NUR 360 Exam One Questions With
Correct Answers
Normal Lab Values - CORRECT ANS✔✔K 3.5 - 5
Mg 1.8 - 3
Calcium 8.5 - 10.5
Sodium 135 - 145
What causes hyponatremia (low sodium)? - CORRECT ANS✔✔-Imbalance of
water
▪ Aldosterone deficiency from renal insufficiency
▪ Medications
What causes hypernatremia (high sodium) - CORRECT ANS✔✔Insensible water
loss (hyperventilation, burns, diarrhea)▪ Fluid deprivation in those that cannot
respond to thirst▪ Hypertonic solutions▪ Sodium bicarb use
HYPONATREMIA (MAIN MANIFESTATIONS) - CORRECT ANS✔✔Decreased LOC
(think of the shrinking brain r/t decreased fluid)▪ Seizures▪ Dry mucous
membranes▪ Poor skin turgor
HYPERNATREMIA (MAIN MANIFESTATIONS) - CORRECT ANS✔✔FIX
UNDERLYING CAUSE Gradual lowering of sodium levels 0.3% NS D5W
Desmopressin if it is caused by DI Synthetic ADH
Neurologic Exam Mentation Pupillary response Ability to follow commands
Musculoskeletal Hyperreflexia Ataxia Tremor Signs and symptoms Laboratory
result assessment
Hyponatremia Medical Management - CORRECT ANS✔✔Complete history and
physical Neurologic exam Mentation Pupillary response Ability to follow
commands Signs and symptoms Laboratory result assessment Medication
evaluation Current medical management IV fluids
FIX UNDERLYING CAUSE Sodium replacement Water restriction (fluid restricted
diet) Medications AVP antagonists conivaptan hydrochloride
,Hypernatremia medical management - CORRECT ANS✔✔FIX UNDERLYING
CAUSE▪ Oral rehydration▪ IV fluids▪ Medications▪ Diuretics
What causes hypokalemia (low potassium)? - CORRECT ANS✔✔Excess
elmination of potassium▪ Potassium wasting diuretic use▪ Alkalosis (shifts)▪
Medications
Monitor for patients at high risk Monitor for cardiac abnormalities/ ECG changes
Administer prescribed potassium supplements Monitor vital signs Apical pulse
Educate patient on increasing potassium intake Fruits, vegetables, legumes,
whole grains, milk, meat Educate patient on use of laxatives
What causes hyperkalemia (high potassium)? - CORRECT ANS✔✔Kidney
injury/failure▪ Potassium sparing diuretics▪ Addison's disease▪ Rapid infusion of
potassium supplement
Identify and monitor patients at high risk Monitor for cardiac abnormalities/ECG
changes Monitor intake and output Monitor for signs of muscle weakness Monitor
vital signs Monitor for GI symptoms Assess for muscle weakness Monitor for
hypokalemia while attempting to decrease potassium
HYPOKALEMIA (MAIN MANIFESTATIONS) - CORRECT ANS✔✔CARDIAC
DYSFUNCTION▪ Ventricular fibrillation▪ Asystole▪ Prolonged PR▪ Flattened T
wave▪ U wave▪ ST Depression
HYPERKALEMIA (MANIFESTATIONS) - CORRECT ANS✔✔CARDIAC
DYSFUNCTION▪ Tachycardia→bradycardia▪ TALL PEAKED T WAVES▪ Prolonged
PR interval▪ Prolonged QRS interval▪ Absent P waves▪ ST Depression
hypokalemia medical management - CORRECT ANS✔✔Increase of potassium
through PO diet or supplements▪ IV replacement therapy▪ Routine monitoring of
cardiac function▪ Routine monitoring of labs
hyperkalemia medical management - CORRECT ANS✔✔12 lead EKG to monitor
for slow polarization and peaked T waves▪ Restrict dietary intake of potassium▪
Dialysis▪ Medications to protect and correct▪ IV calcium gluconate▪ Sodium
bicarbonate▪ Regular insulin with D50▪ Kaexylate
What causes hypocalcemia? - CORRECT ANS✔✔Primary Hypoparathyroidism▪
Surgical Hypoparathyroidism▪ Infusion of large amount of citrated blood▪
Inflammation of the pancreas▪ Kidney injury/failure▪ Hyperphosphatemia▪
Reciprocal effect on calcium
Positive Chvostek and Trousseau sign
, What causes hypercalcemia? - CORRECT ANS✔✔Malignant tumors▪
Hyperparathyroidism▪ Thiazide diuretics▪ Increase in Vit D and Vit A intake▪
Mineralization from immobility▪ RARE
HYPOCALCEMIA (MAIN MANIFESTATIONS) - CORRECT ANS✔✔Tetany▪
