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HESI/NCLEX Review

Question	Answer
Sodium Normal	135–145 mEq/L
Potassium Normal	3.5–5.5 mEq/L
Calcium Normal	8.5–10.9 mg/L
Chloride Normal	95–105 mEq/L
Magnesium Normal	1.5–2.5 mEq/L
Phosphorus Normal	2.5–4.5 mg/dL
RBC Normal	4.5–5.0 million
WBC Normal	5,000–10,000
Plt Normal	200,000–400,000
Hgb Normal	12–16 gms women; 14–18 gms men
HCO3 Normal	24–26 mEq/L
CO2 Normal	35–45 mEq/L
PaO2 Normal	80%–100%
SaO2 Normal	> 95%
Glucose Normal	70–110 mg/dL
Specific gravity Normal	1.010–1.030
BUN Normal	7–22 mg/dL
Serum creatinine Normal	0.6–1.35 mg/dL (< 2 in older adults)
LDH Normal	100–190 U/L
CPK Normal	21–232 U/L
Uric acid Normal	3.5–7.5 mg/dL
Triglyceride Normal	40–50 mg/dL
Total cholesterol Normal	130–200 mg/dL
Bilirubin Normal	< 1.0 mg/dL
Protein Normal	6.2–8.1 g/dL
Albumin Normal	3.4–5.0 g/dL
Digoxin Therapeutic level	0.5–2.0 ng/ml
Lithium Therapeutic level	0.8–1.5 mEq/L
Dilantin Therapeutic level	10–20 mcg/dL
Theophylline Therapeutic level	10–20 mcg/dL
Heart rate Normal (adult)	80–100
Respiratory rate Normal (adult)	12–20
Blood pressure Normal (adult)	110–120 (systolic); 60–90 (diastolic)
Temperature Normal (adult)	98.6° ?/–1
FHR Normal	120–160 BPM.
Variability Normal	6–10 BPM.
Contractions Normal	normal frequency 2–5 minutes apart; normal duration < 90 sec.; intensity < 100 mm/hg.
Amniotic fluid Normal	500–1200 ml (nitrozine urine-litmus paper green/amniotic fluid-litmus paper blue).
Apgar scoring	A: appearance, P: pulses, G: grimace, A: activity, R: reflexes (Done at 1 and 5 minutes with a score of 0 for absent, 1 for decreased, and 2 for strongly positive.)
AVA	The umbilical cord has two arteries and one vein. (Arteries carry deoxygenated blood. The vein carries oxygenated blood.)
FAB 9	Folic acid/B9. Hint: B stands for brain (decreases the incidence of neural tube defects); the client should begin taking B9 three months prior to becoming pregnant.
Early decelerations	Begin prior to the peak of the contraction and end by the end of the contraction. Caused by head compression. No need for intervention if the variability is within normal range (rapid return to the baseline FHR) and the FHR is within normal range.
Variable decelerations	V-shaped on the monitoring strip. Can occur anytime. Caused by cord compression. Intervention: change position; if pitocin is infusing, stop the infusion; apply oxygen; and increase the rate of IV fluids. Contact the doctor if the problem persists.
Late decelerations	Occur after peak of the contraction and mirror the contraction in length and intensity. Caused by uteroplacental insuffiency. Intervention: change position; if pitocin is infusing, stop it; apply O2; and increase rate of IVF. Contact doctor if persists.
TORCHS syndrome in the neonate	This is a combination of diseases. These include toxoplasmosis, rubella (German measles), cytomegalovirus, herpes, and syphyllis. Pregnant nurses should not be assigned to care for the client with toxoplasmosis or cytomegalovirus.
STOP (treatment for maternal hypotension after an epidural anesthesia)	Stop pitocin if infusing; Turn the client on the left side; Administer oxygen; If hypovolemia is present, push IV fluids.
Warfarin (Coumadin) monitoring	therapeutic goal is PT 1.5 to 2.5 times greater than the control (normal: 10-12 sec), or INR of 2 to 3 (normal 0.75-1.25)
Warfarin (Coumadin) antidote	Vitamin K
Heparin/Lovenox/Dalteparin monitoring	APTT (activated partial thromboplastin time) 1.5-2 times the control, normally 46-70 seconds (1.5-2 times normal value of 25-35)
Heparin/Lovenox/Dalteparin antidote	protamine sulfate
Rule of nines for calculating TBSA for burns	Head: 9%; Arms: 18% (9% each); Torso: 36% (18% each front/back); Legs; 36% (18% each); Genitalia: 1%
Arab American cultural attributes	Females avoid eye contact with males; touch accepted if by same-sex; most decisions made by males; Muslims (Sunni) refuse organ donation; most do not eat pork; avoid icy drinks when sick or hot/cold drinks together; colostrum considered harmful to newborn
Asian American cultural attributes	Avoid direct eye contact; feet considered dirty (should be touched last); males make most decisions; usually refuse organ donation; generally do not prefer cold drinks, believe in the “hot-cold” theory of illness.
