HESI CASE STUDIES
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). ANS: 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 ANS: 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 ANS: 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 ANS: 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 ANS: 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) ANS: 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
e) stridor
f) yellow Gray pallor ANS: B, D, F
Tall tented T waves on electrocardiogram = potassium excretion occurs mainly through the kidney. any
increase in potassium load during the later stages of CKD can lead to hyperkalemia (high serum
potassium levels)
Decreased attention span = problems ranging from lethargy to seizures or coma which may indicate
uremic encephalopathy
Yellow-gray pallor = the client with ESRD often exhibits a yellow Gray pallor as the result of anemia and
uremia. in addition the client with ESRD may exhibit other skin manifestations such as bruising and
uremic frost (a very late manifestation)
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). ANS: 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 ANS: 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 ANS: 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 ANS: 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 ANS: 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) ANS: 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
e) stridor
f) yellow Gray pallor ANS: B, D, F
Tall tented T waves on electrocardiogram = potassium excretion occurs mainly through the kidney. any
increase in potassium load during the later stages of CKD can lead to hyperkalemia (high serum
potassium levels)
Decreased attention span = problems ranging from lethargy to seizures or coma which may indicate
uremic encephalopathy
Yellow-gray pallor = the client with ESRD often exhibits a yellow Gray pallor as the result of anemia and
uremia. in addition the client with ESRD may exhibit other skin manifestations such as bruising and
uremic frost (a very late manifestation)
