Antihypertensive Drugs: Diuretics in a Nutshell

When talking about heart conductivity, the first thing that comes to mind is the rate in which the heart contracts – either too much or too little. If the heart is contracting at an increased, irregular, and uncontrollable speed, then what we usually give is a rate-control drug.

Rate-control drugs are your:

  • Beta-blockers
  • Calcium-channel blockers

These drugs affect the electro-excitability within the heart. Diuretics, on the other hand, do not work like that.

What are Diuretics?

In the simplest sense, diuretics are medications that primarily decrease the heart’s workload. Diuretics are medications that are designed specifically to eliminate increased amounts of salt and water inside the body by passing it out as urine. Diuretics that are mainly used for high blood pressure reduces the amount of fluid from the blood vessels which significantly decreases pressure within the vessels. While they are usually prescribed for high blood pressure, there are other conditions that diuretics can treat as well.

Antihypertensive Medications

When talking about diuretics for the heart, there is some pertinent information that you need to know. It can be quite confusing to identify the different kinds of antihypertensive medications. But, there is an easier way to pinpoint which is which; just do the ABCD; those letters stand for the following:

  • A – Ace Inhibitors, Angiotensin Receptor Blockers (ARBs)
  • B – Beta-blockers (rate-control drug)
  • C – Calcium-channel blockers (inhibit electrical stimulations)
  • D – Diuretics (bring down the volume)

Classifications of Diuretics

Think of it this way: diuretics causes diarrhea of the kidneys and the bladder. You are basically diuresing contents out of the body. So what are the different kinds of diuretics?

  1. Loop Diuretics (Furosemide, popularly known as Lasix)
  2. Thiazide Diuretics (Hydrochlorothiazide)
  3. Potassium-Sparing Diuretics (Spironolactone, Aldactone, “-tone”)
  4. Osmotic Diuretics (Mannitol)

To easily ascertain what kind of diuretics you’re encountering, just try to relate to the different suffixes mentioned since these are the most commonly used diuretics in a hospital setting:

  • Loop = Furosemide

Considered as the “big guns” when decreasing workload, loop diuretics are potassium-wasting diuretics; they are fast-acting and effectively take off fluid out of the vascular spaces into the potty and not the body.

  • Thiazide = Hydrochlorothiazide

Thiazides are the second string of potassium-wasting diuretics; think of it as the backup quarterback. This medication is quite effective but not as good as loop diuretics.

  • Potassium-Sparing = Spironolactone, Aldactone

Potassium-sparing diuretics block aldosterone which you can think of as Aldos “Tyrone”). So, Aldostyrone is a nightclub bouncer that stands at the door of your kidneys. He is that bouncer that prevents sodium from going out of the kidneys. Holding back sodium inside the kidneys will attract more water. Blocking Aldostyrone will allow sodium to leave the kidneys and water will instantaneously follow.

Since this type of diuretic is potassium-sparing, there is no need to educate your client about potassium-rich foods. Unlike your loop and thiazide diuretics that you are required to emphasize the need for increased potassium intake because they waste potassium out of the body.

  • Osmotic = Mannitol

Osmotic diuretics are your last line of drugs and are rarely given in hospital settings just because Furosemide is more popular and fast-acting. However, osmotic diuretics can also be provided to decrease blood pressure and volume inside the vascular system.

There you go, a very informative, concise, and useful way of identifying and remembering your antihypertensive diuretics. For other relevant nursing topics, you can head on to our website,

Memory Trick for Remembering Insulin Peak, Onset, and Duration

Hello, nurses!

Are you having a hard time pinpointing and memorizing the different types of insulin with their peak, onset, and duration? Here’s a nifty trick for you – we will show you how to effortlessly recall the peak, onset, and duration of the different types of insulin. This was a question raised to Mike and is now being answered with clarity and ease.

Remember the peak, onset, and duration of insulin is one of the most confusing topics in nursing pharmacology that a lot of students and nurses are having trouble with. But here’s an easy technique for you.

Insulin Peak

First, we’ll tackle the different types of insulin which are:

  1. Rapid-acting
  2. Short-acting
  3. Long-acting

Long-acting insulin does not have a peak. So you can totally smudge that one problem from your mind and just focus on the other types. Short-term acting insulin is between 4 to 12 hours for NPH while rapid-acting is 30 to 90 minutes.

How can you quickly remember that?

First, remember that your rapid-acting is between 30 to 90 minutes. To recognize that short-acting is 4 to 12 hours, you have to multiply rapid-acting time by four so that will give you around 6 hours for the next dose of short-acting insulin.

An efficient way to remember short-term acting insulin (intermediate-acting insulin) is that they end in “-lin” like Humulin or Novolin. So think of these as short actresses that have the height of 4”12’. In that way, you’ll easily point out that short actresses are 4”12’ tall; meaning the peak of short-acting insulin is between 4 – 12 hours.

