Case Study: Client with Diabetes, COPD, and Hypertension (Nursing)

00:01 Okay, here we go. Here is another kind of long question.

00:05 "Mr. Rosenstein has a history of Type II diabetes, COPD, and hypertension." Okay, when you get multiple diagnoses in a test question, we don't know if it's going to be the diabetes, the COPD, or the hypertension that we're dealing with.

00:20 So just kind of file it away in your brain.

00:22 You have a picture of what this patient's history is.

00:25 Now, "He also has an acute bacterial infection of the right leg.

00:30 The wound drainage is purulent.

00:32 His vital signs and blood pressure are 142/88.

00:36 Pulse is 97, respiration, 16, and temp is 39.4°C." Before you go on, let's go back to that sentence and break it down like we've talked about.

00:47 So, we know that he has these chronic problems: Type II diabetes, COPD, and hypertension.

00:53 But he also has something going on right now that's acute; a bacterial infection of his right leg.

00:59 Now, the wound drainage is purulent, so we know that we have an infection.

01:04 His vital signs are 142/ 88.

01:07 Now that's a little higher than we would like it, but I'm not really alarmed.

01:11 His pulse is 97. That's within normal.

01:14 Respiratory rate is fine, it's 16.

01:17 Temp is 39.4°C or 102.9° Fahrenheit.

01:21 That's a little high.

01:23 Now, with what I know about him, oh, he has an acute bacterial infection, his temp is high. That means his body is working at fighting that infection.

01:32 Look at that last sentence.

01:34 "Which of the following would you most likely anticipate seeing when his lab results are returned?" All right. I've got written A, B, C and D on my paper.

01:46 Now when I look at the answer choices, I notice that -- I almost go cross-eyed.

01:50 They all look the same. White blood cell, white blood cell, white blood cell.

01:54 That's good. We see a pattern there.

01:56 So, really, what this question is asking me is, "What would I expect to see with someone who has an acute infection," right? We had to work through a lot of stuff to get to that point, but because we spent so much time in the stem, this is going to go a lot quicker.

02:12 So I know before I even look at these answer choices, I'm going to expect a white blood cell count that is elevated.

02:20 So, A, I -- white blood cell count of 7, that's within normal, I can get rid of it.

02:26 B, ooh, a white cell count of 13. Okay, that's higher than normal.

02:31 I'm going to leave that one in, but I'm not going to stop there.

02:35 White blood cell of 4 in option C. Oh, that's normal. We can get rid of it.

02:40 White blood cell count of 9. That's also normal so we can get rid of it.

02:45 Correct answer? Right. It's answer B.

02:49 Okay. So even if you got that question, right, you're like, "Eh, I got that without eliminating answers," don't do that to yourself.

02:56 You want to take your time and think through every question.

03:00 Remember, when you're on the NCLEX and you're taking those questions, when you are slow and methodical, but accurate, you'll actually end up having a shorter test. It will shut off sooner, which is what everybody wants.

03:13 When you're taking your nursing school exams, if you take your time and focus yourself, you'll also see an increase in your exam scores.