u/RNExamRoom

Guys, if you’re taking the HESI A2 soon, a few things I’d definitely review.
Math: Ratios, fractions, percentages, conversions. Eg, 0.75 = 3/4, 2.5 L = 2500 mL, and 15% of 80 = 12. Practice without a calculator too.
A&P: Know blood flow through the heart, nephron function, hormones, and gas exchange. Eg, ADH increases water reabsorption, while aldosterone increases sodium reabsorption.
Biology: Mitosis vs meiosis, osmosis, DNA/RNA, and cell organelles. Ribosomes make proteins, mitochondria produce ATP.
Chemistry: pH, atomic structure, chemical bonds, and balancing equations. Eg, pH 3 is 10 times more acidic than pH 4.
Reading: Main idea, inference, author’s purpose. Don’t pick an answer just because it sounds medically correct. Stick to the passage.
Grammar/vocab: Their vs there, affect vs effect, subject-verb agreement, and common medical terms.
Also pls check which sections YOUR nursing program requires. Some don’t test every subject.
Try a few timed practice sets and review the ones you missed. Even 20–30 mins of focused practice daily can help.
Which HESI A2 section is stressing you out rn? A&P, math, or reading?

Guys, we spend so much time on diabetes, CHF, COPD, etc. But some of the less common conditions have really dangerous complications, and NCLEX loves testing what the nurse should recognize FIRST.
A few worth knowing. Esp if you’re doing prioritization questions.
1. Guillain-Barré syndrome (GBS)
Weakness starts in the legs and moves upward. Reflexes disappear. Often happens after a GI or respiratory infection.
Big danger? Respiratory failure. Monitor vital capacity, breathing, and swallowing. SpO₂ can look normal even when respiratory muscles are getting dangerously weak.
2. Myasthenia gravis
Ptosis, double vision, difficulty swallowing. Weakness gets worse w activity and improves w rest.
If the pt suddenly can’t swallow, cough effectively, or hold their head up, think myasthenic crisis. Airway and respiratory assessment come FIRST.
3. Thrombotic thrombocytopenic purpura (TTP)
Low platelets + hemolytic anemia, often w schistocytes. May have confusion, renal problems, or fever.
This one is a true emergency. Urgent plasma exchange is the key treatment. And btw, platelet transfusions are generally avoided unless there’s life-threatening bleeding.
4. Hemolytic uremic syndrome (HUS)
Child has bloody diarrhea, then develops pallor, low platelets, and decreased urine output.
Think acute kidney injury. Monitor BP, electrolytes, urine output, and renal function. Antibiotics and antimotility drugs should be avoided in suspected STEC infection.
5. Malignant hyperthermia
Pt under anesthesia develops rising end-tidal CO₂, tachycardia, muscle rigidity, and metabolic acidosis.
Here’s what ppl miss. HIGH FEVER CAN BE LATE.
Stop triggering anesthetic agents, call for help, give 100% O₂, and prepare IV dantrolene.
6. Stevens-Johnson syndrome (SJS)
Recently started a med such as lamotrigine or allopurinol. Now fever, painful rash, blisters, mouth sores, maybe eye involvement.
Not a simple drug allergy. Stop the suspected med, notify the provider immediately, assess airway and fluids. These pts can deteriorate very quickly.
7. Kawasaki disease
Persistent fever, strawberry tongue, red eyes, cracked lips, rash, swollen hands/feet.
Major concern is coronary artery aneurysm. IVIG + prescribed aspirin are standard treatment. Yes, aspirin in a child. This is one of the important exceptions.
8. Pheochromocytoma
Severe episodic HTN, headaches, sweating, palpitations.
Remember the med sequence. ALPHA blockade before BETA blockade when both are needed. Beta blockade first can cause a serious hypertensive crisis.
9. Heparin-induced thrombocytopenia (HIT)
Platelets drop over 50%, usually 5–10 days after heparin exposure.
The scary part is thrombosis, not just bleeding. With intermediate/high clinical suspicion, stop ALL heparin, including flushes. Anticipate a non-heparin anticoagulant.
10. Meningococcemia
Fever, petechiae or purpura, hypotension, confusion. Can progress to septic shock and DIC really fast.
Droplet precautions, immediate escalation, prompt IV antibiotics, and sepsis management. Do NOT wait for the rash to spread.
A lot of NCLEX prioritization comes down to recognizing which pt is deteriorating, even when the initial findings look pretty ordinary.
Also, dont memorize these as just disease names. Connect the symptoms to the actual complication and the FIRST nursing action.
Which rare condition did your nursing school barely teach? Curious what ppl are actually seeing in clinicals lol.

