AG-ACNP - BARKLEY REVIEW EXAM
QUESTIONS & VERIFIED PASSED
ANSWERS ALREADY GRADED A+
Hyperkalemia S/S - CORRECT ANSWER weakness, flaccid paralysis
Abdominal distention
diarrhea
Tall peaked waves on ECG
Management of Hyperkalemia - CORRECT ANSWER Kayexalate
if >6.5 or cardiac toxicity or muscle paralysis is present, consider: Insulin 10U with one
amp D50 (pushes K into cell)
What are normal calcium levels? - CORRECT ANSWER Normal total calcium: 8.5-
10.5; normal ionized calcium: 4.5-5.5
Does albumin effect calcium levels? - CORRECT ANSWER Albumin affects calcium
level by binding to it
Does albumin effect ionized calcium levels? - CORRECT ANSWER Ionized calcium
does not vary with the albumin level
What maintains calcium levels in the body? - CORRECT ANSWER Vitamin D,
parathyroid hormone and calcitonin
What is the relationship of albumin to calcium? - CORRECT ANSWER Calcium is
~50% to albumin
If calcium is normal and albumin is low, then calcium is high.
S/S of hypocalcemia - CORRECT ANSWER increased DTRs, muscle abdominal
cramps, carpopedal spasm (trousseau's sign)convulsions, Chvostek's sign (cheek
twitch), and prolonged QT interval
Management of hypocalcemia - CORRECT ANSWER Check pH for alkalosis, if acute
give IV calcium gluconate, if chronic give oral supplements, vitamin d, and aluminum
hydroxide
Acidemia _____ Ionized calcium - CORRECT ANSWER increases
Alkalemia _____ ionized calcium - CORRECT ANSWER decreases
,Hypercalcemia causes - CORRECT ANSWER Causes: hyperparathyroidism,
hyperthyroidism, Vitamin D intoxication, prolonged immobilization, thiazide diuretics
S/S of hypercalcemia - CORRECT ANSWER Fatiguability, muscle weakness,
depression, anorexia, n/v, constipation, severe hypercalcemia can cause coma or
death.
Serum Ca >12 is considered medical emergency
Management of hypercalcemia - CORRECT ANSWER Calcitonin if impaired
cardiovascular or renal fx, dialysis, if >12 begin NS and loop diuretics.
Respiratory acidosis pH and pCO2 levels - CORRECT ANSWER pH <7.35 with pCO2
>45
Causes of respiratory acidosis - CORRECT ANSWER Decreased alveolar ventilation
What happens in acute respiratory acidosis? - CORRECT ANSWER In acute
respiratory failure, there is a sharp rise in pCO2 with only a small increase in plasma
HCO3
What happens in 6-12 hours after acute respiratory failure in terms of respiratory
acidosis? - CORRECT ANSWER After 6-12 hours, the increase in pCO2 will evoke the
renal compensatory mechanism (this takes several days to manifest)
S/S of respiratory acidosis - CORRECT ANSWER Somnolence and confusion
Myoclonus with asterixis
increased cerebral blood flow causes increased CSF pressure causing increase ICP
Lab/diagnostics of respiratory acidosis - CORRECT ANSWER Low arterial pH
PCO2> 45
Serum HCO >26
Low serum chloride (<93) in chronic patients
Management of respiratory acidosis - CORRECT ANSWER Narcan 0.4-2mg
Improve ventilation, intubate if necessary
Increase vent rate
Respiratory alkalosis causes - CORRECT ANSWER Hyperventilation decreases
arterial PCO2 and increases pH; clinical symptoms are related to decreased cerebral
blood flow
S/S of respiratory alkalosis - CORRECT ANSWER Light headedness, anxiety,
paraesthesia, stocking/glove tingling, tetany if very severe
Labs/diagnostics of respiratory alkalosis - CORRECT ANSWER Increased pH >7.45
Low PCO2 < 35
,Serum HCO3 low if chronic
Management of respiratory alkalosis management - CORRECT ANSWER Manage
underlying cause
If acute hyperventilation, have patient breath into paper bag
Decrease rate of vent
Sedation may be necessary
Rapid correction of chronic alkalosis may result in metabolic acidosis
Metabolic acidosis hallmark sign - CORRECT ANSWER Hallmark sign is a low serum
HCO3
What is a normal anion gap? What does an increased anion gap indicate?What does an
increased anion gap indicate? - CORRECT ANSWER Normal: 7 to 17 (12 - or +5 either
way)
If gap is increased the clinical situation is generally more acute
Causes of increased anion gap
When is it expected to have an anion gap? - CORRECT ANSWER DKA, alcoholic
ketoacidosis, lactic acidosis, drug or chemical anion
Diarrhea, ileostomy, renal tubular acidosis, recovery from DKA
What is the treatment for an increased anion gap? - CORRECT ANSWER Treat
underlying disorder, fluid resuscitation
HCO3 not indicated if acidosis is due to hypoxia or DKA
HCO3 is indicated if significant hyperkalemia is present
Normal gap treatment for chronic conditions - CORRECT ANSWER Common with
chronic conditions like renal failure
Bicitra 10-30 cc with meals and h.s.
