this is how to score over a thousand in the hesse med surg exam how you can score over 850 and even score above a thousand so the tv tuberculosis this is a heavily tested topic for hesses atis and the nclex and some medications that you should be familiar with include rifampin isoniazid pyrozytamine and it's important to know that prolonged therapy for six to nine months is required when you have a patient positive for tb um just be aware that this medication it doesn't last a few days or weeks but it's prolonged therapy and this is key to knowing how to answer questions that you maybe um that you may encounter with tb um tv questions tend to ask um how long therapy usually lasts and just remember it's prolonged and it usually lasts six to nine months the type of precautions is airborne it is particulate absorbing mask that should be used and not a surgical mass so just remember that it's airborne and it's a particulate absorbing mask um when doing testing for tv the best um testing you could do is as pew gym collection for at least two to three days and just know that it should not be done all at once but it should be consecutively for the negative sputum smear this means that tb is no longer it no longer can be transmitted via the airborne route also if you are asked um a question for example where they say a patient comes in and they say that they have orange secretions and your reply should be this is normal for example they might have orange tears or urine when patients are taking the medication rifampin and isoniazid this is an expected outcome that they would have orange secretions also a yellow tin sclera is a sign of hepatotoxicity of rifampin and isoniazid the bcg vaccine shows positive mantu tests okay another heavily tested topic is pancreatitis um one should know that if um there's elevated lipase this is an indication of pancreatitis um medications to treat practices include um well should be taken at meal time this is something that you should know that these medications should be taken at meal time and patients with this have a high risk for hypocalcemia one sign to look out for with hypocalcemia is the vostex sign on the trausus sign the vostex sign is where you twi where is twitching of the facial muscles when the cheek is tapped the trouser sign um occurs when a patient is wearing a blood pressure cuff and when inflated over the systolic pressure experiences a carpal spasm so make sure you remember this the abdominal mass is of most concern due to the possibility of an abscess decreased pain with npo status and this is something you can expect because then there's decreased activity in the stomach your gastrointestinal system so it does if you like decrease eating and you're on npo status that helps to decrease pain the colon sign this is where you have the area around the umbilicus it has echemosis which is a sign of severe acute pancreatitis okay so senile angel genes these are age spots that are normal in older patients they are irregular wrong lesions stroke when you if you get a question asking about stroke always remember it is important to assess people's people size vitals and consciousness and screening for dysphagia is necessary before oral intake is resumed what are some signs of fluid overload dyspnea and tachycardia these are signs of fluid overload in a patient with acute kidney injury as i said guys these are some topics that you should know for your med surg exam for hesis atis and your nclex hypertension it's most prevalent in african males okay so we're going to do some practice questions now and the first question is you the rn cares for a patient who was admitted a few hours previously with back pain after an accident which action can the rn delegate to a uap a determined the patient's priority problems be finished documenting the admission assessment c obtain the health history from the patient's caregiver and d take the patient's temperature pulls and blood pressure so i'll give you guys a few minutes to think about it and come up with an answer and if you selected take the patient's temperature pulse and blood pressure you are correct just remember um a uap they cannot do anything um relating to a pie they cannot assess diagnose come up with priority problems teach but they can take the patient's temperature pulse and blood pressure they can take vital signs okay a patient who was admitted to the hospital with hyperglycemia and newly diagnosed diabetes is scheduled for discharge the second day after admission when implementing patient teaching what is a priority action for the nurse a provide detailed information about dietary control of glucose b teach glucose self-monitoring and medication administration see give information about the effects of exercise on glucose control de-instruct about the risk for cardiovascular disease with hyperglycemia so if you guys came up with the answer b teach glucose self-monitoring and medication administration you are correct so always remember that when answering these questions most times the question contains a part of the answer for example it says in this question this patient was admitted with hyperglycemia and has been newly diagnosed and this person is going to be discharged so what is the most important thing for you to do to help this patient with their newly diagnosed diabetes it will be to teach glucose self-monitoring and medication administration this is what will help this is what is answering your question and what what will be priority in helping a patient as newly diagnosed with this disease okay and older asian patient seen at the clinic is diagnosed with protein malnutrition what action should a nurse plan to implement first a suggests the use of liquid supplements as a way to increase protein intake b encourage the patient to increase the dietary intake of meat cheese and milk c ask the patient to record the intake of all foods and beverages for a three day period d focus on the use of combinations of beans and rice to improve the daily protein intake so if you selected ask the patient to record the intake of all foods and beverages for a three-day period you are correct so this is also a question that is seen on many test banks or many practice questions and this is helping you to be able to further assess if you