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HESI PN EXIT
From PN PEARLS. By no means is all the information included, just review :)
| Question | Answer |
|---|---|
| When would you elevate the head of bed to 30-45 degrees? | After neuro surgeries, except those that are infratentorial. (page 3) |
| When would you elevate the head of bed to 45-75 degrees? | Cardiac, coughing, pain, and GI (page 3) |
| What type of procedure (Arterial or venous) is a cardiac catheterization? | Arterial (page 4) |
| What are the 4 main signs of an unstable client? | Cyanosis, hypotension, cool/clammy, chest pain. | Note that SOB and pain are NOT signs of being unstable. (page 4) |
| How do you remove PPE? | Gloves, goggles, gown, mask. |
| Risk reduction: When ambulating a client with hemiplegia, which side do you stand on? | The side of the weakness. (page 11) |
| For HESI and NCLEX, how many people does it require to operate a hoyer? | ONE. (page 12) |
| If there is a sudden increase in confusion, what are three potential causes? | UTI, hypoxia, and electrolyte imbalance. (page 12) |
| 1 oz = ?ml | 30ml (page 13) |
| Formula for Celsius to Farenheit | C * 1.8 + 32 (page 13) |
| What are normal BUN and creatinine levels? | BUN: 10 to 20. | Creatinine <1.2 (page 18) |
| What is a normal specific gravity? | 1.005 to 1.030. High values indicate dehydration or hypovolemia. (page 18) |
| What is a normal bilirubin level? | <1.2 (page 19) |
| What is a normal hemoglobin level? What happens when it is <7? | 12 to 18. | When <7, you will see bounding pulses and cardiac output will increase. (page 20) |
| What is a normal hematocrit? | 36 to 54 (3x the level of hemoglobin) (page 20) |
| Normal WBC count? | 5-11,000. More indicates infection, less indicates immunosuppression. (page 20) |
| If the immune system is suppressed, what are 3 things that they cannot have? | 1) Raw fruits and vegetables | 2) Unpasteurized milk or undercooked meat | 3) Fresh flowers (page 21) |
| What are the antidotes for heparin and warfarin? | Heparin: Protamine sulfate | Warfarin: vitamin K (page 21) |
| At what level would Lithium cause toxicity? When are levels drawn? What is this medication given for? | a level greater than 1.5 indicates toxicity | draw level 8 to 12 hours after dose | It is given for client who are bipolar. (page 21) |
| If you suspect fluid overload, what 3 things would you assess? | Vital signs, lung sounds, and respiratory effort. (page 25) |
| What is the treatment for a suspected air embolism? | Place on left side in Trendelenburgs. (page 25) |
| What are the preferred places for IM injections for HESI and NCLEX? | Hesi: ventrogluteal | NCLEX: dorsogluteal (page 28) |
| How long do most psych drugs take to begin working? | 2 to 4 weeks. |
| What is the cardinal sign that a medication has induced Neuroleptic Malignant Syndrome (NLMS)? | Hyperpyrexia with a temperature up to 108 degrees. (page 39) |
| What are Extrapyramidal side effects (EPS) and what is it caused by? | EPS are reactions to antipsychotics and include muscle rigidity like Parkinsons and tardive dyskinesia (lip smacking, tongue rolling, etc). (page 39) |
| Pharmacology: What is the ending for most benzodiazepines? | Most benzos end in "pam". IE: Diazepam, Lorazepam. (page 40) |
| Pharmacology: what are the effects of cholinergics? | SLUDGE! Salivation, Lacrimation, Urination, Diarrhea, GI motility, Emesis. |
| Mental health: What are the four "As" of Schizophrenia? | Autism (preoccupied with self) | Affect (flat) | Associations (loose) | Ambivalence (no decisions) (page 49) |
| What is Wernicke's encephalopathy caused by? | It is a psychosis induced by a vitamin B deficiency. (page 56) |
| What is the last physiologic function to lose with anesthesia? | Respiratory effort. This is considered stage 4 anesthesia and is rarely recommended. (page 58) |
| Post-operatively, if a dressing becomes saturated, what is your priority treatment? | Direct pressure. (page 58) |
| What types of food should you avoid with gout patients? | Foods with purine in them, such as ham and shellfish. (page 30) |
| What types of patients should utilize a low protein diet? | Those with glomerulonephritis, end stage renal failure, and hepatic failure. (page 30) |
| What are some early post-operative complications? | Hypoxia, Atelectasis, Hypovolemic shock, paralytic ileus. (page 59) |
| What are some late post-operative complications? | Pulmonary embolus, pneumonia, wound infections (page 59) |
| What two types of wound are most susceptible to dehiscence? | Abdominal and vertical (page 60) |
| What is the peak of rapid acting (R) insulin? | 2 to 4 hours (page 63) |
| What is the peak of intermediate acting (NPH) insulin? | 4 to 8 hours (page 63) |
| What is the peak of "basal" long acting insuling (Lantus)? | 6 hours (page 63) |
| Pharmacology: What is the ending for most steroids? | Most steroids end in "sone". IE: cortisone, prednisone. (page 65) |
