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HESI®-RN Comprehensive Review | Registered Nurse (RN) School Study Aid

The Nursing Process

ADPIE

Assessment

Diagnosis

Planning

Implementation

Evaluation

2 mins

Maslow's Hierarchy of Needs

Oxygen, Water, Nutrition

Body temperature, Elimination, Shelter, Sexual Expression

Physical Safety

Physiological Safety

Affection and Companionship

Self Respect and Respect for Others

Fulfillment

2 mins

Airway, Breathing, Circulation (ABC's)

Changed Sound of Voice

"See-saw" Respirations

Stridor

Normal Respiratory Rate: 12–20 Breaths/Min

Use of Accessory Muscles in Respiration

Cyanosis

Color of Hands and Digits

Normal Capillary Refill Time (CRT): 2 Seconds

Decreased LOC

Initial ‘Look, Listen and Feel” Assessment

Emergency Treatment

Prioritization in Exam Questions

5 mins

How to Use ADPIE for Exam Questions

Data Collection

Data Analysis

Plan of Care

Action or Intervening

Outcomes of Care

Read Entire Question

Identify Step in the Nursing Process

Eliminate Answer Choices; Choose the Best Answer

3 mins

Strategic Words

First/Initial/Early

Highest Priority

Most Appropriate

Assess

Collect/Gather

Identify

Action/Intervention

Normally/Generally

Always/Never/None

3 mins

Guidelines for Prioritizing

Airway, Breathing, Circulation (ABCs)

MAA-U-AR

Mental Status Change

Acute Pain

Acute Urinary Elimination Problems

Untreated Medical Problems

Abnormal Laboratory Values

Risk of Infection, Safety or Security

Long-Term Treatments

2 mins

How to Use Prioritization in Exam Questions

Airway

Breathing

Circulation

Change in LOC (Altered Mental Status)

Sepsis

Acute Pain

Untreated Medical Problems

Education

Feelings

Patient Waiting to be Discharged

Maslow’s Hierarchy of Needs

3 mins

Cardiopulmonary Resuscitation (CPR) for Adults

Scan Scene

Activate Emergency Response System

Check For Breathing (Max 10 Seconds)

Open Airway

Compressions: 2 Inches Deep (100-120 Compressions/Min)

Airway: Ensure Airway is Still Open

Breathing: Administer 2 Rescue Breaths

Repeat C-A-B Sequence (30:2) Until Help Arrives

3 mins

Registered Nurse Roles

Caregiver

Counselor

Educator/Teacher

Communicator

Advocate

Leader

Researcher

Collaborator

2 mins

Age 2 Months - Developmental Milestones

Holds Head Up, But Unsteady

Moves Both Arms and Both Legs

Opens Hands Briefly

Tracks Objects to the Midline

Produces Sounds Aside from Crying

Reacts to Loud Noise

Social Smile

Recognizes Parents

Soothed When Spoken to or Picked Up

2 mins

Age 4 Months - Developmental Milestones

Keeps Head Steady Without Support

Pushes Up on Elbows While on Tummy

Holds a Toy in Hands

Moves Hands Towards Mouth

Cooing

Turns to Voice

Chuckles

Enjoys Looking Around

Looks at Hands With Interest

Opens Mouth When Hungry

2 mins

Age 6 Months - Developmental Milestones

Sits Propped Up On Hands

Rolls

Raking Grasp

Makes Squealing Noises

Blows "Raspberries"

Turn-Taking in Sounds

Laughs

Enjoys Looking at Self in a Mirror

Recognizes Familiar People

Closes Lips to Signal Fullness

Puts Objects in Mouth

Reaches for Desired Toys

2 mins

Age 9 Months - Developmental Milestones

Sits Up Independently

Transfers Objects Between Hands

Uses Fingers to Pull Food Toward Self

Produces Various Sounds Like "mamamama" and "bababababa"

Raises Arms to be Lifted Up

Separation Anxiety

Shows Facial Expressions

Looks When Calling Name

Smiles or Laughs at Peek-a-boo

Looks for Dropped Objects Out of Sight

Bangs Two Items Together

2 mins

Age 1 Year - Developmental Milestones

Pulls Up to Stand

First Steps

Drinks From an Open Cup with Assistance

Two-Finger Pincer Grasp

Understands “No”

Waves "Bye-Bye"

"Mama & Dada"