Insulin Onset

For rapid-acting insulin, you just need to remember that onset is between 15 to 30 minutes then it immediately peaks at 30 minutes until an hour and a half. Knowing the onset of rapid-acting will immediately prompt you that anything above 30 minutes is your short-term acting insulin. So, the onset of short-term acting insulin is from 30 to 60 minutes and because they are short actresses, they will peak at 4 to 12 hours. If you are able to keep that in mind, it’s easier for you to recall short-term acting insulin.

A Quick Recap

Rapid-acting insulin has an onset of 15 to 30 minutes and peaks between 30 to 90 minutes. Some examples of this type of insulin are Humalog and NovoLog.

Short-acting insulin, which Mike also refers to as “short actresses with a height of 4”12’,” has an onset of 30 to 60 minutes and peaks between 4 to 12 hours. Majority of short-term acting insulin medications end in “-lin” like Humulin and Novolin.

Note: Insulin names of rapid-acting and short-term acting are almost similar it’s just that, it is easier for you to identify short-acting insulin because of the “-lin” attached to the name.

Long-acting insulin does not have a peak although its onset is from one hour until 24 hours.

In Other Topics

On our next topic, we’ll be discussing diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS). For those who want to find out more about the nursing topics that usually come out of nursing exams, visit us at and indulge yourself to a wide variety of resources to help you cut your study time while effortlessly memorizing everything you need to beat the system and get higher grades.

See you there!

Renal Labs: Uncomplicated BUN and Creatinine Interpretation

Today, Mike Linares will teach you about one of the favorite topics in nursing exams – BUN and creatinine.

Let’s begin.

The kidneys’ primary function is mainly to filter the following:

  1. Hydrogen ions
  2. Urea
  3. Creatinine

You can easily remember this because your kidneys look like a hook; so that’s HUC (pronounced as “hook”).

Hydrogen ions are acidic. Therefore, with clients who have renal failure, they will be experiencing metabolic acidosis because the kidneys have increased hydrogen ions.

Urea is the by-product or waste product of ammonia that is detoxified into the liver, then goes into a portion of the portal vein and is finally sent to the kidneys for filtering. Once filtered, urea is excreted out of the body in the form of urine. BUN (blood urea nitrogen) technically means the amount of urea concentration in the blood.

Creatinine is the by-product of muscle breakdown. Creatinine is filtered by the kidneys and is also passed out from the body as urine.

Normal Levels

Kidneys filter out creatinine and BUN; this is evident in a metabolic panel. What we want to see in our metabolic panel for creatinine and BUN is a good ratio. This means that normal laboratory values should show as:

  • Creatinine – 0.7 to 1.2 mg
  • BUN – less than 20 mg/dL

Acute Renal Failure

In acute renal failure you have to identify the following indicators:

  1. Urine output – how much pee the client has excreted
  2. Glomerular filtration rate (GFR) – how fast glomeruli (the little washer machines) in the kidneys wash blood milliliters per minute. Normal GFR should be between 85 to 110 mL/min. Acute renal failure clients will show a GFR of less than 60.
  3. BUN and creatinine ratio – if creatinine and BUN have increased ratio. A creatinine that shows more than 1.2 mg will equate to a BUN that’s thrice as much. Example, if you have a creatinine level of 3 mg, your BUN will be 60 mg/dL.

To explain further, the body filters typically creatinine and BUN. However, the most significant indicator for kidneys failing in its primary function (filtering), is the presence of high creatinine. This is because BUN can be high in the body but not in the potty. This could just mean that you are just dehydrated. To remember this, keep in mind that your “BUNs get burned” when you are dehydrated.

Now, if your BUN and creatinine are both increased, you have kidney involvement. If in case you are still confused with kidney involvement, just remember this by recalling that you have two kidneys, therefore, two lab values should both be increased. If you only have “burned BUNs,” then you’re probably just dehydrated.

In the other lectures, we will have a comprehensive discussion on the topics of:

  • Acute renal failure
  • Chronic renal failure
  • Creatinine ratios
  • Oliguric phase
  • Diuresis phase
  • Recovery phase from acute renal failure
  • Recovery phase from intrarenal and extrarenal
  • ABGs with renal failure (sodium, calcium, potassium phosphate)

If you want to check out other topics that commonly show up in nursing exams, visit

Peripheral Catheters: Pulmonary Caths explained (SWANS) Pt 5

In this lecture we are going to talk about the following:

  1. Hemodynamics
  2. SWANS catheter
  3. Cardiac output
  4. Pulmonary artery wedge pressure
  5. Atrium pressure (central venous pressure)


The main reason for to run a hemodynamics test is to measure four different things:

  1. Vascular capacity – how much pressure is going into the heart
  2. Blood volume – how much volume of blood the heart should push
  3. Pump effectiveness – deals with cardiac output, stroke volume, preload, afterload
  4. Tissue perfusion – concerned with the oxygen that the body consumes

SWANS Catheter

SWANS catheter (pulmonary artery catheter), on the other hand, measures three things, namely:

  1. Pressure
  2. Cardiac output – how much blood the heart pushes in one minute
  3. Oxygen – how much oxygen is going out of the heart

To measure pressure, the doctor inserts the catheter into the right atrium (adjacent to the SA node) and inflates the balloon. Through natural force, the air follows the pressure of the fluid inside the heart and will rest at the pulmonary arteries. Take note that the right side of the heart is responsible for pumping blood directly into the lungs; therefore, the inserted catheter will measure the pressure from the body, into the lungs.