| When will you see "twitch twitch seize seize?" | Hypocalcemia, Hypomagnesemia, and Hyperphosphatemia. (page 65) |
| What hormones are secreted by the adrenal cortex? | "Sugar, salt, sex": Cortisol, Aldosterone, Estrogen/Testosterone. (page 67) |
| Addison's disease: what is the cardinal sign, and what is it caused by? | The cardinal sign is bronzed skin, especially of the hands and elbows. | It is caused by adrenal cortex insufficiency, especially aldosterone. (page 67) |
| Cushing's disease: What are the cardinal signs, and what is it caused by? | Cardinal signs: moon face and buffalo hump | It is caused by overproduction of adrenal cortex hormones, especially cortisol. (page 67) |
| What are the signs and symptoms of DKA (diabetic ketoacidosis), and which type of diabetes is it associated with? | Signs/symptoms: Dehydration, Ketonuria, Kussmauls, acidosis, acetone breath | It is associated with Type 1 diabetes mellitus. (page 69) |
| How do you treat diabetic ketoacidosis? | With hydration and insulin administration. (page 69) |
| The saying to remember the difference between hypoglycemia and hyperglycemia: | "Hot and dry, sugar high. Cold and clammy, need some candy." (page 69) |
| Treatment for hypoglycemia: | Simple sugar, followed by a complex carb and then protein. Orange juice is a good choice for adults; milk for kids. (page 70) |
| What is diabetes insipidus, and what is it caused by? | The body is unable to hold onto water - so urination 3 to 15 L per day. It is caused by too little ADH. (page 71) |
| If the question is about respiratory, what are the two main things to examine? | Lung sounds and SaO2 (oxygen sats). (page 76) |
| If a patient is on antitubercular agents, what studies should they have done, and when? | They need to have liver studies performed; antitubercular agents are toxic to the liver. They should be done at the beginning of therapy for baseline, and once a month thereafter. (page 79) |
| Rifampin is a common antitubercular drug. What is a caution to give to patients about it? | Rifampin will color your urine, tears, and sweat red. This may damage contact lenses. (page 79) |
| Who are the "blue bloaters" and "pink puffers"? | Blue bloaters = COPD | Pink puffers = emphysema (page 81) |
| Because cystic fibrosis creates a mucus that plugs bile ducts, what is something you can expect? | Steatorrhea. (page 81) |
| Cystic fibrosis has a genetic component. What is it? | CF is autosomal recessive; ie, you need both parents to carry the gene to transmit the disease. (page 81) |
| What is silicosis, and what is the pattern you would see on the xray? | Silcosis is lung disorder from the inhalation of silicon, and the pattern is "eggshell" on lung xrays. (page 82) |
| What are the 3 components of Virchows triad, and what is the purpose? | Components: Venous Stasis, Hypercoagulation, Vascular injury | The purpose is to identify predisposing factors of a patient to have a DVT/pulmonary embolism. (page 82) |
| When is a fat embolism most likely to occur? | Within 36 hours of a fracture. (page 82) |
| What is the purpose of a greenfield filter, and where is it located? | It is to catch clots, and is placed in the inferior vena cava. (page 83) |
| When is a chest tube placed high in the chest? | For a pneumothorax (air in the pleural space). Remember, "air rises and fluid falls" for chest tube placement. (page 83) |
| What position would you lay a patient with left sided pleurisy? | On their left side - their good lung should be up. This allows the bed to splint their bad side, and for full expansion of their good lung. (page 84). |
| What is a flail chest, and what is the cardinal sign? | A flail chest is instability of the chest wall due to rib fractures. The cardinal sign is that the chest is asymmetrical. (page 84) |
| What test should you perform before taking ABG's? | Allens test - raise the arm and occlude to the radial artery to ensure the ulnar artery can supply enough blood to the hand. (page 87) |
| What number on a pulse oximeter is considered critical? | <90% is critical. (page 87) |
| What is the clinical manifestation of chronic hypoxia? | Clubbing of the fingers (page 87) |
| When suctioning a patient, how long should each suction last? What should you do before hand? | Each suction should last no more than 10 to 15 seconds. You need to hyper-oxygenate the patient before each suctioning. (page 88) |
| Which sections of a chest tube should bubble, and which should not? | The suction control should continuously bubble. | The water seal should intermittently bubble | The drainage collection should never bubble. (page 89) |
| In regards to a chest tube, what is "tidaling"? | The rise and fall of the water seal with each breath of the patient. (page 89) |
| When should you "milk" a chest tube? | Only when occlusion is suspected. (page 89) |
