Med Surg II - MASTER HESI Review Packet
complete solution latest 2023/2024
REVIEW TOPICS (PART 1)
TESTING TIP FROM A SENIOR
STUDENT: ALSO BE SURE TO
COMPLETE THE KAPLAN
“MED-SURG PRACTICE TEST 180 QUESTIONS)….YOU WILL SEE COMMON TESTING
OBJECTIVES ON THIS TEST!! You still have access to Kaplan so be sure to use this
resource while studying for HESI exam.
1. Diabetes Insipidus – pg 1148 – 1149
• Caused by a deficiency of production of ADH or a decreased renal response to ADH
▪Clinical Manifestations: Polydipsia and Polyuria
• Diagnostic Studies
▪Water Deprivation Test
o Patient is Deprived of Water for 8-12 hrs
o Afterwards, Give Desmopressin Acetate Subcut or Nasally
▪Measure level of ADH after an analog of ADH is given.
• Types of Diabetic Insipidus
▪Central DI
o Results from an Interference of ADH Synthesis, Transport, and Release.
➢ Head Injury; CNS Infection
➢ Brain Tumor; Brain Surgery
▪Nephrogenic DI
o Results from Inadequate Renal Response to ADH Despite
Presence of Adequate ADH.
➢ Drug Therapy; Renal Damage; Hereditary Renal Disease
▪Primary DI
o Results from Excessive Water Intake
➢ Structural Lesion in Thirst Center
➢ Psychological Disorder
▪Nursing Management
o Early Detection
o Maintaining Adequate Hydration
o Provide Patient Teaching for Long-Term Management
2. Healthcare Associated Pneumonia [HAP; Nosocomial Pneumonia]
• Nosocomial Pneumonia
▪Non-Intubated Patient that Begins 48 hrs or Longer After Admission
to Hospital (Wasn’t Present at Time of Admission)
• Ventilator-Associated Pneumonia (Also a Type of HAP)
Page 1 of 64
Med Surg II - MASTER HESI Review Packet
, Med Surg II - MASTER HESI Review Packet
complete solution latest 2023/2024
▪Pneumonia that Occurs More than 48 hrs or Longer After
Endotracheal Intubation
• Treatment
▪Culture (Start Antibiotics after Culture has been Identified)
• Risks
▪Organisms that Cause Pneumonia can Become Multidrug-Resistent
o Limits the Available Antibiotics that Can be Used for Treatment
• REMEMBER: Older Adults, Pregnant Women, and Immunocompromised
Patients SHOULD Receive the Vaccine for Pneumonia [PCV13;
PPSV23]
3. Diabetes Mellitus – Long Term Complications
• Long Term Complications
▪Stroke
▪Hypertension
▪Dermopathy
▪Nephropathy
▪Peripheral Neuropathy
▪Atherosclerosis
▪Neurogenic Bladder
▪Retinopathy; Cataracts; Glaucoma; Blindness
▪Coronary Artery Disease [CAD]
▪Gastroparesis (Decreased Gastric Emptying)
▪Islet Cell Loss (Cells in Pancreas; Responsible for Insulin Production)
▪Erectile Dysfunction
▪Peripheral Vascular Atherosclerosis
▪Gangrene
▪Infections
• Interventions
▪Examinations Performed Daily, Annually, or When Visiting HCP
▪Funduscopic; Fundus Photography
▪Urinalysis
▪Feet Examination
▪Stress Tests
Page 2 of 64
Med Surg II - MASTER HESI Review Packet
, Med Surg II - MASTER HESI Review Packet
complete solution latest 2023/2024
4. Renal Dosing/Issues with Drugs – pg 1012, Table 44.3
Potentially Nephrotoxic Agents
ANTIBIOTICS OTHER DRUGS OTHER AGENTS
Amikacin Captopril Gold
Amphotericin B Cimetidine Heavy Metals
Bacitracin Cisplatin
Cephalosporins Cocaine
Gentamicin (Especially this one!) Cyclosporine
Neomycin Ethylene Glycol
Polymyxin B Heroin
Streptomycin Lithium
Sulfonamides Methotrexate
Tobramycin Nitrosoureas
Vancomycin NSAIDS
Phenacetin
Quinine
Rifampin
Salicylates
5. Spinal Cord Injury – pg 1403 – 1420
• Classifications (pg 1405)
▪Mechanism of Injury (Effect on ROM)
▪Level of Injury (Where on the Spine?)
