2026 NUR 355 EXAM SG 4 MOD 6 & 7 Study Guide BLUE PRINT (Acute and Chronic
Health Disruption in Adult I) Arizona College of Nursing
MS EXAM SG 4: MOD 6 & 7
[Ch. 8-10/ 43-45 ; Ch. 61-67/ 60, 62-66]
Sodium Na+ : Hyponatremia VS Hypernatremia [Normal Ranges = 136 - 145 mEq/L]
Hyponatremia < 135 Hypernatremia > 145
,Causes: Causes:
Medications (diuretics) Reduced water intake
Diarrhea or vomiting Limited ability to express thirst
Hyperglycemia with glucosuria Diabetes insipidus
Perspiration Hyperglycemia
SIADH Neoplasms
Hypothyroidism Hypercalcemia
Adrenal insufficiency Hyperkalemia
Psychotic polydipsia Medications
Heart failure
Cirrhosis Clinical Manifestations (S/SX):
Nephrotic syndrome Nonspecific Neurological changes
(Neuromuscular Irritability, Agitation, Restlessness, Lethargy, Coma,
Clinical Manifestations (S/SX): Seizure)
Related to cerebral edema and neurological decline
Lethargy Severe: Hallucinations, Delusions, Disorientation
Headache Thirst/Signs of Dehydration
Confusion
Gait disorders Medical Management (TX):
Nausea & Vomiting Limiting sodium intake
Seizure, Coma, Permanent Brain Damage, death if not treated Replacing water deficits
TX of underlying cause
Medical Management (TX): Fluid replacement 0.45% NaCl or D5W
Replacement of sodium (Oral, Enetral, Parenteral)
Fluid restriction Nursing Management:
Hypertonic saline (3% NaCl) if Neuro involvement Monitor I&O
Loop Diuretics Ensuring adequate water intake
Monitor daily weight
Nursing Management: Monitor serum sodium
Monitor sodium levels
Monitor fluid status (Daily weight, I&O) Foods High in
Patient Education Frozen pizza (plain cheese)
Soup (tomato)
Tomato juice
1
, Pretzels/Potato/Tortilla chips
Salsa
Salad dressing, Regular fat, all types
Breads, all types
Frozen vegetables, all types
Calcium Ca+ : Hypocalcemia VS Hypercalcemia [Normal Ranges = 9.0 - 10.5 mEq/L]
Hypocalcemia < 9.0 Hypercalcaemia > 10.2
Causes: Causes:
Vitamin D Deficiency Malignancy
Hypoparathyroidism Primary Hyperparathyroidism
Diarrhea Medications
Malnutrition (Thiazide Diuretics, Lithium, Calcium Carbonate, Theophylline,
Lactation Vitamins A&D)
Pregnancy (Lactation)
Chronic Renal Failure Clinical Manifestations (S/SX):
Bone Disease Bradycardia
Chronic Alcohol Use Hypertension
Thirst
Clinical Manifestations (S/SX): Lethargy
Excitability of nerves and muscles Muscle weakness and soreness
Smooth muscle spasms (Tetany) Abdominal discomfort
Prolonged QT interval Constipation
Decreased Myocardial Contractility Decreased deep tendon reflexes
Anxiety, Confusion, Irritability Anorexia
Positive Trousseau (wrist flexion with BP cuff) and Nausea, Vomiting
Chvostek sign (facial twitch upon tap ) Confusion
Renal Calculi (stones) and Renal Failure
Medical Management:
Protection and maintenance of airway Medical Management:
Cardiac monitoring Stabilization and Reduction of Calcium Levels
IV access Hydration with 0.9% NaCl
IV replacement of calcium Dialysis
Treat other Electrolyte Abnormalities, especially Magnesium Loop diuretics
Oral calcium and vitamin D supplements IV Bisphosphonates
(Calcium Gluconate) Calcitonin
Treatment of Malignancy
