ATI MED SURG Proctored Final Exam Study
Guide (LATEST-2026)
1. Understand k,the k,ABG’s k,and k,how k,to k,decide k,if k,a k,patient k,is k,in k,resp k,acidosis k,or k,resp
k,alkalosis, k,metabolic k,acidosis, k,or k,metabolic k,alkalosis.
2. Understand k,the k,function k,of k,potassium, k,sodium, k,and k,calcium k,in k,the k,body- k,especially k,the
k,heart k,and k,how k,to k,administer k,these k,electrolytes. k,Be k,able k,to k,correct k,the k,calcium k,using k,the
k,calculation.
- Sodium: k,Na
- Normal k,value: k,135-145
- Hyponatremia k,<135
- Common k,imbalance k,in k,the k,elderly k,caused k,by k,Na k,loss k,or k,water k,gain
- Symptoms: k,decrease k,BP, k,poor k,skin k,turgor, k,headache,
k,nausea, k,cramps
- If k,seizure k,occurs: k,small k,infusion k,of k,3%-5% k,NaCl k,SLOWLY
- Hypernatremia k,>145
- Sodium k,gain k,or k,water k,loss
- Problem k,with k,elderly/pts k,who k,can’t k,sense k,thirst k,or k,don’t k,meet
k,fluid k,needs
- Symptoms: k,increase k,in k,temp, k,dry k,swollen k,tongue,
k,neuro k,symptoms/changes=FIRST k,sign k,usually
- Potassium: k,K
- Normal k,value: k,3.5-5.0
, - K+ k,necessary k,for k,normal k,cardiac k,rhythms, k,necessary k,for k,skeletal
k,and k,smooth k,muscle k,contraction, k,K+ k,helps k,make k,glycogen
k,deposit k,in k,the k,liver
- K k,imbalances k,can k,be k,life k,threatening
- Hyperkalemia k,>5.0
- Manifestations: k,cardiac k,changes k,& k,dysrhythmias, k,ECG k,shows
k,tented k,T k,waves, k,arrhythmias, k,muscle k,weakness, k,GI k,cramps
- Management: k,Give k,diuretics k,to k,excrete k,K+, k,10 k,units k,regular
k,insulin k,IV k,push k,with k,glucose k,(1 k,amp k,D50), k,Beta-2 k,agonist
k,(albuterol k,MDI), k,Kayexalate k,(ionexchange k,resin) k,- k ,
k , Hypokalemia k,<3.5
- Manifestations: k,fatigue, k,dysrhythmias, k,DTRs, k,constipations,
k,muscle k,weakness, k,anorexia, k,ECG k,changes: k,flat k,T k,waves k,or
k , inverted k,T k,waves k,or k,both, k,suggesting k,ischemia, k,and k,depressed
k,ST
segments
- Med k,Management: k,increase k,PO k,of k,K+, k,give k,KCL k,supplements
k,when k,patient k,is k,on k,loop k,or k,thiazide k,diuretics k,to k,prevent
k,hypokalemia
- KCl k,should k,be k,administered k,IV k,at k,rate k,of k,10-20 k,mEq/L k,per
k,hour k,→ k,rapid k,infusion k,can k,cause k,CARDIAC k,ARREST
- Hold k,KCl k,unless k,urine k,output k,is k,at k,least k,0.5 k,ml/kg k,of k,body
k,weight k,per k,hour
- Calcium: k,Ca
- Normal k,Value: k,9-11
- Ca++ k,works k,as k,an k,enzyme k,co-factor k,for k,clotting k,and k,hormone
k,secretion. k,Stored k,in k,parathyroid k,glands, k,maintains k,plasma
k,membrane k,stabilityparticularly k,in k,the k,cardiac k,cell k,nerve
k,receptors, k,aids k,in k,the k,transmission k,of
nerve k,impulses k,and k,contraction k,of k,muscles k,-
Corrected k,Calcium:
- Measured k,total k,serum k,Ca++ k,level k,(mg/dl) k,= k,0.8 k,x k,(4.0 k,–
k,measured k,albumin k,level k,[g/dL]) k,= k,corrected k,total k,calcium
k,concentration k,(mg/dL)
- Pt’s k,serum k,calcium k,level k,is k,reported k,as k,7.5 k,mg/dL k,and
k,serum k,albumin k,is k,2.5 k,g/dL.
