HESI PN Exam Prep

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  1. Lab Values for Heparin? What should you know about heparin?
    • Collect blood 30 mins prior to administering drug, have protamine sulfate avail- 1mg for every 100 units heparin.
    • Monitored by-aPTT: (activated partial thromboplastin time)
    • Goal: 1.5 to 2.5 times control value
    • Control: (normal)-25 to 35 seconds
    • Heparin therapy value: 2x normal value (50-70) sec
    • Over: 100 seconds too high.

    PTT: therapeutic range is 40-90 if it's within a therapeutic range, medication may be held.
  2. Lab values for Warfarin? What should you know about warfarin?
    • PT (prothrombin time): Normal value without therapy: 10-13 sec
    • Warfarin therapy value: 1.5x normal value (15-19.5) sec

    • INR used to monitor Warfarin (coumadin)
    • Normal value without therapy: <2 sec
    • Pt. with venous thrombosis (DVT), PE, Valvular heart: anticoagulant therapy: 2.0-3.0 is ideal
    • Mechanical heart valve replacement: 2.5-3.5 is ideal.
  3. H/H for Men and Women
    Hematocrit and hemoglobin
    • Hgb:Male: 13.5-18g/Dl 
    • Female: 12-15g/Dl

    • Hematocrit panic value less than 15% or greater than 60%. RBC per 100ml
    • Hct:Male: 40-54% 
    • Female: 36-46%
    • Hct should be 3 times the HgB
  4. MCV? 
    Mean Corpuscular Volume=RBC size
    Most useful lab for diagnosing anemias.
    • Measures average volume of RBC(80-98 um^3) 
    • Low value indicates iron deficiency anemia. (chronic blood loss, cancers of GI)
    • High value indicates B12 deficiency anemia ( pernicious/ folic acid)
  5. WBC count?
    4,500-10,000 uL (mm^3)
  6. Serum Iron?
    Normal 50-150 mcg/dl
  7. Platelet count?
    • 150,000-400,000 uL0.15-0.4 x 10^12/L (SI units)
    • A decrease in circulating platelets of less than 50% of normal value will cause bleeding: if the decrease is severe (<50,000 uL) hemorrhaging might occur.
  8. RBC count for men and women
    • Men: 4.6 million/uL-6.0 million/ul
    • Women: 4.0-5.0 million/u
  9. Neutrophil Range?
    • Associated with bacterial infections
    • 50-70%
    • 2,500-7,000 uL (mm^3)
  10. Eosinophil range?
    • act against infestation of parasitic larvae and increased in allergic reactions
    • think: Drug allergies
    • 1-3% 100-300 uL (mm^3)
  11. Basophil range
    • contains granules with chemical that act upon blood vessels (◦Heparin, histamine, serotonin, kinins, & leukotrienes)-
    • manifestation of inflammation.
    • 0.4-1.0% 40-100 uL (mm^3)
  12. Lymphocyte range?
    • Increased number associated with viral infections and  lymphoid leukemia. 
    • 25-35% 1,700-3,500 uL (mm^3)
  13. Monocyte range?
    • Phagocytes-bacteria and debris
    • 4-6% 40-100 uL (mm^3)
  14. Reticulocyte range?
    • 0.5-1.5% of all RBCs
    • 25,000-75,000 uL
    • Indicator for bone marrow activity
  15. Leukopenia?
    • Decreased number of WBC
    • Neutropenia: decreased # of neutrophils which can lead to life threatening sepsis 
    • Absolute granulocyte count=Neutrophils + Bands=Less than 1000 needs neutropenic percautions
  16. PH?
    7.35-7.45
  17. PaCO2 value=respiratory low value is basic, high value is acidic
    • CO2+H2O=Acid
    • Normal value: 40
    • Acceptable 35-45
    • <35 is alkalosis
    • >45 acidosis
  18. HCO3=metabolic low value is acidic, high value is basic
    • Kidney regulation of PH indicated by Bicarbonate.
