HESI Fundamentals Review

HESI Fundamentals Review BASIC TEST-TAKING TIPS ● Read every QUESTION thoroughly ○ Catch words and phrases like: initial, first, immediate, priority, side effect vs. toxic/adverse effect, would/would not, most appropriate, least appropriate, needs additional teaching, understands the teaching, correct, incorrect ● Read all the ANSWERS thoroughly ○ Catch words like - only, all, always, never ○ These are generally too EXTREME to be correct, so you oftencan safely eliminate those answers ● Eliminate answers that don't DIRECTLY answer the question: ○ Some answers will be somewhat but indirectly related to the question being asked - ELIMINATE ○ Some answers will be grammatically incorrect for the question being asked -> ELIMINATE ● Avoid ADDING information ○ NO asking "What if...?" ○ Critical thinking - base your answer off the information you HAVE REMEMBER YOUR ABCs ● Airway 1st priority) ○ Obstruction, Aspiration, Positioning of head/neck ï BREATHING (2nd) ○ Respiratory muscle function, Ventilation, Gas Exchange, LOC ï CIRCULATION (3rd) ○ Peripheral tissue perfusion, BP, cardiac output (CO), Shock THE NURSING PROCESS ³ ADPIE ● Assessment - Always first! ● Diagnosis - What are the problems? Set priorities. ï Planning - What are the goals? Solution(s)? ● Implementation - Administration of care ● Evaluation - Patient outcomes & reassessment - what needs to change? MASLOW9S HIERARCHY ● Physiologic needs come before ALL else ○ Physiological needs =air, water, food, shelter, sleep, clothing, reproduction ï Safety needs=personal security, employment, resources, health, property ï Love and belonging = friendship, intimacy, family, sense of connection ○ Esteem = respect, self-esteem, status, recognition, strength, freedom ï Self-actualization =desire to become the most that one can be lOMoARcPSD| RULES FOR PRIORITIZATION ● Acute beats chronic ○ Acute, new ● Fresh post-op (<12 hours) beats other medical or surgical ○ B/c of hemorrhage, infection ○ Recent anesthesia ï Unstable beats stable ○ Change in vital signs, newly admitted, not ready for discharge, unexpected/unrelated conditions, hemorrhaging, fever > 105, hypoglycemia, pulseless, restless SELECT ALL THE APPLY ● Circle/Jot down the answers you know FOR SURE are correct. ï Cross-out the answers you know FOR SURE are incorrect. ● You will likely have 1-3 possible answers left, then choose using your best judgment ORDER/ARRANGEMENT ● These question ask you to arrange nursing interventions in the order of priority, or the order in which you would perform them. ● FIRST, think of your ABCs & Maslow's Hierarchy ● Be prepared for some skills-related technical questions. RIGHTS OF MEDICATION ADMINISTRATION ● Six& ○ Right PATIENT (at least 2 identifiers) ○ Right MEDICATION ○ Right DOSE ○ Right TIME ○ Right ROUTE ● Plus& ○ Patient allergies ○ Patient consent ○ Expiration date of drug ○ Documentation MEDICATION CALCULATION ● When first reading through the question, note the UNITS required for your calculation - this will tell you how to setup the equation: ○ What unit(s) is the order using? ○ What unit is the medication available in? ○ What unit(s) is the question asking for? ○ Are the units the same or different? (i.e., mcg-:mg-:g, mL- L, min-, hr) ï Know units and unit conversions lOMoARcPSD| ● Make your own list! ● Do practice questions! MEDICATION ● Therapeutic effect ï Toxic effect ● Anaphylactic/ Adverse reaction ï Trough = lowest concentration ï Peak = highest concentration ï Associated lab values ● Basic meds ● Proper needles ○ IM ³ 1M ³ 21 gauge, 1 in needle ○ SQ ³ 5Q ³ 25 gauge, } in needle lOMoARcPSD| ● Examples of drugs to think about& ○ Digoxin ■ Apical pulse rates before ○ Insulin ■ Types ○ Potassium ■ Never push it through IV ○ Coumadin and Vitamin K PAIN ● Remember: PAIN is what the patient says it is ○ Pain is subjective! ● Know how to conduct a thorough pain assessment ○ Provocative/Palliative ³ What caused the pain? ○ Quality/Quanitiy ³ What describes the pain? ○ Radiation/Region ³ Where is the pain? ○ Severity ³ How is the pain rated? ○ Timing/Treatment ³ How long has the pain been? Does anything make it worse or better? ○ Understanding ï Pain is IMPORTANT ○ Delaying pain medication DELAYS CARE ○ HESI/NCLEX do NOT like when you delay care ï Pain, however, will NOT KILL your patient. ● Therefore, if there are other physiological needs (for any of your patients) that are life-threatening, tend to those FIRST. PATIENT POSITIONING ● Know the different patient positions and what they are used for! ï Aspiration prevention is paramount b ● Respiratory distress/difficulty lOMoARcPSD| ○ High-fowlers ● Shock ○ Flat ○ Elevated legs for blood return to heart ï Venous stasis ○ Elevated feet for blood return ï Hemorrhage of a limb ○ Elevation to prevent blood flow to site