NURS5463 EXAM 4 STUDY GUIDE 2026
TESTED QUESTIONS AND PRACTICE
SOLUTION GRADED A+
◉ give an example of a hypertonic solution.
Answer: 3% NaCl, 5% NS
◉ critical sodium values.
Answer: <120 or >160
◉ Hyponatremia S/S.
Answer: SALT
> S tupor/coma
> A norexia (nausea/vomiting)
> L ethargy (weakness/fatigue)
> T achycardia (thready pulse)
LOSS
> L imp (muscle weakness)
> O rthostatic hypotension aka falls
> S eizures / headache
,> S tomach cramping (hyperactive bowels)
Confusion, tired, abdominal cramping, headache, craving salt,
seizures, Coma, nausea, vomiting
◉ Hyponatremia causes.
Answer: Water intoxication (dilutes sodium), diuretics (water gain >
sodium gain)
•Moves water into cells causing cellular swelling (neuro issues)
- sodium loss exceeds water loss
◉ Hyponatremia Interventions.
Answer: A: admin IV fluids (if due to fluid volume loss)
D: diuretics if due to hypervolemia
D: daily weights
S: safety - orthostatic hypotension aka falls
A: airway protection - don't give food to lethargic confused patient
L: limit water intake if it's hypervolemia induced
T: teach to avoid diet low in salt
◉ Hypernatremia S/S.
Answer: big & bloated
,FRIED
*Fever (low grade), flushed skin
*Restless (irritable)
*Increased fluid retention and *increased BP (tachycardia)
*Edema (peripheral and pitting)
*Decreased urinary output,
SALT
>skin flushed and dry
> agitation
> low grade fever
> thirst (dry mucous membranes)
◉ Hypernatremia causes.
Answer: hemoconcentration: excess water loss, excess sodium
administration, diabetes insipidus (excess of ADH hormone
produced or a resistance to it), heat stroke, hypertonic IV solutions
decreased sodium excretion - kidneys
◉ hypernatremia interventions.
Answer: if due to fluid loss - admin iv fluids - hypotonic
if cause is inadequate renal excretion of sodium - give sodium
wasting diuretics
, restrict sodium and fluids as prescribed
◉ what are the critical values for potassium?.
Answer: <3 or >8
◉ Hypokalemia S/S.
Answer: slow & low: 7 Ls
Lethargy (& confusion)
Low shallow respirations - decreased ability to use accessory
muscles for breathing
Lethal cardiac dysthymias - ST depression, shallow T wave,
projecting U wave
Lots of urine - kidneys unable to make the urine concentrated
Leg cramps
Limp muscles - decreased deep tendon reflexes
Low BP and HR
Low GI function
◉ Hypokalemia causes.
Answer: > potassium wasting diuretics
> vomiting / diarrhea
> lack of dietary intake
TESTED QUESTIONS AND PRACTICE
SOLUTION GRADED A+
◉ give an example of a hypertonic solution.
Answer: 3% NaCl, 5% NS
◉ critical sodium values.
Answer: <120 or >160
◉ Hyponatremia S/S.
Answer: SALT
> S tupor/coma
> A norexia (nausea/vomiting)
> L ethargy (weakness/fatigue)
> T achycardia (thready pulse)
LOSS
> L imp (muscle weakness)
> O rthostatic hypotension aka falls
> S eizures / headache
,> S tomach cramping (hyperactive bowels)
Confusion, tired, abdominal cramping, headache, craving salt,
seizures, Coma, nausea, vomiting
◉ Hyponatremia causes.
Answer: Water intoxication (dilutes sodium), diuretics (water gain >
sodium gain)
•Moves water into cells causing cellular swelling (neuro issues)
- sodium loss exceeds water loss
◉ Hyponatremia Interventions.
Answer: A: admin IV fluids (if due to fluid volume loss)
D: diuretics if due to hypervolemia
D: daily weights
S: safety - orthostatic hypotension aka falls
A: airway protection - don't give food to lethargic confused patient
L: limit water intake if it's hypervolemia induced
T: teach to avoid diet low in salt
◉ Hypernatremia S/S.
Answer: big & bloated
,FRIED
*Fever (low grade), flushed skin
*Restless (irritable)
*Increased fluid retention and *increased BP (tachycardia)
*Edema (peripheral and pitting)
*Decreased urinary output,
SALT
>skin flushed and dry
> agitation
> low grade fever
> thirst (dry mucous membranes)
◉ Hypernatremia causes.
Answer: hemoconcentration: excess water loss, excess sodium
administration, diabetes insipidus (excess of ADH hormone
produced or a resistance to it), heat stroke, hypertonic IV solutions
decreased sodium excretion - kidneys
◉ hypernatremia interventions.
Answer: if due to fluid loss - admin iv fluids - hypotonic
if cause is inadequate renal excretion of sodium - give sodium
wasting diuretics
, restrict sodium and fluids as prescribed
◉ what are the critical values for potassium?.
Answer: <3 or >8
◉ Hypokalemia S/S.
Answer: slow & low: 7 Ls
Lethargy (& confusion)
Low shallow respirations - decreased ability to use accessory
muscles for breathing
Lethal cardiac dysthymias - ST depression, shallow T wave,
projecting U wave
Lots of urine - kidneys unable to make the urine concentrated
Leg cramps
Limp muscles - decreased deep tendon reflexes
Low BP and HR
Low GI function
◉ Hypokalemia causes.
Answer: > potassium wasting diuretics
> vomiting / diarrhea
> lack of dietary intake