Now, remember, right-sided heart failure is equivalent to body failure. This means that the body does not have sufficient amount of pressure to pump blood into the lungs, causing blood to be forced back into the body, which then leads to edema.

Whereas, if there is a backflow of blood into the left ventricle and goes back into the lungs, there will be the presence of crackles, which is one of the symptoms of left-sided heart failure. Remember that left-sided heart failure can also be considered as a lung-heart failure because the fluid from the heart is being sent back into the lungs.

There are three specific ways to measure the pressure inside the heart.

  1. Right atrial pressure (central venous pressure) – this should be between 1 – 8 mmHg.
  2. PAP (pulmonary artery pressure) – always deflated; resulting in systolic pressure of 15-26 mmHg and a diastolic of 5 – 15 mmHg.
  • Systolic pressure is the squeeze, the force that the heart exerts during contraction (depolarization) and into the lungs and the left ventricle.
  • Diastolic pressure is the decompression or relaxation
  1. PAWP (pulmonary artery wedge pressure) – catheter inflation in the pulmonary artery down to the lungs. Inflation lasts for three to five seconds, cutting off circulation for a quick moment. This will provide a direct measurement of the pressure being back-flowed from the lungs to the prongs. The pressure should be between 4 – 12 mmHg. Furthermore, this measures left ventricular pressure and the diastolic pressure; these are just fancy words for left ventricle “filling time.”

Trivia: in a laboratory setting, this phenomenon is determined by brain natriuretic peptides (BNP). BNP inside the left ventricle helps in the stretching of this specific chamber.

If in case the PAWP is less than 4 mmHg, the client will experience hypovolemia or decreased pressure being pushed into the left ventricle. Hypervolemia, on the other hand, happens if PAWP is more than 12 mmHg; which is also indicative of left ventricular failure.

Example, if your client has 18 mmHg, there will be increased pressure on the left ventricle due to the pooling of blood inside the chamber which causes it to stretch further. The backflow will extend into the right ventricle.

Cardiac Output

Cardiac output (CO) measures the blood flowing into the heart. SWANS measures cardiac output through the thermodilution method which you can remember as the cold choo-choo train.

Take note that normal cardiac output is 4 – 8 L/min. In the thermodilution method, how is that measured with the catheter?

The doctor will pump 5 to 10 ml of cold, normal saline into the catheter, which goes through the heart. The measurement will depend on how fast or how long it took for normal saline to travel into the heart; thus, the cold choo-choo train.


This measurement basically focuses on how much oxygen is present in the heart and how much oxygen is going back into the lungs. Here, the SVO2 caliber in the catheter is used. Normal SVO2 is between 60% to 80% hemoglobin going back into the lungs. A fiber optic light is used in this type of measurement.

As a recap, a SWANS catheter measures a client’s:

  • Pressure
  • Cardiac Output
  • Oxygenation
  • Heart and blood volume

When is a SWANS catheter (pulmonary artery catheter) used?

SWANS catheter is inserted in clients who underwent cardiac surgery, usually post-CABG. Here, we wanted to observe how the heart is coping with the procedure. Aside from that, SWANS is also inserted in cases of heart failure wherein the doctor has already exhausted all pharmacologic measures like taking volume-depleting drugs which includes ACE inhibitors, Lasix (furosemide), beta-blockers, and calcium-channel blockers.

How is the SWANS catheter inserted?

The client is put on a supine or Trendelenburg position. The doctor will insert the catheter into the jugular vein of the neck or the subclavian vein right under the clavicle or collarbone. From there, the catheter will then be inserted in the right atrium of the heart.

Antihypertensive Medication: Calcium Channel Blockers – Part 2

Calcium channel blockers are antihypertensive medications that technically reduce hypertension or blood pressure; thus, relieving stress from the heart.

How does one quickly spot a calcium channel blocker?

More often than not, calcium channel blockers end in “-pine.” Not to be confused with another antihypertensive medication known as beta-blockers that end in “-lol.” The most popular calcium channel blocker used in a hospital setting, which doesn’t end in “-pine” is Cardizem (Diltiazem). Cardizem drip is given to clients who have significantly high blood pressure and suffers chronic stable angina or chest pain.

Anatomy of the Heart

How do calcium channel blockers relieve the pressure on the heart that results to smooth contraction? All your questions will be answered momentarily but first, let’s do quick anatomy and physiology of the heart.