| What are Kussmaul respirations associated with? | Diabetic ketoacidosis and metabolic acidosis - the body is trying to blow off CO2. (page 91) |
| What are Cheyne Stokes respirations associated with? | They are indicative of ICP or brain injury (page 91) |
| Wide QRS complexes are associated with what imbalance? | Hyperkalemia (page 93) |
| Pharmacology: What do ACE inhibitors end in? | "pril" ie: benazepril, lisinopril (page 99) |
| Pharmacology: What are two key problems with ACE inhibitors? | Hyperkalemia and a constant, nagging cough (page 99) |
| Pharmacology: What do ARBs end in? | "artan" ie: candesartan, losartan (page 100) |
| Pharmacology: What do Alpha blockers end in? | "sin" ie: doxazosin, prazosin (page 100) |
| How long should aspirin be held before surgery? | Preferably 5 days, but a minimum of 48 hours (page 100) |
| What are the four types of treatment give to someone who has had an MI? | MONA: Morphine, Oxygen, Nitro, Aspirin. (page 103). |
| What are the clinical manifestations of left sided heart failure? | Shortness of breath and crackles due to pulmonary edema. (page 105) |
| What are the clinical manifestations of right sided heart failure? | Distended neck veins, liver enlargement, pitting edema. (page 105) |
| Chronic hypertension leads to what four diseases? | CAD: coronary artery disease | CRF: chronic renal failure | CHF: congestive heart failure | CVA: stroke (page 108) |
| What are your 3 priorities for a patient in sickle cell crisis? | Hydration, oxygenation, pain management (page 108) |
| Who has a tendency towards iron deficiency anemia? | Growing children/adolescents, pregnant women, and those with inadequate nutrition (page 108) |
| What are early signs of shock? | Anxiety, agitation, increased HR (BP stays normal), increased respiration, decreased urine. (page 110) |
| What position is important for a patient after a cardiac catheterization? | Supine with their leg straight for at least four hours (page 111) |
| What blood type is the universal donor? What type is the universal recipient? | O negative is the universal donor. AB positive is the universal recipient. (page 112) |
| What is the difference between cardioversion and defibrillation? | Cardioversion is elective, and the defib is synced to their heart rhythm. | Defibbing is done in emergencies, unconcious clients, and at a higher amperage of joules. (page 113) |
| Pharmacology: What substance must you avoid when taking cephalosporins? | ALCOHOL. It will cause a reaction similar to someone on Antabuse (copious vomiting, syncope, flushing, nausea). (page 117) |
| A bullseye rash is indicative of what? | Lyme disease (page 124) |
| What tests are used to diagnose lyme disease? | Elisa and western blot (page 124) |
| What are the clinical manifestations of pediatric HIV? | Pneumonitis, Pulmonary hyperplasia, and opportunistic infections (page 126) |
| What kind of precautions should you use with meningitis? | Droplet precautions(page 127) |
| What kind of precautions should you use with herpes zoster? | Airborne and contact (page 127) |
| What kind of precautions should be used with tuberculosis? | Airborn precautions (+negative pressure room and special respirators) (page 127) |
| Pharmacology: What is a serious warning with antiandrogen medications? | They are severely teratogenic - pregnant women should avoid the sperm of men on them (and nurses should be careful in handling the medications) (page 129) |
| After a TURP (transurethral resection of prostate), the bladder is continuously irrigated. What color will the urine be? | Red at first, then pink (page 131) |
| What types of disorders does a spastic bladder occur with? What about a neurogenic bladder? | Spastic bladders occur with upper motor neuron disoders, such as cerebral palsy. | Neurogenic bladders occur with lower motor neuron disorders, such as a stroke. (page 144) |
| What exercises can be helpful to reduce incontinence? | Kegel exercises (page 144) |
| What two things should you assess daily in a client with ascites? | Abdominal girth and weight. (page 145) |
| What is the cardinal sign of renal cancer? | Hematuria (page 146) |
| What is a normal urinary output per hour? | 30 ml (page 146) |
| Crushing injuries release which electrolytes? | Intracellular - especially potassium (page 147) |
| What is a normal arterial pH? | 7.35 to 7.45 ( page 153) |
| What are normal CO2 levels? | 35 to 45 (page 153) |
| What are normal HCO3 levels? | 22 to 26 (page 153) |
| If your blood pH is 7.20, your PCO2 levels are 60, and your HCO3 levels are 24, what acid-base situation are you encountering? | Respiratory acidosis (page 155) |
| What are the common areas for spinal fractures? | Cervical: 5, 6, 7 | Thoracic: 12 | Lumbar: 1 (page 163) |
| If a person has pins in their skin/bones, how are they cared for? | Pin care is a cleaning with 1/2 strength hydrogen peroxide, then rinse with water. (page 166) |