    • HCO3- main base for regulation of PH
    • METABOLIC CONTROL
    • Normal: 24
    • Acceptable: 22-26
    • <22:  acidosis
    • >26: alkalosis
  19. PH panic values?
    Death<6.8 or >7.8
  20. RR for Pediatrics?
    • newborn 30-60
    • 1 year: 20-40
    • 3 year: 20-30
    • 6 year: 16-22
    • 10 year: 16-20
  21. PH: 7.48
    PaCO2: 38
    HCO3: 30
    Uncomp. Met. Alkalosis
  22. PH: 7.33
    PaC02: 50
    HCO3: 22
    Uncomp. Resp. acidosis
  23. PH: 7.38
    PaCO2: 48
    HCO3: 28
    Fully Comp. Resp. Acidosis
  24. CBG normal values?
    • 70-110=adult
    • 60-100=child
    • 30-80=newborn
    • Adult brain requires: 60-100
  25. Hemoglobin A1c
    Glycosylated Hemoglobin
    • bond between RBC and hemoglobin for lifespan of RBC (120Days)
    • (normal 4-6%)
    • uncontrolled diabetic >8%
  26. Glucose tolerance test (GTT)
    CBG checked every 30mins for 2 hours.
    12 hours fast followed by a 300ml high carb drink.
    • Less than 140mg/dl is a normal glucose test
    • 140-199 is prediabetes
    • >200mg/dl is DIABETES
  27. ADH
    • Saves water-Makes the kidney tubules more permeable.
    • Leads to concentrated urine.
    • synthesized by hypothalamus
    • secreted by posterior pituitary
    • Controlled by osmoreceptors in hypothalamus
    • Other factors which stimulate ADH- hypovolemia, stress, nausea, nicotine and morphine
  28. Renin
    Released by kidneys due to decrease in pressure or sodium. Converts angiotensinogen to angiotensin 1 which then gets converted by ACE to angiotensin 2 which has vasoconstrictive effects and increases blood flow to kidneys.
  29. Aldosterone
    • angiotensin 2 stimulates release of aldosterone from adrenal glands which act on the kidneys to reabsorb and conserve sodium and also increasing water reabsorption. 
    • Aldosterone also stimulates ADH.
  30. Nursing process for test questions, depending on the question you must answer the question in order of the nursing process.
    • Assessment
    • Analyze your assessment
    • Planning based on your analysis 
    • Implement your plan
    • Evaluate effectiveness of implemented plan
  31. Impending renal failure
    urine output less than 30cc/hr indicates potential renal failure
  32. Urine specific gravity<1.010
    • indicates dilute urine. 
    • Can be caused by too little ADH
  33. Fluid gain and loss equivalents
    • 1 liter=1kg
    • 1kg=2.2 pounds
    • 1 pound=454ml
    • 1 Oz=30ml
    • 1 cup= 8oz
  34. Serum Osmolarity
    <280 mOsm/l- sodium determines this less than 280=FVE
  35. Calcium (serum)
    • Necessary for transmission of nerve impulses, blood clotting, strengthens capillary membranes.
    • Adult: 4.5-5.5mEq/L, 9-11mg/dL. 
    • Child: 4.5-5.8 mEq/L, 9-11.5mg/dL.
  36. Chloride (serum)
    • maintaining homeostasis, osmolality of body fluids, Ph balance
    • Adult: 95-105 mEq/L
    • Child: 98-105 mEq/L
  37. Magnesium (Serum)
    • Neuromuscular activity, influences use of potassium, calcium and protein. responsible for transport of sodium and potassium across cell membrane.
    • Adult: 1.5-2.5 mEq/L, 1.8-3.0mg/dL
    • Child: 1.6-2.6 mEq/L
  38. Osmolality (serum)
    • Indicator of hydration status, helpful in diagnosing fluid and electrolyte imbalances. Sodium contributes 85-90% of serum osmolality.
    • Adult: 280-300 mOsm/kg
    • Child: 270-290 mOsm/kg
    • Panic values: <240 or >300 mOsm/kg
    • High value indicates: hemoconcentration due to dehydration
    • Low value indicates: hemodilution due to overhydration.
  39. Phosphorus (serum)
    • Principal intracellular anion; exists in blood as phosphate. functions include metabolism of carbohydrates, fats, ph balance, use of B vitamins, promotion of nerve transmission. Requires vitamin D for absorption from gastrointestinal tract-stored with calcium in bones/teeth.
    • Adult: 1.7-2.6 mEq/L or 2.5-4.5mg/dL
    • Child: 4.5-5.5 mg/dL
  40. Potassium (serum)
    • Most abundant intracellular fluids, Narrow range (2.5 mEq/L-7.0 mEq/L)-can lead to cardiac arrest. 90% of potassium excreted by kidneys. *Rhabdomyolysis can lead to hyperkalemia.