Native American cultural attributes	They sustain eye contact; blood and organ donation is generally refused; they might refuse circumcision; may prefer care from the tribal shaman rather than using western medicine.
Mexican American cultural attributes	They might avoid direct eye contact with authorities; they might refuse organ donation; most are very emotional during bereavement; believe in the “hot-cold” theory of illness.
Jehovah’s Witness religious beliefs	No blood products should be used
Hindu religious beliefs	No beef or items containing gelatin
Jewish religious beliefs	Special dietary restrictions, use of kosher foods
Renal diet	High calorie, high carbohydrate, low protein, low potassium, low sodium, and fluid restricted to intake equal to output + 500 ml
Gout diet	Low purine; omit poultry (“cold chicken”); medication for acute episodes: Colchicine; maintenance medication: Zyloprim
Spironolactone (Aldactone) diet	a potassium-sparing diuretic, so diet high in potassium should be avoided, including potassium salt substitutes, which can lead hyperkalemia
Warfarin (Coumadin) diet	avoid foods and substances containing vitamin K such as green leafy vegetables (spinach, broccoli, brussel sprouts)
MAO inhibitor diet	tyramine consumption can cause a hypertensive crisis (explosive headache, palpitations, sudden elevation of BP, chest pain, nausea, and vomiting); avoid cheese, aged meats, and imported beers
Heart healthy diet	Low fat (less than 30% of calories should be from fat)
Acid/base balance when pH down, CO2 up, and HCO3 up	respiratory acidosis
Acid/base balance when pH down, CO2 down, and HCO3 down	metabolic acidosis
Acid/base balance when pH up, CO2 down, and HCO3 down	respiratory alkalosis
Acid/base balance when pH up, CO2 up, and HCO3 up	metabolic alkalosis
Addison’s vs. Cushing’s	diseases involving either overproduction or inadequate production of cortisol; Addison’s Treatment: increase sodium intake, cortisone preparations vs Cushing’s Treatment: restrict sodium; observe for signs of infection.
Treatment for spider bites/bleeding	RICE (rest, ice, compression, and elevate extremity)
Treatment for sickle cell crises	HHOP (heat, hydration, oxygen, pain medications)
Five Ps of fractures and compartment syndrome	Pain, Pallor, Pulselessness, Paresthesia, Polar (cold)
Hip vs. Femur fractures	Hip fractures commonly hemorrhage, whereas femur fractures are at risk for fat emboli.
Profile of gallbladder disease	Fair, fat, forty, five pregnancies, flatulent (can occur in all ages and both sexes).
Autonomy	An individual's right of self-determination and freedom of decision making.
Beneficence	Doing good for clients and providing benefit balanced against risk.
Nonmaleficence	Doing no harm to clients.
Justice	Being fair to all and giving equal treatment, including distributing benefits, risks, and costs equally.
Fidelity	Being loyal and faithful to commitments and accountable for responsibilities.
Veracity	Telling the truth and not intentionally deceiving or misleading clients.
Daily fluid requirements	0-10 kg: 100 ml/kg/day; 10-20 kg: 1000 ml for first 10 kg plus 50 ml/kg/day for each kg between 10-20; 1500mL for first 20 kg + 20mL/kg for each additional kg over 20 kg
Normal urine output	1 mg/kg/hr
DKA vs. HHNS	onset: DKA sudden vs. HHNS gradual; precipitating factor: DKA inadequate insulin vs. HHSN poor fluid intake; manifestations: DKA ketosis, Kussmaul resp, “fruity” breath, nausea, abdominal pain vs. HHNS altered CNS function; glucose: DKA >300 vs. HHNS >600
Right-sided vs. left-sided HF manifestations	Right-sided: edema, JVD, an enlarged liver, abdominal ascites, and weight gain vs. Left-sided: dyspnea, lung crackles, tachycardia, fatigue, and anxiety
Left-sided brain attack manifestations	aphasia, agraphia, alexia; memory deficit; inability to discriminate words and letters, reading problems, deficits in right visual field; slowness, cautiousness, anxiety with new tasks, depression, guilt, worries, quick anger, intellectual impairment
Right-sided brain attack manifestations	impaired sense of humor; disorientation to time, place, person, inability to recognize faces; visual spatial deficits, left-side neglect, loss of depth perception; impulsiveness, denial, confabulation, euphoria, poor judgment, overestimation of abilities
Residual in feeding tube that indicates next feeding should be held	> 60 mL
Virchow’s triad	three major factors involved in the development of DVT: stasis of blood, vessel wall injury, altered blood coagulation
GTPAL	Gravida (number of pregnancies including current); Term (number pregnancies at least 38wks); Preterm (number of pregnancies 20-37 wks); Abortion (pregnancies with fetal loss up to 20 weeks); Living (number of living children)
HELLP	hemolysis (H), evidenced by burr cells or elevated bilirubin level; elevated liver enzymes (EL), evidenced by elevated AST and ALT; and low platelets (LP), evidenced by a platelet count of < 100,000 mm3
Preeclampsia vs. HELLP syndrome	HELLP syndrome occurs in 2-12% of those with severe preeclampsia. Pts with HELLP syndrome may complain of malaise over several days, epigastric or upper abdominal pain, and n/v. BP may be only slightly elevated or normal and proteinuria may be absent.