- 4.0 k,– k,2.5 k,= k,1.5 k,g/dL k,(albumin k,difference)
- 1.5 k,x k,0.8 k,= k,1.2
- 1.2 k,+ k,7.5 k,= k,8.7 k,mg/dL k,(corrected k,calcium) k,- k , k , Hypocalcemia: k,<9 k,-
Manifestations:
- Tetany- k,paresthesias k,of k,nose, k,ears, k,fingertips k,that k,progresses k,to
k,painful k,muscle k,spasms k,and k,convulsions; k,Positive k,Chvostek’s
k,sign- k,cheek k,twitch; k,Positive k,Trousseau’s k,sign- k,carpal k,spasm k,of
k,hand- k,with k,BP k,cuff k,inflation;
,Hyperreflexia; k,Laryngospasm; k,Arrhythmias- k,VF, k,torsades k,de k,pointes, k,Long
k,QT, k,↓ k,Cardiac k,contractility k,and k,↓ k,blood k,pressure,
Hypomagnesemia
- trousseau’s
chvostek’s
- Meds: k,Emergency k,Management:
- Administer k,Calcium k,Gluconate k,or k,Calcium k,Chloride k,by k,slow k,IV
k,push k,(0.5-1.0 k,ml/min)
- Maximum k,rate k,for k,intermittent k,infusion k,is k,200 k,mg/min.
- For k,Non-Acute k,Hypocalcemia:
- Give k,Calcium k,Carbonate k,PO k,with k,Vitamin k,D k,to k,help k,with
++
k,absorption k,of k,Ca k,in k,the k,GI k,tract
- May k,need k,to k,give k,Magnesium k,if k,serum k,levels k,are k,low
- Hypercalcemia: k,>11
- Levels k,>12= k,coma k,; k,<14=death
- Causes: k,increase k,Vitamin k,D k,and k,A, k,hyperparathyroidism,
k,metastatic k,cancer k,to k,bone
- Manifestations: k,fatigue/weakness, k,constipation, k,dehydration,
k,ECG k,changes= k,decreased k,heart k,rate, k,heart k,blocks, k,shortened k,QT
k,interval k,and k,depressed k,T k,Wave; k,kidney k,stones
- Med k,Management: k,IV k,fluids k,followed k,with k,loop k,diuretics k,(lasix)
k,→ k,increase k,hydration k,(IV k,fluids) k,to k,3000-4000 k,ml/day k,to k,flush
++
k,Ca k,and k,to k,↓ k,calculi k,formation, k,synthetic k,Calcitonin k,can k,be
++
k,given k,to k,lower k,Ca k,levels, k,IV k,calcitonin-promotes k,renal
k,excretion k,of k,Ca, k,antiemetics k,for k,nausea, k,IV k,biphosphates k,to
k,reduce k,bone k,resorption
- k , Magnesium:
- Hypomagnesium k,Mg+ k,< k,1.5 k,mEq/L k,- k,Causes:
- Alcoholism
- Hemodialysis
- Poor k,dietary k,intake
- Poor k,absorption k,of k , by k,GI k,tract
- Excessive k,Mg+ k,loss k,from k,GI k,tract k,(diarrhea)
, - Kidney k,disease(primary k,aldosteronism, k,DKA,
k , hyperparathyroidism) k,Sepsis, k,burns, k,some k,wounds k,- k,S/Sx:
- Neuromuscular: k,muscle k,weakness, k,respiratory k , muscle
k,paralysis, k,hyperactive k,DTRs
- CV: k,Complete k,heart k,block k,(EKG k,changes), k , tachycardia
- CNS: k,Altered k,LOC, k,confusion, k,hallucinations
- GI: k,Dysphagia, k,anorexia, k,nausea, k , vomiting k,- Tx:
- Dietary k,replacement
- Oral k,supplements
