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HESI CASE STUDIES/HESI CASE STUDIES, Exams of Health sciences

Abilene Christian University (ACU)Health sciences

HESI CASE STUDIES/HESI CASE STUDIES/

Typology: Exams

2024/2025

Available from 07/13/2025

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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). - correct 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 - correct 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?

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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). - correct 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 - correct 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 - correct 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 - correct answer Serum calcium = Serum calcium is decreased in CKD in response to an increase in serum phosphorus

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 - correct answer 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)
Stridor is a crowing respiratory noise due to bronchoconstriction it is not an expected finding in ESRD
Clay-colored stools = not a manifestation seen in ESRD Which explanation best describes the pathology resulting in her hypertension? -An increase in the excretion of sodium and water from the kidneys causes hypertension -activation of the renin angiotensin cycle and excretion of aldosterone causes hypertension -the increase of uremic waste products in the bloodstream increase the blood pressure

-irritation of the pericardial lining of the heart due to uremic toxins increases the blood pressure - correct answer Activation of the renin-angiotensin cycle and excretion of aldosterone causes hypertension = the renin angiotensin cycle causes vasoconstriction of the periphery which increases the blood pressure. in addition the excretion of aldosterone causes the retention of sodium and water further increasing the fluid volume which increases the blood pressure

An increase in the excretion of sodium and water from the kidneys causes hypertension = hypertension would be caused by an increase in the retention of sodium and water rather than an increase in the excretion
the increase of uremic waste products in the bloodstream increase the blood pressure = this is the probable cause for gastrointestinal manifestations such as anorexia, nausea and vomiting -irritation of the pericardial lining of the heart due to uremic toxins increases the blood pressure = explains the cause of pericarditis Which assessment finding indicates to the nurse that the desired outcome of the calcium acetate (PhosLo) has been achieved? Serum hemoglobin of 12 g/dL serum glucose of 90 mg/dL serum phosphorus of 4.0 mg/dL Serum hematocrit of 32% - correct answer Serum phosphorous of 4.0 mg/dL = calcium acetate (PhosLo) acts as a phosphate binder reducing the high serum phosphorus levels commonly found in the client with CKD -hemoglobin and hematocrit are not affected by the use of PhosLo
serum glucose of 90 mg/dL = this normal glucose level is managed with the clients glipizide (Glucotrol) Which assessment should the nurse perform to determine if the desired outcome of the captopril (Capoten) has been achieved? Blood pressure Intake and output

-offer high protein snacks frequently - correct answer Encourage pt to ask questions and discuss fears about diagnosis = an open atmosphere that allows for discussion can decrease anxiety. facilitate discussions with family members about the prognosis and the impact on lifestyle -Encourage oral fluid intake = fluid restrictions will be instituted -avoid any substances and intramuscular injections = although the client with CKD is likely to bruise easily due to a reduction in platelets avoidance of injections is not necessary -offer high protein snacks frequently = protein is restricted to reduce the accumulation of waste products associated with protein metabolism which causes the manifestations of uremia Which intervention is most important for the nurse to implement? -Hold the dose of Key Ciel and contact the HCP to report the serum potassium level -calculate the millimeters of medication needed in record the amount on the fluid intake record

administer the dose of Key Ciel and document the serum potassium level in the medical record -ask the pharmacist to supply a tablet rather than an elixir since the patient is on fluid restriction - correct answer Hold the dose of Kay Ciel and contact the HCP to report the serum potassium level = the serum potassium level is elevated and administering additional potassium in any form is potentially dangerous to the client -calculate the millimeters of medication needed in record the amount on the fluid intake record = if the potassium level was within normal limits and the medication was given this would be an appropriate intervention however since the potassium level is high this is not the correct intervention
administer the dose of Key Ciel and document the serum potassium level in the medical record = this is not an appropriate intervention considering the client's elevated serum potassium level -ask the pharmacist to supply a tablet rather than an elixir since the patient is on fluid restriction = the HCP must be contacted regarding this change since the administration of this prescription would be unsafe for the client in any form there is another intervention that should be implemented What intervention should the nurse implement?

