Free HESI Exam Flashcards

From base to top: Physiological (airway, breathing, food, water), Safety & Security (fall prevention, infection control), Love & Belonging (family, support), Esteem (independence, dignity), Self-Actualization (growth). Always address lower levels first when prioritizing nursing care.

A = Assessment (collect data), D = Diagnosis (identify problems), P = Planning (set goals, expected outcomes), I = Implementation (carry out interventions), E = Evaluation (determine if goals met). Continuous, cyclical process. Assessment is always the first step.

Right Task (appropriate to delegate), Right Circumstance (stable patient), Right Person (competent delegate), Right Direction/Communication (clear instructions), Right Supervision/Evaluation (follow up). RNs cannot delegate assessment, planning, evaluation, or teaching.

Applied to ALL patients regardless of diagnosis. Includes: hand hygiene, gloves (contact with body fluids), gowns (if splashing expected), masks/eye protection (aerosol-generating procedures), safe needle disposal, respiratory hygiene/cough etiquette.

Contact (MRSA, C. diff): gown + gloves, dedicated equipment. Droplet (flu, pertussis, meningitis): surgical mask within 3 feet, private room. Airborne (TB, measles, chickenpox): N95 respirator, negative pressure room, keep door closed.

Must include: procedure explanation, risks, benefits, alternatives, right to refuse. Patient must be competent, voluntary, and informed. Physician obtains consent; nurse witnesses the signature. Nurse ensures patient understanding and can notify MD if patient has questions.

Right Patient, Right Drug, Right Dose, Right Route, Right Time, Right Documentation. Additional rights: right reason, right to refuse, right assessment, right education. Verify with two patient identifiers (name + DOB). Three checks: when pulling, preparing, and administering.

Therapeutic range: 0.5-2.0 ng/mL. Toxicity signs: nausea, vomiting, anorexia, visual disturbances (yellow-green halos), bradycardia, dysrhythmias. Check apical pulse for 1 full minute before administering. Hold if HR <60 bpm (adult). Monitor potassium—hypokalemia increases toxicity risk.

Therapeutic range: 0.6-1.2 mEq/L. Toxicity signs: coarse tremors, confusion, seizures, oliguria. Draw levels 8-12 hours after last dose. Patient must maintain adequate sodium and fluid intake. Toxicity is medical emergency—no antidote, supportive care + possible dialysis.

Heparin: IV/SubQ, rapid onset, monitor aPTT (target 1.5-2.5× control), antidote = protamine sulfate. Warfarin (Coumadin): oral, delayed onset (3-5 days), monitor INR (target 2-3), antidote = vitamin K. Both increase bleeding risk. Avoid IM injections.

Examples: lisinopril, enalapril, captopril. Used for HTN, heart failure, diabetic nephropathy. Side effects: dry cough (most common), hyperkalemia, angioedema (rare but serious), first-dose hypotension. Contraindicated in pregnancy. Monitor potassium and renal function.

Left-sided: pulmonary congestion—dyspnea, orthopnea, crackles, pink frothy sputum, fatigue, S3 gallop. Right-sided: systemic congestion—peripheral edema, JVD, hepatomegaly, weight gain, ascites. Right failure often caused by left failure. Treatment: diuretics, ACE inhibitors, monitor daily weights.

MONA: Morphine (pain), Oxygen (if SpO2 <94%), Nitroglycerin (vasodilation), Aspirin (antiplatelet). Elevate HOB 45°. Continuous cardiac monitoring. Serial troponins and 12-lead ECG. Pain rated 0-10. Goal: door-to-balloon time <90 min for STEMI. Monitor for dysrhythmias.

Type 1: autoimmune destruction of beta cells, no insulin production, requires exogenous insulin, younger onset, DKA risk. Type 2: insulin resistance ± decreased production, managed with lifestyle + oral meds ± insulin, older onset, HHS risk. Both: monitor A1C (goal <7%), blood glucose, complications.

DKA: Type 1, BG 300-800, ketones present, Kussmaul breathing, fruity breath, pH <7.35, rapid onset. HHS: Type 2, BG >600 (often >1000), no ketones, severe dehydration, altered mental status, gradual onset. Both: IV fluids first, then insulin drip, monitor potassium closely.

Hypothyroid: fatigue, weight gain, cold intolerance, constipation, bradycardia, dry skin, low T3/T4, high TSH. Treat with levothyroxine. Hyperthyroid: anxiety, weight loss, heat intolerance, diarrhea, tachycardia, exophthalmos, high T3/T4, low TSH. Treat with methimazole/PTU.

Monitor I&O, daily weights, electrolytes (hyperkalemia!), BUN/creatinine. Diet: restrict sodium, potassium, phosphorus, protein, fluids. Medications: phosphate binders, erythropoietin (anemia), vitamin D. Avoid nephrotoxic drugs (NSAIDs, aminoglycosides). Prepare for dialysis when GFR <15.

ABCs first (airway patency, breathing, circulation). Then check: level of consciousness, vital signs, surgical site (bleeding, drainage), pain level, IV sites, urine output (≥30 mL/hr). Turn, cough, deep breathe every 2 hours. Incentive spirometry. Early ambulation to prevent DVT.