▪Degree of Injury (Complete or Incomplete Involvement)
• Clinical Manifestations (Think “Decreasing Vitals, Stiff Body, Flaccid Muscles”)
▪Integumentary
o Warm Dry Skin Below the Level of Injury
o Skin Breakdown; Pressure Ulcers
o Poikilothermia (Inability to Regulate Body Temperature)
▪Respiratory
o C1 – C3 Injury: Apnea; Inability to Cough
o C4 Injury: Poor Cough; Diaphragmatic Breathing; Hypoventilation
o C5 – T6 Injury: Decreased Respiratory Reserve
▪Cardiovascular (Injury Above T6)
o Bradycardia; Hypotension; Absence of Vasomotor Tone
o Peripheral Vascular Issues (Pain; VTE; PE)
▪Gastrointestinal
o Decreased/Absent Bowel Sounds; Decreased GI Secretions
o Abdominal Distention
o Constipation; Fecal Incontinence; Fecal Impaction
o Megacolon (Abnormal Dilation of the Colon)
o Ileus (Painful Obstruction of the Ileum or Other Part of the Intestine)
▪Neurologic
Page 3 of 64
Med Surg II - MASTER HESI Review Packet
, Med Surg II - MASTER HESI Review Packet
complete solution latest 2023/2024
o Complete-Areflexia; Flaccid Paralysis
o Hyperactive Deep Tendon Reflexes
o Bilateral POSTIVIE Babinski Test (Toes Go Up and Fan Out)
o Incomplete/Mixed Loss of Voluntary Motor Activity/Sensation
▪Musculoskeletal
o Muscle Atony (NO Muscle Tone); Contractures
▪Urinary
o Retention; Flaccid Bladder
o Spasticity with Reflex Bladder Emptying
▪Reproductive
o Priapism (Erection that Lasts Longer than 4 hrs)
➢ Think: “The Wheelchair’s Not the Only Hard Part of a Vegetable”
o Altered Sexual Function
▪Pain
o Neuropathic; Musculoskeletal; Visceral
• Emergency Management – pg 1409, Table 60.3
6. Autonomic Dysreflexia [AD; Autonomic Hyperreflexia] (r/t Spinal Cord Injury)(pg 1414)
• After a Spinal Injury at T6 or Higher…
▪Tissues Begin to Swell and Compress Nerve Impulses
▪Once Swelling Decreases, Nerve Impulses Begin to Return Causing SNS Override
o Think: “A Dam of Nerve Impulses Gets Released All at Once”
• Risk Factors for AD
▪Distended Bladder/Bladder Retention (MOST Common Cause)
▪Tight Restrictive Clothing
▪Kinked Catheter Tubing
▪Fecal Impaction
▪Stress
7. Blood in Stool
• Melena (Could Indicate an Upper GI Bleed)
▪Black, Tarry Stool; Often Foul Smelling
▪Caused by Digestion of Blood in the GI Tract
▪Black, NON-Tarry Stool = Excessive Iron Intake
• Occult [Hidden] Bleeding
▪Small Amounts of Blodo in Gastric Secretions, Vomitus, or Stools that
are NOT Visible by Appearance
▪Detected by Using a Guaiac Test
o Think: “Bat Guana” to Remember Name/Purpose of Test
• Hemorrhoids (MOST Common Reason for Bleeding with Defecation)
Page 4 of 64
Med Surg II - MASTER HESI Review Packet
complete solution latest 2023/2024
REVIEW TOPICS (PART 1)
TESTING TIP FROM A SENIOR
STUDENT: ALSO BE SURE TO
COMPLETE THE KAPLAN
“MED-SURG PRACTICE TEST 180 QUESTIONS)….YOU WILL SEE COMMON TESTING
OBJECTIVES ON THIS TEST!! You still have access to Kaplan so be sure to use this
resource while studying for HESI exam.