Plays Pat-A-Cake

Puts Block in Cup

Searches for Hidden Toys

2 mins

Age 18 Months - Developmental Milestones

Walks Independently

Climbs On/Off Furniture Without Help

Drinks from Open Cup Independently

Scribbles

Eats with Fingers

Tries to Use a Spoon

Stacks Three Blocks

Attempts Three-word Phrases

Follows One-step Commands

Checks While Moving Away

Points to Objects

Engages With Toys Simply

Copies Parent Doing Chores

Extends Hands for Washing

2 mins

Age 2 Years - Developmental Milestones

Kicks a Ball

Runs

Walks Up Stairs With Help

Stacks Six Blocks

Feeds Self With a Spoon

Two-Word Phrases

Points to Book Items as Prompted

Demonstrates Varied Gestures

Identifies Body Parts When Prompted

Shows Empathy

Holds and Manipulates Objects Simultaneously

Engages With Multiple Toys

2 mins

Age 3 Years - Developmental Milestones

Starts Dressing Independently

Rides Tricycle

Stack Nine Block Tower

Threads Items Together

Copies Circle

Uses Fork

Engages in Two-way Conversation

75% Speech Understood by Stranger

Says First Name

Avoids Hot Objects When Warned

Joins Other Kids in Play

2 mins

Age 4 Years - Developmental Milestones

Unbuttons Some Buttons

Catches a Large Ball

Serves Food or Pours Water With Help

Copies Line, Circle, Stick Figure

100% Speech Understandable

Identifies Colors

Cooperative Play

Imaginary Friends

Likes Being a “Helper”

Avoids Danger

2 mins

Age 5 Years - Developmental Milestones

Buttons Some Buttons

Hops on One Foot

Prints Letters

Counts to 10

Uses Simple Rhymes

>3 Back-and-forth Exchanges

Answers Simple Questions

Tells a Story

Names Some Letters When Pointed

Follows Rules

Sings, Dances, Acts

Does Simple Chores

2 mins

Erikson’s Theory Of Psychosocial Development - Stage 8 (Older Adult)

Older Adult (65+ to Death)

Integrity vs. Despair

Reflection on Life

Wisdom

1 min

Fire - Environmental Emergencies

R.A.C.E

Rescue

Alarm

Confine

Extinguish

P.A.S.S.

Fire Exits

Do Not Use Elevators

Manual Ventilation

2 mins

FEMA Levels of Disaster

Level I Disaster

Level II Disaster

Level III Disaster

Personal and Professional Preparedness

2 mins

Triage

Simple Triage And Rapid Treatment (START)

Red: Immediate (Critical)

Yellow: Delayed (Urgent)

Green: Minor (Ambulatory)

Black: Deceased (Expired)

Ability to Walk

Spontaneous Breathing

Respiratory Rate

Check Circulation

Mental Status

4 mins

Pediatric Vaccinations - Age 2 Months

Hepatitis B

DTaP - Diphtheria Tetanus acellular Pertussis

RV - Rotavirus

HiB - Haemophilus Influenzae Type B

IPV - Inactivated Polio Vaccine

PCV - Pneumococcal

1 min

Pediatric Vaccinations - Age 4 Months

DTaP - Diphtheria Tetanus acellular pertussis

RV - Rotavirus

HiB - Haemophilus Influenzae Type B

IPV - Inactivated Polio Vaccine

PCV - Pneumococcal

1 min

Pediatric Vaccinations - Age 6 Months

Hepatitis B

DTaP - Diphtheria Tetanus acellular pertussis

RV - Rotavirus

HiB - Haemophilus Influenzae Type B

IPV - Inactivated Polio Vaccine

PCV - Pneumococcal

Influenza

2 mins

Pediatric Vaccinations - Age 12 to 15 Months

Varicella Zoster

MMR

Hepatitis A

DTaP - Diphtheria Tetanus acellular pertussis

HiB - Haemophilus Influenzae Type B

IPV - Inactivated Polio Vaccine

PCV - Pneumococcal

2 mins

Pediatric Vaccinations Age 4-6 Years

Varicella Zoster

DTaP - Diphtheria Tetanus acellular pertussis

IPV - Inactivated Polio Vaccine

MMR

1 min

Fetal Circulation

Placenta

Umbilical Vein

Ductus Venosus

Right Atrium

Foramen Ovale

Left Atrium

Aorta

Right Ventricle

Ductus Arteriosus

Umbilical Arteries

2 mins

Discomforts of Pregnancy - First Trimester

Breast Tenderness

Supportive Bra

Nausea and Vomiting

Frequent Small Meals

Urinary Frequency and Urgency

Frequently Empty Bladder

Leukorrhea

Perineal Pad

Ptyalism

2 mins

Discomforts of Pregnancy - Second Trimester

Supine Hypotension

Side-lying Position

Food Cravings

Heartburn (Pyrosis)