The heart’s primary responsibility is to pump blood. Think of the heart as a pumping station that pumps fuel to a car, the car is your body. Blood is composed of nutrients as well as oxygen. If the heart is dysfunctional, blood will not be sufficiently pumped, and the organs will malfunction which leads to the deterioration of the system.

Now, the veins vacuum deoxygenated blood into the heart to be re-oxygenated while the arteries send oxygenated blood away from the body. So remember:

  • Veins – Vacuum
  • Arteries – Away

The left ventricle, one of the main chambers of the heart, is the chamber that is mainly responsible for pumping oxygenated blood throughout the entire body. For this reason, the left ventricle is the thickest and the largest chamber of the heart.

If the peripheral vessels (arteries) are stiff, this causes the left ventricle to push hard against the resistance. If this happens, a lot more energy is required, and the left ventricle exerts more stress to pump more blood into the system.

If there was less resistance, the heart does not suffer. The tendency is for the heart to push as much as it can just to suffice different parts of the body with the blood it needs to function correctly. To lessen the strain on the heart and bring the blood pressure down, you need your calcium channel blockers.

How does calcium works inside the body?

Blood vessels are composed of epithelial cells. Imagine that every cell operates as a city – it has walls, a city hall, a cleaning or trash department, a post office, and gates. The central area that we will be focusing on is the city gates which are known as “channels” of the cell. The primary functions of these barriers are:

  • Break down enzymes
  • Allow enzymes into the cell
  • Releases enzymes from the cell

One of the main channels that you want to block in cases of hypertension is calcium. Why do you want to prevent calcium from coming inside the cell? This is because calcium is a mineral that contributes to the following:

  • Cellular connection
  • Blood clot
  • Muscle contraction
  • Nerve function
  • Teeth and bone strength

Calcium hardens the cells which then makes the arteries rigid. Increased cardiac output and stroke volume are two identifiers that the left ventricle is putting a lot of effort to pump blood into the stiff vessels.

Mechanisms of calcium channel blockers

This is where calcium channel blockers come in. Calcium channel blockers prevent calcium from entering the cells which lessens the cell’s hardness thereby making the blood vessels or the highways of the heart more flexible. It is now easier for the left ventricle to push blood out of the heart and into the vessels resulting to lower blood pressure.

For those who haven’t had a copy of the Pathophysiology Bible, get yourself a copy now. It contains more 70 concept maps that you can utilize for your clinical days. Concept maps vary from nursing outcomes, interventions, signs and symptoms, and pathophysiology of the Top 70 diagnoses of common admissions inside the hospital. With the Pathophysiology Bible, your study time will be cut by 200%.

For our next discussion, we will be tackling Nitroglycerin and vasodilators. See you on our next lecture!


OB Nursing: Fetal Heart Monitoring – Part 5

In this part of OB nursing, we’ll discuss fetal monitoring with pregnant women who are in labor.

Whether it’s a client coming into the labor room, or someone who’s had her water broken, or even anytime that you are required to do a fetal assessment, this is what you’ll need to do.

To begin with, there will be two monitors placed on the mother’s belly; one will measure the contractions while the other will measure the fetal heart rate or fetal heart tones. Focusing on the fetal heart rate, there are certain classifications that tell whether the heart rate is:

  • Reassuring
  • Elevated
  • Early deceleration (bradycardic)
  • Late deceleration (severely bradycardic)

Classification 1: Reassuring

In reassuring, the egg cells last for 15 beats per minute over a period of 15 seconds. This means that there is baseline of 140 which goes up then goes back down. So that’s 15bpm. This is similar to a reactive stress test. If there are two accelerations, it just means that your baby’s moving which makes the heart rate go up.

Classification 2: Elevated heart rate

How can you spot an increased heart rate? The baseline is usually above 160. This is now referred to as tachycardia. Here, there’s inadequate blood supply that can either be caused by a lot of factors like drugs, medication, or infection. Any type of external stressor or sepsis (infection) can cause elevated heart rate. Tachycardic babies can show a heart rate of 180 and can even reach as high as 200.

To confirm the presence of infection, the doctor might order an amniocentesis to take samples of amniotic fluid and trace where the infection started inside the body.

Classification 3: Early decelerations

What you have to remember with early deceleration is that the baby’s heart rate goes down as the mom’s goes up. The mom’s uterus is contracting to push the baby out thereby dilating the cervix to 10cm. All that pressure that the uterus is doing on the amniotic sac is causing the placenta to become stressed, thus the decrease in the baby’s heart rate. After that quick dip, the baby’s heart rate will return to its normal baseline with contractions.
Early decelerations are good. Remember, it’s good to be early.

