I took the HESI test today and thankfully passed with a 946. My school was allowed to take a ‘practice HESI’ test last semester. I scored in the low 600s. A lot of my classmates didn’t pass and we only get three chances. I sometime check the forums but not periodically and noticed there weren't a whole lot of HESI specific test taking strategies. I thought that this little guide would help. I'm not gonna vouch for any of this, I just hope it helps. Everyone thinks differently, and this is the way I was thinking when I was studying for the HESI.
I have done a lot of research on HESI through the internet and taught myself (through the HESI book, Saunders Questions, course reviews dealing specifically with critical thinking) how to answer questions and came up with this really short guide. Tell me what you guys think. This is really a bare bones guide and I came up with it just now based on what I know. I might add to it later.
HESI is a test that is designed to see how well you can pick the correct answer. If you can always pick the correct answer you have a good chance of passing NCLEX. That’s all it does. It sounds stupid but that’s what it boils down to. It doesn’t measure how much you know or how well you would be as a nurse. It comes down to critical thinking and test taking skills.
Schools use HESI because (at least in Texas) if the pass rate of NCLEX of a new graduate on the first try is below a certain level the board can shut down the school mid semester and kick everyone out. If you stop the people that won’t pass the NCLEX on the first try you can have a great pass rate. It sucks. A lot of good nurses never get a chance. There isn’t a substitute for knowing the content but it’s obvious you can’t know every single detail about every single drug or disease. As one of my favorite instructors always says “You know more than you think you know”. You just need to learn how to get it out of you.
Even then, studying content alone will not guarantee you will pass. You could know everything about meningitis and know everything about COPD. What interventions do you do when you get a client with COPD that contracts meningitis? What interventions can you not do? If you have good test taking skills and critical thinking you can probably figure out what to do first even if you didn’t know EVERYTHING about either disease. You could probably get by with the minimum amount of info on either disease process. Do you know EVERY single calcium channel blocker? Probably not, But if you know that most end in –dipine and how they work then you can probably figure out what to do next or what foods they can’t have.
HOW DID I STUDY?
I studied by breaking apart questions and the answer choices. At the same time I had to review basic content. This was all memory work. The hard part was applying and using critical thinking when you break apart questions. That meant I had to do a lot of questions. But blindly doing questions without figuring out why the correct answer is correct and why the other answers are incorrect won’t help you. You need to know why the correct answer is correct and what clues in the questions led you to that correct answer. But you also need to use the knowledge you’ve gained so far and figure out why the other answers are incorrect. I needed to fully know everything about the question and the answer choices to improve my test taking skills. Better to do 10 questions and break them apart then 100 questions and just look at the rationales. So how do you break apart a question? First and foremost I read the question. THE WHOLE QUESTION. SOMETIMES TWICE TO GET ALL MY INFO. I DON’T EVEN LOOK AT THE OPTIONS AT THIS POINT. WHY? BECAUSE YOU CAN GET A LOT INFO FROM JUST THE QUESTION.
- The first thing I do is ask “WHO IS THE CLIENT?” Is the client a newborn, a teenager, male or female, geriatric or adult etc. Why is this important? You know that you can’t speak to a teenager the same way you speak to a pregnant woman the same way you speak to a widowed Chinese wife and etc. If you know who the patient is then you can infer some things right away: Pedi clients need to be communicated a certain way (Kohlberg, etc), elderly clients may be hard of hearing and need things repeated. These are communication aspects. What about physical aspects? Pregnant women may have physiologic anemia of pregnancy and so their blood levels are off and etc. These are juts broad categories, you should be able to study the more in depth levels with your notes and lectures (communication, age specific diagnosis and interventions or problems, etc..) Knowing WHO the client is might tell you what you CAN and CAN’T DO, SAY, EXPECT etc…
But sometimes they tell you it’s just a client. No male or female or age or anything. Sometimes its not even relevant to the question and can even throw you off. But more often than not, it means something. What you CAN NOT DO is assume things. Just because the client has osteoporosis DOES NOT MEAN that the client is female or elderly. DON’T READ INTO THE QUESTION HERE!
- The next thing I do is figure out what the problem is. This is the scenario stuff. Maybe the client has respiratory arrest or is complaining about pain somewhere. Maybe the client is showing a physical symptom or an emotional one. The main thing I try to get it out of it is WHAT IS THE PROBLEM. You may get a disease name (client comes in with suspected end stage renal disease) or you may get symptoms (client comes in and complains of coughing up bloody sputum with a fever). Just from this you could probably know what is physically, emotionally, and medically wrong. BUT THAT ISN’T ALWAYS THE PROBLEM ! Let me go off on a tangent here with symptoms…
You need to be able to equate 3 main things. THE NAME OF THE DISEASE- THE PATHOPHYSIOLOGY OF THE DISEASE – AND THE EXPECTED SYMPTOMS OF THE DISEASE. If you get either one of the three you should know the other two, at least a little bit. This is all book study. If you know the the patho of a disease you could logically figure out the symptoms. (If you have damage to VIII cranial nerve you could have hearing disorders). If you get the symptoms you could logically guess the pathology as well (the client can’t hear, maybe he has damage to the cranial nerve or lost his hearing with rheumatic fever or some kind of ototoxic drug may have caused it).This will give you the clues about where you need to go next with the problem. Regarding symptoms what I thought was important was not knowing every single symptom about each disease but general categories.
