HESI Med-Surg Exam Preparation Notes
Key Topics to Focus On
Tuberculosis (TB)
- Medications: Rifampin, Isoniazid, Pyrazinamide
- Therapy Duration: Prolonged therapy required (6-9 months)
- Precautions: Airborne; use particulate absorbing mask, not surgical mask.
- Testing: Best method is sputum collection over 2-3 days.
- Transmission: Negative sputum smear indicates non-transmissible via airborne route.
- Effects of Medication: Orange secretions (tears, urine) due to Rifampin/Isoniazid.
- Hepatotoxicity Signs: Yellow tinted sclera due to Rifampin/Isoniazid.
- BCG Vaccine: Positive Mantoux tests.
Pancreatitis
- Indicators: Elevated lipase levels.
- Medication Timing: Take at mealtime.
- Hypocalcemia Risks: Look out for Chvostek's and Trousseau's signs.
- Chvostek's Sign: Twitching of facial muscles when cheek is tapped.
- Trousseau's Sign: Carpal spasm with blood pressure cuff inflation.
- Concern: Abdominal mass indicating possible abscess.
- Pain Management: Decreased pain with NPO status.
- Cullen's Sign: Ecchymosis around the umbilicus indicating severe acute pancreatitis.
Other Health Conditions
- Senile Lentigines: Normal age spots in older patients.
- Stroke: Assess pupil size, vitals, consciousness, and screen for dysphagia before oral intake.
- Fluid Overload Signs: Dyspnea and tachycardia, especially in acute kidney injury.
- Hypertension: Most prevalent in African males.
Practice Questions and Rationale
Delegation and Prioritization
- RN Delegation: UAP can take vital signs but cannot assess or diagnose.
- Discharge Education for Diabetes: Teach glucose self-monitoring and medication administration.
- Protein Malnutrition in Older Adults: Start with recording all food and beverage intake for a three-day period.
- Diabetes Insulin Administration: Demonstrate how to draw up and administer insulin first.
- Drug Interactions in Older Adults: Instruct patients to bring all medications to each appointment.
- UTI and Diuretics: Request patient to empty bladder first.
- Pain Management Post-Op: Assess patient treated for pain before returning from PACU first.
- Distended Bladder with BPH: Insert an indwelling urinary catheter.
- AKI with Hyperkalemia: Place the patient on a cardiac monitor first.
Hemodialysis and Cataract Surgery
- Hemodialysis Side Effects: Check blood pressure if patient reports nausea and dizziness.
- Cataract Surgery: Do not encourage coughing post-operation.
Important Tips for HESI/ATI and NCLEX
- Promote Venous Return: Elevate legs above heart level.
- Blood Transfusion Impact: One unit of packed RBCs increases count by 3%.
- Stroke and Dysphagia: Screen before resuming oral intake.
- Esophageal Varices: Report blood vomiting to healthcare provider.
- Cataract Care: Instruct clients to wear an eye shield to prevent rubbing.
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