HESI HINT NCLEX GEMS ACTUALTEST AND GUIDE EXAM

HESI HINT & NCLEX GEMS ACTUALTEST AND GUIDE EXAM

LATEST 2023.

• Maslow’s Hierarchy of Needs

• Physiologic • Safety • Love and Belonging • Esteem • Self-actualization o Nursing Process • Assessment • Diagnosis (Analysis) • Planning • Implementation (treatment) • Evaluation o ABCs • Airway • Breathing • Circulation • Normal Values o Hgb • Males 14-18 • Females 12-16

• Hct

• Males 42-52 • Females 37-47

• RBCs

• Males 4.7-6.1 million • Females 4.2-5.4 million

• WBCs 4.5-11k
• Platelets 150-400k
• PT(Coumadin/Warfarin) 11-12.5 sec (INR and PT TR = 1.5-2 times normal) o APTT

(Heparin) 60-70 sec (APTT and PTT TR = 1.5-2.5 times normal)

• BUN 10-20
• Creatinine 0.5-1.2
• Glucose 70-110 o Cholesterol < 200 o Bilirubin Newborn 1-12 o

Phenylalanine Newborn < 2, Adult < 6 o Na+ 136-145 o K+ 3.5-5 • HypoK+ . . . Prominent U waves, Depressed ST segment, Flat T waves • HyperK+ . . . Tall T-Waves, Prolonged PR interval, wide QRS

• Ca++ 9-10.5

• Hypocalcemia … muscle spasms, convulsions, cramps/tetany, + Trousseau’s, + Chvostek’s, prolonged ST interval, prolonged QT segment

• Mg+ 1.5-2.5 o Cl- 96-106 o Phos 3-4.5
• Albumin 3.5-5
• Spec Gravity 1.005-1.030 1 / 3

• Glycosylated Hemoglobin (Hgb A1c): 4-6% ideal, < 7.5% = OK (120 days) o Dilantin

TR = 10-20

• Lithium TR = 0.5-1.5
• Arterial Blood Gases … Used for Acidosis vs. Alkalosis

• PH 7.35-7.45

• CO2 35-45 (Respiratory driver) … High = Acidosis • HCO3 21-28 (Metabolic driver) … High = Alkalosis

• O2 80-100

• O2 Sat 95-100% • Antidotes o Digoxin … Digiband

• Coumadin … Vitamin K (Keep PT and INR @ 1-1.5

X normal) o Benzodiazapines … Flumzaemil (Tomazicon) o Magnesium Sulfate … Calcium Gluconate? o Heparin … Protamine Sulfate (Keep APTT and PTT @ 1.5-2.5 X normal) o Tylenol … Mucomist (17 doses + loading dose)

• Opiates (narcotic analgesics, heroin, morphine)

… Narcan (Naloxone) o Cholinergic Meds (Myesthenic Bradycardia) … Atropine o Methotrexate … Leucovorin • Delegation

• RN Only

• Blood Products (2 RNs must check) • Clotting Factors • Sterile dressing changes and procedures • Assessments that require clinical judgment • Ultimately responsible for all delegated duties o Unlicensed Assistive Personnel • Non-sterile procedures • Precautions & Room Assignments o Universal (Standard) Precautions … HIV initiated • Wash hands • Wear Gloves • Gowns for splashes • Masks and Eye Protection for splashes and droplets • Don’t recap needles • Mouthpiece or Ambu-bag for resuscitation • Refrain from giving care if you have skin lesion o Droplet (Respiratory) Precautions (Wear Mask) • Sepsis, Scarlet Fever, Strep, Fifth Disease (Parvo B19), Pertussis, Pneumonia, Influenza, 2 / 3

Diptheria, Epiglottitis, Rubella, Rubeola, Meningitis, Mycoplasma, Adenovirus, Rhinovirus • RSV (needs contact precautions too) • TB … Respiratory Isolation o Contact Precautions = Universal + Goggles, Mask and Gown o No infection patients with immunosuppressed patients • Weird Miscellaneous Stuf o Rifampin (for TB) … Rust/orange/red urine and body fluids

• Pyridium (for bladder infection) … Orange/red/pink urine
• Glasgow Coma Scale … < 8 = coma o Myesthenia Gravis

• Myesthenic Crisis = Weakness with change in vitals (give more meds) • Cholinergic Crisis = Weakness with no change in vitals (reduce meds) o Diabetic Coma vs. Insulin Shock … Give glucose first – If no help, give insulin o Fruity Breath = Diabetic Ketoacidosis o Acid-Base Balance • If it comes out of your ass, it’s Acidosis.• Vomiting = Alkalosis o Skin Tastes Salty = Cystic Fibrosis

• Lipitor (statins) in PMs only – No grapefruit juice
• Stroke … Tongue points toward side of lesion (paralysis), Uvula deviates away from the

side of lesion (paralysis)

• Hold Digoxin if HR < 60
• Stay in bed for 3 hours after first ACE Inhibitor dose o Avoid Grapefruit juice with

Ca++ Channel Blockers

• Anthrax = Multi-vector biohazard
• Pulmonary air embolism prevention = Trendelenburg (HOB down) + on left side (to trap

air in right side of heart)

• Head Trauma and Seizures … Maintain airway = primary concern o Peptic Ulcers …

Feed a Duodenal Ulcer (pain relieved by food) … Starve a gastric ulcer o Acute Pancreatitis … Fetal position, Bluish discoloration of flanks (Turner’s Sign), Bluish discoloration of pericumbelical region (Cullen’s Sign), Board like abdomen with guarding … Self digestion of pancreas by trypsin.

• Hold tube feeding if residual > 100mL o In case of Fire … RACE and PASS
• Check Restraints every 30 minutes … 2 fingers room underneath o Gullain-Barre

Syndrome … Weakness progresses from legs upward – Resp arrest o Trough draw = ~30 min before scheduled administration … Peak Draw = 30-60 min after drug administration.• Mental Health & Psychiatry o Most suicides occur after beginning of improvement with increase in energy levels o MAOIs … Hypertensive Crisis with Tyramine foods • Nardil, Marplan, Parnate • Need 2 wk gap from SSRIs and TCAs to admin MAOIs o Lithium Therapeutic Range = 0.5-1.5

• / 3