Test Bank MED
SURG NCLEX-RN
ATI
Comprehensive
Review and Key
Concepts
Updated 2026
, lOMoAR cPSD| 64664050
NCLEX-RN COMPREHENSIVE ATI REVIEW
MED SURG: SECTION 1
FLUID & ELECTROLYTES
Intravenous Fluids
• Hypertonic
Higher osmolality than ECF
Use only when serum osmolality is critically low
D10W, D50W, D5NS, D5W in 0.45% NaCl, D5LR
• Hypotonic • Correct cause with: Fluid replacement (oral or
Lower osmolality than ECF IV for severe); electrolyte replacement/IV fluids
For intracellular dehydration
Fluid Volume Excess (FVE)
0.45% NS, 2.5% dextrose in 0.45% NS
• Isotonic • Causes : kidney failure, heart failure, cirrhosis,
Concentration equal to plasma burns, hypertonic solutions, excessive water
For deficit of fluid in vascular system intake, long term corticosteroid therapy
0.9% NS, LR, D5W • S/S : cough, dyspnea, crackles, increased BP,
tachycardia/tachypnea, bounding pulse, weight
gain, JVD, increased CVP, pitting edema
Fluid Volume Deficit (FVD) • Diagnosis : serum electrolytes, BUN,
creatinine, Hct (may be low due to dilution),
• Causes : excess GI/renal loss, fever,
urine specific gravity and osmolality. Chest x-
diaphoresis, long term NPO, hemorrhage,
ray if respiratory complications present.
insufficient intake, burns, diuretics, aging
• Monitor vitals (RR, symmetry, and effort),
(older adults have less body water and
breath sounds for pulmonary edema
decreased thirst)
• Monitor for edema: pitting edema scale 1+
• S/S : weight loss, dry mucous membranes,
(minimal) to 4+ (severe); dependent edema
rapid/weak/thready pulse, cap refill <3
measured by circumference of extremities
seconds, weakness/fatigue, orthostatic
• Monitor for ascites (measure abdominal girth)
hypotension, poor skin turgor, specific gravity
<1.030, >30 ml/hr, increased RR
LATE SIGNS: oliguria, decreased CVP,
flattened neck veins
• Diagnosis : serum electrolytes, BUN,
creatinine, Hct (may be high due to
hemoconcentration), urine specific gravity and
osmolality
• Monitor vitals (pulse quality), I&Os (output at
least 0.5 mL/kg/hr), skin turgor, weigh daily, fall
precautions (RISK FOR FALL IS PRIORITY)
Downloaded by Weykey Pinn ()
, lOMoAR cPSD| 64664050
• Weigh daily, admin diuretics, strict I&O (limit • NOTE with hypertonic solutions risk for
POTASSIUM (K+)
Hypokalemia Hyperkalemia
S/S: muscle weakness, fatigue, decreased DTR S/S: muscle twitching and paresthesia
N/V, irritability, confusion, decreased bowel (early), ascending muscle weakness (late),
motility, abdominal distention, paralytic ileus, increased DTR, increased bowel motility,
paresthesia, dysrhythmias, orthostatic diarrhea, ventricular dysrhythmias,
hypotension, flat/inverted T waves, ST hypotension and bradycardia,
depression, prominent U wave elevated/peaked T waves
Caused by meds, body fluid loss, excessive Caused by adrenal insufficiency, renal failure,
diaphoresis, kidney disease, dietary deficiency, acidosis; meds- ACE inhibitors & potassium
and alkalosis sparing diuretics
See pg. 81 Monitor ECG, bowel sounds, initiate
Initiate fall precautions, give potassium; dialysis, dietary restriction/teaching Admin
monitor- ECG, I&O, respiratory status meds
NOTE never give K+ bolus, dilute it! Also Kayexalate (monitor bowel sounds)-
it should not exceed 20 mEq/hr! think K+ exit kayexalate
Also remember “No P= No K” don’t give 50% glucose with insulin
potassium if client isn’t urinating Calcium gluconate
Bicarbonate
Loop diuretics
SODIUM (Na+)
fluid intake), semi-fowlers, restrict sodium cerebral edema
Hyponatremia
Hypernatremia
• Caused by GI loss, SIADH, NPO, water
• Caused by dehydration, burns, kidney failure,
intoxication, excessive diaphoresis, meds such
DI
as
• S/S: fever, swollen/dry tongue, sticky mucus
Diuretics, anticonvulsants, SSRI’s,
membrane, hallucinations, lethargy,
lithium, demeclocycline
restlessness irritability, seizures, tachycardia,
• S/S: weakness, lethargy, confusion, seizures,
HTN, hyperreflexia, twitching, pulmonary
headache, anorexia, N/V, muscle
edema
cramps/twitching, hypotension, tachycardia,
• Initiate seizure precautions, IV
weight gain, edema, low specific gravity,
isotonic/hypotonic fluids, diuretics, sodium
elevated Hgb
restriction, daily weight
• Give sodium, restrict oral fluids, monitor
weight, I&O
Downloaded by Weykey Pinn ()
SURG NCLEX-RN
ATI
Comprehensive
Review and Key
Concepts
Updated 2026
, lOMoAR cPSD| 64664050
NCLEX-RN COMPREHENSIVE ATI REVIEW
MED SURG: SECTION 1
FLUID & ELECTROLYTES
Intravenous Fluids
• Hypertonic
Higher osmolality than ECF
Use only when serum osmolality is critically low
D10W, D50W, D5NS, D5W in 0.45% NaCl, D5LR
• Hypotonic • Correct cause with: Fluid replacement (oral or
Lower osmolality than ECF IV for severe); electrolyte replacement/IV fluids
For intracellular dehydration
Fluid Volume Excess (FVE)
0.45% NS, 2.5% dextrose in 0.45% NS
• Isotonic • Causes : kidney failure, heart failure, cirrhosis,
Concentration equal to plasma burns, hypertonic solutions, excessive water
For deficit of fluid in vascular system intake, long term corticosteroid therapy
0.9% NS, LR, D5W • S/S : cough, dyspnea, crackles, increased BP,
tachycardia/tachypnea, bounding pulse, weight
gain, JVD, increased CVP, pitting edema
Fluid Volume Deficit (FVD) • Diagnosis : serum electrolytes, BUN,
creatinine, Hct (may be low due to dilution),
• Causes : excess GI/renal loss, fever,
urine specific gravity and osmolality. Chest x-
diaphoresis, long term NPO, hemorrhage,
ray if respiratory complications present.
