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