1. Diabetes Insipidus – pg 1148 – 1149
• Caused by a deficiency of production of ADH or a decreased renal response to ADH
▪Clinical Manifestations: Polydipsia and Polyuria
• Diagnostic Studies
▪Water Deprivation Test
o Patient is Deprived of Water for 8-12 hrs
o Afterwards, Give Desmopressin Acetate Subcut or Nasally
▪Measure level of ADH after an analog of ADH is given.
• Types of Diabetic Insipidus
▪Central DI
o Results from an Interference of ADH Synthesis, Transport, and Release.
➢ Head Injury; CNS Infection
➢ Brain Tumor; Brain Surgery
▪Nephrogenic DI
o Results from Inadequate Renal Response to ADH Despite
Presence of Adequate ADH.
➢ Drug Therapy; Renal Damage; Hereditary Renal Disease
▪Primary DI
o Results from Excessive Water Intake
➢ Structural Lesion in Thirst Center
➢ Psychological Disorder
▪Nursing Management
o Early Detection
o Maintaining Adequate Hydration
o Provide Patient Teaching for Long-Term Management
2. Healthcare Associated Pneumonia [HAP; Nosocomial Pneumonia]
• Nosocomial Pneumonia
▪Non-Intubated Patient that Begins 48 hrs or Longer After Admission
to Hospital (Wasn’t Present at Time of Admission)
• Ventilator-Associated Pneumonia (Also a Type of HAP)
Page 1 of 64
Med Surg II - MASTER HESI Review Packet
, Med Surg II - MASTER HESI Review Packet
complete solution latest 2023/2024
▪Pneumonia that Occurs More than 48 hrs or Longer After
Endotracheal Intubation
• Treatment
▪Culture (Start Antibiotics after Culture has been Identified)
• Risks
▪Organisms that Cause Pneumonia can Become Multidrug-Resistent
o Limits the Available Antibiotics that Can be Used for Treatment
• REMEMBER: Older Adults, Pregnant Women, and Immunocompromised
Patients SHOULD Receive the Vaccine for Pneumonia [PCV13;
PPSV23]
3. Diabetes Mellitus – Long Term Complications
• Long Term Complications
▪Stroke
▪Hypertension
▪Dermopathy
▪Nephropathy
▪Peripheral Neuropathy
▪Atherosclerosis
▪Neurogenic Bladder
▪Retinopathy; Cataracts; Glaucoma; Blindness
▪Coronary Artery Disease [CAD]
▪Gastroparesis (Decreased Gastric Emptying)
▪Islet Cell Loss (Cells in Pancreas; Responsible for Insulin Production)
▪Erectile Dysfunction
▪Peripheral Vascular Atherosclerosis
▪Gangrene
▪Infections
• Interventions
▪Examinations Performed Daily, Annually, or When Visiting HCP
▪Funduscopic; Fundus Photography
▪Urinalysis
▪Feet Examination
▪Stress Tests
Page 2 of 64
Med Surg II - MASTER HESI Review Packet
, Med Surg II - MASTER HESI Review Packet
complete solution latest 2023/2024
4. Renal Dosing/Issues with Drugs – pg 1012, Table 44.3
Potentially Nephrotoxic Agents
ANTIBIOTICS OTHER DRUGS OTHER AGENTS
Amikacin Captopril Gold
Amphotericin B Cimetidine Heavy Metals
Bacitracin Cisplatin
Cephalosporins Cocaine
Gentamicin (Especially this one!) Cyclosporine
Neomycin Ethylene Glycol
Polymyxin B Heroin
Streptomycin Lithium
Sulfonamides Methotrexate
Tobramycin Nitrosoureas
Vancomycin NSAIDS
Phenacetin
Quinine
Rifampin
Salicylates
5. Spinal Cord Injury – pg 1403 – 1420
• Classifications (pg 1405)
▪Mechanism of Injury (Effect on ROM)
▪Level of Injury (Where on the Spine?)