A 29-year-old woman with severe preeclampsia is receiving IV magnesium sulfate after delivery.
Two hrs later, BP is 142/88 mm Hg and her headache is better. The nurse finds:
RR 9/min
O2 sat 93%
Urine output 20 mL/hr
Patellar reflexes absent
What should the nurse do first?
A. Increase the magnesium infusion
B. Stop the magnesium infusion
C. Give IV labetalol
D. Place her in Trendelenburg position
E. Encourage oral fluids
Answer: ?
This is magnesium toxicity.
The important findings are RR 9/min + absent DTRs + low urine output. Magnesium is cleared by the kidneys, so oliguria increases the risk of accumulation.
The nurse should stop the magnesium infusion first and prepare for calcium gluconate if ordered.
Good NCLEX point: dont focus only on the diagnosis the pt came in with. Reassess what the current findings are telling you.
Which finding would have made you stop the infusion first?

The Nurse Practice Act in each state defines what an RN may do, what an LPN may do, and what may be delegated. It is law. A hospital policy can be stricter than it and cannot be looser.

So three things can conflict, and they rank.

The practice act first. If the state says u may not do it, no order and no policy makes it lawful.
Hospital policy second. It can narrow ur scope and often does.
A provider order last. An order cannot expand ur scope or override either of the above.

The exam phrases this as a provider telling u to do something u are not licensed for, and the answer is never that the order covers u.

Delegation stays accountable to the delegator. U remain responsible for the decision to delegate, the clarity of the instruction, and the follow up, whatever the person u delegated to does.

There's a free set of these on RNExamRoom. No account.

Rapid acting, lispro and aspart. Onset 15 minutes, peak 1 to 2 hrs, duration 3 to 5. Give it with the tray in front of the pt.

Short acting, regular. Onset 30 to 60 minutes, peak 2 to 4 hrs, duration 5 to 8. The only one that goes IV.

Intermediate, NPH. Onset 1 to 2 hrs, peak 4 to 12, duration up to 18. Cloudy, and the only one that is mixed.

Long acting, glargine and detemir. Onset 1 to 2 hrs, no pronounced peak, duration around 24. Never mixed with anything.

The peak is where the question comes. A pt on NPH at 0700 is most likely to go hypoglycaemic late morning to early afternoon. That gap between the injection and the symptoms is what gets tested.

Mixing order is clear before cloudy. Air into NPH first, then air into regular, then draw regular, then NPH.

Same style of question, free, on RNExamRoom. No sign up.

An infusion of 1,250 mL is ordered over 8 hrs.

What rate is set on the pump, to the nearest whole mL/hr?

A. 125 mL/hr
B. 156 mL/hr
C. 160 mL/hr
D. 172 mL/hr

1,250 divided by 8 is 156.25, so 156 to the nearest whole number.

Write the units into the setup and they check themselves. mL divided by hrs gives mL/hr, which is what the pump wants.

125 is what u get dividing by 10, which is the error to watch for when the numbers look round.

B.

RNExamRoom runs these timed or untimed. Free either way.

Airway, breathing, circulation first. Always.

Then: is this actual or potential. An actual problem beats a risk for.

Then: is it acute or chronic. New shortness of breath beats long standing shortness of breath.

Then: is it unstable or stable. A changing value beats a bad value that has not moved.

Maslow comes last, and only once nobody is physiologically unstable. Safety before belonging, belonging before esteem.

Two that override everything. A pt who cannot maintain an airway. And anything u did that is still going in, so an infusion u started and an error u are mid way through outrank a pt who is waiting.

When two options are both physiological, pick the one that kills sooner. Airway kills in minutes, circulation in minutes to hours, and a potassium of 6.8 before a haemoglobin of 7.

Same style of question, free, on RNExamRoom. No sign up.

A process produces four daughter cells, each with half the chromosome number of the parent, and each genetically distinct.

Which process is this?

A. Mitosis
B. Meiosis
C. Binary fission
D. Cytokinesis alone

Meiosis. Two divisions, four cells, haploid, and genetically distinct because crossing over in prophase I and independent assortment in metaphase I shuffle the material.

Mitosis produces two cells, diploid, genetically identical to the parent. That is growth and repair.

The distinct part matters as much as the halving. It is the reason siblings actually differ.

B.

RNExamRoom has these free. Pick timed if u want the pressure.

These are not the reference range. The number where u stop charting and pick up a phone.

K+ under 2.5 or over 6.5. Arrhythmia at both ends.
Na+ under 120 or over 160. Seizure at the low end, and correcting either too fast does its own harm.
Glucose under 40 or over 500.
Ca2+ under 6 or over 13.
Mg2+ under 1 or over 4.
Platelets under 20,000. Spontaneous bleeding.
Hgb under 7, which is the usual transfusion threshold in a stable pt.
INR over 5 on warfarin.
pH under 7.2 or over 7.6.

The exam asks these as which result do u report first, and the answer is the one that kills soonest. Potassium and glucose move fastest.

Report it, and document who u told and when.

Free bank on RNExamRoom if u want to drill this one.

Chart what u did, when u did it, and what the pt said, in their words where it matters.

A late entry is labelled as one. Date and time of the entry, date and time of the event, and no squeezing it into a gap between existing notes. Backdating is falsification.

An error is corrected with a single line through it, the word error or mistaken entry, ur initials and the date. The original stays legible. Never obliterate, never use correction fluid, never delete an electronic entry outside the system's own amendment trail.

