HESI PN Exam Prep

• 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.

• 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.

• 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

• 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)

4,500-10,000 uL (mm^3)

Normal 50-150 mcg/dl

• 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.

• Men: 4.6 million/uL-6.0 million/ul
• Women: 4.0-5.0 million/u

• Associated with bacterial infections
• 50-70%
• 2,500-7,000 uL (mm^3)

• act against infestation of parasitic larvae and increased in allergic reactions
• think: Drug allergies
• 1-3% 100-300 uL (mm^3)

• 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)

• Increased number associated with viral infections and  lymphoid leukemia. 
• 25-35% 1,700-3,500 uL (mm^3)

• Phagocytes-bacteria and debris
• 4-6% 40-100 uL (mm^3)

• 0.5-1.5% of all RBCs
• 25,000-75,000 uL
• Indicator for bone marrow activity

• 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

7.35-7.45

• CO2+H2O=Acid
• Normal value: 40
• Acceptable 35-45
• <35 is alkalosis
• >45 acidosis

• 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

Death<6.8 or >7.8

• newborn 30-60
• 1 year: 20-40
• 3 year: 20-30
• 6 year: 16-22
• 10 year: 16-20

Uncomp. Met. Alkalosis

Uncomp. Resp. acidosis

Fully Comp. Resp. Acidosis

• 70-110=adult
• 60-100=child
• 30-80=newborn
• Adult brain requires: 60-100

• bond between RBC and hemoglobin for lifespan of RBC (120Days)
• (normal 4-6%)
• uncontrolled diabetic >8%

• Less than 140mg/dl is a normal glucose test
• 140-199 is prediabetes
• >200mg/dl is DIABETES

• 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

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.

• 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.

• Assessment
• Analyze your assessment
• Planning based on your analysis 
• Implement your plan
• Evaluate effectiveness of implemented plan

urine output less than 30cc/hr indicates potential renal failure

• indicates dilute urine. 
• Can be caused by too little ADH

• 1 liter=1kg
• 1kg=2.2 pounds
• 1 pound=454ml
• 1 Oz=30ml
• 1 cup= 8oz

<280 mOsm/l- sodium determines this less than 280=FVE

• 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.

• maintaining homeostasis, osmolality of body fluids, Ph balance
• Adult: 95-105 mEq/L
• Child: 98-105 mEq/L

• 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

• 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.

• 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

• 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

• 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

• 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

• 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.

• 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.

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,

• 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

• 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

• 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.

• Hypothyroidism
• Administer: Thyroid replacement-levothyroxine

• 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

• Loss of Aldosterone
• K, Na, water imbalance
• hypovolemia: decrease in BP
• Hyperkalemia: Metabolic acidosis and dysrhythmias
• Hyponatremia: AMS
• Hypoglycemia

• Excessive thirst
• dilute urine <1.005
• dry mucous membranes
• rapid heart rate
• electrolyte imbalance
• unintended weight loss
• fever
• fatigue

• 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

• 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)

• Urine osmolality or specific gravity. 
• Too little ADH: Urine is dilute
• Too much ADH: Urine is concentrated.

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

4.5-11.5 mcg/dLMain hormone secreted by thyroid and is at least 25 times more concentrated than triiodothyronine (T3).

80-200ng/dl more short acting and more potent than thyroxine.

• 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

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

• 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.

• 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

Early indicator of widespread inflammatory reaction due to infection or autoimmune disorders­Usually normal in OA

• 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)

0.6-1.2 normal

• 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.

• Hypersensitivity and allergic reactions.
• Can be mild or life threatening.

• 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

Neutropenia, bands indicate immature neutrophils.

7-56 units per liter

9.5 to 49 mcg/dl

10-40 u/l

• Therapeutic level 0.8ng/mll-2.0ng/ml. 
• Level above 1.8ng/ml is considered Toxic.
• ANTIDOTE: given for toxicity called Digibind.

• 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

Stable

Least stable condition

There will be assessment, analysis, planning, implementing and evaluating questions....the answer will include wordings from the question. Don't fall for "distractors"

True :) This does not work for the NCLEX RN

• 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.

Recall/recognition-understanding-application---analysis(these are the most abundant on the NCLEX.)

• 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.

Stem of the question is the situation that describes the client, his or her problems or healthcare needs and other relevant information.

• 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

• 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.