ask the patient to record and the intake of all foods and beverages for a three-day period then you're getting more information that you need and you're getting further assessments done okay a man diagnosed with diabetes says i want to understand how to give my own insulin what action should you complete first a demonstrate how to draw up an administered insulin b discuss the use of exercise to decrease insulin needs c teach about differences between the various types of insulin d provide handouts about therapeutic and adverse effects of insulin so if you selected a you are correct demonstrate how to draw up and administer insulin so this one is pretty straightforward hopefully you understood why this answer is correct which nursing action will be most helpful in decreasing the risk for drug to drug interactions in an older adult teach the patient to have all prescriptions filled at the same pharmacy make a schedule for the patient as a reminder of when to take each medication occupation to bring all medications supplication herbs supplements and herbs to each appointment instruct the patient to avoid taking over-the-counter medications or supplements so guys remember okay let's see if you selected c after patient to bring in all medication supplements and hoops to each appointment this is directly answering the question how would you know if there is a drug to drug interaction you have to free the assess and have that patient bringing those medication otherwise the other answers is not directly answering the question so remember to read your question slowly and properly okay the nurse will assess an older patient who takes diuretics and has a possible uti which action should a nurse take first palpate over the suprapubic area and spec for abdominal distension question the patient about hematuria request the patient to empty the bladder if you guys selected request a patient to empty the bladder you are correct so knowing that this patient is taking diuretics and has a possible uti this will be able to help you to fully assess that patient if he has that empty bladder i see mts.bladder that will make it easier to be able for you to be able to assess and get um the information you need otherwise if you if you keep if he keeps that blood as full as he's gonna be in pain it's gonna be uncomfortable and he will experience discomfort while you assess okay the nurse on a surgical inpatient unit is caring for several patients which patient should a nurse assess first patients with post-op pain who received morphine sulfite patient who received dilaudid one hour ago patient who was treated for pain prior to return from the pacu patient with neuropathic pain who is scheduled to receive a dose of lower tab if you selected the patient who was treated for pain just prior to return from the pacquiao you are correct and this one is also pretty straightforward you know that patient was experiencing pain before and now that they have come back from the pacu they are also going to be in pain so you want to keep on top of that p in medication okay a 76 year old with benign or bph prostate hypothesia is agitated and confused with markedly distended bladder which intervention prescribed by the healthcare provider should the nurse implement first insert a indwelling urinary catheter draw blood for a serum creatinine level schedule an intravenous pyelinogram administer lorazepam if you selected insert an indwelling urinary catheter you're correct now guys this is another question where you can see part of the answer was in the question oh it's hinted that person had a distended bladder and the only thing to relieve that is inserting a urinary catheter okay a patient admitted with aki due to dehydration has oliguria anemia and hyperkalemia which prescribed action should the nurse take first insert a urinary retention catheter administer epoitin alpha place the patient on a cardiac monitor or give sodium polycysteine sulfonate if you selected place the patient on a cardiac monitor you are correct so we know that this person has aki and they have oliguria anemia and hyperkalemia so once you see hyperkalemia you know that is something relating to the heart and how could you further assess if their heart is being affected is only if they're on a cardiac monitor during routine hemodialysis a patient reports nausea and dizziness which action should a nurse take first slow down the rate of dialysis check the blood pressure review hematocrit level or give prescribed antimatic drugs if you selected check the blood pressure you were correct this is another question where you can apply um a pi assess your patient and as you see here assessing the patient um that answer is checking for blood pressure also if you do your abcd's um you'll also see that this is there's nothing with airway breathing but this directly deals with circulation okay the charge nurse observe a newly hired nurse performing all of the following interventions for a patient who has just undergone right cataract removal and an inter intraocular lens implant which action requires that the charge nurse intervene if you select an answer that says the nurse encourages the patient to cough you are correct so a person who has cataract you know that they have that high [Music] pressure in your eyes they have that high pressure and if you're encouraging that patient to cough that would just increase that pressure and make things worse so this is this would require the nurse to intervene finally these are some points that i would employ to remember in preparation for your hesi or your ati medical surgical exam how do you promote venous return you elevate the legs above the heart level one unit of pack red blood cells increases the count by three percent so if you give four units then you can expect it to increase by 12 percent stroke victims need to be screened for dysphasia as mentioned before if someone has esophageal varices and you see that they're vomiting blood that is something you need to report to your healthcare provider and a client who has cataract some implementation a nurse should do is instruct a client to wear an eye shield to prevent rubbing the eye so remember to subscribe share subscribe and like and turn on your notification button for more hesi ati and nclex tips