ALL HESI HINTS 7TH EDITION
LEADERSHIP
● Most questions are written in a positive style.
● Negative style questions contain key words that denote the negative style.
● Delegating to the right person requires the nurse be aware of the qualifications and job description of the
person delegated to perform the task. For example, the nurse must be certain the person to whom they are
delegating the task has the requisite documented education, training, knowledge, skills, experience, and
competencies to complete the delegated task. UAPs generally are not allowed or permitted by the state
nurse practice act to perform sterile procedures or invasive procedures.
● Some tasks may not be delegated to UAP. For example, delegated activities fall within the implementation
phase of the nursing process and may not be delegated to UAPs. Any activity or task requiring nursing
judgment cannot be delegated to a UAP.
● The PN has the legal authority to delegate certain tasks or activities to a designated (delegate), competent
individual but the PN is responsible for making certain the person to whom a task or activity is delegated is
competent and duly supervised.
● The PN is ultimately responsible for the outcome of the activities delegated to others.
● The PN who delegates to the delegated must assess and evaluate the outcome(s) of the task(s) that have
been delegated.
● The nurse has a legal responsibility to report suspected child abuse
● Often an NGN-NCLEX-PN question asks who should explain and describe a surgical procedure to the client,
including both complications and the expected results of the procedure. The answer is the health care
provider. Remember that it is the nurse’s responsibility to be sure that the operative permit is signed and is
in the client’s medical record. It is not the nurse’s responsibility to explain the procedure to the client. The
nurse must document that the client was given the information and agreed to it.
● Often NGN-NCLEX-PN questions address the Good Samaritan Act, which is the means of protecting a
nurse when she or he is performing emergency care
● If the nurse carries out a health care provider’s prescription for which he or she is not prepared and does not
inform the health care provider of his or her lack of preparation, the nurse is solely liable for any damages.
● Restraints of any kind may constitute false imprisonment. Freedom from unlawful restraint is a basic human
right and is protected by law. Use of restraints must fall within guidelines specified by state law and hospital
policy.
● In a disaster the nurse must consider both the individual and the community.
,ALL HESI HINTS 7TH EDITION
Respiratory Failure
● The initial presentation of ARDS is often subtle. At the time of initial injury, for several hours to 1–2 days
afterward, the client may not experience respiratory symptoms or may exhibit only dyspnea, tachypnea,
cough, and restlessness. Chest auscultation may be within normal parameters or reveal fine, scattered
crackles.
● A child in severe respiratory distress should receive 100% oxygen until diagnostic test results, keep in mind
the percentage of oxygen the child is receiving.
● The NGN-NCLEX-PN asks many questions about clinical assessment and related pathophysiology.
Example: The nurse is assessing an infant who grunts during expiration. Which is the likely cause of this
finding? Infants and young children grunt during expiration as respiratory distress begins. Grunting is how
the body attempts to create a form of “PEEP” (positive end-expiratory pressure) to help keep the alveoli
open.
● The NGN-NCLEX-PN tests your ability to assess the child’s condition and then subsequently apply and
implement actions to address acute life-threatening situations. For example, you need to know acute
respiratory failure describes any impairment in oxygenation or ventilation in which the arterial oxygen tension
falls below 60 mm Hg (acute hypoxemia), the carbon dioxide tension rises above 50 mm Hg (acute
hypercarbia, hypercapnia), and the pH drops below 7.35, or both
SHOCK
● If cardiogenic shock exists with the presence of pulmonary edema (i.e., from cardiac pump failure) position
the client in high Fowler’s with the legs facing downward to reduce venous return to the left ventricle.
RESUSCITATION
● NGN-NCLEX-PN questions on cardiopulmonary resuscitation (CPR) often use critical thinking skills to
determine prioritization of actions.
● The nurse must stay current with the American Heart Association (AHA) guidelines for basic life support
(BLS) by being certified every 2 years, as required. See the AHA website for current CPR Guidelines and to
locate a CPR class.
