HESI Hints & NCLEX Gems
• Answering NCLEX Questions
o 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
o Hct
• Males 42-52
• Females 37-47
o RBCs
• Males 4.7-6.1 million
• Females 4.2-5.4 million
o WBCs
• 4.5-11k
o Platelets
• 150-400k
o 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)
o BUN 10-20
o Creatinine 0.5-1.2
o 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
o Ca++ 9-10.5
• Hypocalcemia … muscle spasms, convulsions, cramps/tetany, + Trousseau’s, +
Chvostek’s, prolonged ST interval, prolonged QT segment
o Mg+ 1.5-2.5
o Cl- 96-106
o Phos 3-4.5
o Albumin 3.5-5
o Spec Gravity 1.005-1.030
o Glycosylated Hemoglobin (Hgb A1c): 4-6% ideal, < 7.5% = OK (120 days)
o Dilantin TR = 10-20
o Lithium TR = 0.5-1.5
o 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
o 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)
o Opiates (narcotic analgesics, heroin, morphine) … Narcan (Naloxone)
o Cholinergic Meds (Myesthenic Bradycardia) … Atropine
o Methotrexate … Leucovorin
• Delegation
o 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, 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 Stuff
o Rifampin (for TB) … Rust/orange/red urine and body fluids
o Pyridium (for bladder infection) … Orange/red/pink urine
o 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
o Lipitor (statins) in PMs only – No grapefruit juice
o Stroke … Tongue points toward side of lesion (paralysis), Uvula deviates away
from the side of lesion (paralysis)
o Hold Digoxin if HR < 60
o Stay in bed for 3 hours after first ACE Inhibitor dose
o Avoid Grapefruit juice with Ca++ Channel Blockers
o Anthrax = Multi-vector biohazard
o Pulmonary air embolism prevention = Trendelenburg (HOB down) + on left side
(to trap air in right side of heart)
o 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.
o Hold tube feeding if residual > 100mL
o In case of Fire … RACE and PASS
o 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
• Answering NCLEX Questions
o 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
o Hct
• Males 42-52
• Females 37-47
o RBCs
• Males 4.7-6.1 million
• Females 4.2-5.4 million
o WBCs
• 4.5-11k
o Platelets
• 150-400k
o 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)
o BUN 10-20
o Creatinine 0.5-1.2
o 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
o Ca++ 9-10.5
• Hypocalcemia … muscle spasms, convulsions, cramps/tetany, + Trousseau’s, +
Chvostek’s, prolonged ST interval, prolonged QT segment
o Mg+ 1.5-2.5
o Cl- 96-106
o Phos 3-4.5
o Albumin 3.5-5
o Spec Gravity 1.005-1.030
o Glycosylated Hemoglobin (Hgb A1c): 4-6% ideal, < 7.5% = OK (120 days)
o Dilantin TR = 10-20
o Lithium TR = 0.5-1.5
o 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
o 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)
o Opiates (narcotic analgesics, heroin, morphine) … Narcan (Naloxone)
o Cholinergic Meds (Myesthenic Bradycardia) … Atropine
o Methotrexate … Leucovorin
• Delegation
o 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, 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 Stuff
o Rifampin (for TB) … Rust/orange/red urine and body fluids
o Pyridium (for bladder infection) … Orange/red/pink urine
o 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
o Lipitor (statins) in PMs only – No grapefruit juice
o Stroke … Tongue points toward side of lesion (paralysis), Uvula deviates away
from the side of lesion (paralysis)
o Hold Digoxin if HR < 60
o Stay in bed for 3 hours after first ACE Inhibitor dose
o Avoid Grapefruit juice with Ca++ Channel Blockers
o Anthrax = Multi-vector biohazard
o Pulmonary air embolism prevention = Trendelenburg (HOB down) + on left side
(to trap air in right side of heart)
o 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.
o Hold tube feeding if residual > 100mL
o In case of Fire … RACE and PASS
o 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