Metabolic Acidosis with normal gap causes "Hard ASS" - CORRECT ANSWER
Hyperalimentation
Addisons
Renal tubular necrosis
Diarrhea
Acetazolamine
Spironolactone
Metabolic Acidosis with wide gap causes "MUD PILES" - CORRECT ANSWER
Methanol
Uremia (kidney failure)
DKA
Propylene glycol
IRON/INH
Lactic Acidosis/lack of O2
, Ethylene glycol (oxalic acid)
Salicylates (late response)
How is HCO3 affected in metabolic alkalosis? pCO2? - CORRECT ANSWER High
plasma HCO3 and compensatory pCO2 rarely exceeds 55mmHg
(If PCO2 is >55, superimposed resp. acidosis is likely)
Causes of metabolic alkalosis - CORRECT ANSWER post-hypercapnia alkalosis
NG suctioning
Vomiting
Diuretics
Saline responsive (volume contraction)-most common
Management of saline responsive alkalosis - CORRECT ANSWER Correct volume
deficit with NaCl and KCL
D/C diuretics
H2 blockers in pts with GI loss
Acetazolamide 250-500mg IV q4-6hr if volume Replacement is contraindicated
S/S of metabolic alkalosis - CORRECT ANSWER None normally
Weakness and hyporeflexia may be present if K is very low
Lab/diagnostics of metabolic alkalosis - CORRECT ANSWER Arterial pH 7.45
Arterial HCO3 >26
Arterial pCO2 >45 and < 55
Serum K and Cl --decreased
May see increased anion gap
R-O-M-E - CORRECT ANSWER Respiratory Opposite, Metabolic Equal
Resp: pH and CO2 are opposite
Metabolic: pH and CO2 are equal (moving in same direction)
First Degree Burns - CORRECT ANSWER Dry, red, no blisters, involves epidermis
only
Second degree (partial thickness) - CORRECT ANSWER Moist, blisters, extends
beyond epidermis
Third degree (full thickness) - CORRECT ANSWER Dry leathery, black, pearly, waxy,
extends beyond epidermis to dermis to underlying tissues, fat, muscle and/or bone
Rule of nines - CORRECT ANSWER Each Arm=9
Each Leg=18
Thorax= 18 front and 18 back
Head=9%
Perineum/genitals=1
QUESTIONS & VERIFIED PASSED
ANSWERS ALREADY GRADED A+
Hyperkalemia S/S - CORRECT ANSWER weakness, flaccid paralysis
Abdominal distention
diarrhea
Tall peaked waves on ECG
Management of Hyperkalemia - CORRECT ANSWER Kayexalate
if >6.5 or cardiac toxicity or muscle paralysis is present, consider: Insulin 10U with one
amp D50 (pushes K into cell)
What are normal calcium levels? - CORRECT ANSWER Normal total calcium: 8.5-
10.5; normal ionized calcium: 4.5-5.5
Does albumin effect calcium levels? - CORRECT ANSWER Albumin affects calcium
level by binding to it
Does albumin effect ionized calcium levels? - CORRECT ANSWER Ionized calcium
does not vary with the albumin level
What maintains calcium levels in the body? - CORRECT ANSWER Vitamin D,
parathyroid hormone and calcitonin
What is the relationship of albumin to calcium? - CORRECT ANSWER Calcium is
~50% to albumin
If calcium is normal and albumin is low, then calcium is high.
S/S of hypocalcemia - CORRECT ANSWER increased DTRs, muscle abdominal
cramps, carpopedal spasm (trousseau's sign)convulsions, Chvostek's sign (cheek
twitch), and prolonged QT interval
Management of hypocalcemia - CORRECT ANSWER Check pH for alkalosis, if acute
give IV calcium gluconate, if chronic give oral supplements, vitamin d, and aluminum
hydroxide
Acidemia _____ Ionized calcium - CORRECT ANSWER increases
Alkalemia _____ ionized calcium - CORRECT ANSWER decreases
,Hypercalcemia causes - CORRECT ANSWER Causes: hyperparathyroidism,
hyperthyroidism, Vitamin D intoxication, prolonged immobilization, thiazide diuretics
S/S of hypercalcemia - CORRECT ANSWER Fatiguability, muscle weakness,
depression, anorexia, n/v, constipation, severe hypercalcemia can cause coma or
death.
Serum Ca >12 is considered medical emergency
Management of hypercalcemia - CORRECT ANSWER Calcitonin if impaired
cardiovascular or renal fx, dialysis, if >12 begin NS and loop diuretics.
