t t t
-It is a fatal disorder unless renal replacement therapy is received.
t t t t t t t t t t
-The condition has a rapid onset with frequent remissions
t t t t t t t t
-symptoms are reversible with lifelong medication - correct answer It is a fatal disorder unless renal
t t t t t t t t t t t t t t t t
replacement therapy is received. t t t
CKD is fatal unless some form of renal replacement therapy dialysis or organ transplant is done whereas acute
t t t t t t t t t t t t t t t t t t
renal failure has a good prognosis for the return of kidney function if appropriate supportive care is provided
t t t t t t t t t t t t t t t t t t
during the acute. t t
-symptoms are reversible with lifelong medication = chronic kidney disease is progressive irreversible kidney
t t t t t t t t t t t t t t
injury acute renal failure may be reversible with adequate supportive care during the acute episode
t t t t t t t t t t t t t t
-The condition has a rapid onset with frequent remissions = acute renal failure has a rapid onset but chronic
t t t t t t t t t t t t t t t t t t t
kidney disease has a gradual onset occurring over months or years neither form of renal failure has frequent
t t t t t t t t t t t t t t t t t t
periods of remission t t
,-There are frequent exacerbations since half of all nephrons are damaged =
t t t t t t t t t t t t
half of all nephrons are often damaged in acute renal failure in CKD about 90% of nephrons are typically
t t t t t t t t t t t t t t t t t t t
involved
What additional information in Judy's history may be related to the onset of ESRD?
t t t t t t t t t t t t t
A) Hypertension
t
B) Polycystic Kidney Disease
t t t
C) Hysterectomy at age 35
t t t t
D) Female gender
t t
E) African-American ethnicity
t t
F) Hypertension - correct answer E + F
t t t t t t t
African American ethnicity = African American clients are more likely to develop ESKD and have hypertensive
t t t t t t t t t t t t t t t t
ESKD
Hypertension
Polycystic Kidney Disease = Polycystic kidney disease gene mutation will develop kidney cysts by age 30 half of
t t t t t t t t t t t t t t t t t t
these people develop CKD by age 50t t t t t t
-hysterectomy at age 35 = t t t t t
this is not a risk factor for CKD
t t t t t t t
-Female gender = CKD does not seem to be more common in either gender
t t t t t t t t t t t t t
-HTN = hypertension is one of the primary causes of CKD the vast majority of clients with CKD have
t t t t t t t t t t t t t t t t t t t
hypertension which may be either the cause or the result of CKD t t t t t t t t t t t
Which lab value is likely to be decreased in a client with chronic kidney disease?
t t t t t t t t t t t t t t
-Serum K+ t
,-Serum BUN and Creatinine t t t
-Serum Ca+ t
-Serum Phosphorous - correct answer Serum calcium = Serum calcium is decreased in CKD in response to an
t t t t t t t t t t t t t t t t t t
increase in serum phosphorus t t t
-serum potassium levels are increased in CKD as the kidney loses the ability to remove potassium from the
t t t t t t t t t t t t t t t t t t
body clients with CKD should be assessed carefully for symptoms of hyperkalemia
t t t t t t t t t t t
- serum creatinine and BUN are tests which evaluate the removal of nitrogenous wastes by the kidney. Both
t t t t t t t t t t t t t t t t t t
are increased in CKD although BUN levels are directly impacted by protein intake hydration status and other
t t t t t t t t t t t t t t t t t
factors
- serum phosphorus is increased as less phosphorus is excreted by the kidney
t t t t t t t t t t t t
Judy's hemoglobin level is 7.8. Which underlying pathology does the nurse recognize as the cause of this
t t t t t t t t t t t t t t t t t
abnormal lab value? t t
-Fewer red blood cells are being formed
t t t t t t
-hematuria results in blood loss t t t t
-renal waste products destroy red blood cells
t t t t t t
-dehydration causes dilutional anemia - correct answer Fewer red blood cells are being formed = hemoglobin
t t t t t t t t t t t t t t t t
is decreased as the kidneys become less able to produce erythropoietin necessary for the formation of red
t t t t t t t t t t t t t t t t t
blood cells t
-hematuria results in blood loss = CKD does not result in hematuria t t t t t t t t t t t
-renal waste products destroy red blood cells = this does not occur in CKD
t t t t t t t t t t t t t
-dehydration causes dilutional anemia = if dehydration occurred it would be likely to result in a high
t t t t t t t t t t t t t t t t t
hemoglobin level rather than a low level t t t t t t
What is the correct interpretation of these ABGs?
t t t t t t t
Metabolic acidosis (compensated) t t
respiratory alkalosis (compensated) t t
metabolic alkalosis (compensated) t t
, respiratory acidosis (compensated) - correct answer Metabolic acidosis (compensated) = an excessive
t t t t t t t t t t t t
bicarbonate is excreted, the HCO3 level decreases causing metabolic acidosis (decreased pH). compensation
t t t t t t t t t t t t t
occurs when an increased rate and depth of respirations reduce the CO2 levels returning the pH to low normal
t t t t t t t t t t t t t t t t t t
- alkalosis would be indicated by an increased pH rather than decreased pH
t t t t t t t t t t t t
-respiratory acidosis (compensated) = this is a compensated acidosis but if it were respiratory in nature the
t t t t t t t t t t t t t t t t t
CO2, would be elevated rather than decreased
t t t t t t
Which additional assessment finding is consistent with ESRD?
t t t t t t t
A) Clay colored stool
t t t
b) tall tented T waves on c) electrocardiogram
t t t t t t t
d) decrease attention span
t t t
e) stridor t
f) yellow Gray pallor - correct answer B, D, F
t t t t t t t t t
Tall tented T waves on electrocardiogram = potassium excretion occurs mainly through the kidney. any
t t t t t t t t t t t t t t t
increase in potassium load during the later stages of CKD can lead to hyperkalemia (high serum potassium
t t t t t t t t t t t t t t t t t
levels)
Decreased attention span = problems ranging from lethargy to seizures or coma which may indicate uremic
t t t t t t t t t t t t t t t t
encephalopathy
Yellow-gray pallor = the client with ESRD often exhibits a yellow Gray pallor as the result of anemia and uremia.
t t t t t t t t t t t t t t t t t t t t
in addition the client with ESRD may exhibit other skin manifestations such as bruising and uremic frost (a very
t t t t t t t t t t t t t t t t t t t
late manifestation) t
- Stridor is a crowing respiratory noise due to bronchoconstriction it is not an expected finding in ESRD
t t t t t t t t t t t t t t t t t
- Clay-colored stools = not a manifestation seen in ESRD
t t t t t t t t t
Which explanation best describes the pathology resulting in her hypertension?
t t t t t t t t t
