NSG 123 Med Surg 1 HESI Final Exam Blueprint |2026
Latest Update with Complete Solution-Herzing
Preop assess- checklist
● Consent is obtained- how do you know they understand. If they do not understand it is the surgeons job
to go over surgery.
● Go over patient history
● Allergies and effects of any previous surgery medications.
● Testing, labs, medications and confirmed
● Go over expectation of pre and post-op
Post op vital sign- drug use
● Any regional anesthesia will be weaning off, pain meds may be administered
● Frequent monitoring and safety
● Baseline vitals documented in order to assess if patient is declining after surgery.
Post op priority
● Pain control
● Assessment of the surgical site and drainage tubes
● Monitoring the rate and patency of IV fluids and IV access
● Assessing the patient's level of sensation, circulation.
● Safety
● Signs of infection or decline in bassline vitals
Post op vital signs- reason
● Ensure patient is not decline
● Monitor for post-op infection or complications
● Signs of bleeding or aspiration
Pain scale- med selection
● Preventive approach, rather than an "as needed" (PRN) approach, is more effective in relieving pain
● Opioid analgesic agents are commonly prescribed for pain and immediate postoperative restlessness.
● PCA permits patients to administer their own pain medication when needed
● Epidural Infusions and Intrapleural Anesthesia: allows more effective coughing and deep breathing in
conditions such as cholecystectomy, renal surgery, and rib fractures, in which pain in the thoracic
region would interfere with these exercises
● Catheter is attached to a pump that delivers a continuous amount of local anesthetic at a specific
amount determined and prescribed by the primary provider
Malignant hyperthermia- postop
● The patient is still at risk in the postoperative period
● Severe muscle rigidity or spasms. Rapid, shallow breathing and problems with low oxygen and high
carbon dioxide
Pain outcomes- POC
, ● The nurse assesses the patient's pain level using a verbal or visual analog scale and assesses the
characteristics of the pain.
● The goal is pain prevention rather than sporadic pain control.
● Patients recover more quickly when adequate pain relief measures are used
● PCA permits patients to administer their own pain medication when needed.
Shock- hypovolemic
● Monitor fluid and electrolyte imbalance
● Patient is NPO after surgery which will decrease fluid volume
Pneumonia- CAP
● In older people that live in close quarters.
● Prevention is through vaccination 23.
● Occurs in patients who have not been hospitalized or resided in a long-term care facility within 14 days
of the onset of symptoms.
● Can be treated at home or in hospital
Pneumonia- airway
● Pneumonia arises from normal flora present in patients whose resistance has been altered or from
aspiration of flora present in the oropharynx
● Atelectasis - alveoli unable to expand due to fluid
COPD- oxygen level
● Patient will have a low level for baseline 88%
● Pulse oximetry values to assess the patient's need for oxygen and administers supplemental oxygen as
prescribed
HF & COPD
● Pulmonary vascular changes result in pulmonary and HTN
● Over time, pulmonary hypertension may occur as a result of chronic hypoxemia
COPD & infections - 1st sign
● Infection may be accompanied by subtle changes
● Report any signs of infection!!!!
● Fever
● Change in sputum color, character, consistency, or amount.
● Any worsening of symptoms (increased tightness of the chest, increased dyspnea, fatigue)
Crohn's disease
● Chronic inflammation of the GI tract wall that extends through all layers
● Bowel wall thickens and becomes fibrotic, and the intestinal lumen narrows (cobblestone)
● Diarrhea
● Crampy abdominal pain (especially after meals)
● Malnourishment
● Secondary anemia
Crohn's disease- menu
● Avoid consumption of nuts, corn, chocolate, diary, nuts, seeds, spicy foods, onions, and citrus fruits
Bariatric Surgery- Post op checklist
, ● Watch for dumping syndrome and vitamin/mineral imbalances
● Ulcers can be possible
● Bleeding
● Nutritional education and portion size
● Medical management, including the use of dietary supplements
● Follow-up appointments
Constipation- action
● Defined as less than 3 bowel movements per week
● High fiber/residue diet
● Establishing healthy bowel habits
● Digital dislodgement and enema administration
● Avoiding holding in stool when urge is present
● May consider bulk-forming OTC's
● Fissures likely require stool softener like Docusate
Bowel obstruction- action
● Decompression of the bowel through an NG tube is necessary for all patients with small bowel
obstruction.
● Bowel is completely obstructed then
Appendicitis- pre-op preparation
● To correct or prevent fluid and electrolyte imbalance, dehydration, and sepsis, antibiotics and IV fluids
are given until surgery
● Analgesic agents for pain
● NPO
● If pain stops entirely then emergency situation
Septic shock- peritonitis
● Fever (100-101)
● increased pulse rate
● With progression patients may become hypotensive
● Hardening of the abdomen
● Absent bowel sounds
● Caused by leakage of contents from abdominal organs into the abdominal cavity
Diverticulosis- S&S
● Diverticulum becomes inflamed, causing perforation and potential complications, such as obstruction,
abscess, fistula (abnormal tract) formation, peritonitis, and hemorrhage
● Diverticula form when the mucosal and submucosal layers of the colon herniate through the muscular
wall
● Bowel irregularity with intervals of alternating constipation and diarrhea, with nausea, anorexia, and
bloating or abdominal distention
Colitis
● Typically starts in the rectum and moves inward
● Bloody diarrhea
● Mucus or pus may also be present in stool
● Left lower quadrant abdominal pain
HTN- blurred vision
Latest Update with Complete Solution-Herzing
Preop assess- checklist
● Consent is obtained- how do you know they understand. If they do not understand it is the surgeons job
to go over surgery.