Respiratory acidosis pH and pCO2 levels - CORRECT ANSWER pH <7.35 with pCO2
>45
Causes of respiratory acidosis - CORRECT ANSWER Decreased alveolar ventilation
What happens in acute respiratory acidosis? - CORRECT ANSWER In acute
respiratory failure, there is a sharp rise in pCO2 with only a small increase in plasma
HCO3
What happens in 6-12 hours after acute respiratory failure in terms of respiratory
acidosis? - CORRECT ANSWER After 6-12 hours, the increase in pCO2 will evoke the
renal compensatory mechanism (this takes several days to manifest)
S/S of respiratory acidosis - CORRECT ANSWER Somnolence and confusion
Myoclonus with asterixis
increased cerebral blood flow causes increased CSF pressure causing increase ICP
Lab/diagnostics of respiratory acidosis - CORRECT ANSWER Low arterial pH
PCO2> 45
Serum HCO >26
Low serum chloride (<93) in chronic patients
Management of respiratory acidosis - CORRECT ANSWER Narcan 0.4-2mg
Improve ventilation, intubate if necessary
Increase vent rate
Respiratory alkalosis causes - CORRECT ANSWER Hyperventilation decreases
arterial PCO2 and increases pH; clinical symptoms are related to decreased cerebral
blood flow
S/S of respiratory alkalosis - CORRECT ANSWER Light headedness, anxiety,
paraesthesia, stocking/glove tingling, tetany if very severe
Labs/diagnostics of respiratory alkalosis - CORRECT ANSWER Increased pH >7.45
Low PCO2 < 35
,Serum HCO3 low if chronic
Management of respiratory alkalosis management - CORRECT ANSWER Manage
underlying cause
If acute hyperventilation, have patient breath into paper bag
Decrease rate of vent
Sedation may be necessary
Rapid correction of chronic alkalosis may result in metabolic acidosis
Metabolic acidosis hallmark sign - CORRECT ANSWER Hallmark sign is a low serum
HCO3
What is a normal anion gap? What does an increased anion gap indicate?What does an
increased anion gap indicate? - CORRECT ANSWER Normal: 7 to 17 (12 - or +5 either
way)
If gap is increased the clinical situation is generally more acute
Causes of increased anion gap
When is it expected to have an anion gap? - CORRECT ANSWER DKA, alcoholic
ketoacidosis, lactic acidosis, drug or chemical anion
Diarrhea, ileostomy, renal tubular acidosis, recovery from DKA
What is the treatment for an increased anion gap? - CORRECT ANSWER Treat
underlying disorder, fluid resuscitation
HCO3 not indicated if acidosis is due to hypoxia or DKA
HCO3 is indicated if significant hyperkalemia is present
Normal gap treatment for chronic conditions - CORRECT ANSWER Common with
chronic conditions like renal failure
Bicitra 10-30 cc with meals and h.s.
Metabolic Acidosis with normal gap causes "Hard ASS" - CORRECT ANSWER
Hyperalimentation
Addisons
Renal tubular necrosis
Diarrhea
Acetazolamine
Spironolactone
Metabolic Acidosis with wide gap causes "MUD PILES" - CORRECT ANSWER
Methanol
Uremia (kidney failure)
DKA
Propylene glycol
IRON/INH
Lactic Acidosis/lack of O2
, Ethylene glycol (oxalic acid)
Salicylates (late response)
How is HCO3 affected in metabolic alkalosis? pCO2? - CORRECT ANSWER High
plasma HCO3 and compensatory pCO2 rarely exceeds 55mmHg
(If PCO2 is >55, superimposed resp. acidosis is likely)
Causes of metabolic alkalosis - CORRECT ANSWER post-hypercapnia alkalosis
NG suctioning
Vomiting
Diuretics
Saline responsive (volume contraction)-most common
Management of saline responsive alkalosis - CORRECT ANSWER Correct volume
deficit with NaCl and KCL
D/C diuretics
H2 blockers in pts with GI loss
Acetazolamide 250-500mg IV q4-6hr if volume Replacement is contraindicated
S/S of metabolic alkalosis - CORRECT ANSWER None normally
Weakness and hyporeflexia may be present if K is very low
Lab/diagnostics of metabolic alkalosis - CORRECT ANSWER Arterial pH 7.45
Arterial HCO3 >26
Arterial pCO2 >45 and < 55
Serum K and Cl --decreased
May see increased anion gap
R-O-M-E - CORRECT ANSWER Respiratory Opposite, Metabolic Equal
Resp: pH and CO2 are opposite
Metabolic: pH and CO2 are equal (moving in same direction)
First Degree Burns - CORRECT ANSWER Dry, red, no blisters, involves epidermis
only
Second degree (partial thickness) - CORRECT ANSWER Moist, blisters, extends
beyond epidermis
Third degree (full thickness) - CORRECT ANSWER Dry leathery, black, pearly, waxy,
extends beyond epidermis to dermis to underlying tissues, fat, muscle and/or bone
Rule of nines - CORRECT ANSWER Each Arm=9
Each Leg=18
Thorax= 18 front and 18 back
Head=9%
Perineum/genitals=1
