electrolytes

What is the normal reference range for serum Sodium ($Na^{+}$)?

$135-145$ $mEq/L$

Which electrolyte imbalance is characterized by cellular swelling, lethargy, confusion, and potential seizures?

Hyponatremia

Why must hypertonic saline ($3\%$ $NaCl$) be administered very slowly for severe hyponatremia?

To avoid central pontine myelinolysis.

What are the common assessment findings for Hypernatremia?

Intense thirst, flushed skin, dry mucous membranes, and agitation.

What is the normal reference range for serum Potassium ($K^{+}$)?

$3.5-5.0$ $mEq/L$

Which EKG changes are associated with Hypokalemia?

Flattened T waves, ST depression, and prominent U waves.

What is the maximum infusion rate for IV Potassium replacement via pump?

$10$ $mEq/hr$

Which EKG changes are characteristic of Hyperkalemia?

Tall peaked T waves, prolonged PR interval, and wide QRS complexes.

What is the purpose of administering IV Calcium Gluconate in the setting of hyperkalemia?

To stabilize the myocardium and prevent dysrhythmias.

Which medication combination is used to shift potassium back into cells during a hyperkalemic emergency?

Regular Insulin and $D_{50}W$ (Dextrose $50\%$).

What is the normal reference range for serum Calcium ($Ca^{2+}$)?

$9.0-10.5$ $mg/dL$

Concept: Trousseau's sign

Definition: Carpal spasm induced by inflating a blood pressure cuff; indicative of hypocalcemia.

Concept: Chvostek's sign

Definition: Facial muscle twitching when the facial nerve is tapped; indicative of hypocalcemia.

What mnemonic describes the clinical manifestations of Hypercalcemia?

"Moans, groans, stones, bones, and psychiatric overtones."

What is the primary nursing priority when handling a patient with severe hypercalcemia to prevent injury?

Handle the patient gently to avoid pathologic fractures.

What is the normal reference range for serum Magnesium ($Mg^{2+}$)?

$1.3-2.1$ $mEq/L$

Which life-threatening EKG rhythm is specifically associated with Hypomagnesemia?

Torsades de Pointes

What are the priority assessment findings for Hypermagnesemia?

Lethargy, hyporeflexia (absent DTRs), and respiratory depression.

What is the pharmacological antidote for Magnesium toxicity?

IV Calcium Gluconate

What is the normal reference range for serum Phosphate ($PO_{4}^{3-}$)?

$3.0-4.5$ $mg/dL$

What is the reciprocal relationship between Calcium and Phosphate?

They maintain a strict inverse relationship; when one rises, the other falls.

When should phosphate binders like Sevelamer or Calcium Acetate be administered?

With meals to bind dietary phosphorus.

What blood pressure readings define a Hypertensive Crisis?

Systolic $> 180$ $mmHg$ or Diastolic $> 120$ $mmHg$.

An Echocardiogram showing a Left Ventricular Ejection Fraction (LVEF) of less than $40\%$ indicates _____.

Heart Failure with Reduced Ejection Fraction (HFrEF).

What is the clinical significance of a B-Type Natriuretic Peptide (BNP) level $> 100$ $pg/mL$?

It confirms a heart failure exacerbation and distinguishes it from respiratory causes of dyspnea.

What is the normal reference range for Serum Creatinine?

$0.6-1.2$ $mg/dL$

What is the primary difference between Primary and Secondary Hypertension?

Primary is idiopathic (no known cause), while Secondary results from an identifiable underlying cause.

Which unique side effects are specifically associated with ACE Inhibitors like Lisinopril?

Dry cough and life-threatening angioedema.

What are the specific parameters for holding a Beta Blocker?

Heart Rate $< 60$ $bpm$ or Systolic BP $< 90-100$ $mmHg$.

Why should Beta Blockers be used cautiously in diabetic patients?

They can mask symptoms of hypoglycemia, such as tachycardia.

Which dietary substance must be avoided when taking Calcium Channel Blockers like Diltiazem?

Grapefruit juice

What are the priority monitoring requirements for patients on Loop Diuretics (e.g., Furosemide)?

Severe hypokalemia, daily weights, and strict intake/output ($I/O$).

Which type of heart failure is characterized by pulmonary congestion, crackles, and pink frothy sputum?

Left-Sided Heart Failure

What are the hallmark signs of systemic congestion found in Right-Sided Heart Failure?

Jugular Venous Distention (JVD), hepatomegaly, and peripheral dependent edema.

What weight gain threshold should a heart failure patient report to their provider?

Gain of $> 3$ $lbs$ in a day or $5$ $lbs$ in a week.