Trousseau's sign (BP cuff)▪ Chvostek's sign (cheek)▪ Brittle nails▪ Confusion
HYPERCALCEMIA (MAIN MANIFESTATIONS) - CORRECT ANS✔✔Muscular
weakness▪ Decreased deep tendon reflexes▪ Deep bone pain▪ Kidney stones
hypocalcemia medical management - CORRECT ANS✔✔IV administration of a
calcium salt▪ Administer vitamin D supplement▪ Decrease phosphorus levels▪
Calcium supplement and diet
HYPERCALCEMIA medical management - CORRECT ANS✔✔Decrease serum
calcium levels▪ Identify and treat underlying cause▪ Administer IV fluids (0.9%
NS)▪ Administer furosemide with IVF▪ Decrease intake of calcium▪ Diet and
medications▪ Administer phosphate▪ Administer Calcitonin
What are your priority physical assessments andinterventions for hypocalcemia
and hypercalcemia? - CORRECT ANS✔✔neuro/seizure precautions
*****monitor urinary output prior to replacement of any potassium - this indicates
kidney function and the kidneys ability to excrete any excess potassium -
CORRECT ANS✔✔
hypocalcemia medical management - CORRECT ANS✔✔IV administration of a
calcium salt▪ Administer vitamin D supplement▪ Decrease phosphorus levels▪
Calcium supplement and diet
Hypercalcemia medical management - CORRECT ANS✔✔Decrease serum calcium
levels▪ Identify and treat underlying cause▪ Administer IV fluids (0.9% NS)▪
Administer furosemide with IVF▪ Decrease intake of calcium▪ Diet and
medications▪ Administer phosphate▪ Administer Calcitonin
What causes hypomagnesium (low magnesium)? - CORRECT ANS✔✔Alcoholism▪
Hyperparathyroidism▪ Hyper aldosterone▪ AKI with diuresis▪ Malabsorption
disorders▪ DKA▪ Refeeding▪ Parenteral nutrition▪ Chronic laxative use▪ Diarrhea▪
NG suction▪ Fistulas▪ MI/ heart failure▪ Hypocalcemia and hypokalemia
What causes hypermagnesium (high magnesium)? - CORRECT ANS✔✔Oliguric
kidney injury▪ Adrenal insufficiency▪ Excessive IV magnesium administration▪ DKA▪
Hypothyroidism
Correct Answers
Normal Lab Values - CORRECT ANS✔✔K 3.5 - 5
Mg 1.8 - 3
Calcium 8.5 - 10.5
Sodium 135 - 145
What causes hyponatremia (low sodium)? - CORRECT ANS✔✔-Imbalance of
water
▪ Aldosterone deficiency from renal insufficiency
▪ Medications
What causes hypernatremia (high sodium) - CORRECT ANS✔✔Insensible water
loss (hyperventilation, burns, diarrhea)▪ Fluid deprivation in those that cannot
respond to thirst▪ Hypertonic solutions▪ Sodium bicarb use
HYPONATREMIA (MAIN MANIFESTATIONS) - CORRECT ANS✔✔Decreased LOC
(think of the shrinking brain r/t decreased fluid)▪ Seizures▪ Dry mucous
membranes▪ Poor skin turgor
HYPERNATREMIA (MAIN MANIFESTATIONS) - CORRECT ANS✔✔FIX
UNDERLYING CAUSE Gradual lowering of sodium levels 0.3% NS D5W
Desmopressin if it is caused by DI Synthetic ADH
Neurologic Exam Mentation Pupillary response Ability to follow commands
Musculoskeletal Hyperreflexia Ataxia Tremor Signs and symptoms Laboratory
result assessment
Hyponatremia Medical Management - CORRECT ANS✔✔Complete history and
physical Neurologic exam Mentation Pupillary response Ability to follow
commands Signs and symptoms Laboratory result assessment Medication
evaluation Current medical management IV fluids
FIX UNDERLYING CAUSE Sodium replacement Water restriction (fluid restricted
diet) Medications AVP antagonists conivaptan hydrochloride
,Hypernatremia medical management - CORRECT ANS✔✔FIX UNDERLYING
CAUSE▪ Oral rehydration▪ IV fluids▪ Medications▪ Diuretics
What causes hypokalemia (low potassium)? - CORRECT ANS✔✔Excess
elmination of potassium▪ Potassium wasting diuretic use▪ Alkalosis (shifts)▪
Medications
Monitor for patients at high risk Monitor for cardiac abnormalities/ ECG changes
Administer prescribed potassium supplements Monitor vital signs Apical pulse
Educate patient on increasing potassium intake Fruits, vegetables, legumes,