    • Adult: 3.5-5.3 mEq/L
    • Child: 3.5-4.8 mEq/L
  41. Protein Total (Serum)
    • Composed mostly of albumin and globulins-important in fluid and electrolyte balance.
    • Adult: 6.0-8.0 g/dL
    • Child: 6.2-8.0 g/dL
  42. Sodium (Serum)
    • Major cation in extracellular fluid, retains water,Maintains body fluids, neuromuscular impulses via sodium pump (Na+ shifts into cells as K+ shifts out for cellular activity) Enzyme activity, regulates PH balance by combining with chloride or bicarbonate ions. 
    • Adult: 135-145 mEq/L
    • Panic: < 115 mEq/L
  43. Hypo or Hyper-natremia
    Panic values: <115 mEq/L and >150 mEqL
    • CNS most easily affected by this.
    • <115 mEq/L leads to cerebral edema. Water/fluids from ECF goes into the ICF causing swelling.
    • Opposite is said for >150 mEq/L-Crenation takes place or shrinkage.
  44. Hypo or hyper-kalemia
    Panic value: <2.5 mEq/L and >7.0 mEq/L
    • Mainly found in ICF, with hypo there is an increase in ICF distribution leading to abnormal amounts.
    • Leads to Cardiac arrest and respiratory insufficiency. Respiratory failure #1 cause of death in Hypokalemia.
    • Never give potassium supplement if urine output less than 0.5ml/kg/hr. Kidneys main regulator for K+.
    • Most common cause of Hyperkalemia is Renal failure
    • Maximum infusion rate: K+ 5-10 mEq/hr never exceed 20 an hour.
  45. Hypo or Hyper-calcemia
    Panic Value: <7mg/dL and >13mg/dl ; <4.5 mEq/L and > 5.5 mEq/L
    Low value causes tetany any lower leads to arrhythmias or death. Common cause: is renal failure, hypomagnesemia, hypoparathryoidism, diuretics, malabsorption, hypoalbuminemia, hyperphophatemia (reciprocal relationship).hyperexcitability of cells, (think twitchy) cells are easily depolarized due to increased permeability of membranes

    High value causes (Think floppy), decreased neuromuscular excitability, bradyarrhythmias, decreased LOC, confusion, hypophophatemia. Common causes: Renal failure, hyperparathyroidism, vitamin D intoxication,
  46. Hypertonic solutions
    • fluids are pulled from the cells and interstitial spaces and into the intravascular space
    • Rarely used, very dangerous.water pulled from cells causing crenation 3-5% saline bags for dangerously low sodium levels
  47. Hypotonic solution
    • fluids are forced into cells and interstitial spaces
    • Dilutes ECF, restores ICF balance-flushes kidneys and excretes electrolytes.
    • 0.45% NaCl
    • D5-10W-2/3 enters cells, 1/3 stays in ECF
  48. Isotonic solutions
    • used to replace ECF due to illness. expands circulating volume. has same osmolality as plasma
    • 0.9% NaCl
    • Ringers-Balanced electrolyte solution resembling normal plasma
    • Lactated Ringers-Converted into bicarbonate by the liver.
  49. TSH levels are high but T3 & T4 levels are low?Anticipation of administering?
    • Hypothyroidism
    • Administer: Thyroid replacement-levothyroxine
  50. Hypoparathyroidism S&S?
    • Mild tingling or numbness around the mouth or in hands/feet— 
    • Severe muscle cramps— 
    • Carpopedal spasms— 
    • Seizures— 
    • Irritability—
    • Clouded concentration— 
    • Psychosis
    • Causes a decrease in serum calcium due to lack of PTH
  51. Adrenal Hypofunction S&S?
    • Loss of Aldosterone
    • K, Na, water imbalance
    • hypovolemia: decrease in BP
    • Hyperkalemia: Metabolic acidosis and dysrhythmias
    • Hyponatremia: AMS
    • Hypoglycemia
  52. Diabetes insipidus due to too little ADH?
    • Excessive thirst
    • dilute urine <1.005
    • dry mucous membranes
    • rapid heart rate
    • electrolyte imbalance
    • unintended weight loss
    • fever
    • fatigue
  53. Adrenal Hyperfunction
    • Increased Aldosterone
    • can be caused by cushings, adrenal adenoma and pregnancy
    • Na+ and water rentention
    • BP increase and weight gain, edema
    • Hypernatremia 
    • Hyperglycemia
    • Hypokalemia: Metabolic alkalosis
  54. Serum lab values thyroid disorders
    • TA-Thyroid autoimmune 
    • TSH: Thyroid Stimulating Hormone-released by anterior pituitary gland
    • T4: Thyroxine
    • T3: Triiodothronine Both of these are created by the thyroid and synthesized from iodine and tryosine(amino acid)
  55. ADH puts water into urine which effects?
    • Urine osmolality or specific gravity. 
