NCLEX Quick Sheet – Advanced Renal & Metabolic
Pathophysiology and Pharmacology
•Acid–Base Overview – Metabolic acidosis: ↓ HCO■■ (DKA, renal failure). Metabolic alkalosis: ↑ HCO■■
(vomiting, diuretics). Respiratory acidosis: ↓ pH, ↑ CO■ (hypoventilation). Respiratory alkalosis: ↑ pH, ↓
CO■ (hyperventilation).
•Fluid Types – Isotonic (0.9% NS, LR): replaces volume. Hypotonic (0.45% NS): rehydrates cells, avoid in ↑
ICP. Hypertonic (3% NS, D10W): pulls fluid out of cells, risk of overload.
•Loop Diuretics (furosemide, bumetanide) – ↓ preload, ↑ urine. SE: hypokalemia, ototoxicity. NCLEX: Monitor
K■, give in AM, watch BP.
•Thiazide Diuretics (HCTZ) – Mild diuresis; SE: hypokalemia, hyperglycemia, hyperuricemia. NCLEX: Monitor
glucose and gout risk.
•Potassium-Sparing Diuretics (spironolactone) – K■ retention; SE: hyperkalemia, gynecomastia. Avoid K■
supplements.
•Osmotic Diuretic (mannitol) – Used for ↑ ICP/IOP. Monitor for pulmonary edema and dehydration.
•Carbonic Anhydrase Inhibitor (acetazolamide) – Causes metabolic acidosis; used for glaucoma and altitude
sickness.
•Hyperkalemia – Causes: renal failure, ACEIs, K-sparing diuretics. Tx: IV calcium gluconate (cardiac
protection), insulin + D50, albuterol, sodium bicarbonate, furosemide, dialysis.
•Hypokalemia – Causes: diuretics, vomiting. S/S: muscle cramps, arrhythmias, flat T waves. Tx: oral/IV K■
(max 10 mEq/hr IV). NCLEX: Never IV push potassium.
•Hyponatremia – Causes: SIADH, water excess. S/S: confusion, seizures. Tx: fluid restriction, hypertonic
saline (slowly).
•Hypernatremia – Causes: dehydration, DI. S/S: thirst, agitation. Tx: hypotonic fluids, treat cause slowly to
prevent cerebral edema.
•Hypocalcemia – Causes: ↓ PTH, renal failure. S/S: Chvostek/Trousseau, tetany. Tx: calcium gluconate IV,
vitamin D.
•Hypercalcemia – Causes: ↑ PTH, malignancy. S/S: fatigue, constipation, arrhythmias. Tx: fluids,
bisphosphonates, calcitonin, loop diuretics.
•Phosphate Balance – Hyperphosphatemia common in CKD. Tx: phosphate binders (sevelamer, calcium
acetate). Take with meals.
•Magnesium Disorders – Hypomagnesemia (torsades, tremors): give MgSO■ IV slowly. Hypermagnesemia (↓
reflexes, bradycardia): treat with calcium gluconate.
•Acute Kidney Injury – Pre-renal (↓ perfusion), Intrinsic (ATN), Post-renal (obstruction). Monitor urine output,
avoid nephrotoxins.
•Chronic Kidney Disease – GFR <60 for >3 mo. Labs: ↑ BUN/Cr, K■, PO■; ↓ Ca, Hgb. Tx: phosphate
binders, EPO, vitamin D analogs, limit K■/PO■ intake.
•Dialysis NCLEX Tips – AV fistula: thrill/bruit check. No BP/IVs in arm. Hold antihypertensives pre-dialysis.
Cloudy peritoneal effluent = peritonitis.
•Gout – Uric acid crystals in joints. Tx: allopurinol (chronic), colchicine (acute). NCLEX: Stop if rash (SJS).
Avoid purine-rich foods and alcohol.
•Renal Osteodystrophy – From CKD phosphate retention and ↓ vitamin D. Tx: phosphate binders, calcitriol,
Ca supplements; fall prevention.
•Diabetic Nephropathy – Early sign: microalbuminuria. Tx: ACEI/ARB to slow progression, control glucose and
BP.
•Rhabdomyolysis – Muscle breakdown → myoglobinuria → AKI risk. Tx: aggressive IV fluids, monitor CK and
urine output.
•Tumor Lysis Syndrome – ↑ K■, ↑ PO■, ↓ Ca, ↑ uric acid. Tx: aggressive IV fluids, allopurinol, rasburicase.
•NCLEX Renal Priority – Monitor labs (K■, BUN/Cr), urine output (<30 mL/hr = report), daily weights, and
signs of fluid overload or electrolyte imbalance.