insufficient intake, burns, diuretics, aging
• Monitor vitals (RR, symmetry, and effort),
(older adults have less body water and
breath sounds for pulmonary edema
decreased thirst)
• Monitor for edema: pitting edema scale 1+
• S/S : weight loss, dry mucous membranes,
(minimal) to 4+ (severe); dependent edema
rapid/weak/thready pulse, cap refill <3
measured by circumference of extremities
seconds, weakness/fatigue, orthostatic
• Monitor for ascites (measure abdominal girth)
hypotension, poor skin turgor, specific gravity
<1.030, >30 ml/hr, increased RR
LATE SIGNS: oliguria, decreased CVP,
flattened neck veins
• Diagnosis : serum electrolytes, BUN,
creatinine, Hct (may be high due to
hemoconcentration), urine specific gravity and
osmolality
• Monitor vitals (pulse quality), I&Os (output at
least 0.5 mL/kg/hr), skin turgor, weigh daily, fall
precautions (RISK FOR FALL IS PRIORITY)
Downloaded by Weykey Pinn ()
, lOMoAR cPSD| 64664050
• Weigh daily, admin diuretics, strict I&O (limit • NOTE with hypertonic solutions risk for
POTASSIUM (K+)
Hypokalemia Hyperkalemia
S/S: muscle weakness, fatigue, decreased DTR S/S: muscle twitching and paresthesia
N/V, irritability, confusion, decreased bowel (early), ascending muscle weakness (late),
motility, abdominal distention, paralytic ileus, increased DTR, increased bowel motility,
paresthesia, dysrhythmias, orthostatic diarrhea, ventricular dysrhythmias,
hypotension, flat/inverted T waves, ST hypotension and bradycardia,
depression, prominent U wave elevated/peaked T waves
Caused by meds, body fluid loss, excessive Caused by adrenal insufficiency, renal failure,
diaphoresis, kidney disease, dietary deficiency, acidosis; meds- ACE inhibitors & potassium
and alkalosis sparing diuretics
See pg. 81 Monitor ECG, bowel sounds, initiate
Initiate fall precautions, give potassium; dialysis, dietary restriction/teaching Admin
monitor- ECG, I&O, respiratory status meds
NOTE never give K+ bolus, dilute it! Also Kayexalate (monitor bowel sounds)-
it should not exceed 20 mEq/hr! think K+ exit kayexalate
Also remember “No P= No K” don’t give 50% glucose with insulin
potassium if client isn’t urinating Calcium gluconate
Bicarbonate
Loop diuretics
SODIUM (Na+)
fluid intake), semi-fowlers, restrict sodium cerebral edema
Hyponatremia
Hypernatremia
• Caused by GI loss, SIADH, NPO, water
• Caused by dehydration, burns, kidney failure,
intoxication, excessive diaphoresis, meds such
DI
as
• S/S: fever, swollen/dry tongue, sticky mucus
Diuretics, anticonvulsants, SSRI’s,
membrane, hallucinations, lethargy,
lithium, demeclocycline
restlessness irritability, seizures, tachycardia,
• S/S: weakness, lethargy, confusion, seizures,
HTN, hyperreflexia, twitching, pulmonary
headache, anorexia, N/V, muscle
edema
cramps/twitching, hypotension, tachycardia,
• Initiate seizure precautions, IV
weight gain, edema, low specific gravity,
isotonic/hypotonic fluids, diuretics, sodium
elevated Hgb
restriction, daily weight
• Give sodium, restrict oral fluids, monitor
weight, I&O
Downloaded by Weykey Pinn ()