    • Too little ADH: Urine is dilute
    • Too much ADH: Urine is concentrated.
  56. Thyroid stimulating hormone (TSH)
    0.35-5.5 ulU (microinternational unit/ml), Less than 3ng/mlsecreted by anterior pituitary gland, in response to thyroid releasing hormone from hypothalamus. Stimulates release of thyroxine (T4). Dependent on the negative feed back system
  57. Thyroxine (T4) serum
    4.5-11.5 mcg/dLMain hormone secreted by thyroid and is at least 25 times more concentrated than triiodothyronine (T3).
  58. Triiodothyronine (T3) serum
    80-200ng/dl more short acting and more potent than thyroxine.
  59. BUN Serum Range
    • Blood urea nitrogen level
    • Adult: 8-21 mg/dL
    • Approximately two thirds of renal function must be lost before a significant rise in the BUN level occurs.
    • High level: dehydration, prerenal failure or renal failure, GI bleeding. They will usually check a serum creatinine level to determine if the high BUN is renal or due to dehydration. Also indicative of BPH
    • Low level: overhydration (hypervolemia), severe liver damage, low protein diet, malnutrition
  60. BUN/Creatinine ratio
    10:1 -20:1 (BUN:creatinine)Average is 15:1High value indicative of renal disease, inadequate renal perfusion, shock, dehydration.Low value indicative of  liver disease, malnutrition, low protein diet, overhydration
  61. Creatinine serum range?
    • Adult: Male: 0.6-1.2
    • Female: 0.5-1.1  mg/dL, 45-132.3 umol/L. Creatinine value of 10mg/dl: 90% of kidney function has been lost
    • Females may have a slightly lower value due to less muscle mass. Creatinine, a by product of muscle catabolism (creatine phosphate). Considered a more sensitive test for renal failure. It's not as easily influenced by diet or fluid intake. 
    • High value: acute and chronic renal failure, shock, systemic lupus erythematosus, cancers, HF. Drug influence: amphotericin (antifungal), cephalosporins(cefazolin), aminoglycosides (gentamicin), lithium, ketone bodies. 
    • Low value: pregnancy, eclampsia.
  62. urinalysis (routine)
    • Color: light straw to dark amber
    • Appearance: clear
    • Odor: aromatic
    • PH: 4.5-8.0 average 6
    • Specific gravity: 1.005-1.030
    • protein: (2-8 mg/dL negative reagent strip test)
    • Glucose: negative
    • Ketones: negative
    • Blood: negative
    • Microscopic examination
    • RBC: 0-2 per High power field
    • WBC: M: 0-3, F: 0-5 HPF
    • Casts: occasional hyaline
  63. ESR
    Early indicator of widespread inflammatory reaction due to infection or autoimmune disorders­Usually normal in OA
  64. Lab values for muscle
    • CK-Creatine Kinase for skeletal and cardiac muscle
    • CPK-MM-Creatine phosphokinase for skeletal muscle 10 to 120 micrograms per liter (mcg/L)
    • CK-MB (My beat)-is an enzyme found in the myocardium. NR: 5-25IU/L or 3 to 5%
    • LDH- Lactic acid dehydrogenase 140-280
    • HS-CRP (high sensitivity C-reactive protein)
    • 1.0 to 3.0 mg
    • ­AST (liver, kidney, heart, skeletal muscles)
  65. Lithium level?
    0.6-1.2 normal
  66. Liver Lab tests
    • ALT-Most specific to liver
    • alanine aminotransferase: enzyme released from hepatocytes when the liver is injured.
    • AST: Aspartate aminotransferase found in hepatocytes and cardiac cells may increase more than 10 times normal, and stay elevated, less specific than ALT
    • ALP: Alkaline phosphatase Primarily found in liver and bone, may be markedly elevated
    • GGT: Gamma-glutamyltransferase: elevated with liver, heart and kidney injury. 
    • Serum ammonia: increases with liver issues Due to the liver being unable to convert ammonia to urea
    • Serum albumin: decreases with liver issues due to liver being unable to create albumin 
    • PT: Will increase due to liver being unable to  synthesize clotting factors.