| What is Cushing's triad, and what does it's presence indicate? | the triad: decreased pulse, irregular resprs, and widening pulse pressure. | It indicates increased intracranial pressure. (page 175) |
| Pharmacology: What kind of medication will be given for ICP? | Mannitol, a diuretic, to decrease the fluid in the brain. (page 176) |
| Thrombotic strokes are related to what kind of disease? | Artherosclerosis (page 178) |
| Embolic strokes are related to what disease? | Atrial fib or Atrial flutter (page 178) |
| Hemorrhagic stroke is related to what disease? | Hypertension (page 178) |
| What is apraxia? | absence of purposeful movements (page 179) |
| What is dysarthria? | Difficulty articulating speech (page 179) |
| What is agraphia? | absence of ability to write (page 179) |
| What is alexia? | Absence of ability to read (page 179) |
| What are the physical signs of meningitis? | Kernigs and Bruzinksi's sign. Kernigs - cannot straighten the leg. Brudzinksis - pain when flexing the neck. (page 179) |
| What is the cardinal sign of bell's palsy? | Unilateral facial paralysis. It is not painful. (page 180) |
| What is the cardinal sign of trigeminal neuralgia? | Excruciating facial pain (page 180) |
| When should a moro reflex begin to disappear? | Around 3 to 4 months of age (page 182) |
| What kind of pain medication should you administer for a patient with pancreatitis? | Demerol (page 185) |
| What is a primary intervention for patients who have GERD or a hiatal hernia? | HOB elevated for 30 to 60 minutes after eating, as well as elevated at night. (page 187) |
| What is fetor hepaticus? | Breath odor of chronic liver disease (sometimes referred to as the breath of the dead) (page 190) |
| What position should someone be in for a colonoscopy? | Sims (page 193) |
| What should you look for with electrical wounds? | They should have an entrance AND an exit wound. (page 202) |
| When is a fetus considered viable? | At 24 weeks (page 204) |
| What is Nagele's rule? | It calculates gestation/due date. First day of last menstrual period minus 3 months plus 7 days( page 205) |
| What is Gravida? Para? | Gravida = number of times pregnant Para = number of pregnancies after 20 weeks (page 205) |
| What is Chadwick's sign? | A bluish vagina - a probable sign of pregnancy that appears as early as 4 weeks. (page 206) |
| Wat is ballottement? | When the fetus' head rebounds from the tip of your fingers - a probable sign of pregnancy. (page 206) |
| If the fundus is displaced, what intervention needs to take place? | The bladder needs to be emptied before you palpate the fundus further. (page 206) |
| Can diabetic mothers take oral hypoglycemics during pregnancy? | No. they are teratogenic. They should only be taking insulin during pregnancy. (page 207) |
| What reaction are you looking for in a non-stress test? | For the fetal heart rate to go up by 15 beats for 15 seconds. A positive test is good. (page 213) |
| What is a normal fetal heart rate? | 110 to 160 (page 215) |
| Where is the fetus located when at "zero station"? | The head is positioned between the ischial spines. (page 215) |
| In the case of cord compression or cord prolapse, what position should the mother be placed into? | Knee chest (page 216) |
| What are the 4 stages of labor and delivery? | 1: dilation | 2: delivery of baby | 3: delivery of placenta | 4: the first 4 hours after delivery (page 217) |
| What are the 3 phases of labor stage 1? | 1: Latent phase: 0-4 cm, contractions every 5 to 30 minutes | 2: Active phase: 4-7 cm dilation, contractions every 3 to 5 minutes. | 3: Transitional phase: 8-10 cm dilated, contractions every minute (page 217) |
| After delivery, where should the fundus height be? | At the umbilicus (page 220) |
| What is acrocyanosis? | It is a NORMAL bluish discoloration of the hands and feet in newborns. (page 225) |
| In infants, what is the easiest way to tell the difference between a cephalohematoma and caput succedaneum? | Cephelahematomas do not cross the suture lines of the skull, whereas caput succedaneum does. (page 228) |
| When does a babies birth weight double and triple? | It doubles at 6 to 8 months and triples 9 to 12 months (page 230) |
| Which cardiac birth defects are acyanotic? | VSD, ASD, and PDA (ventricular septal defect, atrial septal defect, and patent ductus arteriosas). (page 234) |
| Which cardiac birth defects are cyanotic? | Tetrology of fallot, truncus arteriosus, and transposition of the great arteries. (page 235) (if it starts with a T, it's a cyanotic defect) |
| What is included in the Tetralogy of Fallot? | Ventricular septal defect, pulmonic stenosis, and right ventricular hypertrophy (page 235) |
| What are the 3 C's of esophageal atresia? | Choking, coughing, cyanosis (page 239) |
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