MED SURG EXAM 1:
How we ask Med Surg Questions Safety & Nursing priorities:
- Patient safety
Clinical Judgment module:
- Infection setting
Assess Interpret Plan Take action Evaluate - Priority setting in renal & Electrolyte cases
OVERVIEW:
DOSAGE CALCULATION 3 questions
TYPES OF FLUIDS 4 questions
FLUID IMBALANCE 10 questions
ELECTROLYTE IMBALANCES 10 questions
BLOOD TRANSFUSION 4 questions
ABG 4 questions
URINARY 15 uestions
Lab/Intervention NCLEX Relevance
↑ BUN/Creatinine Kidney impairment; monitor trends
↓ GFR <60 for 3+ months = CKD
↑ Potassium Cardiac risk; monitor ECG, give insulin + D50, calcium gluconate, or sodium polystyrene
↓ Hgb Give epoetin alfa for CKD-induced anemia
Fluid Overload Lung sounds, edema, ↑ BP → restrict fluids, give diuretics or dialysis
Renal Diet Low Na⁺, K⁺, phosphate, protein; high calories
,1. Fluid Volume Overload – Nursing priorities 8. Acute Kidney Injury [AKI]
2. Fluid Volume Deficit – Nursing priorities - Causes
3. Third Space Fluid Shift - Phases
4. Electrolyte imbalances (hyper/hypo) à Priority setting in electrolyte 9. Chronic Kidney Disease [CKD]
cases - Stages
- Potassium -- Kalemia - Complications
- Calcium -- Calcimia 10. Dialysis
- Sodium -- Natremia - Hemodialysis
- Magnesium -- Magnesemia - Peritoneal dialysis
- Phosphatase -- Phospatemia - Safety considerations
- Chloride -- Chloremia 11. Glomerulonephritis
5. Types of fluid: 12. Nephritic syndrome
- Isotonic 13. Renal cancer
- Hypertonic - Early stages
- Hypotonic - TX:
6. ABGs – interpretation o Staging the cancer
- Metabolic Acidosis ** o Nephrectomy
7. Blood Product administration – Blood Transfusion 14. ESRD
- Safe Administration 15. Polycystic Kidney Disease (PKD)
- Reactions - NO CURE!
- Nursing Care - You need to have a family history to get diagnosed
,Types of Fluids (4 Qs)
, OSMOLARITY: The concentration of a solution.
à Higher osmolality = Higher solutes (heavy)
à Lower osmolality = Lower solutes (light & dilute)
Hypotonic solutions: Lower osmolality Isotonic solutions: Equal osmolality Hypertonic solutions: High osmolality
- (lighter & dilute) - (270 - 300 millimoles / kg) - (heavy & thick concentration)
- Less than 300 millimoles / kg - (same as blood concentration) - OVER 300 millimoles / kg
Fluid Imbalance (10 Qs)
Factors that influence Fluid balance:
o Muscle (more fluid à muscles retain more water)
o Body fat (less fluid)
o Gender (men retain more fluid)
o Age
Monitor I&Os and daily weights: best indicator of fluid status.
Most accurate indicator of fluid loss or agin ----- weight
o How to we weigh -- In morning // No clothes // Before food
o Important to weight every day --- HF patients
How we ask Med Surg Questions Safety & Nursing priorities:
- Patient safety
Clinical Judgment module:
- Infection setting
Assess Interpret Plan Take action Evaluate - Priority setting in renal & Electrolyte cases
OVERVIEW:
DOSAGE CALCULATION 3 questions
TYPES OF FLUIDS 4 questions
FLUID IMBALANCE 10 questions
ELECTROLYTE IMBALANCES 10 questions
BLOOD TRANSFUSION 4 questions
ABG 4 questions
URINARY 15 uestions
Lab/Intervention NCLEX Relevance
↑ BUN/Creatinine Kidney impairment; monitor trends
↓ GFR <60 for 3+ months = CKD
↑ Potassium Cardiac risk; monitor ECG, give insulin + D50, calcium gluconate, or sodium polystyrene
↓ Hgb Give epoetin alfa for CKD-induced anemia
Fluid Overload Lung sounds, edema, ↑ BP → restrict fluids, give diuretics or dialysis
Renal Diet Low Na⁺, K⁺, phosphate, protein; high calories
,1. Fluid Volume Overload – Nursing priorities 8. Acute Kidney Injury [AKI]
2. Fluid Volume Deficit – Nursing priorities - Causes
3. Third Space Fluid Shift - Phases
4. Electrolyte imbalances (hyper/hypo) à Priority setting in electrolyte 9. Chronic Kidney Disease [CKD]
cases - Stages
- Potassium -- Kalemia - Complications
- Calcium -- Calcimia 10. Dialysis
- Sodium -- Natremia - Hemodialysis
- Magnesium -- Magnesemia - Peritoneal dialysis
- Phosphatase -- Phospatemia - Safety considerations
- Chloride -- Chloremia 11. Glomerulonephritis
5. Types of fluid: 12. Nephritic syndrome
- Isotonic 13. Renal cancer
- Hypertonic - Early stages
- Hypotonic - TX:
6. ABGs – interpretation o Staging the cancer
- Metabolic Acidosis ** o Nephrectomy
7. Blood Product administration – Blood Transfusion 14. ESRD
- Safe Administration 15. Polycystic Kidney Disease (PKD)
- Reactions - NO CURE!
- Nursing Care - You need to have a family history to get diagnosed
,Types of Fluids (4 Qs)
, OSMOLARITY: The concentration of a solution.
à Higher osmolality = Higher solutes (heavy)
à Lower osmolality = Lower solutes (light & dilute)
Hypotonic solutions: Lower osmolality Isotonic solutions: Equal osmolality Hypertonic solutions: High osmolality
- (lighter & dilute) - (270 - 300 millimoles / kg) - (heavy & thick concentration)
- Less than 300 millimoles / kg - (same as blood concentration) - OVER 300 millimoles / kg
Fluid Imbalance (10 Qs)
Factors that influence Fluid balance:
o Muscle (more fluid à muscles retain more water)
o Body fat (less fluid)
o Gender (men retain more fluid)
o Age
Monitor I&Os and daily weights: best indicator of fluid status.
Most accurate indicator of fluid loss or agin ----- weight
o How to we weigh -- In morning // No clothes // Before food
o Important to weight every day --- HF patients