Classification 4: Late decelerations

If there’s good, there’s definitely bad. Late decelerations are the worst classification of fetal heart rate because as previously mentioned, after contraction, the baby’s heart rate should immediately return to its baseline. Late decelerations occur when the baby’s heart rate does not return to normal. What you’ll see on the monitor are fluttering lines, like a bird flying down or a staircase.

Possible indications for this would be oxygen depletion with decreased uterine blood flow; there might be an insufficient placenta, possibly placenta previa. Interventions for late decelerations are:

  1. Lower the head of the bed and turn the mom on her left side to take the pressure off the vena cava and allow blood flow to the heart and to the lungs. Note: This is a key nursing intervention so you have to keep this in mind.
  2. Re-oxygenation or the reintroduction of oxygen to the baby by giving oxygen to the mother. Give about six liters of oxygen.

This intervention will allow re-perfusion to the uterus and manage late decelerations.

In cases that standard interventions don’t work and late decelerations are still showing, the best way to deal with this is through a C-section. This is because you have a de-oxygenated baby that is getting too little oxygen who is going to die. Once the baby is out of the womb, resuscitation will follow.

So, that’s it for fetal heart rate monitoring. Check out our previous OB nursing lectures from part 1 until part 4 in our other videos and web pages by visiting

Key Terms for NCLEX® Delegation and Management Questions

Recent NCLEX® topics are primarily focused on delegation, prioritization and leadership. Among those that were mentioned, delegation type questions are going to be a huge part of nursing schools.

Fortunately, Mike is here to provide the gist and the important keywords that you have to watch out for every time you encounter delegation and management questions on your comprehensive exams, especially on your NCLEX®.

The PACET Method

When dealing with client and task delegations, there are five things that you cannot entrust to other people and that is broken down into the acronym, PACET (pronounced as “paket”). As a registered nurse, you cannot delegate the nursing process which is also known in other schools as SOAPIE, ADPIE, or DAR. Mike simplifies this as PACET.

P for Planning

If you are an RN, one of your main tasks is to plan and collaborate for client goals; thus you cannot delegate planning to an LPN or a CNA. This is because it is expected of you, as a registered nurse, to take on full responsibility of your client and you cannot share that responsibility with other healthcare teams.

A for Assessment

Secondary assessments can be delegated; however, you cannot pass primary assessments to anybody. That said, can you pick which is the right answer to the question below?

Q: Which of the following clients would you delegate?

  1. A post-op client who just came out from the operating room
  2. New admissions
  3. Three-day-old chest pain

When picking the right answer, you always have to remember that nurses do the first assessment. Now, among the three situations given above, which do you think needs first assessment?

Answer: The client who just came out of the operating room is unstable and needs initial assessment which is also termed as vigilant assessment. On the other hand, nurses are required to gather more information from new admissions. Therefore, both post-op (A) and new admissions (B) are NOT to be delegated.

So now, you’re left with the post-operative client who’s already been in the hospital for a couple of days and is considered stable. So the answer for the question above is “C”.

C for Collaboration

Collaboration is for working with other members of the healthcare team to achieve client goals. Some of the collaborations inside the hospital are wound consult, social services, dietary services, and if the client needs a respiratory therapist. Only the RN does this kind of collaboration, not the LVNs.

E for Evaluation

LPNs and CNAs can take note of the pain scale and vital signs but are not allowed to evaluate because it’s specifically the RN’s role – to think critically and evaluate efficiently. Therefore, the nurse should evaluate:

  • Care plans
  • Client goals
  • Vital signs
  • Pain scale

T for Teaching

Primary education or client teaching cannot be delegated. LVNs can reinforce education but they are not responsible for providing exemplary client education to decrease complications that might occur after discharge.

During the exam

Keep in mind, during your NCLEX®, that if you see any of the PACET keywords the multiple choice questions, it’s automatically the correct answer under the topic of delegation. Once again, those that you should not delegate and are your primary responsibilities are:

  • Planning
  • Assessment
  • Collaboration
  • Evaluation
  • Teaching

As registered nurses, you have to assume obligation and accountability for the five keywords mentioned above. Furthermore, being keen on identifying if it’s primary or secondary evaluation can help you quickly point out the right answer to your NCLEX®.

Don’t forget PACET.

For more information and other easy-to-understand nursing lectures and videos, visit our website at

See you in the next video!

Ace Your NCLEX® and Exit Exam in 3 Outrageously Simple Steps

Hello, we are back to give you the simplest, most uncomplicated way possible to get you through your exams, whether it’s the HESI or ATI or even your NCLEX.

Comprehensive exams are something that student look forward to but wish would never happen. It’s probably one of the most stressful times in a nursing student’s life. And more often than not, they make it difficult for everyone. And for that reason, we at will provide what you need to do and what you should not do when taking your exams.

Test preparation

Doomsday is right around the corner and you feel like there’s still so much to comprehend, memorize, and remember. Universities or colleges usually allow students to prepare for at least seven to 14 days. HESI or ATI week is one of the most stressful periods of students’ lives that they even experience physical manifestations like ulcer, anxiety, panic attack, and insomnia.