GENERAL CATEGORIES OF SYMPTOMS: Early versus Late signs:
If you know something is an early sign you could know what to do to prevent it from getting worse. Expected Symptoms (easy)
: you have use what you know, if someone has an infection they usually have a fever, and fever is a symptom. If someone has a respiratory problem the probably have dyspnea or coughing or some sputum. If they have a renal problem they probably have weird amounts and colors and smells in the urine. A lot of symptoms should come naturally. Use your pathology to back up your knowledge and ALWAYS ASK WHY! People with bacterial meningitis have nuchal rigidity. Why? Because the meninges in the brain are irritated. WHY? Because there is an infection Why? The most common routes of bacterial meningitis are community acquired like in college dorms. Why? And so on…It’s a helpful exercise. You really do know a lot! Expected Symptoms (hard or giveaways):
but sometimes they are just weird and you’re just gonna have to memorize them. The patho might not be explained or it might not make that much sense. But luckily some things are dead giveaways. If a kid sounds like a seal when he coughs he probably has croup. If a patient has black tarry stools he’s probably on iron supplements.
Sadly, this DOES NOT ALWAYS TELL YOU WHAT THE PROBLEM IS. Take this hypothetical example: A client is diagnosed with some late stage terminal cancer and expresses worried concern about how her family will handle the news of the diagnosis. What is the problem? Is it that she has a terminal cancer or that she has to figure out how the family will take it? How about a kid who yells and angrily refuses to take medication because it makes him feel sick? What is the problem? Is it that the meds make the kid feel like crap or that he just won’t take meds and has an attitude problem? You could very easily read too much into the question here.
Here’s what we know so far: we have the client and can infer certain things about them (use facts, don’t read too much into it and don't ask what if? They’re males, females, learning disabled, teenagers, pediatrics, or mothers) We know the scenario (the client has this medical diagnosis and from that we know these are expected symptoms or we have symptoms and we can guess what is wrong with them. We can think of certain drugs that would be given and what the earliest signs of the disease are. We can even predict what interventions we would do) and we have a general idea of what the problem is (it might be the symptoms, it might be the symptoms are causing the client to worry, it might be a family functioning thing or something, etc.) but we need one more part of the question!
WHAT IS THE QUESTION ASKING OF YOU?
This can be a really tricky or really easy part. It’s also one of the most important. and the part I need to improve on....
A question might ask you what to do FIRST. You have four choices. One of them is the BEST answer but ALL of them could be CORRECT. You have to do some book study and figure out where the priority is. Use Maslow, think safety, think ABCs, think what is killing the client fastest, think which client dies first. I don’t really have a way of doing this rationally. When a question asks me what to do first I have to look at it from different points of view to figure out what is priority. Sometimes the other answer choices may not even deal with question. Hypothetical: You have a client going into shock, and one of the answer choices deals with a diet. Obviously, not a priority. Sometimes ALL the answer choices make sense. What I did is if I couldn’t eliminate a single answer because they all sounded good I put them in priority of what should be done first. And what you do first is the right answer. It doesn’t always work but its better than blind guessing. You can relate the answer choices to the patho or symptoms for clues. Like if it’s a respiratory disorder GI interventions don’t take priority. It sounds like common sense. And it is. But if you second guess yourself, well, then what can you do?
See if the question is asking you to complete an INTERVENTION, ASSESS A SYMPTOM, MAKE A NURSING DIAGNOSIS, EVALUATE A SITUTATION, PLAN AN INTERVENTION…etc… The reason for this is simple. If the question asks you what intervention you would complete, you HAVE to pick an INTERVENTION. Why? Because the INTERVENTION will FIX the PROBLEM. You can toss out answers that ask you to evaluate something. How can you evaluate something when you’ve done nothing to fix it? You can toss out answers that ask you to fix the disease but not deal with the PROBLEM. Remember the angry kid who wouldn’t take his meds cause it made him feel sick? Throw out the intervention that says ‘You have to take the meds or you’ll stay sick or get sicker”. Yeah, the kid needs to take the meds. He won’t get better if he doesn’t. But you’re not dealing with his anger or med side effects. An intervention that deals with those makes more sense.
What if one of the answers tells you do document? Ask yourself is this expected? If it’s an expected outcome then it’s ok and you should just document. Doing anything else is redundant or could harm the patient. But you have to know what is EXPECTED!
What if an answer choice tells you to pass on the client to someone else? DON’T! You’re the nurse, you have do something. Just ask yourself “Are you passing the buck?” If you are, then you’re picking the wrong answer.
What if the answer choice is asking you to notify the MD? Ask yourself when do you notify an MD? Obviously, if the situation is an emergency! But what if there is an expected complication, even an unexpected one? Say you have a postop patient from surgery with a dressing and you notice a foul odor. Are you just going to run and call the MD that you smelled a foul odor? Or should you assess the client and see if there is bleeding, how much bleeding? Presence of pus? How much pus? You’re thinking infection, take his temperature. Get all the info that is relevant and try to rule out obvious things before you talk to the MD. What if that foul odor wasn’t coming from the dressing and was coming from somewhere else and you just ran to the MD without assessing? What if the foley catheter is not draining? Run to the MD? No, check to see if its kinked.
It’s really incomplete and I started rambling somewhere towards then end. Just let me know what you guys think.