DSM-IV-TR axis	Axis I: Clinical syndromes; Axis II: Personality disorders; Axis III: General medical conditions; Axis IV: Psychosocial and environmental problems; Axis V: Global assessment of functioning
Psychosis vs. schizophrenia	negative symptoms are characteristic of schizophrenia and include behaviors such as minimal eye contact, poor grooming and hygiene, apathy, flat affect, and social inattentiveness (spaciness)
Piaget's Period for Infancy	Sensorimotor: Reflexive behavior is used to adapt to the environment; egocentric view of the world; development of object permanence.
Erikson's Stage for Infancy	Trust vs. Mistrust (0-18 months): Development of a sense that the self is good and the world is good when consistent, predictable, reliable care is received; characterized by hope.
Piaget's Period fo Toddlers & Preschoolers	Preoperational Thought: Thinking remains egocentric, becomes magical, and is dominated by perception.
Erikson's Stage for Toddlers	Autonomy vs. Shame and Doubt (2-3 yr): Development of sense of control over the self and body functions; exerts self; characterized by will.
Erikson's Stage for Preschoolers	Initiative vs. Guilt (3-5 yr): Development of a can-do attitude about the self; behavior becomes goal-directed, competitive, and imaginative; initiation into gender role; characterized by purpose.
Piaget's Period for School Age	Concrete Operations: Thinking becomes more systematic and logical, but concrete objects and activities are needed.
Erikson's Stage for School Age	Industry vs. Inferiority (6-11 yr): Mastering of useful skills and tools of the culture; learning how to play and work with peers; characterized by competence.
Piaget's Period for Adolescence	Formal Operations: New ideas can be created; situations can be analyzed; use of abstract and futuristic thinking; understands logical consequences of behavior.
Erikson's Stage for Adolescence	Identitity vs. Role Confusion (12-18 yr): Begins to develop a sense of “I”; this process is lifelong; peers become of paramount importance; child gains independence from parents; characterized by faith in self.
Erikson's Stage for Young Adulthood	Intimacy vs. Isolation (19-40 yr): Development of the ability to lose the self in genuine mutuality with another; characterized by love.
Erikson's Stage for Middle Adulthood	generativity vs. stagnation (40-65 yr): Production of ideas and materials through work; creation of children; characterized by care.
Erikson's Stage for Mature Adults	Ego Integrity vs. Despair (> 65 yr): Realization that there is order and purpose to life; characterized by wisdom.
Age posterior fontanel closes	2-3 months
Age Anterior fontanel closes	18 months
Age infant raises head and holds position	2 wk-2 mo
Age infant sits alone, using hands for support	3-6 months
Age infant smiles in response to stimuli	6-8 weeks
Age Moro, tonic neck, and rooting reflexes disappear	4-5 months
Age infant turns from abdomen to back and back to abdomen	6-7 months
Age infantcan crawl	6-9 months
Age infant begins to pull up	by 11 months
Age pincer grasp develops	8-9 months; complete by 12 months
Age Babinski reflex disappears	10-12 months
Age grasp reflex disappears	2-3 months
Age children cruise (walk with support)	by 12 months
Age children can sit from a standing posture	by 12 months
Age children can walk alone	15 months
Age handedness begins to emerge	about 3 years; clearly established by 4 years
Age children can jump and climb well	4 years
Stages of dying	denial, anger, bargaining, depression, and acceptance
Immunization contraindications for children with immunodeficiency	can’t have any live vaccines (chickenpox [varicella], MMR [measles-mumps-rubella], intranasal influenza)
Hepatitis B vaccine minimum age, maximum age, and minimum dose intervals	Min: Birth (in hospital); Max: none; Dose intervals: 4 wks, 8 wks (and 16 wks from fist dose with minimum age for final dose 24 wks)
Rotavirus vaccine minimum age, maximum age, and minimum dose intervals	Min: 6 wks; Max: <15 wks; Dose interval: 4 wks, 4 wks (with max age 8 mos)