Concept: Intermittent Claudication

Definition: Sharp, cramping leg pain induced by exercise and relieved by rest; a classic sign of Peripheral Artery Disease (PAD).

How should a patient with Peripheral Artery Disease (PAD) be positioned to assist blood flow?

Dangle legs in a dependent position; do not elevate above heart level.

Which vascular disorder is characterized by brownish skin discoloration (hemosiderin staining) and leathery skin?

Chronic Venous Insufficiency (CVI)

What are the characteristic features of a venous ulcer?

Irregular borders, located near the medial malleolus, with beefy red granulation and heavy drainage.

What are the '6 Ps' used to assess for acute limb ischemia after peripheral artery bypass surgery?

Pain, Pallor, Pulselessness, Paresthesia, Paralysis, and Poikilothermia.

Which cardiac biomarker is the gold standard for diagnosing myocardial injury?

Troponin (I and T)

What is the LDL (bad cholesterol) goal for a patient at high risk for CAD?

$< 70$ $mg/dL$

What are the nursing pre-procedure requirements for a cardiac stress test?

NPO for 4 hours, hold beta-blockers and caffeine for 24 hours.

Which assessment is the highest priority immediately following a cardiac catheterization via the femoral artery?

Monitor the access site for hematoma or bleeding and palpate distal pulses.

What is the required positioning and duration for a patient after a femoral artery cardiac catheterization?

Strict bed rest with the affected leg completely straight for $4-6$ hours.

What is the most serious complication indicated by severe back or flank pain after a cardiac catheterization?

Retroperitoneal bleeding

When is the optimal time of day to administer Statin medications?

At bedtime, because cholesterol synthesis peaks at night.

What is the primary patient education regarding the use of sublingual Nitroglycerin for chest pain?

Take 1 tablet; if pain persists after 5 minutes, call 911 and take a second tablet (max 3 doses).

Which medication class is absolutely contraindicated with Nitroglycerin due to the risk of fatal hypotension?

Phosphodiesterase inhibitors (e.g., Sildenafil/Viagra).

In the EKG waveform, what does the P wave represent?

Atrial depolarization

What is the normal duration of the PR Interval?

$0.12-0.20$ seconds ($3-5$ small boxes).

What is the normal duration of the QRS complex?

$< 0.12$ seconds (less than 3 small boxes).

Which EKG segment change is the primary indicator of an acute Myocardial Infarction (STEMI)?

ST segment elevation

What is the first-line pharmacological treatment for symptomatic Sinus Bradycardia?

IV Atropine

Which cardiac rhythm is characterized by a grossly irregular rate and the absence of distinct P waves?

Atrial Fibrillation (A-Fib)

What is the primary long-term complication risk for a patient in Atrial Fibrillation?

Thromboembolic stroke

Which rhythm is identified by uniform "Sawtooth" waves (F-waves)?

Atrial Flutter

What is the normal reference range for Blood Urea Nitrogen (BUN)?

$10-20$ $mg/dL$

Which lab value is the best overall index and the gold standard for measuring kidney function?

Glomerular Filtration Rate (GFR)

A GFR of less than $15$ $mL/min$ indicates which stage of renal disease?

End-Stage Renal Disease (ESRD)

Which urinalysis finding is the earliest marker of structural glomerular injury, particularly in diabetes?

Proteinuria (Albuminuria)

What defines a "Complicated" Urinary Tract Infection (UTI)?

An infection occurring in males, pregnant women, or those with catheters/structural abnormalities.

Which condition is characterized by systemic symptoms like fever, chills, and flank pain with CVA tenderness?

Pyelonephritis (Upper UTI)

What important side effect should the nurse teach a patient taking Phenazopyridine (Pyridium)?

The medication turns urine a bright orange color.

Concept: Hydronephrosis

Definition: Dilation and swelling of the kidney due to backpressure from a urinary obstruction.

Which dietary restriction is necessary for the prevention of Calcium Oxalate renal calculi?

Restrict high-oxalate foods like spinach, rhubarb, nuts, and tea.

Patients with Uric Acid stones should avoid high-purine foods, such as _____.

Organ meats, sardines, anchovies, and red meats.

Which type of renal calculi is caused by urea-splitting bacteria and often grows into large "staghorn" shapes?

Struvite stones

What is the formula for calculating Cardiac Output ($CO$)?

$CO = HR \times SV$

What is the primary hemodynamic effect of ACE inhibitors on Systemic Vascular Resistance ($SVR$)?

Profound vasodilation, which decreases $SVR$ (afterload).

Which electrolyte stabilization is required before certain cellular ATP pumps can function effectively?

Magnesium