▪Degree of Injury (Complete or Incomplete Involvement)
• Clinical Manifestations (Think “Decreasing Vitals, Stiff Body, Flaccid Muscles”)
▪Integumentary
o Warm Dry Skin Below the Level of Injury
o Skin Breakdown; Pressure Ulcers
o Poikilothermia (Inability to Regulate Body Temperature)
▪Respiratory
o C1 – C3 Injury: Apnea; Inability to Cough
o C4 Injury: Poor Cough; Diaphragmatic Breathing; Hypoventilation
o C5 – T6 Injury: Decreased Respiratory Reserve
▪Cardiovascular (Injury Above T6)
o Bradycardia; Hypotension; Absence of Vasomotor Tone
o Peripheral Vascular Issues (Pain; VTE; PE)
▪Gastrointestinal
o Decreased/Absent Bowel Sounds; Decreased GI Secretions
o Abdominal Distention
o Constipation; Fecal Incontinence; Fecal Impaction
o Megacolon (Abnormal Dilation of the Colon)
o Ileus (Painful Obstruction of the Ileum or Other Part of the Intestine)
▪Neurologic
Page 3 of 64
Med Surg II - MASTER HESI Review Packet
, Med Surg II - MASTER HESI Review Packet
complete solution latest 2023/2024
o Complete-Areflexia; Flaccid Paralysis
o Hyperactive Deep Tendon Reflexes
o Bilateral POSTIVIE Babinski Test (Toes Go Up and Fan Out)
o Incomplete/Mixed Loss of Voluntary Motor Activity/Sensation
▪Musculoskeletal
o Muscle Atony (NO Muscle Tone); Contractures
▪Urinary
o Retention; Flaccid Bladder
o Spasticity with Reflex Bladder Emptying
▪Reproductive
o Priapism (Erection that Lasts Longer than 4 hrs)
➢ Think: “The Wheelchair’s Not the Only Hard Part of a Vegetable”
o Altered Sexual Function
▪Pain
o Neuropathic; Musculoskeletal; Visceral
• Emergency Management – pg 1409, Table 60.3
6. Autonomic Dysreflexia [AD; Autonomic Hyperreflexia] (r/t Spinal Cord Injury)(pg 1414)
• After a Spinal Injury at T6 or Higher…
▪Tissues Begin to Swell and Compress Nerve Impulses
▪Once Swelling Decreases, Nerve Impulses Begin to Return Causing SNS Override
o Think: “A Dam of Nerve Impulses Gets Released All at Once”
• Risk Factors for AD
▪Distended Bladder/Bladder Retention (MOST Common Cause)
▪Tight Restrictive Clothing
▪Kinked Catheter Tubing
▪Fecal Impaction
▪Stress
7. Blood in Stool
• Melena (Could Indicate an Upper GI Bleed)
▪Black, Tarry Stool; Often Foul Smelling
▪Caused by Digestion of Blood in the GI Tract
▪Black, NON-Tarry Stool = Excessive Iron Intake
• Occult [Hidden] Bleeding
▪Small Amounts of Blodo in Gastric Secretions, Vomitus, or Stools that
are NOT Visible by Appearance
▪Detected by Using a Guaiac Test
o Think: “Bat Guana” to Remember Name/Purpose of Test
• Hemorrhoids (MOST Common Reason for Bleeding with Defecation)
Page 4 of 64
Med Surg II - MASTER HESI Review Packet