-administer the prescribed tablet -request a faxed copy of the prescription -obtain the name of the office nurse

ask to speak directly to the HCP - correct answer Ask to speak directly with the HCP = the medication prescription is unsafe and requires direct communication with the prescribing HCP -administer the prescribed tablet = this is an unsafe intervention since the client's serum potassium is elevated -request a faxed copy of the prescription = requesting a written copy of a prescription is always desirable but in this case will only confirm an unsafe prescription -obtain the name of the office nurse = this is an appropriate action but it is not the most important action at this time Which statement should serve as the basis for the nurse's reply?
state nurse practice acts indicate that the professional nurse should only administer legally prescribed medications
the nurses job description in most hospital policy manuals clearly states that adhering to the HCP's prescriptions is required
only the prescribing HCP is legally liable for the administration of a prescribed but unsafe medication
the professional nurse can be held accountable for the administration of any unsafe medication - correct answer The professional nurse can be held accountable for the administration of any unsafe medication.
state nurse practice acts indicate that the professional nurse should only administer legally prescribed medications = the nurse practice act in each state does establish the legal regulation of the practice of nursing however the issue in question is not the legality of the prescription but rather the safety
the nurses job description in most hospital policy manuals clearly states that adhering to the HCP's prescriptions is required = the nurse must use sound professional judgment to determine if a prescribed medication or treatment is safe and should collaborate with the prescribing HCP. in addition the nurse

abdominal infection
osteoarthritis - correct answer Abdominal infection = peritoneal dialysis places the client at high risk for peritonitis since the catheter and fluid entered the peritoneal cavity. the client must be heparinized during hemodialysis therefore bleeding is a more likely potential complication than thrombosis
hepatitis B&C = clients on hemodialysis are at a greater risk for contracting hepatitis B&C then clients on peritoneal dialysis because of the equipment used in hemodialysis. hepatitis B vaccine is encouraged for clients with CKD
hypertension = the client is at risk for developing hypotension during treatment due to the fluid being removed. nausea vomiting diaphoresis, tachycardia and dizziness are common signs of hypotension
osteoarthritis = osteoarthritis is not a potential complication of hemodialysis What is the best description of an AV graft?
Synthetic tubing tunneled beneath the skin connecting an artery and a vein
central line tunneled catheter with a barrier cuff
external loop of synthetic tubing connecting an artery and a vein
internal surgical anastamosis between an artery and a vein - correct answer Synthetic tubing tunneled beneath the skin connecting an artery and a vein = these graphs can be placed in the arm or inner thigh and can be used within one to two weeks of surgery
central line tunneled catheter with a barrier cuff = this describes a soft flexible catheter that is tunneled under the skin and placed in the superior vena cava. this cuff keeps the catheter in place and serves as a barrier to infection
external loop of synthetic tubing connecting an artery and a vein = this describes an AV shunt which can be used immediately after insertion but since the advent of central line catheters shunts are no longer commonly used
internal surgical anastamosis between an artery and a vein = this describes an AV fistula typically located in the forearm which require prolonged healing (2-4 months) before use Which documentation should the nurse enter into the nurses' notes?
health care provider notified of graft occlusion

bruit intact and palpated
+4 bounding pulse palpated
thrill present and palpated - correct answer Thrill present and palpated = this buzzing sensation indicates that the graph is patent in addition to palpating for a thrill the nurse should auscultate for a bruit which is the sound heard at a Peyton graph site as well As for intact pulses distal to the graph site
health care provider notified of graft occlusion = a palpable thrill in audible with stethoscope bruit over the graph site indicate that the graph is patent the nurse should also assess the pulse distilled to the gravesite to ensure adequate circulation
bruit intact and palpated = a bruit is the swishing sound heard when the graph site is auscultated this should also be assessed when the graph is palpated
+4 bounding pulse palpated = this sensation does not reflect the client's pulse although it is important for the nurse to assess the pulse distal to the graph Which intervention should the nurse include in Judy's plan of care? A. empty and record the drainage from the graph tubing regularly B. perform sterile dressing changes at the dual lumen catheter site C. instruct lab personnel to obtain blood specimens from the dual lumen catheter D. regularly rotate IV insertion sites above and below the graph site E. assess patients distal pulses in circulation in the arm with the access - correct answer B + E Perform sterile dressing changes at the dual-lumen catheter site = central vein insertion sites are major sources of nosocomial infection, and they should be cleaned weekly using a strict aseptic technique Assess pt's distal pulses and circulation in the arm with the access = ischema occurs in a few patients with vascular access when the fistula decreases arterial blood flow to areas below the fistula (steal syndrome). manifestations vary from cold or numb fingers to gangrene. if the collateral circulation is poor the fistula may need to be surgically tied off and a new one created in another area to preserve extremity circulation
empty and record the drainage from the graph tubing regularly = the graft tubing is internal and there is no attached external drainage device. the surgical site should be assessed for bleeding