- IM k,or k,IV k,supplementation—SLOWLY
- Hypermagnesium k,Mg+ k,> k,1.5 k,mEq/L k,- Causes:
- Renal k,insufficiency
- Continuous k,infusions k,of k,Mg+ k,as k,used k,with
k,seizures, k,pregnancyinduced k,HTN, k,preterm k,labor
k,- k,S/Sx:
- Decreased k,muscle k,and k,nerve k , activity
- Hypoactive k,DTRs
- Generalized k,weakness, k,lethargy, k,flaccid, k,paralysis
- Nausea k,& k,vomiting
- Shallow, k,depressed k,respiratory k,system
- Hypotension k,- Sedation
- ECG k,changes k,- Cardiac k,arrest k,- k , Tx:
- Fluids k,up, k,Mg+ k,level k,down
- Increased k,fluid k,intake k,raises k,urine k,output k,to k,rid k,of k , excess k,Mg+
- Dialysis
- Phosphorus:
- Hypophosphatemia
-
- Hyperphosphatemia
-
→ k,Functions k,of k,electrolytes k,in k,the k,heart: k,CONDUCTION
● Phase k,4: k,resting k,membrane k,potential k,associated k,with k,diastole
● Phase k,0: k,rapid k,depolarization; k,rapid k,influx k,of k,Na+ k , into k,cell k,through k,fast k,channels
● Phase k,1: k,movement k,of k,K+ k,and k,Cl- k,ions k,out k,of k,cell
● Phase k,2: k,movement k,of k,Ca++ k , into k,cell k,and k,movement k,of k,K+ k,out k,of k,cell
● Phase k,3: k,rapid k,repolarization; k,electrolytes k,return k,to k,normal k,location k,either k,in k,or
k,out k,of k,cell; k,membrane k,potential k,returns k,to k,normal
Guide (LATEST-2026)
1. Understand k,the k,ABG’s k,and k,how k,to k,decide k,if k,a k,patient k,is k,in k,resp k,acidosis k,or k,resp
k,alkalosis, k,metabolic k,acidosis, k,or k,metabolic k,alkalosis.
2. Understand k,the k,function k,of k,potassium, k,sodium, k,and k,calcium k,in k,the k,body- k,especially k,the
k,heart k,and k,how k,to k,administer k,these k,electrolytes. k,Be k,able k,to k,correct k,the k,calcium k,using k,the
k,calculation.
- Sodium: k,Na
- Normal k,value: k,135-145
- Hyponatremia k,<135
- Common k,imbalance k,in k,the k,elderly k,caused k,by k,Na k,loss k,or k,water k,gain
- Symptoms: k,decrease k,BP, k,poor k,skin k,turgor, k,headache,
k,nausea, k,cramps
- If k,seizure k,occurs: k,small k,infusion k,of k,3%-5% k,NaCl k,SLOWLY
- Hypernatremia k,>145
- Sodium k,gain k,or k,water k,loss
- Problem k,with k,elderly/pts k,who k,can’t k,sense k,thirst k,or k,don’t k,meet
k,fluid k,needs
- Symptoms: k,increase k,in k,temp, k,dry k,swollen k,tongue,
k,neuro k,symptoms/changes=FIRST k,sign k,usually
- Potassium: k,K
- Normal k,value: k,3.5-5.0
, - K+ k,necessary k,for k,normal k,cardiac k,rhythms, k,necessary k,for k,skeletal
k,and k,smooth k,muscle k,contraction, k,K+ k,helps k,make k,glycogen
k,deposit k,in k,the k,liver
- K k,imbalances k,can k,be k,life k,threatening
- Hyperkalemia k,>5.0