DTaP (diphtheria, tetanus, pertussis) vaccine minimum age, maximum age, and minimum dose intervals	Min: 6 wks; Max: none; Dose intervals: 4 wks, 4 wks, 6 mos, 6 mos
Hoemophilus influenza type b (Hib) vaccine minimum age, maximum age, and minimum dose intervals	Min: 6 wks; Max: none; Dose Intervals: 4wks (if < 12 mos), 8 wks (final dose if 12-14 mos), no further doses needed (>14 mos)
Pneumococcal (PCV) vaccine minimum age, maximum age, and minimum dose intervals	Min: 6 wks; Max: 24 mos; Dose Intervals: 4 wks (if < 12 mos), 8 wks (final dose if 12-24 mos)
Inactivated poliovirus (IPV) vaccine minimum age, maximum age, and minimum dose intervals	Min: 6 wks; Max: 18 years; Dose Intervals: 4 wks, 4 wks, 6 mos (min age 4 yrs for final dose)
Varicella vaccine minimum age, maximum age, and minimum dose intervals	Min: 12 mos; Max: 18 years; Dose Intervals: 3 mos
Measles, Mumps, and Rubella (MMR) vaccine minimum age, maximum age, and minimum dose intervals	Min: 12 mos; Max: none ; Dose Intervals: 3 mos
Hepatitis A vaccine minimum age, maximum age, and minimum dose intervals	Min: 12 mos; Max: none; Dose Intervals: 6 mos
Vaccines not given to older children with no immunizations	Rotavirus (not given after 14 wks) and Pneumococcal (not given after 24 mos).
Vaccines that contain Neomycin	Inactivated poliovirus (IPV) and Measles, Mumps, and Rubella (MMR)
Vaccine associated with egg or chicken allergic reactions	influenza, MMR
Vaccine that contains baker’s yeast	HPV4
Vaccines given SQ	Varicella, MMR, IPV
Vaccines given IM	DTaP, Hib, Hep A, Hep B, Influenza (also nasal mist), Pertussis, PCV
Vaccines given PO	Rotavirus
Vaccine given to newborn before discharge	Hep B
high-iron foods	Breads, Cereals, and Grain Products; Meat, Poultry, Fish, and Alternatives
high-fiber foods	Vegetables, Fruits, and Grain Products
high-sodium foods	cured meats, pickled foods, canned soups and stews, frankfurters, cold cuts, soy sauce, and salad dressings
high-potassium foods	salt substitutes, oranges, bananas, melons, tomatoes, prunes, raisins, deep green and yellow vegetables, beans, and legumes
high-phosphate foods	dairy products (e.g., meat, milk, ice cream, cheese, yogurt) and foods containing dairy products (e.g., pudding)
high-calcium foods	Milk, cheese, ice cream, yogurt, sauces containing milk; all beans (except green beans), lentils; fish with fine bones (e.g., sardines, kippers, herring, salmon); dried fruits, nuts; Ovaltine, chocolate, cocoa
high-purine foods	Sardines, herring, mussels, liver, kidney, goose, venison, meat soups, sweetbreads
high-oxalate foods	Dark roughage, spinach, rhubarb, asparagus, cabbage, tomatoes, beets, nuts, celery, parsley, runner beans; chocolate, cocoa, instant coffee, Ovaltine, tea; Worcestershire sauce
high-folate foods	Liver, legumes, vegetables, Papaya, Breakfast cereal, wheat germ
Urinary tract calculi diet	low-purine, low-calcium, low-oxalate
Chemotherapy diet	low-fiber; To prevent diarrhea, other foods that may be avoided include fried or highly seasoned foods, or other foods that are gas producing; hydration and electrolyte supplementation
First trimester pregnancy diet	same kcal & protein as nonpregnant
Second trimester pregnancy diet	nonpregnant kcal + 340; nonpregnant protein + 25g
Third trimester pregnancy diet	nonpregnant kcal + 452; nonpregnant protein + 25g
Lactation diet	nonpregnant kcal 330-400
CKD Diet	low-normal protein (greater during PD to compensate for losses); fluid restriction based on daily urine output and weight gain; Sodium & Potassium Restriction; Phosphate Restriction
CKD foods to avoid	high-sodium foods; high-potassium foods; high-phosphate foods
Parkland (Baxter) formula for estimating fluid replacement	4 mL lactated Ringer's solution per kilogram (kg) of body weight per percent of total body surface area (% TBSA) burned = total fluid requirements for first 24 hr after burn; 1/2 given in first 8hr
Burn Diet	high-calorie, high-protein, supplemental vitamins (especially iron)

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