Constipation

Moderate Exercise

Varicose Veins

Elevate Legs

Backache

Pelvic Tilt Exercise

Nutrition

2 mins

Discomforts of Pregnancy - Third Trimester

Shortness of Breath (SOB)

Rest Periods

Return of Urinary Frequency and Urgency

Empty Bladder Regularly

Leg Cramps

Stretching Exercises

Ankle Edema

Elevate Legs

2 mins

Principles of Delegation

Assigning Responsibility

Noninvasive Procedures

Stable Patients with Predictable Outcome

Dressing Changes

Catheterization

Select Med Administration

Unstable Patients

Parenteral Therapy

Discharge Planning & Health Education

3 mins

5 Rights of Delegation

Right Task

Right Circumstance

Right Person

Right Direction/Communication

Right Supervision/Evaluation

1 min

Ethical Principles

Autonomy

Beneficence

Nonmaleficence

Justice

Fidelity

Veracity

Accountability

Nightingale Pledge

3 mins

Nursing Code of Ethics

Ethical Principles

Nurse to Patient

Nurse to Nurse

Nurse to Self

Nurse to Others

Nurse to Profession

Nurse to Society

2 mins

NANDA Structure

NANDA-International (NANDA-I)

Nursing Diagnoses

Problem and Definition

Etiology

Defining Characteristics

Risk Factors

Domains

3 mins

Hemoglobin (Hgb) Lab Values

Men: 13 - 17 g/dL

Women: 12 - 16 g/dL

47 secs

Hematocrit (Hct) Lab Values

Women: 36% - 46%

Men: 41% - 53%

1 min

WBC Differential Lab Value

White Blood Cells (WBC)

5-10 (5,000-10,000)

Neutrophils (50%-70%)

Bands (2%-5%)

Segs (50%-70%)

Lymphocytes (20%-40%)

Monocytes (4%-8%)

Eosinophils (2%-4%)

Basophils (0.5%-1.5%)

2 mins

Red Blood Cell Count (RBC) Lab Values

Women: 3.5-5.5 million cells/ MuL

Men: 4.3-5.9 million cells/ MuL

1 min

Platelet Lab Value

150,000-400,000 Micro L

40 secs

Potassium (K+) Lab Value

3.5 to 5.0 mEq/L

20 secs

Sodium (Na+) Lab Value

135-145 mEq/L

24 secs

Calcium (Ca2+) Lab Value

8.5 to 10.5 mg/dL

26 secs

Magnesium (Mg2+) Lab Value

1.5 to 2.5 mEq/L

28 secs

Chloride (Cl-) Lab Value

95-105 mEq/L

28 secs

Phosphate (PO43-) Lab Value

2.5 to 4.5 mg/dL

29 secs

BUN (Blood Urea Nitrogen) Lab Values

10-20 mg/dL

40 secs

pH - Blood and Urine Lab Value

Blood

7.35 - 7.45

Urine

4.0 - 8.0

1 min

PT/PTT Lab Values

Prothrombin Time (PT)

10-14 seconds

Activated Partial Thromboplastin Time (PTT or aPTT)

25-35 seconds

1 min

Hypernatremia

> 145 mEq/L Na+

Change in LOC

Extreme Thirst

Orthostatic Hypotension

Dry Flushed Skin

Muscle Twitching

Seizures

Treat and Prevent Dehydration

Hypotonic Solutions (0.225% or 0.45% NaCl)

Sodium Restriction

Diuretics

2 mins

Hyponatremia

< 135 mEq Na+

Nausea and Vomiting

Decreased LOC

Confusion / Lethargy

Seizures

Assess Airway

Reduce Diuretic Dosage

Mannitol (Osmitrol)

Fluid Restriction

Hypertonic Solution (3% or 5% NaCl)

2 mins

Hyperkalemia

> 5.0 mEq/L K+

Abdominal Cramps

Muscle Weakness

Diarrhea

Arrhythmia

Tall, Peaked T Waves

IV Calcium

Infusion of Glucose and Insulin

Loop or Thiazide Diuretics

Kayexalate

Dialysis

Prevention Education

2 mins

Hypokalemia

< 3.5 mEq/L

Muscle Weakness

Arrhythmia

U Wave

Ileus

Hyporeflexia

IV K+ Infusion at 5-10 mEq/hr

Give Orally with Food

Monitor Respiratory Status

3 mins

Hypocalcemia Causes

Hypoalbuminemia

Hypomagnesemia (Less Common Hypermagnesemia)

