Mark Klimek Nursing Lecture Notes & NCLEX Review Guide 2025 |
Complete 12 Lectures (Acid-Base, Electrolytes, Psych, Maternity,
Prioritization & More)
GUIDE • Mark Klimek’s Lecture
Lecture 1— Acid-Base Balance Dumping/HH
Ventilators Electrolytes: K+, CA, MG,
and NA
Lecture 2— Alcohol TX for HyperKalemia
Wernicke
Overdose and Withdrawal Lecture 7— Thyroid (Hyper-, Hypo-)
S/Sx Adrenal Cortex (Addison
Aminoglycosides Disease, Cushing)
Peak and Trough Toys
Laminectomy
Lecture 3— Drug Toxicities (Lithium,
Lanoxin, Dilantin, Bilirubin, Lecture 8— Lab Values
Aminophylline) Five Deadly Ds
Kernicterus Neutropenic Precaution
Dumping/HH
Electrolytes: K+, CA, MG, Lecture 9— Psych Drugs
and NA Tri
TX for HyperKalemia Benzo
MAOI
Lecture 4— Crutches Lithium
Canes Prozac
Walkers Haldol
Delusions Clozaril
Hallucinations Zoloft
Psychosis
Psychotic and Non-Psychotic Lecture 10— Maternity and Neonatology
Hallucination
Illusion Lecture 11— Fetal Complications
Delusion Stages of Labor
Assessments
Lecture 5— Diabetes Mellitus Variations for NB
Diabetes Insipidus Maternity Meds
SIADH Medication Hints
Insulin Psych Tips
DKA Operational Stages
HHNK
Lecture 12— Prioritization
Lecture 6— Drug Toxicities (Lithium, Delegation
Lanoxin, Dilantin, Bilirubin, Staff Management
Aminophylline) Guessing Strategies
Kernicterus
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, Lecture 1 • Mark Klimek • 92:21
Acid/Base Balance (Start times: 30:00)
The first value to look at in an acid-base
disorder is the pH
•HCO3 22 to 26
•If pH is <7.35, the acid-base imbalance
•If pH is <7.45, the acid-base imbalance
is acidotic
is alkalotic
Now, to determine if the imbalance is metabolic or respiratory, determine whether HCO3 goes
in the same or opposite direction with pH
•Rule of the Bs: If pH and Bicarb move both in the same direction, then the acid-base
imbalance is metabolic … Otherwise, it is respiratory
Example #1
•pH 7.3 Acidotic
•HCO3 20 Metabolic
•This is an example of metabolic acidosis
Example #2
•pH 7.58 Alkalotic
•HCO3 32 Metabolic
•This is an example of metabolic alkalosis
In order to
Example #3solve acid-base disorders, it is
important
•pH 7.22toAcidosis
know the normal values for
pH, CO2 and HCO3
•HCO3 35 Respiratory(bicarbonate), which
are shown
•This is anbelow
example of respiratory acidosis
•pH 7.35 to 7.45
As•CO2
the pH35goes,
to 45so goes my patient, except for Potassium … That means
•If pH is low, everything is low, except potassium •If
pH is high, everything is high, except potassium
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, If pH goes over 7.45, this is alkalosis
•Therefore everything is up: tachycardia, tachypnea, HTN, seizures, irritability, spastic,
diarrhea, borborygmi (increase bowel sounds), hyperreflexia (3+, 4+)
•However, potassium is opposite. Therefore, hypokalemia
•What is the nursing intervention?
oPt need suctioning because of seizures
If pH goes below 7.35, this is acidosis
•Therefore, everything is down: bradycardia, constipation, absent bowel sounds, flaccid,
obtunded, lethargy, coma hyporeflexia (0, 1+), bradypnea, low BP
•However, potassium is high (hyperkalemia)
•What is the nursing intervention?
oPt needs to be ventilated with an Ambu bag—respiratory arrest
So, remember that “MAC Kussmaul” is the only acid-base imbalance to cause Metabolic
ACidosis with Kussmaul respirations
Causes of Acid/Base imbalance
First ask yourself, “Is it LUNG? … If yes, then it is respiratory
•Then ask yourself, “Are they overventilating or underventilating? oIf
UNDERventilating, then pick acidosis—pH is under 7.35 oIf
OVERventilating, then it is alkalosis, pH is over 7.45
What type of acid-base derangement is present in the following condition?
•In labor?
oRespiratory alkalosis … Overventilating—pH increases … Alkalosis)
•Drowning?
oRespiratory acidosis … Underventilating—pH decreases … Acidosis
•Pt is on PCA (patient-controlled anesthesia) pump?
oVentilation is down … Respiratory acidosis
If it is not LUNG, then it is metabolic. If the patient has prolonged
gastric vomiting or suction (sucking out acid), pick alkalosis
•For everything else that isn’t lung, pick metabolic
acidosis•So, when you don’t know what to pick,pick
metabolic acidosis
Tip
•Set your default setting to Metabolic Acidosis
•Always pay attention to modifying phrase rather than original
noun
Figure 1. Patient-
controlled anesthesia
(PCA) pump.