Preparation for comprehensive exams feels like dumping a lot of information in your brain all at once and remembering nothing at all. But fear not, Mike is here to help make things simpler and far less complicated. This game plan in facing your exams has been proven effective by over 40,000 students and counting.

Step 1: Focus on the top three most difficult subjects of the semester.

Passing nursing exams is not rocket science. You need to create a plan that works for you which is effective enough to get you from point A to point B. Studying all the materials given at school is not enough. Initially, you need to create a strategic plan to conquer the most frustrating parts of studying.

So, the basic goal here is to select which subjects are giving you the hardest time and underneath that, prioritize the topics that you find most difficult to comprehend. Know where to focus your time and effort. Instead of focusing on what you have already mastered by heart, concentrate on the areas that are crippling your mind.

To give you a solid example:

Your HESI or ATI is coming up, and you’ve realized that on all the areas that are covered by the exams, the subjects that are giving you a hard time, namely:

  • Medical-surgical
  • Pharmacology
  • Pediatrics
  • OB
  • Psychiatric

Note: Usually, community health questions do not show up on the exams or have a significant effect on the test questions.

So, among the provided list of subjects, which of the three are giving you a hard time? As for Mike, his Waterloos are medical-surgical, OB, and psychiatric nursing. So, the next thing that you should do is to identify which top three topics about medical-surgical, OB, and psychiatric nursing stress you the most. Mike has identified his topics like this:

  • Medical-surgical – Heart, Lungs, Brain
  • OB – Labor, Mom assessment, Prenatal
  • Psychiatric – Pharmacology, Two (2) types of personality disorders

That’s basically the top three hardest topics of your top three hardest subjects which you should be focusing on. But that’s not all. You should also identify underneath the top three topics, the sub-topics that you struggle with the most. For example, what lessons about the heart do you find most difficult? Write it down.

Now, because there usually are more than three areas that we struggle with for our sub-topics, that’s the time that we head on out to our step two.

Step 2: Create a plan.

Now that you know where your focus should be, the next thing that you should do is to make the plan and implement it in an organized manner. In creating the plan, you have to do a couple of things:

  1. Print out a calendar. Take note that HESI or ATI exams give at least two weeks of preparation. However, if you are in an accelerated program, you probably just have seven days to take it all in. That’s not sufficient at all. Now, to give you a better picture, if you are given two weeks to study, you will do so in four to six days in a week which means, in 14 days, you will have 8 to 12 rigorous study periods.
  2. Pinpoint important dates. In order to implement the study days, you should point out the date when you would start studying, as well as the date of the exam.
  3. Cross out your calendar. Get a red pen or marker then diagonally cross each day out. The diagonal line is the division between your morning (AM) and afternoon (PM) study sessions. The division of AM and PM is to save your brain from fatigue. Rigorous study hours, usually consisting of up to eight hours in a day is not helpful at all. This is because the exhausted brain will normally zone out what you’ve studied in between and just remember what you’ve learned at the beginning and the end.
  4. Break up the days. It is advisable that there should only be three hours of studying done in the morning. As for the PM study session, that will be tackled on step 3.

Now, you’re wondering, “Why is it just 3 hours in the morning? And why does it have to be in the morning?” Mornings are the best time of the day to be active and productive. The brain has replenished itself from a well-rested sleep, making it fruitful that it can accommodate complex questions.

Furthermore, the reason why you should only study for three hours in the morning is because in a span of three hours, you’ll be able to answer and rationalize 60 of the most difficult questions about the complicated sub-topics that you have previously identified. Here’s how:

  1. Break down your three hours.
  2. For every hour, you have 20 minutes to answer 20 questions, then 40 minutes to rationalize. You will also be doing this in your second and third hour.

This technique works effectively for anyone especially for those slow, anxious test-takers. For those who have text anxiety, Mike suggests the following effective methods:

  1. Stress yourself out within the 20 minutes of taking the 20 questions.
  2. Listen to loud, distracting music that you hate.
  3. Hope on one foot.

Distraction within those 20 minutes is recommended because it will take you out of your comfort zone and make you immune to other forms of distraction during the test day. You might think that’s nonsense but it actually works for most people because it lessens the anxiety and increases focus.

What to do in the remaining 40 minutes? Aside from rationalizing, you should note down the topics that you’ve missed. These are the topics that you’ve missed within those 20 minutes.

Not only have you accomplished 60 test questions in three hours, you’ve also accumulated and outlined 60 specific topics you are having problems with. This technique saves you a lot of time than scouring through all your nursing books and jotting down the topics that you don’t know.

Step 3: Summarize and memorize content efficiently.

Now, we go to your PM study session. Study time here should not be more than four hours. Come to think about it, AM and PM sessions combined, you have a total of seven hours study time. Not bad.

