WHAT THE HESI!?

As if nursing school exams aren’t enough, some programs require you to take semesterly HESI exams. The HESI exam is designed to better your chances of passing the NCLEX. Each semester’s HESI correlates to the semester’s materials. For instance, during your Psychiatric semester, your HESI will be only Psychiatric questions. This allows you to study the most important material in depth. This way when you get to the NCLEX you should have a strong knowledge base on the concepts, making your chances of passing higher.

HESI questions include audio, locating what is asked on an image, select all that apply, organizing from first to last, and generic multiple choice. A score of 850 or above is considered passing. Anything in the 1000’s usually converts to an A letter grade. There is a conversion score at the end which shows your exam grade as a percentage based off of your score. Once you have finished your HESI, you will get your score instantly.

There is strategy to HESI but for the most part you have to know your material. Studying is crucial for success. HESI tests your knowledge on the subject whereas NCLEX tests if you will keep your patient alive or not. The best study advice for this HESI is to do as many questions and case studies as you can. Read the rationales, pick up on the themes, and carry what you’ve learned into your next question sets. Make sure you know how to do math problems. The math problems carry the heaviest weight in determining your score. These problems can be the difference between passing and failing so study medication calculations and conversions!

I am going to break down the HESIs for you by semester/exam below. I will also provide some study tips and strategies accordingly. This alone won’t get you through the exams. You will need to devote time and energy to the material, however it is a solid place to start!

HESI 1: GERIATRICS

This HESI is very straight forward. It is making sure you know how to take the exam. There are plenty of common themes that HESI wants you to pick up on and carry forward for the HESIs to come.

Maslow’s Hierarchy of Needs: Physiological needs come first, then psychological.
ABC’s: Prioritize with Airway first, Breathing second, and Circulation third.
Least invasive measure should always be taken first. Don’t stick your patient if you don’t have to.
Read the questions. They provide all of the information you need to answer the question and cancel out irrelevant options.
You live in the perfect HESI world. You have access to all of the supplies you could need. You have plenty of time to focus on this patient. Give them your best care.
Be therapeutic. These questions will pop up repeatedly and they are the easiest points. Avoid yes or no answered questions. Present your patient with an opportunity to discuss the situation.
ADPIE: Assessment, Diagnosis, Planning, Intervention, Evaluation. If it asks what the next step is, use ADPIE to see what comes next.
Don’t pass the buck. The patient is yours. You have the time to take care of them, so do it yourself (unless the question states otherwise).
Don’t change the answers. Don’t add “what ifs.” The answer is exactly as it reads. If something is off with it, eliminate the answer and carry on.
Please note that all of these themes carry over into every HESI exam!

HESI 2: PSYCHIATRIC

This HESI was one of my highest scoring HESIs. There were some themes on this HESI for sure, but the majority of it came down to knowing the material. They heavily tested on medications and psychiatric disorders. Read the HESI book section devoted to Psych and study the material. Do the corresponding case studies and read why you got the answers wrong.

Don’t support hallucinations, however remain therapeutic.
As long as the patient is safe, divert their attention if needed.
If a patient is being rude, let them know that behavior is unacceptable.
If patient is combative, remove others from situation.
If a patient is hearing voices ask them “what are the voices are saying?”
If a patient is suicidal ask follow up questions as to whether they have a plan or not, or access to a gun.

HESI 3: MED SURG

Goodness gracious…this HESI covered SO much material. Luckily, all of it was covered in my corresponding nursing course. Once again there are always themes, but knowing the material is what best leads to success:

Safety is the priority. Are the side rails up? If the patient is taking a PO med, have you assessed their swallow?
Know the different scopes:
- Nurses:
  - Assess, plan, teach, communicate with HCP, can delegate tasks to NAP. Only the nurse can assess.
- NAP
  - Blood glucose checks, mobilization if already assessed by the nurse, feeding in stable clients (not CVA patients who’s swallow hasn’t been assessed yet).
  - Cannot delegate tasks. Cannot speak to HCP about patient’s status.
- LVN
  - Can reteach what RN has already taught. Can change sterile dressings, can ambulate patients.
  - Cannot discharge patients. Cannot give IV meds
Delegation- if a nurse delegates a task to the NAP, it is on the nurse to follow up on that task.
Know the legal implications of being a nurse: battery, negligence, assault, etc.
You need to have a strong understanding of all the body systems and related disorders. If it comes down to two answers and you can’t choose, use the HESI themes discussed in HESI 1

HESI 4: PEDIATRICS

You could succeed on the Pediatrics HESI exam if you did well on the Med Surg exam. However, studying the Pediatrics portion of the HESI book will make the exam significantly easier for you. This being said, this exam expects that you still know the information from HESI 3: Med Surg.

Marry the Erikson developmental stages. Know them inside and out.
Know what happens at what age. For example, three year old can ride a tricycle.
There are numerous cardiac questions related to Peds. Know the Pediatric related cardiac conditions.
Know the immunizations timing and schedule.

HESI 5: MATERNITY

Maternity is one of the largest sections in the HESI book and also one of the easier HESIs in my opinion. This HESI is big picture. They want to see if you know what to do in certain maternal scenarios.

Know the orders in which to do things, for example: stop Pitocin, turn to left side, apply oxygen, alert HCP. There are numerous different scenarios and orders in which to do things so make sure you study and memorize them.
Know the labor stages
After the mother’s water breaks, assess the color. Then perform a vaginal exam.
Know the different S/Sx of ectopic pregnancy, miscarriage, etc.
What will keep the patient the safest? Keep in mind that there are huge fluid losses with birth. Avoid fainting with the RN walking the mother to bathroom for the first time after birth, massage the fundus to prevent postpartum hemorrhage, and maintain IV access with LR.
Know APGAR scores and immunizations post-birth.
Know what is normal and abnormal for a baby: central cyanosis is abnormal but cyanosis of the hands and feet can be expected.
All and all, know what is normal for the entire process of pregnancy to birth. If you know that the amniotic fluid should be clear/yellow then you will know that green amniotic fluid should be reported.

HESI 6: CUMULATIVE HESI EXAM

This exam seems daunting, but think of how much studying you have done for HESI up to this point! This HESI is about 60-75% Med Surg. The two least tested on sections are Pediatrics and Maternity. This should help you prioritize your studying.

Memorize electrolyte imbalances related to certain diseases/conditions
- Know the implications of having an electrolyte imbalance and how to respond
The Renal System was heavily tested on in my exit HESI.
Maternity, Psych, and Peds are big picture questions.
Remember Geriatric S/Sx for conditions are different than adults and children. Study these for this exam.
NAP, LVN, and RN roles are heavily tested on. Know them as best as you can!
There will be random questions that you have no idea what they are even talking about. Use strategy here. Eliminate obviously wrong answers. Which answer is not like the others? For the most part, this is the right answer.
Know all about digoxin SDR and medication schedule. Know what to do with certain dig levels
Study when certain meds are given. For example, steroids are to be given with food.
A common theme is when a patient is on a BP drug and their BP is normal, give the patient their BP med still. We want to keep the BP within the normal range.

Once again, these are just themes I noticed from the exams! The best key to success is to put in the work, study the material, and begin studying early!