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Complete 12 Lectures (Acid-Base, Electrolytes, Psych, Maternity,
Prioritization & More)
GUIDE • Mark Klimek’s Lecture
Lecture 1— Acid-Base Balance Dumping/HH
Ventilators Electrolytes: K+, CA, MG,
and NA
Lecture 2— Alcohol TX for HyperKalemia
Wernicke
Overdose and Withdrawal Lecture 7— Thyroid (Hyper-, Hypo-)
S/Sx Adrenal Cortex (Addison
Aminoglycosides Disease, Cushing)
Peak and Trough Toys
Laminectomy
Lecture 3— Drug Toxicities (Lithium,
Lanoxin, Dilantin, Bilirubin, Lecture 8— Lab Values
Aminophylline) Five Deadly Ds
Kernicterus Neutropenic Precaution
Dumping/HH
Electrolytes: K+, CA, MG, Lecture 9— Psych Drugs
and NA Tri
TX for HyperKalemia Benzo
MAOI
Lecture 4— Crutches Lithium
Canes Prozac
Walkers Haldol
Delusions Clozaril
Hallucinations Zoloft
Psychosis
Psychotic and Non-Psychotic Lecture 10— Maternity and Neonatology
Hallucination
Illusion Lecture 11— Fetal Complications
Delusion Stages of Labor
Assessments
Lecture 5— Diabetes Mellitus Variations for NB
Diabetes Insipidus Maternity Meds
SIADH Medication Hints
Insulin Psych Tips
DKA Operational Stages
HHNK
Lecture 12— Prioritization
Lecture 6— Drug Toxicities (Lithium, Delegation
Lanoxin, Dilantin, Bilirubin, Staff Management
Aminophylline) Guessing Strategies
Kernicterus
,https://www.etsy.com/shop/NursingHero
, Lecture 1 • Mark Klimek • 92:21
Acid/Base Balance (Start times: 30:00)
The first value to look at in an acid-base
disorder is the pH
•HCO3 22 to 26
•If pH is <7.35, the acid-base imbalance
•If pH is <7.45, the acid-base imbalance
is acidotic
is alkalotic
Now, to determine if the imbalance is metabolic or respiratory, determine whether HCO3 goes
in the same or opposite direction with pH
•Rule of the Bs: If pH and Bicarb move both in the same direction, then the acid-base
imbalance is metabolic … Otherwise, it is respiratory
Example #1
•pH 7.3 Acidotic
•HCO3 20 Metabolic
•This is an example of metabolic acidosis
Example #2
•pH 7.58 Alkalotic
•HCO3 32 Metabolic
•This is an example of metabolic alkalosis
In order to
Example #3solve acid-base disorders, it is
important
•pH 7.22toAcidosis
know the normal values for
pH, CO2 and HCO3
•HCO3 35 Respiratory(bicarbonate), which
are shown
•This is anbelow
example of respiratory acidosis
•pH 7.35 to 7.45
As•CO2
the pH35goes,
to 45so goes my patient, except for Potassium … That means
•If pH is low, everything is low, except potassium •If
pH is high, everything is high, except potassium
Page 3 of 92
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, If pH goes over 7.45, this is alkalosis
•Therefore everything is up: tachycardia, tachypnea, HTN, seizures, irritability, spastic,
diarrhea, borborygmi (increase bowel sounds), hyperreflexia (3+, 4+)
•However, potassium is opposite. Therefore, hypokalemia
•What is the nursing intervention?
oPt need suctioning because of seizures
If pH goes below 7.35, this is acidosis
•Therefore, everything is down: bradycardia, constipation, absent bowel sounds, flaccid,
obtunded, lethargy, coma hyporeflexia (0, 1+), bradypnea, low BP
•However, potassium is high (hyperkalemia)
•What is the nursing intervention?
oPt needs to be ventilated with an Ambu bag—respiratory arrest
So, remember that “MAC Kussmaul” is the only acid-base imbalance to cause Metabolic
ACidosis with Kussmaul respirations
Causes of Acid/Base imbalance
First ask yourself, “Is it LUNG? … If yes, then it is respiratory
•Then ask yourself, “Are they overventilating or underventilating? oIf
UNDERventilating, then pick acidosis—pH is under 7.35 oIf
OVERventilating, then it is alkalosis, pH is over 7.45
What type of acid-base derangement is present in the following condition?
•In labor?
oRespiratory alkalosis … Overventilating—pH increases … Alkalosis)
•Drowning?
oRespiratory acidosis … Underventilating—pH decreases … Acidosis
•Pt is on PCA (patient-controlled anesthesia) pump?
oVentilation is down … Respiratory acidosis
If it is not LUNG, then it is metabolic. If the patient has prolonged
gastric vomiting or suction (sucking out acid), pick alkalosis
•For everything else that isn’t lung, pick metabolic
acidosis•So, when you don’t know what to pick,pick
metabolic acidosis
Tip
•Set your default setting to Metabolic Acidosis
•Always pay attention to modifying phrase rather than original
noun
Figure 1. Patient-
controlled anesthesia
(PCA) pump.
Page 4 of 92
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