Hypovitaminosis D

Hypoparathyroidism

Medications

Hyperphosphatemia

Malnutrition

Acute Pancreatitis

Alkalosis

Sepsis

Chronic Kidney Disease

2 mins

Iron (Ferrous Sulfate)

Ferrous Salts

Anemia

GI Distress

Nausea and Vomiting

Dark Stools

Take Between Meals

Liquid can Stain Teeth

Keep out of Reach from Children

Caution with GI Disorders

Avoid Antacids

3 mins

Vitamin K1 (Phytonadione)

Synthesizes Clotting Factors II, VII, IX, X

Hypoprothrombinemia

Newborn Prophylaxis

Bleeding from Warfarin Overdose

Shock

Kernicterus

Cardiac Arrest

Bile Salts required for Intestinal Absorption

Increased Risks with IV Administration

2 mins

Total Protein Lab Values

6.4 - 8.3 g/dL

1 min

Therapeutic Diets

High Fiber

Low Residue (Fiber)

Low Sodium

Low Cholesterol

Diabetic

Renal

Dysphagia

Diet Education

2 mins

Diet Progression

Clear Liquid

Full Liquid

Pureed

Mechanical Soft

Low Residue (Fiber)

High Fiber

Regular

1 min

Prenatal Nutrition

Prenatal Vitamins

Iron Supplement 30 mg Daily

Folate/Folic Acid 400 mcg Daily

Appropriate Weight Gain Recommendations

340 Calorie Increase

25 gram Protein Increase

Coffee, Alcohol, Tobacco

Fish Containing High Mercury Levels

3 mins

Dialysis

Hemodialysis

Rapid Shifts of Fluid and Electrolytes

Disequilibrium Syndrome

Hypotension

NO BP IN ARM with Shunt or Fistula

Assess for Thrill and Bruit

Peritoneal Dialysis

Slow Process

Peritonitis

Loss of Protein

Hyperglycemia

3 mins

Burns Considerations

Maintain Body Temperature

Increased Risk of Infection

Venous Thromboembolism (VTE) Prophylaxis

Curling's Ulcer

Excision and Grafting

Adequate Nutrition

Contractures

2 mins

Burns Interventions

Ensure Airway Patency

IV Fluid Replacement

Dry Sterile Dressing

Debridement

Elevate Burned Limbs

Analgesics

Silver Sulfadiazine

Escharotomy

2 mins

Food Allergies and Restrictions

Gluten-Free

Lactose-Free

Plant-Based

Diabetic and Sugar-Free

Nut Allergy

Soy Allergy

4 mins

6 Rights of Medication Administration

Right Patient

Right Medication

Right Dose

Right Time

Right Route

Right Documentation

Three Checks

Check for Allergies

Assess the Patient

Education

2 mins

Liver Enzyme Tests: AST and ALT

AST/ALT Ratio

AST: 8-20 U/L

ALT: 8-20 U/L

1 min

Vital Signs - Adult

Temperature (96.8-100.4 Degrees F) (36-38 Degrees C)

Rectal

Tympanic

Oral

Axillary

Temporal

Respiration (12-20)

Oxygen Saturation (95%-100%)

Pulse (60-100)

Blood Pressure (<120/80)

Pain

2 mins

Peak and Trough

Peak

Highest Concentration

Trough

Lowest Level of Therapeutic Range

Obtain Before Next Dose

Half-Life

2 mins

Evaluation

Consider the Effectiveness of Care

Reassess

Make Necessary Modifications

Continuously Ensure Favorable Patient Outcome

Evaluate

Outcome

Consider the Degree of Effectiveness

2 mins

Patient Needs

Allergy to Banana, Papaya, Chestnuts and Kiwi

Asthma

Spina Bifida

History of Multiple Surgical Procedures

Call Light within Reach

Eliminate Physical Hazards

Leave Items within Reach

Bed in Low Position

Side Rails Up

Patient Safety

Health Promotion and Maintenance

Psychosocial Integrity

3 mins

Patient’s Rights

Respectful Care

Information

Consent or Refuse Treatment

Continuity of Care

Privacy and Confidentiality

Medical Record Review

Consent or Refuse Part in Research

Health Alternatives

Explanation of Charges and Bills

3 mins

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