Stage 1: Onset of contractions to full cervical dilation (10 cm). Latent phase: 0-6 cm. Active phase: 6-10 cm. Stage 2: Full dilation to delivery of baby. Stage 3: Delivery of baby to delivery of placenta (5-30 min). Stage 4: First 1-2 hours postpartum (monitor for hemorrhage).

Signs: BP ≥140/90 after 20 weeks, proteinuria, edema (face/hands), headache, visual changes, epigastric pain. Severe: BP ≥160/110, HELLP syndrome. Treatment: magnesium sulfate (seizure prevention)—monitor for toxicity (decreased reflexes, respiratory depression). Antidote: calcium gluconate. Delivery is the cure.

Assessed at 1 and 5 minutes. Appearance (color): 0=blue, 1=acrocyanosis, 2=pink. Pulse: 0=absent, 1=<100, 2=>100. Grimace: 0=none, 1=grimace, 2=cough/cry. Activity: 0=limp, 1=some flexion, 2=active. Respirations: 0=absent, 1=slow/irregular, 2=strong cry. Score 7-10 = normal.

Blood loss >500 mL (vaginal) or >1000 mL (cesarean). #1 cause: uterine atony (boggy uterus). Nursing actions: fundal massage, monitor vital signs, IV oxytocin (Pitocin), empty bladder, notify provider. Other causes: lacerations, retained placenta, coagulopathy. 4 T's: Tone, Trauma, Tissue, Thrombin.

Newborn: HR 120-160, RR 30-60. Infant: HR 100-150, RR 25-50. Toddler: HR 70-110, RR 20-30. School-age: HR 65-110, RR 18-25. Adolescent: HR 55-105, RR 12-20. BP increases with age. Fever: temp >100.4°F (38°C) rectal.

Mild (3-5%): slightly dry mucous membranes, decreased tears. Moderate (6-9%): sunken fontanel, decreased skin turgor, tachycardia, oliguria. Severe (>10%): lethargy, sunken eyes, absent tears, delayed capillary refill, hypotension. Treat with oral or IV rehydration based on severity.

Epiglottitis: bacterial, abrupt onset, high fever, drooling, tripod position, toxic appearance—do NOT examine throat (risk of complete obstruction). Croup: viral, gradual onset, barking cough, stridor, low-grade fever—treat with cool mist, racemic epinephrine, corticosteroids.

Effective: open-ended questions, reflecting, restating, silence, offering self, validating feelings, summarizing. Non-therapeutic (AVOID): giving advice, false reassurance, 'why' questions, changing the subject, minimizing feelings, approving/disapproving.

Risk factors: previous attempts (#1 predictor), plan with means, hopelessness, substance abuse, social isolation, recent loss. Warning signs: giving away possessions, sudden calmness after depression, talking about being a burden. Always ask directly about suicidal thoughts. One-to-one observation for high-risk patients.

Examples: fluoxetine, sertraline, paroxetine, citalopram. First-line for depression and anxiety. Side effects: GI upset, sexual dysfunction, insomnia, weight changes. Black box warning: increased suicidality in ages <25. Full therapeutic effect: 4-6 weeks. Do NOT stop abruptly.

Examples: lorazepam, diazepam, alprazolam, midazolam. Used for anxiety, seizures, alcohol withdrawal. CNS depressants—monitor for respiratory depression. High addiction potential. Do NOT combine with alcohol or opioids. Antidote: flumazenil. Taper slowly to discontinue.

Causes: renal failure, acidosis, tissue damage, ACE inhibitors, potassium-sparing diuretics. ECG changes: tall peaked T waves, widened QRS, cardiac arrest. Treatment: calcium gluconate (cardiac protection), insulin + glucose, kayexalate, albuterol, dialysis. RESTRICT potassium foods.

Causes: diuretics (loop, thiazide), vomiting, diarrhea, NG suction. Symptoms: muscle weakness, leg cramps, decreased reflexes, paralytic ileus, U waves on ECG, dysrhythmias. Treatment: potassium replacement (NEVER IV push—must dilute). Monitor cardiac rhythm. High-potassium diet: bananas, oranges, potatoes.

Causes: SIADH, water intoxication, diuretics, heart failure. Symptoms: confusion, headache, nausea, seizures, cerebral edema. Treatment: fluid restriction, hypertonic saline (3%) for severe cases—infuse slowly (risk of osmotic demyelination). Monitor neuro status frequently. Correct no faster than 8-12 mEq/L per 24 hours.

Isotonic (NS 0.9%, LR): replaces volume, stays in vascular space. Hypotonic (0.45% NS): shifts fluid INTO cells—for cellular dehydration. Hypertonic (3% NS, D10W): pulls fluid OUT of cells—for hyponatremia. Never give hypotonic to patients with increased ICP.

Respiratory acidosis: pH <7.35, CO2 >45 (hypoventilation). Respiratory alkalosis: pH >7.45, CO2 <35 (hyperventilation). Metabolic acidosis: pH <7.35, HCO3 <22 (DKA, renal failure). Metabolic alkalosis: pH >7.45, HCO3 >26 (vomiting, NG suction). ROME: Respiratory = Opposite, Metabolic = Equal.