The goal for hemodialysis clients is to keep their intradialytic (between dialysis treatments) weight gain under 1.5 kg Which nursing assessment has the highest priority during the first 24-hour postoperative period?

Range of motion
bowel sounds
pedal pulses
vital signs - correct answer Vital signs = vital signs should be monitored frequently to assess for post operative bleeding infection and organ rejection
the others are an important assessment but not the highest priorities, bowel sound should return w/in 24 hours, but again not highest priority Which intervention should be included in the plan of care during the immediate postoperative period?
monitor patients urinary output hourly using a urimeter
monitor patients nasal gastric tube every four hours
encourage patient to use the incentive spirometer daily
assess patient surgical incision every shift - correct answer Monitor pt's urinary output hourly using an urimeter = a kidney from a living donor related to the client usually begins to function immediately after surgery and may produce large amounts of dilute urine therefore the UO should be closely monitored
monitor patients nasal gastric tube every four hours = the client usually does not have an NG2 in place after the surgery if one is present it should be monitored more frequently then every four hours
encourage patient to use the incentive spirometer daily = patient should use the incentive spirometer at least every two to four hours to prevent complications from immobility such as pneumonia
assess patient surgical incision every shift = the surgical incision should be assessed at least every two hours in the immediate postoperative.

The nurse is preparing to give Judy's medications. The cyclosporine (Sandimmune) comes in a vial with 50 mg/mL. Judy weighs 132 lbs (60 kg). How many milliliters of the medication should the nurse draw up? (Enter numeric value only. If rounding is necessary, round to the tenth.) - correct answer 4. D/H x V = X 122lbs/2.2 kg = 60kg 60kg x 4mg/kg = 240 mg 240mg x 1 mL/50mg = 4.8mL Which nursing diagnosis has the greatest priority when caring for a client receiving immunosuppressive agents?

Risk for infection
Pain
Fatigue
Diarrhea - correct answer Risk for infection = suppression of the normal immune response causes leukopenia that can reduce the client's ability to fight infection resulting in the potential for life threatening sepsis
Pain = immunosuppressive agents such as Imuran can cause arthralgia, but this is not the highest priority
Fatigue = immunosuppressive agents can cause fatigue but this is not the highest priority
Diarrhea = immunosuppressive agents such as cyclosporine can cause diarrhea but this is not the highest priority Which interventions are important to include in Judy's plan of care while she is receiving multiple immunosuppressants? A. reinforce but do not routinely change any dressings

Convert the IV to a saline lock = converting the IV to saline lock is a low priority at this time
remove the indwelling catheter = this action is a low priority and one that can increase the clients discomfort temporarily as the catheter is pulled from the bladder it should be deferred until the client's higher priority need has been addressed
change the surgical dressing = since only the tape is loose this is not the highest priority intervention Which action can be delegated to the unlicensed assistive personnel (UAP)?
administer an analgesic
convert the IV to a saline lock
measure the client's urinary output
change the surgical dressing - correct answer Measure the client's urinary output. What is the best initial response by the nurse?
Going home often causes anxiety which can increase your pain
you have developed a tolerance to your pain medication
describe the location and type of pain you're having
the HCP will need to call you back later if you need more pain medication - correct answer Describe the location and type of pain you are having = the nurse must always assess first as complete data is needed to determine the nature of the problem and then to intervene appropriately
the others not the best responses since the nurse has not obtained adequate data to make this determination and the nurse first needs to obtain additional information before recommending contacting the HCP Which instructions should the nurse give Judy?
take her prescribed diuretic and analgesic and record when she voids