whole grains, milk, meat Educate patient on use of laxatives
What causes hyperkalemia (high potassium)? - CORRECT ANS✔✔Kidney
injury/failure▪ Potassium sparing diuretics▪ Addison's disease▪ Rapid infusion of
potassium supplement
Identify and monitor patients at high risk Monitor for cardiac abnormalities/ECG
changes Monitor intake and output Monitor for signs of muscle weakness Monitor
vital signs Monitor for GI symptoms Assess for muscle weakness Monitor for
hypokalemia while attempting to decrease potassium
HYPOKALEMIA (MAIN MANIFESTATIONS) - CORRECT ANS✔✔CARDIAC
DYSFUNCTION▪ Ventricular fibrillation▪ Asystole▪ Prolonged PR▪ Flattened T
wave▪ U wave▪ ST Depression
HYPERKALEMIA (MANIFESTATIONS) - CORRECT ANS✔✔CARDIAC
DYSFUNCTION▪ Tachycardia→bradycardia▪ TALL PEAKED T WAVES▪ Prolonged
PR interval▪ Prolonged QRS interval▪ Absent P waves▪ ST Depression
hypokalemia medical management - CORRECT ANS✔✔Increase of potassium
through PO diet or supplements▪ IV replacement therapy▪ Routine monitoring of
cardiac function▪ Routine monitoring of labs
hyperkalemia medical management - CORRECT ANS✔✔12 lead EKG to monitor
for slow polarization and peaked T waves▪ Restrict dietary intake of potassium▪
Dialysis▪ Medications to protect and correct▪ IV calcium gluconate▪ Sodium
bicarbonate▪ Regular insulin with D50▪ Kaexylate
What causes hypocalcemia? - CORRECT ANS✔✔Primary Hypoparathyroidism▪
Surgical Hypoparathyroidism▪ Infusion of large amount of citrated blood▪
Inflammation of the pancreas▪ Kidney injury/failure▪ Hyperphosphatemia▪
Reciprocal effect on calcium
Positive Chvostek and Trousseau sign
, What causes hypercalcemia? - CORRECT ANS✔✔Malignant tumors▪
Hyperparathyroidism▪ Thiazide diuretics▪ Increase in Vit D and Vit A intake▪
Mineralization from immobility▪ RARE
HYPOCALCEMIA (MAIN MANIFESTATIONS) - CORRECT ANS✔✔Tetany▪
Trousseau's sign (BP cuff)▪ Chvostek's sign (cheek)▪ Brittle nails▪ Confusion
HYPERCALCEMIA (MAIN MANIFESTATIONS) - CORRECT ANS✔✔Muscular
weakness▪ Decreased deep tendon reflexes▪ Deep bone pain▪ Kidney stones
hypocalcemia medical management - CORRECT ANS✔✔IV administration of a
calcium salt▪ Administer vitamin D supplement▪ Decrease phosphorus levels▪
Calcium supplement and diet
HYPERCALCEMIA medical management - CORRECT ANS✔✔Decrease serum
calcium levels▪ Identify and treat underlying cause▪ Administer IV fluids (0.9%
NS)▪ Administer furosemide with IVF▪ Decrease intake of calcium▪ Diet and
medications▪ Administer phosphate▪ Administer Calcitonin
What are your priority physical assessments andinterventions for hypocalcemia
and hypercalcemia? - CORRECT ANS✔✔neuro/seizure precautions
*****monitor urinary output prior to replacement of any potassium - this indicates
kidney function and the kidneys ability to excrete any excess potassium -
CORRECT ANS✔✔
hypocalcemia medical management - CORRECT ANS✔✔IV administration of a
calcium salt▪ Administer vitamin D supplement▪ Decrease phosphorus levels▪
Calcium supplement and diet
Hypercalcemia medical management - CORRECT ANS✔✔Decrease serum calcium
levels▪ Identify and treat underlying cause▪ Administer IV fluids (0.9% NS)▪
Administer furosemide with IVF▪ Decrease intake of calcium▪ Diet and
medications▪ Administer phosphate▪ Administer Calcitonin
What causes hypomagnesium (low magnesium)? - CORRECT ANS✔✔Alcoholism▪
Hyperparathyroidism▪ Hyper aldosterone▪ AKI with diuresis▪ Malabsorption
disorders▪ DKA▪ Refeeding▪ Parenteral nutrition▪ Chronic laxative use▪ Diarrhea▪
NG suction▪ Fistulas▪ MI/ heart failure▪ Hypocalcemia and hypokalemia
What causes hypermagnesium (high magnesium)? - CORRECT ANS✔✔Oliguric
kidney injury▪ Adrenal insufficiency▪ Excessive IV magnesium administration▪ DKA▪
Hypothyroidism
