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 ○ PATIENT POSITIONING ● Position for enema? L or R? Left! ○ Whenever opposites are mentioned in a question, one of them is the answer& ● Center of gravity ○ In most adults ³ hips ○ In older adults ³ upper torso ■ Changes in bone density (i.e. osteoporosis) lOMoARcPSD| ■ Flexion of elbows, knees POSITIONING/LIFTING ³ BODY MECHANICS ● Nurse positioning ● Know how to protect your ï back/yourself ● Ask for HELP (lift team, colleague) ï Lift devices PPE / SPECIAL & STANDARD PRECAUTIONS ● Types of precautions ○ Standard/Universal ○ Contact ■ Gloves, gown ■ Ex. Fecal-oral, RSV, MRSA ○ Droplet ■ Ex. Meningitis ○ Airborne ■ Everything! ■ Negative airflow room ■ Ex. MTV ● Know your PPE ³ In order! ○ ON: Gown, Mask, Goggles, Gloves (donning) ○ OFF: Gloves & Gown together (roll), Goggles, Mask ● Think& How could I get infected? Use PPE as needed regardless of set precautions! PRESSURE INJURIES ● Staging system: I-IV, Unstageable, Deep Tissue Injury ○ Can9t go back in stages ³ Healed stage = lOMoARcPSD| ● DO NOT rub or massage areas with non-blanchable erythema! ï Braden Scale for Predicting Pressure Sore Risk ○ Scoring ○ What's on it? ■ Sensory Perception ■ Activity ■ Mobility ■ Nutrition ■ Moisture ■ Friction and Shear THERAPEUTIC COMMUNICATION ● Address the client's concern directly ● Do NOT change the subject ● If you can HELP the client within your scope of practice, do so before "referring" them to the HCP ● Encourage/Invite the patient's "story" ● Don't make assumptions ● Tell the truth ● Do not tell the patient something you don't know FOR SURE ï Therapeutic touch ● Do not respond to test questions based on.. ○ A familiar phrase or term ○ "Of course, I would have already...' ○ What YOU think is REALISTIC ○ Your personal response to something ○ The what ifs ● HESI Hospital is the perfect hospital INFORMED CONSENT ● You cannot explain medical procedures to clients (that is the HCPs job), but you CAN answer additional questions or provide clarifications within your scope of practice. ● When to call the HCP: ○ If a patient does not understand WHY they are getting the procedure ○ If the patient does not WANT the procedure done ○ If the patient does not understand what the procedure ENTAILS ○ If the patient is confused as the which body part (i.e., which limb) will be operated on SCOPE OF PRACTICE ● These Qs test your knowledge of RN, LPN, UAP, and HCP ï roles ● You can't delegate what you EAT ○ Evaluation lOMoARcPSD| ○ Assessment ○ Teaching STAFF MANAGEMENT ● Always presented with 4 answers: ○ Tell supervisor ■ Is it illegal? What do you suspect? ○ Confront them and take over the task immediately ■ Is someone in immediate physiological/psychological danger? ■ Ex. Breaking sterile field ○ Talk to them later ■ Inappropriate ■ Bring it up to them later ○ Ignore it ■ Never! ETHICAL PRINCIPLES ● Nurses are mandated reporters. ï Autonomy ○ Respect the patient's right to self-determination/independent decision-making ï Non-maleficence ○ Do no harm ï Beneficence ○ You have a duty to do good to others ï Justice ○ No special treatment, ensure equitable distribution of potential benefit ï Veracitv ○ Tell the patient the truth ï Fidelity ○ Keep your promises to the patient SBAR ● Know the order; know what info is a part of each component ï Used in shift handoff and w/ HCPs ● SBAR: ○ Situation - What is happening now? What's the problem? ○ Background - What brought the patient in? Relevant health hx? ○ Assessment - What is YOUR assessment right now? ○ Recommendation - What do you recommend is done to fix the problem, and what are your questions? FLUID BALANCE / FLUID SHIFTS ● Tonicity: Hypo/Hyper/Isotonic ï IV Fluids lOMoARcPSD| ○ Isotonic ³ NS, lactated ringers ○ Hypotonic ³ ½ NS ○ Hypertonic ³ 5-10% dextrose and water ï Edema & Third-Spacing ○ Edema ■ Excessive swelling caused by fluids trapped in tissue ○ Third-spacing ■ Intravascular space Interstitial or third space (nonfunctional) ï Hypovolemia vs. Hypervolemia ○ Fluid volume deficit ■ Sensible vs. insensible losses ● Urinary output, wound drainage, GI losses ï Skin (sweat), lung ■ Infants/Children ³ More sensitive to fluid shifts, rely on others ■ Older adults ³ Have atypical signs/sx, dehydrate more easily due to decreased lean body mass, often rely on others, decreased thirst sensation ■ Signs/SX: ● Dry mucous membranes (mouth, for example) ï Tachycardia ● Dry skin ● Increased thirst ● Concentrated urine, low urine output ï HA, dizziness ○ Fluid volume excess ACID BASE BALANCE ● ROME ○ Respiratory opposite ³ pH and HCO3 go in opposite direction ○ Metabolic equal ³ pH and HCO3 go in the same direction ï Causes of acid base imbalances ○ Respiratory acidosis: hypoventilation ○ Respiratory alkalosis: hyperventilation ○ Metabolic alkalosis: prolonged vomiting and gastric suctioning ○ Metabolic acidosis: everything else ● As the pH goes, so goes my patient, except for potassium. ○ Slow symptoms& Bradycardia, bradypnea, etc.! SPECIAL DIETS ● Clear liquid ○ Surgery prep, GI issues ○ I.e. broth, coffee, gelatin ï Full liquid ○ Swallowing/chewing problems