increase her fluid intake and report any increase in her weight
advise her to come to the clinic right away for further evaluation
monitor her temperature and report a fever over 101 degrees F - correct answer Advise her to come to the clinic right away for further evaluation = she is experiencing symptoms consistent with organ rejection she needs immediate assessment and evaluation for this potentially fatal complication. the nurse should assess for kidney pain oliguria and anuria hypertension lethargy fever and fluid retention as well as an increased serum BUN creatinine and potassium
for the others = she is experiencing symptoms that require a different intervention
temperature and report a fever over 101 degrees F = the presence of a fever requires further investigation by the nurse because it can be a symptom of both infection and rejection which are treated very differently What is the best response by the nurse?
This is a very difficult time for you and your family
don't blame the HCP's they're doing everything possible
your obvious anger will not help her now
why do you think the HCP's are at fault - correct answer This is a very difficult time for you and your family Raymond Malone, age 45 years admitted from his healthcare provider's office (HCP) to the acute care facility. Jeff was diagnosed HIV positive 2 years ago. His history includes fatigue, a productive cough, and weight loss. A tuberculosis(TB) test was administered in the healthcare provider's office. Admission prescriptions include "isolation precautions for suspected pulmonary tuberculosis." - correct answer Background for HIV + TB HESI Case Study The nurse admits Raymond to a private room at the end of the hall. According to hospital protocol, the nurse put on a mask before starting the admission process. Raymond tells the nurse that his significant other is downstairs and that he would like for him to stay in the room with him.1. How should the nurse respond?

What information should the nurse provide to the UAP on infection control services?

A private room is required to implement contact precautions for possible TB
The pt needs to be at the end of the hallway bc they require privacy
The pt needs to be at the end of the hallway for confidentiality
The implementation of airborne precautions for possible TB requires a private, negative pressure room assignment - correct answer The implementation of airborne precautions for possible TB requires a private, negative pressure room assignment. According to the Centers for Disease Control (CDC), in addition to isolating Raymond by using a private room, engineering controls can help to prevent the spread of TB. Controlling the direction of the airflow can prevent contamination of air in adjacent areas. The nurse notices the UAP about to enter Raymond's room to deliver a meal tray without wearing any protective apparel. What information should the nurse provide the UAP?
Wearing a mask, gown, and gloves is required for healthcare workers entering Raymond's room for any reason
A mask is required for healthcare workers entering the room of someone suspected of having active TB
The UAP will only be in the room for a brief moment so no intervention is needed
Non-sterile gloves are necessary to deliver the meal and prevent the spread of TB - correct answer A mask is required for healthcare workers entering the room of someone suspected of having active TB TB is spread by airborne transmission of droplet nuclei. A specific fit tested, high-efficiency particulate air (HEPA) mask is necessary to filter the mycobacterium tuberculosis bacillus. An acid-fast-bacilli (AFB) stain is part of the initial admission prescriptions. Early morning sputum specimens will be collected for three consecutive days and sent onto the lab. Which tasks may the nurse delegate to the UAP? (SATA)

A. Allow the UAP to teach the pt how to cough to obtain the sputum from deep in the bronchi B. Have the UAP tell Raymond that the specimen must be collected in the early morning C. Provide Raymond with three sterile specimen cups at his bedside D. Ask the UAP to assess the pt's ability to expectorate a sputum specimen E. Document the time and date that each sputum specimen was collected - correct answer B + C + E Have the UAP tell Raymond that the specimen must be collected in the early morning Provide Raymond with three sterile specimen cups at his bedside Document the time and date that each sputum specimen was collected

This task may be safely delegated. However, it is the nurse's responsibility to ensure that the documentation is completed and sent with the specimen to the lab. Raymond is scheduled for several activities the following morning. Which activity should Raymond perform first upon awakening?
Weigh to determine if weight loss from the disease is continuing
Eat a nutritionally dense, early morning snack sent from the cafeteria
Obtain the first of three sputum specimens for laboratory testing
Take a shower and get ready to go form a chest X-ray - correct answer Obtain the first of three sputum specimens for laboratory testing Secretions collecting during the night provide the opportunity for the client to cough and expectorate upon awakening before performing other morning activities.

HESI CASE STUDIES/HESI CASE STUDIES, Exams of Health sciences

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HESI CASE STUDIES