- Manifestations: k,cardiac k,changes k,& k,dysrhythmias, k,ECG k,shows
k,tented k,T k,waves, k,arrhythmias, k,muscle k,weakness, k,GI k,cramps
- Management: k,Give k,diuretics k,to k,excrete k,K+, k,10 k,units k,regular
k,insulin k,IV k,push k,with k,glucose k,(1 k,amp k,D50), k,Beta-2 k,agonist
k,(albuterol k,MDI), k,Kayexalate k,(ionexchange k,resin) k,- k ,
k , Hypokalemia k,<3.5
- Manifestations: k,fatigue, k,dysrhythmias, k,DTRs, k,constipations,
k,muscle k,weakness, k,anorexia, k,ECG k,changes: k,flat k,T k,waves k,or
k , inverted k,T k,waves k,or k,both, k,suggesting k,ischemia, k,and k,depressed
k,ST
segments
- Med k,Management: k,increase k,PO k,of k,K+, k,give k,KCL k,supplements
k,when k,patient k,is k,on k,loop k,or k,thiazide k,diuretics k,to k,prevent
k,hypokalemia
- KCl k,should k,be k,administered k,IV k,at k,rate k,of k,10-20 k,mEq/L k,per
k,hour k,→ k,rapid k,infusion k,can k,cause k,CARDIAC k,ARREST
- Hold k,KCl k,unless k,urine k,output k,is k,at k,least k,0.5 k,ml/kg k,of k,body
k,weight k,per k,hour
- Calcium: k,Ca
- Normal k,Value: k,9-11
- Ca++ k,works k,as k,an k,enzyme k,co-factor k,for k,clotting k,and k,hormone
k,secretion. k,Stored k,in k,parathyroid k,glands, k,maintains k,plasma
k,membrane k,stabilityparticularly k,in k,the k,cardiac k,cell k,nerve
k,receptors, k,aids k,in k,the k,transmission k,of
nerve k,impulses k,and k,contraction k,of k,muscles k,-
Corrected k,Calcium:
- Measured k,total k,serum k,Ca++ k,level k,(mg/dl) k,= k,0.8 k,x k,(4.0 k,–
k,measured k,albumin k,level k,[g/dL]) k,= k,corrected k,total k,calcium
k,concentration k,(mg/dL)
- Pt’s k,serum k,calcium k,level k,is k,reported k,as k,7.5 k,mg/dL k,and
k,serum k,albumin k,is k,2.5 k,g/dL.
- 4.0 k,– k,2.5 k,= k,1.5 k,g/dL k,(albumin k,difference)
- 1.5 k,x k,0.8 k,= k,1.2
- 1.2 k,+ k,7.5 k,= k,8.7 k,mg/dL k,(corrected k,calcium) k,- k , k , Hypocalcemia: k,<9 k,-
Manifestations:
- Tetany- k,paresthesias k,of k,nose, k,ears, k,fingertips k,that k,progresses k,to
k,painful k,muscle k,spasms k,and k,convulsions; k,Positive k,Chvostek’s
k,sign- k,cheek k,twitch; k,Positive k,Trousseau’s k,sign- k,carpal k,spasm k,of
k,hand- k,with k,BP k,cuff k,inflation;
,Hyperreflexia; k,Laryngospasm; k,Arrhythmias- k,VF, k,torsades k,de k,pointes, k,Long
k,QT, k,↓ k,Cardiac k,contractility k,and k,↓ k,blood k,pressure,
Hypomagnesemia
- trousseau’s
chvostek’s
- Meds: k,Emergency k,Management:
- Administer k,Calcium k,Gluconate k,or k,Calcium k,Chloride k,by k,slow k,IV
k,push k,(0.5-1.0 k,ml/min)
- Maximum k,rate k,for k,intermittent k,infusion k,is k,200 k,mg/min.