● Initiate CPR with BLS guidelines immediately; then move on to advanced cardiac life support (ACLS)
guidelines
● In the Pediatric cardiac arrest algorithm know the reversible causes: The reversible causes of cardiac arrest
include four “H’s”: hypoxia. hypovolemia. hyperkalemia, hypokalemia, other electrolyte disturbances, and
,ALL HESI HINTS 7TH EDITION
four “Ts”: tension pneumothorax, cardiac tamponade, drug toxicity and therapeutics, thromboembolism and
other outflow obstructions.
● For infants and children provide chest compressions that depress the chest at least 1/3 of the anterior
posterior diameter of the chest; use chest compression rate of ∼100–120/min for infants and children.
● Single rescuers compression to ventilation rate 30:2; two rescuers 15:2
FLUID AND ELECTROLYTES BALANCE
● The most common type of dehydration is isotonic (isonatremic) dehydration, which effectively
equates with hypovolemia; but the distinction of isotonic from hypotonic or hypertonic dehydration
may be important when treating people with dehydration. Physiologically, dehydration is both loss
of water and solutes (mainly sodium) and are usually lost in roughly equal quantities as to how they
exist in blood plasma.
1. Hypotonic or hyponatremic (primarily a loss of electrolytes, sodium in particular).
2. Hypertonic or hypernatremic (primarily a loss of water).
3. Isotonic or isonatremic (an equal loss of water and electrolytes).
4. Hypotonic or hyponatremic (primarily a loss of electrolytes, sodium in particular).
5. Hypertonic or hypernatremic (primarily a loss of water).
6. Isotonic or isonatremic (an equal loss of water and electrolytes
● Potassium imbalances are potentially life threatening and must be corrected immediately. A low magnesium
level often accompanies a low potassium level, especially with the use of diuretics. Magnesium must be
corrected to normalize potassium.
INTRAVENOUS THERAPY
● An air embolism can be fatal if the pulmonary capillaries are blocked. Watch for empty IV fluid containers
and ensure all central lines are capped and locked if not in use.
● If an IV catheter is suspected as the causative factor of sepsis, the catheter should be removed and blood
cultures drawn and sent to the laboratory.
● Flushing a saline lock: Attach NS prefilled Luer lock syringe by twisting the syringe to the positive pressure
cap. Inject 3–5 mL of solution using turbulent stop-start technique. Flush until visibly clear. Do not bottom out
syringe (leave 0.2–0.5 mL in the syringe).
, ALL HESI HINTS 7TH EDITION
● Laws for licensed PN (LPN) in many states limit IV and blood product administration. The PN needs to be
aware of the Scope of Practice in his or her state and the agency’s policies. In some states, additional IV
classes may be required for the PN to start IVs.
● The acronym “ROME” can help you remember: respiratory, opposite, metabolic, equal.
ECG
● Blood flow through the heart
● Superior/inferior VENA CAVA (unoxygenated) → Right ATRIUM → (Tricuspid Valve) → Right
● VENTRICLE → (Pulmonic Valve) Pulmonary Artery → LUNGS (gas exchanged at alveoli—oxygenated) →
Left ATRIUM → (Mitral Valve) → Left VENTRICLE → (Aortic Valve) → Aorta
Review the three structures that control the one-way flow of blood through the heart:
Atrioventricular valves
Tricuspid (right side)
Mitral (left side)
Semilunar valves
Pulmonic (in pulmonary artery)
Aortic (in aorta)
Chordae tendineae
Papillary muscles
● The T wave represents repolarization of the ventricle, so this is a critical time in the heartbeat. This action
represents a resting and regrouping stage so that the next heartbeat can occur. If defibrillation occurs during
this phase, the heart can be thrust into a life-threatening dysrhythmia.
● NGN-NCLEX-RN questions are likely to relate to early recognition of abnormalities and associated clinical
actions. Remember to monitor the patient as well as the machine! Feel the pulse! Listen to the heart.
Evaluate the blood pressure. If the ECG monitor shows a severe dysrhythmia but the client is sitting up
quietly watching television without any sign of distress, assess to determine whether the leads are attached
properly.
PREOPERATIVE CARE
● Marking the operative site is required for procedures involving right/left distinctions, multiple structures
(fingers, toes), and levels (spinal procedures). Site marking should be done with the involvement of the
client.
