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HESI®-RN Comprehensive Review | Registered Nurse (RN) School Study Aid

Normal Electrolyte Lab Values

Potassium (K⁺)

3.5 to 5.0 mEq/L

Calcium (Ca²⁺)

8.5 to 10.5 mg/dL

Phosphate (PO₄^3–)

2.5 to 4.5 mg/dL

Magnesium (Mg²⁺)

1.5 to 2.5 mEq/L

Sodium (Na⁺)

135 to 145 mEq/L

Chloride (Cl^–)

95 to 105 mEq/L

2 mins

Sodium (Na+) Lab Value

135-145 mEq/L

24 secs

Calcium (Ca2+) Lab Value

8.5 to 10.5 mg/dL

26 secs

Potassium (K+) Lab Value

3.5 to 5.0 mEq/L

20 secs

Hyponatremia

< 135 mEq Na+

Nausea and Vomiting

Decreased LOC

Confusion / Lethargy

Seizures

Assess Airway

Reduce Diuretic Dosage

Mannitol (Osmitrol)

Fluid Restriction

Hypertonic Solution (3% or 5% NaCl)

2 mins

Hypernatremia

> 145 mEq/L Na+

Change in LOC

Extreme Thirst

Orthostatic Hypotension

Dry Flushed Skin

Muscle Twitching

Seizures

Treat and Prevent Dehydration

Hypotonic Solutions (0.225% or 0.45% NaCl)

Sodium Restriction

Diuretics

2 mins

IV Solutions

Hypotonic (< 280 mOsm/L)

1/4 Normal Saline (0.225% NaCl)

1/2 Normal Saline (0.45% NaCl)

Isotonic (280-300 mOsm)

Normal Saline (0.9% NaCl)

Lactated Ringer's (LR)

Dextrose 5% in Water (D5W)

Hypertonic (> 300 mOsm)

3% or 5% NaCl

Dextrose 5% in 0.45% NaCl

Dextrose 10% in Water (D10W)

3 mins

pH - Blood and Urine Lab Value

Blood

7.35 - 7.45

Urine

4.0 - 8.0

1 min

Blood Acid-Base Control

In a State of Acidemia

Medullary Chemoreceptors Control Ventilation Rate

Expulsion of CO2 through Lungs Increases pH

Bicarbonate Reabsorption from the Kidney Increases pH

Kidney Excretion of H+ Increases pH

2 mins

Parathyroid Gland

Blood Calcium Sensor

Parathyroid Hormone

Bone Resorption

Blood Calcium Increases

Vitamin D Activation

Calcium Absorption From The Small Intestine

1 min

Anterior Pituitary

Hypothalamic Control

FLAT PeG Mnemonic

Follicle-Stimulating Hormone (FSH)

Lutenizing Hormone (LH)

Adrenocorticotropic Hormone (ACTH)

Thyroid-Stimulating Hormone (TSH)

Prolactin (PRL)

Growth Hormone (GH)

2 mins

Posterior Pituitary

Neuroendocrine Reflex Stimulation (By Hypothalamus)

Vasopressin

Increased Water Retention (In Kidneys)

Oxytocin

Increased Uterine Contraction

Mammary Glands Contraction

2 mins

Syndrome Of Inappropriate Antidiuretic Hormone (SIADH)

Hypersecretion of ADH

Increased Sensitivity to ADH

Serum Hypoosmolality

Coma and Seizure

Dilutional Hyponatremia

Cramps and Tremors

Euvolemia

Change in LOC

2 mins

Hypokalemia

< 3.5 mEq/L

Muscle Weakness

Arrhythmia

U Wave

Ileus

Hyporeflexia

IV K+ Infusion at 5-10 mEq/hr

Give Orally with Food

Monitor Respiratory Status

3 mins

Hyperkalemia

> 5.0 mEq/L K+

Abdominal Cramps

Muscle Weakness

Diarrhea

Arrhythmia

Tall, Peaked T Waves

IV Calcium

Infusion of Glucose and Insulin

Loop or Thiazide Diuretics

Kayexalate

Dialysis

Prevention Education

2 mins

Hypocalcemia

Muscle Spasms

< 8.5 mg/dL Ca2+

Decreased Bone Density

Tetany

Chvostek's Sign

Trousseau's Sign

Increased DTR

ECG Changes

QT Prolongation

Oral and IV Replacement of Ca2+

Seizure Precautions

2 mins

Hypercalcemia

> 10.5 mg/dL Ca²⁺

Pathologic Fractures

Lethargy

Hypercoagulation

Constipation

ECG Changes

QT Shortening

No Calcium Intake

Chelating Drugs

Calcitonin

Bisphosphonates

Loop Diuretics instead of Thiazide Diuretics

Increased Risk for Renal Calculi

Increase Fluids

3 mins

Hypocalcemia Causes

Hypoalbuminemia

Hypomagnesemia (Less Common Hypermagnesemia)

Hypovitaminosis D

Hypoparathyroidism

Medications

Hyperphosphatemia

Malnutrition

Acute Pancreatitis

Alkalosis

Sepsis

Chronic Kidney Disease

2 mins

Hypocalcemia Treatments

Treat Underlying Disorder

IV Calcium Gluconate

Cardioprotective

Calcium Carbonate

Calcium Citrate

Vitamin D Supplements

Treat Hypomagnesemia

2 mins

Hypomagnesemia

Confusion

Increased Deep Tendon Reflexes (DTRs)

Neuromuscular Irritability

Seizures

Muscle Cramps

Tremors

Insomnia

Tachycardia

Magnesium Sulfate

Foods High in Magnesium

1 min

Hypermagnesemia

Flushing

Lethargy

Muscle Weakness

Decreased Deep Tendon Reflexes (DTRs)

Decreased Respirations

Bradycardia

Hypotension

Dialysis

IV Calcium Gluconate

Diuretics

Avoid Antacids and Laxatives containing Mg²⁺

2 mins

IV Calculation Formulas

Drop Factor

Macrodrip

Microdrip

Total Volume to Infuse (mL) X Drop Factor/ Time in Minutes = Drops/Minute (gtt/min)

Total Volume to Infuse / mL per Hour Being Infused = Infusion Time

Total Volume in mL / Time in Hours = Number of mL per Hour

3 mins

Infusions Prescribed by Unit Dosage per Hour

Determine Amount of Medication per 1mL

Known Amount of Medication in Solution/Total Volume of Diluent = Amount of Medication per Milliliter

Calculate mL per Hour

Dose per Hour Desired/Concentration per Milliliter = Infusion Rate (mL/hour)

2 mins

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