- For k,Non-Acute k,Hypocalcemia:
- Give k,Calcium k,Carbonate k,PO k,with k,Vitamin k,D k,to k,help k,with
++
k,absorption k,of k,Ca k,in k,the k,GI k,tract
- May k,need k,to k,give k,Magnesium k,if k,serum k,levels k,are k,low
- Hypercalcemia: k,>11
- Levels k,>12= k,coma k,; k,<14=death
- Causes: k,increase k,Vitamin k,D k,and k,A, k,hyperparathyroidism,
k,metastatic k,cancer k,to k,bone
- Manifestations: k,fatigue/weakness, k,constipation, k,dehydration,
k,ECG k,changes= k,decreased k,heart k,rate, k,heart k,blocks, k,shortened k,QT
k,interval k,and k,depressed k,T k,Wave; k,kidney k,stones
- Med k,Management: k,IV k,fluids k,followed k,with k,loop k,diuretics k,(lasix)
k,→ k,increase k,hydration k,(IV k,fluids) k,to k,3000-4000 k,ml/day k,to k,flush
++
k,Ca k,and k,to k,↓ k,calculi k,formation, k,synthetic k,Calcitonin k,can k,be
++
k,given k,to k,lower k,Ca k,levels, k,IV k,calcitonin-promotes k,renal
k,excretion k,of k,Ca, k,antiemetics k,for k,nausea, k,IV k,biphosphates k,to
k,reduce k,bone k,resorption
- k , Magnesium:
- Hypomagnesium k,Mg+ k,< k,1.5 k,mEq/L k,- k,Causes:
- Alcoholism
- Hemodialysis
- Poor k,dietary k,intake
- Poor k,absorption k,of k , by k,GI k,tract
- Excessive k,Mg+ k,loss k,from k,GI k,tract k,(diarrhea)
, - Kidney k,disease(primary k,aldosteronism, k,DKA,
k , hyperparathyroidism) k,Sepsis, k,burns, k,some k,wounds k,- k,S/Sx:
- Neuromuscular: k,muscle k,weakness, k,respiratory k , muscle
k,paralysis, k,hyperactive k,DTRs
- CV: k,Complete k,heart k,block k,(EKG k,changes), k , tachycardia
- CNS: k,Altered k,LOC, k,confusion, k,hallucinations
- GI: k,Dysphagia, k,anorexia, k,nausea, k , vomiting k,- Tx:
- Dietary k,replacement
- Oral k,supplements
- IM k,or k,IV k,supplementation—SLOWLY
- Hypermagnesium k,Mg+ k,> k,1.5 k,mEq/L k,- Causes:
- Renal k,insufficiency
- Continuous k,infusions k,of k,Mg+ k,as k,used k,with
k,seizures, k,pregnancyinduced k,HTN, k,preterm k,labor
k,- k,S/Sx:
- Decreased k,muscle k,and k,nerve k , activity
- Hypoactive k,DTRs
- Generalized k,weakness, k,lethargy, k,flaccid, k,paralysis
- Nausea k,& k,vomiting
- Shallow, k,depressed k,respiratory k,system
- Hypotension k,- Sedation
- ECG k,changes k,- Cardiac k,arrest k,- k , Tx:
- Fluids k,up, k,Mg+ k,level k,down
- Increased k,fluid k,intake k,raises k,urine k,output k,to k,rid k,of k , excess k,Mg+
- Dialysis
- Phosphorus:
- Hypophosphatemia
-
- Hyperphosphatemia
-
→ k,Functions k,of k,electrolytes k,in k,the k,heart: k,CONDUCTION
● Phase k,4: k,resting k,membrane k,potential k,associated k,with k,diastole
● Phase k,0: k,rapid k,depolarization; k,rapid k,influx k,of k,Na+ k , into k,cell k,through k,fast k,channels
● Phase k,1: k,movement k,of k,K+ k,and k,Cl- k,ions k,out k,of k,cell
● Phase k,2: k,movement k,of k,Ca++ k , into k,cell k,and k,movement k,of k,K+ k,out k,of k,cell
● Phase k,3: k,rapid k,repolarization; k,electrolytes k,return k,to k,normal k,location k,either k,in k,or
k,out k,of k,cell; k,membrane k,potential k,returns k,to k,normal
