CNUR 203 LATEST 2026 EXAM QUESTIONS AND
SOLUTIONS GRADED A+
✔✔Hypocalcemia clinical manifestations - ✔✔^ depolarization and excitability
(tachycardia and dysrhythmia)
CRAMPS:
- confusion
- arrhythmias
- muscle spasms
- positive trousseau (carpal spasms with BP) and chvostek (contract face w tap) sign
✔✔Hypocalcemia compplications - ✔✔seizures, CHF
✔✔Hypocalcemia tx and meds - ✔✔Ca carbonate
^ Ca diet and Vit D
IV: Ca gluconate
✔✔Hypercalcemia - ✔✔Hyperparathyroidism
malignancy, multiple myeloma, immobilization (Ca released from bone)
vit D OD
diuretics
acidosis
✔✔Hypercalcemia Clinical Manifestations - ✔✔"stones, bones, goans, moans, thrones,
and psychiatric overtones"
(kidney stones, bone pain/fracture, lethargy/fatigue, constipation/N&V,
confusion/depression/anxiety/hallucinations)
Dysrhythmias
hypophosphatemia
✔✔Hypercalcemia complications - ✔✔kidney stones, renal failure
✔✔Hypercalcemia med/tx - ✔✔IV NS
Loop diuretics, synthetic Calcitonin, Bisphosphonates
✔✔Hypercalcemia nursing - ✔✔fluids and excrete Ca
limit Ca
mobilization
✔✔Hypomagnesemia - ✔✔Serum magnesium level low
dt
- decreased intake and absorption
- increased output (diarrhea, vomiting, polyuria)
,- alcoholism
- DM
✔✔Hypomagnesemia clinical manifestations - ✔✔(neuro and cardiac)
- ^ reflexes, chvostek and trousseau's sign
- confusion, seizures
- dysrhythmias, firbrilation
- hypokalemia
✔✔Hypermagnesemia - ✔✔excess of serum magnesium
dt
- renal failure
✔✔Hypermagnesemia clinical manifestations - ✔✔-impaired nerve/muscle function
-hypotension
- slow reflexes
- muscle paralysis --> cardiac arrest
✔✔respiratory alkalosis - ✔✔high pH, low CO2
dt
- ^ CO2 excretion
- hyperventilation
- compensate for HCO3 kidney excretion
✔✔respiratory alkalosis clinical manifestations - ✔✔- lethargy, dizzy, confusion
-tachycardia, dysrhythmias
-numb, tingling, hyperreflexia, seizures
-hyperventilation
✔✔alkalosis lab values - ✔✔pH > 7.45
low CO2 or high HCO3
✔✔metabolic alkalosis - ✔✔high pH, high HCO3
loss of acid or gain of base
compensate for CO2 retention
- vomiting, diuretics
✔✔metabolic alkalosis clinical manifestations - ✔✔nervous, confusion
tachycardia, dysrhythmias
N/V
tremors, cramps
hypoventilation
✔✔Respiratory acidosis - ✔✔low pH, high CO2
CO2 retention of lungs
,compensate for HCO3 retention
- hypoventilation
- COPD and pneumonia
- OD
✔✔Respiratory acidosis clinical manifestations - ✔✔drowsy, dizzy, disorientation
low BP
warm flush skin
hypoventilation and hypoxia
✔✔pH regulatory systems - ✔✔- Chemical buffers
- Respiratory center
- Kidney excretion
✔✔metabolic acidosis - ✔✔low pH, low HCO3
gain of acids/inability to excrete/loss of base
compensate for CO2 excretion
- DKA
- lactic acidosis
- starvation
- diarrhea
- renal failure
- shock
✔✔metabolic acidosis clinical manifestations - ✔✔confusion
low BP, dysrhythmias
N/V, diarrhea
deep, rapid resp
low BP
✔✔Anemia - ✔✔deficiency of RBC, quality/quantity of Hb, V of packed RBC or both
dt
- low RBC production
- blood loss
- ^ RBC destruction (sickle cell, infection...)
✔✔iron deficiency anemia - ✔✔low Fe to make Hb.