Nursing Management: Removal of Parathyroid Gland
Assessment
2
Health Disruption in Adult I) Arizona College of Nursing
MS EXAM SG 4: MOD 6 & 7
[Ch. 8-10/ 43-45 ; Ch. 61-67/ 60, 62-66]
Sodium Na+ : Hyponatremia VS Hypernatremia [Normal Ranges = 136 - 145 mEq/L]
Hyponatremia < 135 Hypernatremia > 145
,Causes: Causes:
Medications (diuretics) Reduced water intake
Diarrhea or vomiting Limited ability to express thirst
Hyperglycemia with glucosuria Diabetes insipidus
Perspiration Hyperglycemia
SIADH Neoplasms
Hypothyroidism Hypercalcemia
Adrenal insufficiency Hyperkalemia
Psychotic polydipsia Medications
Heart failure
Cirrhosis Clinical Manifestations (S/SX):
Nephrotic syndrome Nonspecific Neurological changes
(Neuromuscular Irritability, Agitation, Restlessness, Lethargy, Coma,
Clinical Manifestations (S/SX): Seizure)
Related to cerebral edema and neurological decline
Lethargy Severe: Hallucinations, Delusions, Disorientation
Headache Thirst/Signs of Dehydration
Confusion
Gait disorders Medical Management (TX):
Nausea & Vomiting Limiting sodium intake
Seizure, Coma, Permanent Brain Damage, death if not treated Replacing water deficits
TX of underlying cause
Medical Management (TX): Fluid replacement 0.45% NaCl or D5W
Replacement of sodium (Oral, Enetral, Parenteral)
Fluid restriction Nursing Management:
Hypertonic saline (3% NaCl) if Neuro involvement Monitor I&O
Loop Diuretics Ensuring adequate water intake
Monitor daily weight
Nursing Management: Monitor serum sodium
Monitor sodium levels
Monitor fluid status (Daily weight, I&O) Foods High in
Patient Education Frozen pizza (plain cheese)
Soup (tomato)
Tomato juice
1
, Pretzels/Potato/Tortilla chips
Salsa
Salad dressing, Regular fat, all types
Breads, all types
Frozen vegetables, all types
Calcium Ca+ : Hypocalcemia VS Hypercalcemia [Normal Ranges = 9.0 - 10.5 mEq/L]
Hypocalcemia < 9.0 Hypercalcaemia > 10.2
Causes: Causes:
Vitamin D Deficiency Malignancy
Hypoparathyroidism Primary Hyperparathyroidism
Diarrhea Medications
Malnutrition (Thiazide Diuretics, Lithium, Calcium Carbonate, Theophylline,
Lactation Vitamins A&D)
Pregnancy (Lactation)
Chronic Renal Failure Clinical Manifestations (S/SX):
Bone Disease Bradycardia
Chronic Alcohol Use Hypertension
Thirst
Clinical Manifestations (S/SX): Lethargy
Excitability of nerves and muscles Muscle weakness and soreness
Smooth muscle spasms (Tetany) Abdominal discomfort
Prolonged QT interval Constipation
Decreased Myocardial Contractility Decreased deep tendon reflexes
Anxiety, Confusion, Irritability Anorexia
Positive Trousseau (wrist flexion with BP cuff) and Nausea, Vomiting
Chvostek sign (facial twitch upon tap ) Confusion
Renal Calculi (stones) and Renal Failure
Medical Management:
Protection and maintenance of airway Medical Management:
Cardiac monitoring Stabilization and Reduction of Calcium Levels
IV access Hydration with 0.9% NaCl
IV replacement of calcium Dialysis
Treat other Electrolyte Abnormalities, especially Magnesium Loop diuretics
Oral calcium and vitamin D supplements IV Bisphosphonates
(Calcium Gluconate) Calcitonin
Treatment of Malignancy
Nursing Management: Removal of Parathyroid Gland
Assessment
2