By now, your anxiety must be getting the best of you. Don’t worry, you have we have a plan. And this plan is going to take you from A to B. One of the main reasons why students fail, aside from not studying efficiently, is because they did not stick with their plans. Whether it’s a HESI, or an ATI, or NCLEX, for as long as you have a plan and don’t divert from it, you’ll be okay.

So, step 3 is about condensing information you absolutely have no idea whatsoever. There are a couple of options that you can do to review these certain topics – go back to the same boring nursing books and climb that steep hill all by yourself or get condensed videos of those topics. You’ve probably seen some of these videos containing summarized topics like the Liver Song and ABGs. There are about 900 videos available at that you can rely on to carry you through these tough 14 days of your life.

Even better if you avail of one our membership plans. Mike has managed to condense three comprehensive NCLEX study guides and other nursing materials. With, you don’t have to figure out which topics you need to focus on because Mike’s done that for you. Aside from that, Mike has arranged keywords and acronyms inside those videos to make it easier for you to understand.

During your PM study session, use the list of topics you’ve gathered in the morning from the test questions then search the website database for keywords. There are about 300 videos available in YouTube for free! But that’s just the tip of the iceberg or 30% of the overall topics that we can provide; 70% of those videos are locked in our membership vault.

So here’s what you have to do with the list of questions you’ve missed in your AM session:

  1. Match the questions or topics to the video content available on YouTube or in our membership plan vault.
  2. Using a regular computer paper, make a four-square outline.
  3. In each of the box, write down the topics that you’re having difficulties with like for example:
    1. First box – Heart
    2. Second box – Lungs
    3. Third box – Brain
    4. Fourth box – Other
  4. These boxes are useful when watching our videos by getting the key information that you might be struggling with and writing it down the specific box.

For example:

If you are taking Neurology exam and you are struggling with multiple sclerosis, or Guillain-Barre Syndrome, or ALS, in Mike’s videos, there are a few key things that he touches on wherein he strongly points out that it is significant to know those points because they usually come out in the tests.

  1. Write those key points, the only need-to-know information, inside the boxes which you can think of as a filing cabinet.

Track your progress

So imagine that it’s been seven days. In a span of seven days, what have you accomplished?

  1. 240 to 360 questions. Inefficient instructors will tell you that you should finish test questions of not less than 400. This is not beneficial to you in any way. Your mind will reach its limit even before you get to the 100th Mike’s words: 60 questions per day and that’s it.
  2. Up to 360 topics are uncovered and understood with qualifying keywords on your piece of paper.
  3. That piece of paper can be brought anywhere and everywhere. Do not be chained to your books.

Don’t miss out on the good stuff

This three-step technique is really everything you need to make it through whatever exams you have. If you’re wondering if this applies for your finals, there is actually an entire course on that at which will absolutely blow your mind. The success stories that we have will inspire you. If they can do it, so can you.

We highly recommend that you become a member especially for those who are struggling with HESI, ATI or NCLEX. All you need to do is drop by and ace that test!

Hematology for Leukemia and Blood-Related Cancers – Part 1

Hello. We will be discussing leukemia and its pathophysiology with its different types.

What is leukemia?

Leukemia is cancer in the blood. “Leuk” came from the immature white blood cells known as blasts; while “-emia” means condition. Basically, what happens with leukemia is that there is an increased production of blood which caused crowding inside the bones.

Normally, the stem cells in the bones are mainly responsible for creating blood cells – red and white blood cells and platelets.  In leukemia, there is an overproduction of white blood cells (WBC). You can think of it as having too many policemen inside a restaurant, causing overcrowding and disproportion with other blood cells.

What should you watch out for with clients that have leukemia?

  1. Elevated WBC count, extremely high
  2. Bone pain due to the pressure of overcrowding inside your bones
  3. Decreased numbers in the other blood cells (platelets, red blood cells, hemoglobin, hematocrit)

What are the different kinds of leukemia?

There are technically four classes of leukemia – the acute and chronic myelogenous leukemia and the acute or chronic lymphoid leukemia. These types mainly depend on how fast the production of white blood cells is in the body.


In a person’s blood stem, there are also different types of white blood cells, one of which is the myeloid stem cells.

Overproduction of the myeloid stem cells causes acute and chronic myelogenous leukemia. Acute myelogenous leukemia (AML) is the rapid production of white blood cells in a course of a few days. On the other hand, chronic myelogenous leukemia (CML) took weeks or months for the white blood cells to increase.


Much like AML and CML, if the problem started with the lymphoid cells, it progresses into either an acute or chronic leukemia – basically known as your acute lymphoma or lymphocyte leukemia (ALL) and chronic lymphoid leukemia (CLL).