LEADERSHIP
● Most questions are written in a positive style.
● Negative style questions contain key words that denote the negative style.
● Delegating to the right person requires the nurse be aware of the qualifications and job description of the
person delegated to perform the task. For example, the nurse must be certain the person to whom they are
delegating the task has the requisite documented education, training, knowledge, skills, experience, and
competencies to complete the delegated task. UAPs generally are not allowed or permitted by the state
nurse practice act to perform sterile procedures or invasive procedures.
● Some tasks may not be delegated to UAP. For example, delegated activities fall within the implementation
phase of the nursing process and may not be delegated to UAPs. Any activity or task requiring nursing
judgment cannot be delegated to a UAP.
● The PN has the legal authority to delegate certain tasks or activities to a designated (delegate), competent
individual but the PN is responsible for making certain the person to whom a task or activity is delegated is
competent and duly supervised.
● The PN is ultimately responsible for the outcome of the activities delegated to others.
● The PN who delegates to the delegated must assess and evaluate the outcome(s) of the task(s) that have
been delegated.
● The nurse has a legal responsibility to report suspected child abuse
● Often an NGN-NCLEX-PN question asks who should explain and describe a surgical procedure to the client,
including both complications and the expected results of the procedure. The answer is the health care
provider. Remember that it is the nurse’s responsibility to be sure that the operative permit is signed and is
in the client’s medical record. It is not the nurse’s responsibility to explain the procedure to the client. The
nurse must document that the client was given the information and agreed to it.
● Often NGN-NCLEX-PN questions address the Good Samaritan Act, which is the means of protecting a
nurse when she or he is performing emergency care
● If the nurse carries out a health care provider’s prescription for which he or she is not prepared and does not
inform the health care provider of his or her lack of preparation, the nurse is solely liable for any damages.
● Restraints of any kind may constitute false imprisonment. Freedom from unlawful restraint is a basic human
right and is protected by law. Use of restraints must fall within guidelines specified by state law and hospital
policy.
● In a disaster the nurse must consider both the individual and the community.
,ALL HESI HINTS 7TH EDITION
Respiratory Failure
● The initial presentation of ARDS is often subtle. At the time of initial injury, for several hours to 1–2 days
afterward, the client may not experience respiratory symptoms or may exhibit only dyspnea, tachypnea,
cough, and restlessness. Chest auscultation may be within normal parameters or reveal fine, scattered
crackles.
● A child in severe respiratory distress should receive 100% oxygen until diagnostic test results, keep in mind
the percentage of oxygen the child is receiving.
● The NGN-NCLEX-PN asks many questions about clinical assessment and related pathophysiology.
Example: The nurse is assessing an infant who grunts during expiration. Which is the likely cause of this
finding? Infants and young children grunt during expiration as respiratory distress begins. Grunting is how
the body attempts to create a form of “PEEP” (positive end-expiratory pressure) to help keep the alveoli
open.
● The NGN-NCLEX-PN tests your ability to assess the child’s condition and then subsequently apply and
implement actions to address acute life-threatening situations. For example, you need to know acute
respiratory failure describes any impairment in oxygenation or ventilation in which the arterial oxygen tension
falls below 60 mm Hg (acute hypoxemia), the carbon dioxide tension rises above 50 mm Hg (acute
hypercarbia, hypercapnia), and the pH drops below 7.35, or both
SHOCK
● If cardiogenic shock exists with the presence of pulmonary edema (i.e., from cardiac pump failure) position
the client in high Fowler’s with the legs facing downward to reduce venous return to the left ventricle.
RESUSCITATION
● NGN-NCLEX-PN questions on cardiopulmonary resuscitation (CPR) often use critical thinking skills to
determine prioritization of actions.
● The nurse must stay current with the American Heart Association (AHA) guidelines for basic life support
(BLS) by being certified every 2 years, as required. See the AHA website for current CPR Guidelines and to
locate a CPR class.