    • Bilirubin may increase and can lead to anemia due to bleeding/malnutrition due to vitamin deficiencies.
  67. Deficiency of T8 Suppressor cell
    • Hypersensitivity and allergic reactions.
    • Can be mild or life threatening.
  68. Lab Value interpretation
    Comp C3 (NR: 83-177)
    Value: 250 mg/dL
    Comp C4 (NR: 12-36)
    Value: 78 mg/dL
    • Complement system in immunology are proteins that move freely through your bloodstream and play a role in the development of inflammation.
    • C3 & C4 are the most commonly checked and High values indicate autoimmune disorders
  69. Lab value interpretation
    Neutrophils (NR: 43-75)
    Value: % 17
    Bands (NR: 3)
    Value: 7
    Neutropenia, bands indicate immature neutrophils.
  70. ALT is normally around?
    7-56 units per liter
  71. Ammonia is normally around?
    9.5 to 49 mcg/dl
  72. AST is normally around?
    10-40 u/l
  73. Digoxin levels?
    • Therapeutic level 0.8ng/mll-2.0ng/ml. 
    • Level above 1.8ng/ml is considered Toxic.
    • ANTIDOTE: given for toxicity called Digibind.
  74. HDL and LDL levels
    • Total cholesterol: < 200 is ideal
    • HDL: 40-59 is healthy too low is bad too high is good.
    • LDL: 100-190 too high is bad too low is good
  75. LPN can only care for what type of conditioned patients?
    Stable
  76. The RN will always see the patient first that is in the ?
    Least stable condition
  77. Pay particular attention to the wording of the question, what is it asking you to do?
    There will be assessment, analysis, planning, implementing and evaluating questions....the answer will include wordings from the question. Don't fall for "distractors"
  78. For LPN questions the length of the answer may increase the probability of it being more correct....true or false
    True :) This does not work for the NCLEX RN
  79. Integrated process of the NCLEX-RN.....Besides the nursing process
    • Caring: for people not about working with high tech equipment.
    • Communication and documentation: you may be asked to identify appropriate documentation of a client of behavior or nursing action. 
    • Teaching and learning principles: Questions may be about teaching a client about their diet or medications
    • Culture and spirituality: be sensitive and respond to unique needs of each client.
  80. Levels of questions on the NCLEX RN
    Recall/recognition-understanding-application---analysis(these are the most abundant on the NCLEX.)
  81. For select all that apply questions you must eliminate the answers that are only "kinda right" example: 
    Nurse caring for a patient with a Right sided CVA with dysphagia,  which actions by the nurse reflects appropriate care for the client? select all that apply....
    • 1: the nurse assesses the client's ability to swallow
    • 2: the nurse positions the client at a 45 degree angle
    • 3: the nurse ofers the client scrambled eggs
    • 4: the nurse instructs the client to place food on the left side of the mouth
    • 5: the nurse turns off the television.



    • Correct: 1, 3, 5
    • 2 is a distractor since the patient should be sitting up right in a full fowlers position.
  82. Majority of the questions on the NCLEX will be multiple choice.
    Pay particular attention to the Stem of the questions
    Stem of the question is the situation that describes the client, his or her problems or healthcare needs and other relevant information.
  83. Example of rewording the stem of a question:
    a client is being treated for heart failure with diuretic therapy. which of the following assessments BEST indicates to the nurse that the clients condition is improving?
    • 1: The clients weight has remained stable since admission.
    • 2: the clients systolic blood pressure has decreased.
    • 3: there are fewer crackles heard when auscultating the clients lungs.
    • 4: the clients urinary output is 1,500ml per day.

    Stem: Heart failure, treatment is diuretic therapy and how do you know the clients condition is improving?

    Correct answer is3
  84. Steps to correctly answer an NCLEX -RN exam question
    • Step 1: reach each question carefully from first word to last word. Do not SKIM
    • Step 2: Look for hints in the wording of the question stem. Adjectives ( Most, First, Best, primary, initial) all indicate that you must establish a priorities. The phrase further teaching is necessary indicates that the answer will contain incorrect information. The phrase client understands the teaching indicates the answer will be correct info.
    • Step 3: Reword the question stem in your own words so that it can be answered with a yes or a no, or with a specific bit of information. 
    • Step 4: check the answer choices for clues to the question.
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HESI PN Exam Prep
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LAB VALUES, Common electrolyte imbalances, testing strats
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