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Studying for Fluid and Electrolytes In Nursing School Made Easy
Oh, the dreaded fluid and electrolytes.
I remember when I was in nursing school and the instructors informed us that we would be studying fluid and electrolytes during the next lecture. The look on their faces were grim as they informed us that the fluid and electrolyte exam is known to be the hardest exam of the semester. And that many students fail this exam.
I was not feeling hopeful or thrilled to say the least.
Do not get me wrong, it was a bit of a challenge to get all the information straight. However, it seemed as though it was a little easier than the instructors made it out to be.
Maybe that was their intention. I do not know. A little reverse psychology, maybe? Or simply a scare tactic to encourage us to study harder.
All that speculation aside, I have a message for you… You can do this! You can master fluid and electrolytes and pass your exam with flying colors.
Especially if you continue reading this post and check out the study guides and cheat sheets I have available for fluid and electrolytes. 😉
If you want to check out the study guides you can click each of the following individual links:
- Hypokalemia & hyperkalemia
- Hypocalcemia & hypercalcemia
- Hypomagnesemia & hypermagnesemia
- Hypophosphatemia & hyperphosphatemia
- Hyponatremia & hypernatremia
And if you want to download the cheat sheets you can click on each of the following links:
- Hypokalemia & Hyperkalemia
- Hypocalcemia & Hypercalcemia
- Hypomagnesemia & Hypermagnesemia
- Hypophosphatemia & Hyperphosphatemia
- Hyponatremia & Hypernatremia
- Fluid & Electrolytes BUNDLE
I am going to lay out what I think is the best way to study fluid and electrolytes to ensure it is as easy as it possibly can be.
Let’s get into this.
Prep
The first thing that you will want to do before you dive into fluid and electrolyte imbalances is to ensure that you have a good understanding about how fluid balance works in the body.
This will make it much easier to understand certain concepts that occur in fluid and electrolyte imbalances.
You will want to comprehend the following concepts before moving forward: osmosis, osmolarity, osmolality, regulation of fluid balance in the body, and how to assess fluid balance in a patient.
I highly recommend you watching this video by RegisteredNurseRN that covers tonicity of IV fluids, as well. It will come in handy!
Skim read the chapter
I do not typically recommend this strategy, however because fluid and electrolytes can be a difficult section for many students, I believe it is appropriate in this instance.
The first time you lay eyes on your fluid and electrolytes chapter, you should focus on simply skimming over the material.
This will give you an idea of the general layout of how the information is presented to you. Do not focus too much on any one detail.
Just get the juices flowing in your brain.
Deep dive
Now that you have an idea what you are getting into, you can put on your scuba diving equipment and submerge yourself into the sea of fluid and electrolytes!
If you read my post about how to pass nursing school exams, then you will remember you should always read the required reading before you go to lecture. So, try to comprehend as much information as you can on your own and then use the lecture time to reinforce the information and clarify any concepts that you do not understand.
The chapters on fluid and electrolyte imbalances typically follow a similar format. For instance, if you are learning about potassium imbalance, then the information should be presented to you as follows:
- Potassium- its role in the body, how its regulated, etc.
- Hypokalemia
- Causes
- S/S
- Treatment
- Hyperkalemia
- Causes
- S/S
- Treatment
We can use this layout to guide how we learn and study the information, as it is quite helpful to stay organized.
With that said, the first topic to tackle is the electrolyte that is in question.
Electrolyte spotlight
For each electrolyte you will want to know the following:
- The role of the electrolyte
- The regulation of the electrolyte
- Normal lab value
The first thing you will want to do is understand the role that the different electrolytes play in the body. You may want to get down to the cellular level and really dissect their role. Or you can focus on the bigger picture. Whatever helps you understand the material better.
If you like to get into the cellular level, then you should check out Osmosis.org or KhanAcademy.com as they offer a lot of great, in-depth information.
You will notice in the study guides that I have available, that I tend to focus more on the bigger picture since there is so much other information that needs to be focused on. But again, do whatever feels best for you.
Nonetheless, you will want to ask yourself “What role does this electrolyte have in the body?”
Once you can fully understand that question, then you can move onto learning how the electrolyte is regulated in the body.
You will want to focus on how it is stored, regulated, and excreted.
If there are any hormones involved in the regulation of the electrolyte, then it would be prudent to review the basic information about those hormones.
Then you will want to memorize the normal lab values for each electrolyte. Sometimes these lab values can vary among sources, so your best bet is to use the value that your instructors give you.
Hypo and Hyper
Now that you understand how the electrolyte functions in the body, you will begin learning about what happens when there is an imbalance with that electrolyte.
If you are learning about potassium, then the electrolyte imbalances would be classified as either hypokalemia or hyperkalemia.
For each of these you will read about the causes, signs and symptoms, treatments, and nursing considerations. (We will dissect each of these in a moment.)
I feel the best approach is to compare the imbalances side-by-side because often they act like opposites.
If you have downloaded any of the fluid and electrolyte cheat sheets, then you will see I like to present the information about each imbalance in a table.