● Go over patient history
● Allergies and effects of any previous surgery medications.
● Testing, labs, medications and confirmed
● Go over expectation of pre and post-op
Post op vital sign- drug use
● Any regional anesthesia will be weaning off, pain meds may be administered
● Frequent monitoring and safety
● Baseline vitals documented in order to assess if patient is declining after surgery.
Post op priority
● Pain control
● Assessment of the surgical site and drainage tubes
● Monitoring the rate and patency of IV fluids and IV access
● Assessing the patient's level of sensation, circulation.
● Safety
● Signs of infection or decline in bassline vitals
Post op vital signs- reason
● Ensure patient is not decline
● Monitor for post-op infection or complications
● Signs of bleeding or aspiration
Pain scale- med selection
● Preventive approach, rather than an "as needed" (PRN) approach, is more effective in relieving pain
● Opioid analgesic agents are commonly prescribed for pain and immediate postoperative restlessness.
● PCA permits patients to administer their own pain medication when needed
● Epidural Infusions and Intrapleural Anesthesia: allows more effective coughing and deep breathing in
conditions such as cholecystectomy, renal surgery, and rib fractures, in which pain in the thoracic
region would interfere with these exercises
● Catheter is attached to a pump that delivers a continuous amount of local anesthetic at a specific
amount determined and prescribed by the primary provider
Malignant hyperthermia- postop
● The patient is still at risk in the postoperative period
● Severe muscle rigidity or spasms. Rapid, shallow breathing and problems with low oxygen and high
carbon dioxide
Pain outcomes- POC
, ● The nurse assesses the patient's pain level using a verbal or visual analog scale and assesses the
characteristics of the pain.
● The goal is pain prevention rather than sporadic pain control.
● Patients recover more quickly when adequate pain relief measures are used
● PCA permits patients to administer their own pain medication when needed.
Shock- hypovolemic
● Monitor fluid and electrolyte imbalance
● Patient is NPO after surgery which will decrease fluid volume
Pneumonia- CAP
● In older people that live in close quarters.
● Prevention is through vaccination 23.
● Occurs in patients who have not been hospitalized or resided in a long-term care facility within 14 days
of the onset of symptoms.
● Can be treated at home or in hospital
Pneumonia- airway
● Pneumonia arises from normal flora present in patients whose resistance has been altered or from
aspiration of flora present in the oropharynx
● Atelectasis - alveoli unable to expand due to fluid
COPD- oxygen level
● Patient will have a low level for baseline 88%
● Pulse oximetry values to assess the patient's need for oxygen and administers supplemental oxygen as
prescribed
HF & COPD
● Pulmonary vascular changes result in pulmonary and HTN
● Over time, pulmonary hypertension may occur as a result of chronic hypoxemia
COPD & infections - 1st sign
● Infection may be accompanied by subtle changes
● Report any signs of infection!!!!
● Fever
● Change in sputum color, character, consistency, or amount.
● Any worsening of symptoms (increased tightness of the chest, increased dyspnea, fatigue)
Crohn's disease
● Chronic inflammation of the GI tract wall that extends through all layers
● Bowel wall thickens and becomes fibrotic, and the intestinal lumen narrows (cobblestone)
● Diarrhea
● Crampy abdominal pain (especially after meals)
● Malnourishment
● Secondary anemia
Crohn's disease- menu
● Avoid consumption of nuts, corn, chocolate, diary, nuts, seeds, spicy foods, onions, and citrus fruits
Bariatric Surgery- Post op checklist
, ● Watch for dumping syndrome and vitamin/mineral imbalances
● Ulcers can be possible
● Bleeding
● Nutritional education and portion size
● Medical management, including the use of dietary supplements
● Follow-up appointments
Constipation- action
● Defined as less than 3 bowel movements per week
● High fiber/residue diet
● Establishing healthy bowel habits
● Digital dislodgement and enema administration
● Avoiding holding in stool when urge is present
● May consider bulk-forming OTC's
● Fissures likely require stool softener like Docusate
Bowel obstruction- action
● Decompression of the bowel through an NG tube is necessary for all patients with small bowel
obstruction.
● Bowel is completely obstructed then
Appendicitis- pre-op preparation
● To correct or prevent fluid and electrolyte imbalance, dehydration, and sepsis, antibiotics and IV fluids
are given until surgery
● Analgesic agents for pain
● NPO
● If pain stops entirely then emergency situation
Septic shock- peritonitis
● Fever (100-101)
● increased pulse rate
● With progression patients may become hypotensive
● Hardening of the abdomen
● Absent bowel sounds
● Caused by leakage of contents from abdominal organs into the abdominal cavity
Diverticulosis- S&S
● Diverticulum becomes inflamed, causing perforation and potential complications, such as obstruction,
abscess, fistula (abnormal tract) formation, peritonitis, and hemorrhage
● Diverticula form when the mucosal and submucosal layers of the colon herniate through the muscular
wall
● Bowel irregularity with intervals of alternating constipation and diarrhea, with nausea, anorexia, and
bloating or abdominal distention
Colitis
● Typically starts in the rectum and moves inward
● Bloody diarrhea
● Mucus or pus may also be present in stool
● Left lower quadrant abdominal pain
HTN- blurred vision