● Initiate CPR with BLS guidelines immediately; then move on to advanced cardiac life support (ACLS)
guidelines
● In the Pediatric cardiac arrest algorithm know the reversible causes: The reversible causes of cardiac arrest
include four “H’s”: hypoxia. hypovolemia. hyperkalemia, hypokalemia, other electrolyte disturbances, and
,ALL HESI HINTS 7TH EDITION
four “Ts”: tension pneumothorax, cardiac tamponade, drug toxicity and therapeutics, thromboembolism and
other outflow obstructions.
● For infants and children provide chest compressions that depress the chest at least 1/3 of the anterior
posterior diameter of the chest; use chest compression rate of ∼100–120/min for infants and children.
● Single rescuers compression to ventilation rate 30:2; two rescuers 15:2
FLUID AND ELECTROLYTES BALANCE
● The most common type of dehydration is isotonic (isonatremic) dehydration, which effectively
equates with hypovolemia; but the distinction of isotonic from hypotonic or hypertonic dehydration
may be important when treating people with dehydration. Physiologically, dehydration is both loss
of water and solutes (mainly sodium) and are usually lost in roughly equal quantities as to how they
exist in blood plasma.
1. Hypotonic or hyponatremic (primarily a loss of electrolytes, sodium in particular).
2. Hypertonic or hypernatremic (primarily a loss of water).
3. Isotonic or isonatremic (an equal loss of water and electrolytes).
4. Hypotonic or hyponatremic (primarily a loss of electrolytes, sodium in particular).
5. Hypertonic or hypernatremic (primarily a loss of water).
6. Isotonic or isonatremic (an equal loss of water and electrolytes
● Potassium imbalances are potentially life threatening and must be corrected immediately. A low magnesium
level often accompanies a low potassium level, especially with the use of diuretics. Magnesium must be
corrected to normalize potassium.
INTRAVENOUS THERAPY
● An air embolism can be fatal if the pulmonary capillaries are blocked. Watch for empty IV fluid containers
and ensure all central lines are capped and locked if not in use.
● If an IV catheter is suspected as the causative factor of sepsis, the catheter should be removed and blood
cultures drawn and sent to the laboratory.
● Flushing a saline lock: Attach NS prefilled Luer lock syringe by twisting the syringe to the positive pressure
cap. Inject 3–5 mL of solution using turbulent stop-start technique. Flush until visibly clear. Do not bottom out
syringe (leave 0.2–0.5 mL in the syringe).
, ALL HESI HINTS 7TH EDITION
● Laws for licensed PN (LPN) in many states limit IV and blood product administration. The PN needs to be
aware of the Scope of Practice in his or her state and the agency’s policies. In some states, additional IV
classes may be required for the PN to start IVs.
● The acronym “ROME” can help you remember: respiratory, opposite, metabolic, equal.
ECG
● Blood flow through the heart
● Superior/inferior VENA CAVA (unoxygenated) → Right ATRIUM → (Tricuspid Valve) → Right
● VENTRICLE → (Pulmonic Valve) Pulmonary Artery → LUNGS (gas exchanged at alveoli—oxygenated) →
Left ATRIUM → (Mitral Valve) → Left VENTRICLE → (Aortic Valve) → Aorta
Review the three structures that control the one-way flow of blood through the heart:
Atrioventricular valves
Tricuspid (right side)
Mitral (left side)
Semilunar valves
Pulmonic (in pulmonary artery)
Aortic (in aorta)
Chordae tendineae
Papillary muscles
● The T wave represents repolarization of the ventricle, so this is a critical time in the heartbeat. This action
represents a resting and regrouping stage so that the next heartbeat can occur. If defibrillation occurs during
this phase, the heart can be thrust into a life-threatening dysrhythmia.
● NGN-NCLEX-RN questions are likely to relate to early recognition of abnormalities and associated clinical
actions. Remember to monitor the patient as well as the machine! Feel the pulse! Listen to the heart.
Evaluate the blood pressure. If the ECG monitor shows a severe dysrhythmia but the client is sitting up
quietly watching television without any sign of distress, assess to determine whether the leads are attached
properly.
PREOPERATIVE CARE
● Marking the operative site is required for procedures involving right/left distinctions, multiple structures
(fingers, toes), and levels (spinal procedures). Site marking should be done with the involvement of the
client.