For example, this is the table that I created for hypokalemia and hyperkalemia.
| Hypokalemia | Hyperkalemia |
| Lab value= <3.5 mEq/L | Lab value= >5 mEq/L |
| Causes: Potassium depleting diuretics Hyperaldosteronism Vomiting and diarrhea Kidney disorders Alkalosis | Causes: Potassium sparing diuretics Addison’s Disease/hypoaldosteronism Kidney failure Tissue damage, burns Acidosis |
| Signs/symptoms: Hyporeflexia, generalized weakness (severe=flaccid paralysis) Decreased respiratory effort Decreased intestinal peristalsis Dysrhythmias AMS- irritability/anxious | Signs/symptoms: Muscle twitching>>weakness>>flaccid paralysis Increased intestinal peristalsis Dysrhythmias Paresthesia |
| Treatment: Oral or IV potassium supplementation (depending on severity) Potassium sparing diuretic (if a diuretic is needed) | Treatment: Kayexalate IV insulin + glucose Potassium depleting diuretic (if kidneys are functioning) Dialysis (if severe and kidneys are not working) Calcium gluconate |
If you compare the information of hypokalemia to hyperkalemia, you will see there are some pieces of information that are opposites, as I previously mentioned. This can be an incredibly helpful way to remember the information!
Causes
As with every disease process, we need to understand what can cause the issue to occur.
This is important for clinical application, and it is also important for test taking purposes because nursing instructors and the NCLEX want to make sure you know who is at risk of developing a fluid and electrolyte imbalance.
Honestly, I feel like this is one of the more difficult parts of fluid and electrolytes. There are SO many causes for each imbalance that it can be difficult to keep them straight.
The best way to sort through all the different causes is to go down the list of causes and decipher if you understand how each cause results in the electrolyte imbalance.
For example, if you are studying hypokalemia, then you should understand how potassium depleting diuretics, hyperaldosteronism, vomiting & diarrhea, kidney disorders, and alkalosis cause hypokalemia. If you can comprehend that information, then you do not have to spend hours trying to memorize all the causes for each imbalance.
Let’s say you get the following as a test question:
Which patient is at increased risk of developing hypokalemia?
- 56 year old male with a history of Addison’s disease
- 89 year old female with nausea, vomiting, and diarrhea x4 days
- 23 year old female with third degree burns to her lower legs
- 45 year old male with recent diagnosis of throat cancer
You may begin to panic when you first see this question as the laundry list of causes for hypokalemia pops in your head, but the image is muddy and you can’t seem to remember any of them for the life of you!
DO NOT PANIC… you can reason your way through this question. If you made sure that you understand how each cause results in the electrolyte imbalance, then you will be able to pick the correct answer with confidence.
Textbooks do not often shed a lot of light on this section, so if you are struggling to comprehend the causes for each electrolyte imbalance, then you can check out the study guides I created. I offered simple explanations for each cause that you may find helpful.
Signs/symptoms:
If you understand how the electrolytes operate in the body, then the signs and symptoms should come easily to you.
You will notice that an overarching theme with electrolytes is that they affect the excitable cells in the body that are responsible for muscle contraction and nerve impulse transmission. Each of the electrolytes are involved in the process in a different way, but the result is similar.
The electrolyte imbalance can affect these processes in one of two ways- they can increase the excitability of the cells or they can decrease the excitability of the cells. The signs and symptoms that result will be reflective of this.
There are a few exceptions to this idea, but the following table can be helpful to categorize the signs and symptoms associated with each electrolyte imbalance.
| Hypo | Hyper | |
| Calcium | Increased excitability | Decreased excitability |
| Magnesium | Increased excitability | Decreased excitability |
| Phosphorous | Decreased excitability | *see hypocalcemia* |
| Potassium | Decreased excitability | Increased excitability |
| Sodium | Decreased excitability | Increased excitability |
You can use this type of table to compare all the electrolytes at once, once you have learned about each individual electrolyte. This can be utilized to visualize the bigger picture in more simplified terms.
Treatments
The goal of treatment is always to bring the electrolyte level to a normal level. For example, in hypokalemia, the goal will be to increase the levels of potassium and prevent excess potassium from being excreted. The opposite will be true for hyperkalemia; the goal is to decrease the levels of potassium and prevent excess potassium from being ingested or retained.
For both imbalances, the goal is to get the level to be between 3.5-5 mEq/L.
There are different methods of doing this for each electrolyte imbalance.
There are medications that are used to increase or decrease the level of an individual electrolyte.
In some electrolyte imbalances, there are medications that are used to mitigate certain manifestations that occur. These medications will not affect the electrolyte imbalance, but they will correct said manifestations.
With these medications and treatments there are often many nursing considerations that you will need to keep in mind. You may need to teach the patient about the medications or treatments. There may also be safety concerns that come into play when using various medications.
Focus on any complications or adverse effects that could occur from using a particular medication or treatment.
That pretty much wraps it up! It is not a perfect science, but I hope the information in this post helps you feel more confident learning and studying fluid and electrolytes.
I know that studying for fluid and electrolytes feels overwhelming and like you will never remember all the information. But if you use the guide in this post and you also utilize the study guides and cheat sheets available on this site, then you have a great chance of acing your fluid and electrolyte exam!
As always, reach out to be if you have any questions. I am here to help!
Happy Nursing!