dt
- diet
- malabsorption
- blood loss
- hemolysis
✔✔Mild anemia clinical manifestations - ✔✔palpitations
, ✔✔moderate anemia clinical manifestations - ✔✔palpitations, bounding pulse
dyspnea
"roaring" in ears
fatigue
✔✔Severe Anemia Clinical Manifestations - ✔✔mod +
pallor, jaundice, pruritus
hemorrhage
smooth tongue
blurred vision
tachycarida, murmurs, claudications, angina, HF, MI, edema
tachypnea, orthopnea, dyspnea,
vertigo, depression
hepatomegaly, splenomegaly
cold sensitivity
✔✔Fe deficiency anemia tx and meds - ✔✔- IV/IM: Fe dextran, Fe sucrose, Na ferric
gluconate
- take meds with vit C
- ^ Fe diet
- Fe supplements
✔✔blood loss tx - ✔✔blood transfusion if <80
IV: RL or NS
infusion: platelets, plasma, cryoprecipitate
fe supplements
✔✔Hyponatremia - ✔✔low sodium in the blood
dt
- water excess (SIAD, HF, hypotonic IV)
- vomiting and diarrhea
- diuretics, renal disease
- burns and wounds
Can be low ECF and low Na or Normal/high ECF and low Na
✔✔Hyponatremia and Hypovolemia clinical manifestations - ✔✔posteriod hypotension
tachycardia, thready pulse, low jug filling and CVP
weight loss
tremors
✔✔Hyponatremia and normal/high ECF clinical manifestations - ✔✔weak
N&V
weight gain
^BP
SOLUTIONS GRADED A+
✔✔Hypocalcemia clinical manifestations - ✔✔^ depolarization and excitability
(tachycardia and dysrhythmia)
CRAMPS:
- confusion
- arrhythmias
- muscle spasms
- positive trousseau (carpal spasms with BP) and chvostek (contract face w tap) sign
✔✔Hypocalcemia compplications - ✔✔seizures, CHF
✔✔Hypocalcemia tx and meds - ✔✔Ca carbonate
^ Ca diet and Vit D
IV: Ca gluconate
✔✔Hypercalcemia - ✔✔Hyperparathyroidism
malignancy, multiple myeloma, immobilization (Ca released from bone)
vit D OD
diuretics
acidosis
✔✔Hypercalcemia Clinical Manifestations - ✔✔"stones, bones, goans, moans, thrones,
and psychiatric overtones"
(kidney stones, bone pain/fracture, lethargy/fatigue, constipation/N&V,
confusion/depression/anxiety/hallucinations)
Dysrhythmias
hypophosphatemia
✔✔Hypercalcemia complications - ✔✔kidney stones, renal failure
✔✔Hypercalcemia med/tx - ✔✔IV NS
Loop diuretics, synthetic Calcitonin, Bisphosphonates
✔✔Hypercalcemia nursing - ✔✔fluids and excrete Ca
limit Ca
mobilization
✔✔Hypomagnesemia - ✔✔Serum magnesium level low
dt
- decreased intake and absorption
- increased output (diarrhea, vomiting, polyuria)
,- alcoholism
- DM
✔✔Hypomagnesemia clinical manifestations - ✔✔(neuro and cardiac)
- ^ reflexes, chvostek and trousseau's sign
- confusion, seizures
- dysrhythmias, firbrilation
- hypokalemia
✔✔Hypermagnesemia - ✔✔excess of serum magnesium
dt
- renal failure
✔✔Hypermagnesemia clinical manifestations - ✔✔-impaired nerve/muscle function
-hypotension
- slow reflexes
- muscle paralysis --> cardiac arrest
✔✔respiratory alkalosis - ✔✔high pH, low CO2
dt
- ^ CO2 excretion
- hyperventilation
- compensate for HCO3 kidney excretion
✔✔respiratory alkalosis clinical manifestations - ✔✔- lethargy, dizzy, confusion
-tachycardia, dysrhythmias
-numb, tingling, hyperreflexia, seizures
-hyperventilation
✔✔alkalosis lab values - ✔✔pH > 7.45
low CO2 or high HCO3
✔✔metabolic alkalosis - ✔✔high pH, high HCO3
loss of acid or gain of base
compensate for CO2 retention
- vomiting, diuretics
✔✔metabolic alkalosis clinical manifestations - ✔✔nervous, confusion
tachycardia, dysrhythmias
N/V
tremors, cramps
hypoventilation
✔✔Respiratory acidosis - ✔✔low pH, high CO2
CO2 retention of lungs
,compensate for HCO3 retention
- hypoventilation
- COPD and pneumonia
- OD
✔✔Respiratory acidosis clinical manifestations - ✔✔drowsy, dizzy, disorientation
low BP
warm flush skin
hypoventilation and hypoxia
✔✔pH regulatory systems - ✔✔- Chemical buffers
- Respiratory center
- Kidney excretion
✔✔metabolic acidosis - ✔✔low pH, low HCO3
gain of acids/inability to excrete/loss of base
compensate for CO2 excretion
- DKA
- lactic acidosis
- starvation
- diarrhea
- renal failure
- shock
✔✔metabolic acidosis clinical manifestations - ✔✔confusion
low BP, dysrhythmias
N/V, diarrhea
deep, rapid resp
low BP
✔✔Anemia - ✔✔deficiency of RBC, quality/quantity of Hb, V of packed RBC or both
dt
- low RBC production
- blood loss
- ^ RBC destruction (sickle cell, infection...)
✔✔iron deficiency anemia - ✔✔low Fe to make Hb.
dt
- diet
- malabsorption
- blood loss
- hemolysis
✔✔Mild anemia clinical manifestations - ✔✔palpitations
, ✔✔moderate anemia clinical manifestations - ✔✔palpitations, bounding pulse
dyspnea
"roaring" in ears
fatigue
✔✔Severe Anemia Clinical Manifestations - ✔✔mod +
pallor, jaundice, pruritus
hemorrhage
smooth tongue
blurred vision
tachycarida, murmurs, claudications, angina, HF, MI, edema
tachypnea, orthopnea, dyspnea,
vertigo, depression
hepatomegaly, splenomegaly
cold sensitivity
✔✔Fe deficiency anemia tx and meds - ✔✔- IV/IM: Fe dextran, Fe sucrose, Na ferric
gluconate
- take meds with vit C
- ^ Fe diet
- Fe supplements
✔✔blood loss tx - ✔✔blood transfusion if <80
IV: RL or NS
infusion: platelets, plasma, cryoprecipitate
fe supplements
✔✔Hyponatremia - ✔✔low sodium in the blood
dt
- water excess (SIAD, HF, hypotonic IV)
- vomiting and diarrhea
- diuretics, renal disease
- burns and wounds
Can be low ECF and low Na or Normal/high ECF and low Na
✔✔Hyponatremia and Hypovolemia clinical manifestations - ✔✔posteriod hypotension
tachycardia, thready pulse, low jug filling and CVP
weight loss
tremors
✔✔Hyponatremia and normal/high ECF clinical manifestations - ✔✔weak
N&V
weight gain
^BP
