ANCC AGACNP Study Guide Latest 2025
Update |Verified
cluster HA - ✔✔unilateral periorbital pain, ETOH, nasal congestion, painfree months
or weeks between attacks
w/ eye redness and rhinorrhea
tx: O2, sumatriptan SQ, ergostat
albumin level # - ✔✔3.5-5
less protein malnutrion
edema if albumin < 2.7
but *prealbumin is best sign for malnutrition
refeeding syndrome (5 e- probs) - ✔✔complication of enteral support
hypophosphatemia
hypokalemia
hypomagnesemia
hypocalcemia
,thiamine (b1) deficiency
thamine - ✔✔B1 vitamine
helps change carbs to energy and nerve signals
urine sodium # - ✔✔10-20meq
>20 renal salt wasting, peeing out (prob w/ kidney)
<10 renal retention to compensate for extrarenal fluid loss
isotonic hyponatremia - ✔✔aka.
pseudohyponatremia serum osmoalality slightly over @
284-295 isotonic- patient asymptomatic
lab artifact, esp hyperlipidemia or hyperproteinemia
tx. cut down fat
serum osmolality # - ✔✔2x Na
275-285 (~280)
hyper vs hypo- tonic
hypotonic hyponatremia # - ✔✔serum osmolality < 280 = diluted!
water excess
-assess: hypovolemic or hypervolemic?
,if hypovolemic:
urine Na < 10
-dehydration, diarrhea or vomiting?
urine Na > 20
- diruetics? ACEi? mineralocorticoid deficiency?
tx hypovolemic: NS
if asymptoatic, NS w/ loop diuretic
if CNS sx +, 3% NS w/ loop diuretic
hypervolemic, hypotonic, hyponatremia
-assess: edematous states
- CHF, liver dz, renal
failure -tx: restrict water
hypernatremia - ✔✔always going to be hyperosmolality, excessive water loss
tx:
hypernatremia w/ hypovolemia- NS followed by 1/2 NS
hypernatremia w/ euvolemia- D5W
hypernatremia w/ hypervolemia- free water (D5W) and loop diuretic, poss dialysis
hypertonic hyponatremia # - ✔✔serum osmolality
>290 -hyperglycemia (HHNK)
, hypokalemia - ✔✔3.5-5
cause- diureitc, GI loss, renal loss, alkalosis, elevated epinephrine
hyporeflexia, flaccid, and rhabdomyolosis if severe hypo (<25)- check serum creatine kinase and
urine myoglobin
dx: ekg (pvcs, decreased amplitude, broad Twaves, u waves)
PO replacement if K >2.5
hyperkalemia - ✔✔cause- excess intake, renal failure, NSAIDS, hypoaldosteronism, cell death,
acidosis (shifts intracellullar k to extracellular space~ +0.7 meq w each 0.1 drop in pH)
weakness, flaccid, abd distention, diarrhea
tx if > 6.5 or cardiac toxicity/muscle paralysis present
-insulin 10 u w/ one amp d50 to push k into cell
hypocalcemia - ✔✔cause- hypoparathyroidism, hypomagnesemia, pancreatitis, renal
failure, trauma, multiple bld txf, alkalosis (calcium is 2+ e-)
-increased DTR, muscle cramps, trousseau's sign, chovostek's sign, prolonged QTi
tx: look for alkalosis, IV calcium gluconate for acute, chronic vit D & aluminum hydroxide
trousseau's sign - ✔✔carpopenal spasm
Update |Verified
cluster HA - ✔✔unilateral periorbital pain, ETOH, nasal congestion, painfree months
or weeks between attacks
w/ eye redness and rhinorrhea
tx: O2, sumatriptan SQ, ergostat
albumin level # - ✔✔3.5-5
less protein malnutrion
edema if albumin < 2.7
but *prealbumin is best sign for malnutrition
refeeding syndrome (5 e- probs) - ✔✔complication of enteral support
hypophosphatemia
hypokalemia
hypomagnesemia
hypocalcemia
,thiamine (b1) deficiency
thamine - ✔✔B1 vitamine
helps change carbs to energy and nerve signals
urine sodium # - ✔✔10-20meq
>20 renal salt wasting, peeing out (prob w/ kidney)
<10 renal retention to compensate for extrarenal fluid loss
isotonic hyponatremia - ✔✔aka.
pseudohyponatremia serum osmoalality slightly over @
284-295 isotonic- patient asymptomatic
lab artifact, esp hyperlipidemia or hyperproteinemia
tx. cut down fat
serum osmolality # - ✔✔2x Na
275-285 (~280)
hyper vs hypo- tonic
hypotonic hyponatremia # - ✔✔serum osmolality < 280 = diluted!
water excess
-assess: hypovolemic or hypervolemic?
,if hypovolemic:
urine Na < 10
-dehydration, diarrhea or vomiting?
urine Na > 20
- diruetics? ACEi? mineralocorticoid deficiency?
tx hypovolemic: NS
if asymptoatic, NS w/ loop diuretic
if CNS sx +, 3% NS w/ loop diuretic
hypervolemic, hypotonic, hyponatremia
-assess: edematous states
- CHF, liver dz, renal
failure -tx: restrict water
hypernatremia - ✔✔always going to be hyperosmolality, excessive water loss
tx:
hypernatremia w/ hypovolemia- NS followed by 1/2 NS
hypernatremia w/ euvolemia- D5W
hypernatremia w/ hypervolemia- free water (D5W) and loop diuretic, poss dialysis
hypertonic hyponatremia # - ✔✔serum osmolality
>290 -hyperglycemia (HHNK)
, hypokalemia - ✔✔3.5-5
cause- diureitc, GI loss, renal loss, alkalosis, elevated epinephrine
hyporeflexia, flaccid, and rhabdomyolosis if severe hypo (<25)- check serum creatine kinase and
urine myoglobin
dx: ekg (pvcs, decreased amplitude, broad Twaves, u waves)
PO replacement if K >2.5
hyperkalemia - ✔✔cause- excess intake, renal failure, NSAIDS, hypoaldosteronism, cell death,
acidosis (shifts intracellullar k to extracellular space~ +0.7 meq w each 0.1 drop in pH)
weakness, flaccid, abd distention, diarrhea
tx if > 6.5 or cardiac toxicity/muscle paralysis present
-insulin 10 u w/ one amp d50 to push k into cell
hypocalcemia - ✔✔cause- hypoparathyroidism, hypomagnesemia, pancreatitis, renal
failure, trauma, multiple bld txf, alkalosis (calcium is 2+ e-)
-increased DTR, muscle cramps, trousseau's sign, chovostek's sign, prolonged QTi
tx: look for alkalosis, IV calcium gluconate for acute, chronic vit D & aluminum hydroxide
trousseau's sign - ✔✔carpopenal spasm
