Acute & Critical Care Medicine – Archer Review 2025 Edition | High-Yield NCLEX and Advanced Practice Study Guide with NGN Clinical Case Questions, Prioritization, and Life-Saving Intervention

ACUTE & CRITICAL CARE MEDICINE
ARCHER REVIEW 2025 EDITION
NCLEX

Acute & Critical Care Medicine – Archer
Review 2025 Edition | High-Yield NCLEX and
Advanced Practice Study Guide with NGN
Clinical Case Questions, Prioritization, and
Life-Saving Intervention

,Acute & Critical Care Medicine


Difference between crystalloids and colloid fluids- CORRECT ANSWER ✔✔crystalloids: most
of volume does not remain in the intravascular space (inside blood vessels) but moves into
extravascular/interstitial space
colloids: primarily remain in intravascular space and increase oncotic pressure



Examples of crystalloids:- CORRECT ANSWER ✔✔5% dextrose (D5W)

0.9% NaCL (NS)

Lactated Ringers (LR)

Plasma-Lyte A



Examples of colloids- CORRECT ANSWER ✔✔albumin 5%, albumin 25%

Hespan (hydroxyethyl starch, dextran



Colloids provide (smaller/larger) intravascular volume than crystaloids- CORRECT ANSWER
✔✔larger



T/F: Colloids are more expensive and have not shown a clear clinical benefit over crystalloids-
CORRECT ANSWER ✔✔true



Fluids most commonly used for volume resuscitation in shock states- CORRECT ANSWER
✔✔NS and LR



lactated ringers contains:- CORRECT ANSWER ✔✔NaCl, KCl, CaCl2, Na-lactate (which is
converted to bicarbonate)



The most commonly used colloid ______ is specifically useful when there is _____ such as in
conditions like _____- CORRECT ANSWER ✔✔albumin

,useful specifically when there is significant edema like in conditions like cirrhosis



T/F: Albumin can be used as a nutritional supplementation when serum albumin is low-
CORRECT ANSWER ✔✔FALSE this is now how to raise albumin



Hespan starch has a boxed warning for ____ and should only be used if other treatments are
unavailable- CORRECT ANSWER ✔✔boxed warning for mortality



Hyponatremia is usually not sympotmatic until:___ where symptoms can be- CORRECT
ANSWER ✔✔<120

symptoms can be headache, confusion, gait disturbances to seizures, coma



3 types of hyponatremia based on osmolality and their preferred treatment- CORRECT
ANSWER ✔✔hypotonic hypervolemic hyponatremia: (fluid overload): treat w/ diuresis and
fluid restriction

isovolemic: diuresis, stopping offending agents, demeclocycline for SIADH off-label

hypovolemic:(caused by diuretics) stop intake of hypotonic solutions, give hypertonic (3%)
sodium chloride IV



Typical treatment goal of sodium correction is ______- CORRECT ANSWER ✔✔4-8
mEq/L/24H



Correcting sodium more rapidly than ______ can cause ________- CORRECT ANSWER
✔✔more rapidly than 12 mEq/L/24H

can cause osmotic demyelination syndrome or central pontine myelinolysis (leading to paralysis,
seizures, death)



Treatment for SIADH, hypervolemic hyponatremia- CORRECT ANSWER ✔✔conivaptan and
tolvaptan (AVP receptor antagonists)

, tolvaptan drug class- CORRECT ANSWER ✔✔arginine vasopressin receptor antagonists (AVP
antagonists)



Do not use Samsca beyond ________- CORRECT ANSWER ✔✔30 days

(tolvaptan)



T/F: tolvaptan must be initiated and re-initated in the hospital- CORRECT ANSWER ✔✔true
(boxed warning)



boxed warning on Samsca- CORRECT ANSWER ✔✔(tolvaptan)

initiated and re-initiated in a hospital

overly rapid correction of hyponatremia (>12 mEq/L/24H is assoc. w/ ODS (life-threatening)



warnings and side effects with tolvaptan- CORRECT ANSWER ✔✔hepatotoxicity

SE: thirst, nausea, dry mouth, polyuria



Tolvaptan is administered ___ for no more than ____ (due to ____)- CORRECT ANSWER
✔✔PO (tablet)

no more than 30 days due to hepatotoxicity



hypovolemic hypernatremia is typically caused by:- CORRECT ANSWER ✔✔dehydration,
vomiting, diarrhea (treat w/ fluids)



hypervolemic hypernatremia is caused by- CORRECT ANSWER ✔✔intake of hypertonic fluids
(treat w/ diuresis)



isovolemic euvolemic hypernatremia is usually caused by:- CORRECT ANSWER ✔✔Diabetes
insipidus which can decrease ADH