Keep drainage system below chest level. Monitor for air leak (bubbling in water seal). Tidaling in water seal is normal (stops when lung re-expands). Never clamp a chest tube without order. If disconnected: submerge end in sterile water. If pulled out: cover site with petroleum gauze, taped on 3 sides.

Acute hemolytic: fever, chills, flank pain, hemoglobinuria—STOP transfusion immediately, maintain IV with NS. Febrile: most common reaction. Allergic: urticaria, itching—antihistamine. Anaphylactic: dyspnea, hypotension—epinephrine. ALWAYS verify patient ID with two nurses before starting.

Restrict: sodium (<2g/day), potassium (<2g/day), phosphorus (<1g/day), protein (pre-dialysis), fluids. Avoid: bananas, oranges, potatoes, tomatoes, dairy, nuts, whole grains, dark colas. Protein increased once on dialysis due to losses.

DASH: Dietary Approaches to Stop Hypertension. Emphasize: fruits, vegetables, whole grains, lean protein, low-fat dairy. Limit: sodium (<2g/day), saturated fat, red meat, sweets, sugary beverages. Also limit caffeine and alcohol. Daily potassium, calcium, and magnesium intake helps lower BP.

Assess fall risk on admission and each shift (Morse Fall Scale). Interventions: bed in lowest position, call light within reach, non-skid footwear, adequate lighting, assist with ambulation, toileting schedule, bed alarm for high-risk. Review medications (sedatives, antihypertensives, diuretics).

Six links: (1) Infectious agent (pathogen), (2) Reservoir (where it lives), (3) Portal of exit (how it leaves), (4) Mode of transmission (how it spreads), (5) Portal of entry (how it enters), (6) Susceptible host. Break ANY link to prevent infection. Hand hygiene is most effective measure.

When multiple answer choices are correct, prioritize: Airway first (suctioning, positioning), then Breathing (oxygen, ventilation), then Circulation (bleeding control, IV fluids). Exception: in cardiac arrest, start compressions (C-A-B). Always choose the most life-threatening option first.

RN: assessment, care planning, evaluation, IV push meds, blood administration, teaching, delegation. LPN/LVN: data collection, stable patients, oral/IM meds, dressing changes, trach/vent care (experienced). UAP: vital signs, hygiene, feeding, ambulation, I&O measurement. Never delegate assessment.

Eye Opening: spontaneous (4), to voice (3), to pain (2), none (1). Verbal: oriented (5), confused (4), inappropriate words (3), incomprehensible sounds (2), none (1). Motor: obeys commands (6), localizes pain (5), withdraws (4), abnormal flexion (3), extension (2), none (1). Total: 3-15. Report changes immediately.

Stage 1: non-blanchable redness, intact skin. Stage 2: partial-thickness, shallow open ulcer or blister. Stage 3: full-thickness, fat visible, no bone/tendon. Stage 4: full-thickness, bone/tendon exposed. Unstageable: covered by slough/eschar. DTPI: intact skin with deep purple/maroon discoloration.

Numeric Rating Scale (NRS): 0-10, used for adults and children >7. Wong-Baker FACES: ages 3-7. FLACC (infants/nonverbal): Face, Legs, Activity, Cry, Consolability (0-2 each, total 0-10). Pain is the 5th vital sign. Reassess after intervention. Document pain level and response to treatment.

Potassium: 3.5-5.0 mEq/L. Sodium: 135-145 mEq/L. Glucose: 70-100 mg/dL (fasting). BUN: 10-20 mg/dL. Creatinine: 0.7-1.3 mg/dL. Hgb: 12-16 (F), 14-18 (M). WBC: 5,000-10,000. Platelets: 150,000-400,000. INR: 2-3 (on warfarin). Report values outside these ranges immediately.

Step 1: pH—acidosis (<7.35) or alkalosis (>7.45)? Step 2: PaCO2 (35-45)—if abnormal, matches pH? = respiratory cause. Step 3: HCO3 (22-26)—if abnormal, matches pH? = metabolic cause. Step 4: Compensation—is the other value trying to normalize pH? Normal pH with abnormal CO2 and HCO3 = fully compensated.

Rapid-acting (lispro, aspart): onset 15 min, peak 1-2 hrs, duration 3-4 hrs. Short-acting (Regular): onset 30-60 min, peak 2-4 hrs, duration 6-8 hrs. Intermediate (NPH): onset 1-2 hrs, peak 6-12 hrs, duration 18-24 hrs. Long-acting (glargine): onset 1-2 hrs, no peak, duration 24 hrs. Only Regular can be given IV.

S = Situation (what's happening now), B = Background (relevant history, context), A = Assessment (your clinical assessment of the problem), R = Recommendation (what you think should be done). Standardized format for nurse-to-provider and nurse-to-nurse handoff communication. Reduces errors.

Autonomy: patient's right to make decisions. Beneficence: do good. Nonmaleficence: do no harm. Justice: fair distribution of resources. Fidelity: keep promises. Veracity: tell the truth. When principles conflict, patient autonomy generally takes precedence for competent adults.