Do not chart an incident report in the notes. Record the clinical facts and the assessment in the chart, and file the report separately.

Do not chart in advance, and do not chart for somebody else.

If a colleague asks u to document care u did not witness, that is the request to decline.

#NCLEX #NCLEXprep #highyield #documentation #RNExamRoom

Select all the findings that point to fluid volume overload.

A. Crackles at both bases
B. Weight up 2.5 kg since yesterday
C. Urine specific gravity 1.035
D. Jugular veins distended sitting at 45 degrees
E. BP 158/92, up from 124/78

Weight is the one to trust most. 2.5 kg overnight is 2.5 litres, because a litre of fluid weighs a kilo. No one gains fat that fast. Crackles, distended neck veins and a rising blood pressure are all the same story, volume the circulation cannot hold.
C is the outlier. Concentrated urine at 1.035 means the kidneys are holding water back, which is what they do when someone is dry. In overload the urine is dilute and the specific gravity is low.

so, its A, B, D and E.

\#NCLEX #NCLEXprep #practicequestions #labvalues #RNExamRoom

Which enzyme begins protein digestion in the stomach?

A. Trypsin
B. Pepsin
C. Amylase
D. Lipase

Answer: B. Pepsin

But heres the detail: stomach cells actually release pepsinogen, the inactive form. Stomach acid helps convert it to pepsin.

Pepsin = protein digestion
Pepsinogen = inactive precursor

very testable BTW.

#ATITEAS #TEAS7 #TEASExam #nursingstudent #nursingschool

The maths on the HESI is ratio, proportion, percentage and conversion. It is the arithmetic of the floor, and some programmes give u no calculator for it.

Ratio and proportion carry the most questions of the lot. If u can set a proportion up cleanly and solve it, a large part of the section is already done.

Seven subjects on the exam and plenty of programmes score only three or four of them. Check what urs counts before u revise all seven.

Free practice at rnexamroom if u want. 310 original questions across all seven subjects, one at a time or the full seven section simulation with its own section timing.

#HESIA2 #HESIprep #freepractice #HESImath #RNExamRoom

Three checks folks. When u pull the drug from storage. When u prepare it. When u put it back or dispose of it.

Against those, the rights: right pt, right drug, right dose, right route, right time, right documentation. Two identifiers for the pt, and a room number is never one of them.

Dosage questions get easier when u write the units into the working. If the units do not cancel to what the question asked for, the number is wrong however tidy the arithmetic looked.

Theres a free practice exam for this at rnexamroom, drawn from a large enough pool that no two attempts look the same.

NCLEX Pharmacology and Dosage Calculations organises the practice by drug class.

#NCLEX #NCLEXprep #freepractice #dosagecalculations #RNExamRoom

A fraction can give you the percent directly.

3/8 = 0.375 = 37.5%.

Now try this:

A practice test has 80 questions. 3/8 are fraction questions. How many questions are left for the other topics?

A. 30

B. 45

C. 50

D. 55

Free HESI A2 practice is in the RNExamRoom free practice set. For a deeper review, HESI’s Admission Assessment Exam Review, 6th Edition covers the math section w/ step-by-step examples.

#HESIA2 #prenursing #nursingschool #NCLEXprep #nursingstudent

Pt on long-term lithium for bipolar. Came in w/ coarse hand tremor, vomiting, and "my legs feel heavy."

lithium level 1.8 mEq/L

started ibuprofen for back pain 5 days ago

has been on a low-salt diet since her BP went up

Which of these fit? Select all that apply.

☐ A. This level is toxic

☐ B. The NSAID raised her lithium

☐ C. Low sodium intake raises lithium

☐ D. Hold the next lithium dose

☐ E. Push fluids and salt-restrict harder

☐ F. A coarse tremor is different from the fine tremor of normal therapy

☐ G. Lithium and NSAIDs dont interact

☐ H. Vomiting can make it worse from here

Lithium and sodium compete at the kidney, so anything that drops sodium, low-salt diet, dehydration, vomiting, pushes lithium up. NSAIDs cut renal blood flow and do the same. E is the trick: restricting salt further is the opposite of what she needs. The tremor distinction matters too, fine is expected, coarse is a warning.

its A, B, C, D, F, H.

#NCLEX #NCLEXprep #practicequestions #nursingschool #RNExamRoom

22 yr old admitted after a motorcycle crash with a fractured femur. About 36 hrs later, he suddenly becomes restless and confused.
RR 32/min, SpO₂ 84% on room air, temp 38.4°C. You also notice tiny red spots across his upper chest and neck.
What should the nurse do first?
A. Place him in high-Fowler position and apply oxygen
B. Give the prescribed acetaminophen
C. Notify the provider about the petechial rash
D. Encourage coughing and deep breathing
Answer: ?
Long-bone fracture + sudden hypoxemia + neurologic changes + petechiae = think fat embolism syndrome.
The rash is the clue, but the immediate problem is his oxygenation. ABCs first: position him upright and give oxygen, then escalate care.
Little NCLEX point: sometimes the weirdest finding helps you identify the complication, but it isnt always the thing you treat first.