Signs and Symptoms 

Regardless of leukemia type, whether it originated form the myeloid stem cells or the lymphoid cells, the client is going to exhibit the following signs and symptsoms:

  1. Decreased hemoglobin and hematocrit levels
  2. Low platelet count
  3. High white blood cell count
  4. Bone pain
  5. Paleness
  6. Presence of hematomas

Test question tip

Nursing exams love to put in a particular question regarding your chronic myeloid leukemia (CML). There is a specific kind of test that primarily indicates the abnormality in leukemia cancer cells that pertains to CML. It’s called the Philadelphia Chromosome. And the main demographic that this affects are pediatric clients for some unknown reason.

Remember: If a particular disease cannot be explained or there are no specific reasons why the disease happened in the first place, it’s called as idiopathic; being idiots in the pathophysiology.

So, if you encounter nursing questions that states a client came in showing signs and symptoms stated above yet it’s idiopathic, the answer would most likely be chronic myeloid leukemia (CML).

On the next part, we tackle the main clinical manifestations of leukemia. We’ve already mentioned some but we’ll break it down further for you to properly understand what’s really causing all those manifestations when a person has leukemia.

See you on part 2!



Psychiatric Pharmacology Made Easy – Part 1

One of the biggest topics in nursing school is psychiatric pharmacology. Here at, we breakdown every single vital information and present it to you in the simplest possible way.

Before going into the drugs that are primarily used for psychiatric clients, we will first tackle the pathophysiology. You have to keep in mind that before you know the mechanism of each type of drug, you must first know what it affects.

So, let’s get into it.

Psychiatric medications affect three major neurotransmitters in the body, namely:

  1. Dopamine
  2. Serotonin
  3. Norepinephrine

Reminder: Dopamine and serotonin are your reward and happiness hormones.


According to nursing books, dopamine inside the brain is for reward, pleasure, motor function, and compulsion. To easily remember all these, remember DOP. It basically stands for:

D – Determination (motivation)

O – Obsession (addiction to drugs like cocaine, methamphetamine, stimulants)

P – Pleasure (reward)

Frontal cortex of the brain is mostly affected by dopamine as a neurotransmitter.

Reminder: Dopamine for the rest of the body is different from dopamine inside the brain.

Basic concept to remember

The brain has a filter, like that of brewing a coffee, which is technically called as the blood-brain barrier (BBB). This BBB filter prevents chemicals and toxic elements to enter the brain to avoid unwanted consequences like the brain shutting down. Think of the BBB as a border patrol or security that doesn’t allow anything and everything to enter the brain.


This is your happy hormone. Serotonin can be best remembered by thinking of Siri, the iPhone application who basically makes you happy because she can answer any kind of question. In the nursing book, serotonin is referred to as your mood, sleep, cognition, and memory. Forget the book and just remember SER:

S – Sleep

E – Emotion

R – Remember

Basic concept to remember

Inside the brain, serotonin first affects the hippocampus and then it goes all the way around the brain, sort of like a racetrack. To remember that serotonin acts on the hippocampus, you can just think of a huge hippo with a bunch of knowledge, walking around campus.

Norepinephrine (Levophed)

Norepinephrine is primarily seen in MAOI drugs and atypical antidepressants. It is the same category as epinephrine (adrenaline) which is also called as noradrenaline or your stress hormone. Stress hormones trigger the body’s sympathetic nervous system (SNS) that then activates the increase in heart rate and blood pressure and the fight and flight mechanisms. If your SNS is activated, your parasympathetic nervous system (PNS), also known as your rest and digest, is automatically deactivated which means that you will be unable to produce gastric juice that is used for digestion and your bowel movement.

So, to remember ALL that, you can associate norepinephrine with NOR:

N – No hesitation

O – On alert

R – Recall memory

Basic concept to remember

Hypertension is a huge qualifier for norepinephrine, especially with MAOI. Also, one must take into consideration the cognitive alertness of a person. Example, a person is going into septic shock or any kind of shock for that matter, norepinephrine is immediately given.

As what Mike’s instructor said, “You use Levophed or you leave him dead.” This is because norepinephrine (Levophed) is the last line of drugs to get increase blood pressure, squeeze in and vaso-press (vasopressor) all the blood back into the vital organs or your SNS (heart, brain, lungs), urgently supplying them with oxygen.

Mike’s study tip

Get three note cards. Separately write down DOP, SER, and NOR on each note card. Copy the acronyms provided by Mike or what he likes to call “memory tricks.” Put in all information for the specific acronym. For example, for the DOP card, put in its equivalent meanings and what it mainly affects in the body.

What do you put at the back? It’s going to be further explained on the next video. So stay tuned!

For the meantime, has created its first psychiatric course called Psychiatric 101. Here, Mike focuses on the struggle points which are the areas where students usually fail. What are these struggle points?

  1. NCLEX®-style questions
  2. Pharmacology

Psychiatric 101 is mainly created to help students pass and clear their understanding of the topics then retaining it fully. Mike will help you breakdown the biggest issues on psychiatric nursing and pharmacology. Just visit our website and be a member of our diamond and annual plans to request videos or have live webcam streaming for lectures.

Check it out!