Exam Question on Endocrine System – NCLEX Review (Nursing)

00:01 Okay, enough repetition and going over that.

00:03 Let' see how you're gonna do all on your own.

00:06 I want you to put all the signs and system from head to toe on Cushing's and then on the other side, Addison's.

00:14 So make sure to pause the video and invest the time to do that now.

00:20 Let's look at an NCLEX question you've already seen.

00:24 Remember back at the beginning of this series.

00:26 So the nurse assesses a client's at-home medication compliance.

00:31 Mrs. Baird, a type 1 diabetic, and has been prescribed albuterol, lisinopril, methylprednisone, fludrocortisone for 10 years.

00:40 Which of the following patient statements requires immediate follow-up? Right, that last sentence is my major focus.

00:48 I'm looking for the statement that requires immediate follow-up.

00:52 That means it's something wrong or unsafe for this particular patient.

00:56 Let's go back up and find out what's particular about this patient.

01:00 So I'm looking at their at-home medication compliance.

01:04 I know the patient, Mr. Baird, is a type 1 diabetic.

01:08 He's been prescribed albuterol, lisinopril, methylprednisone, and fludrocortisone for 10 years.

01:16 Okay, that matters. That's a pretty long length of time.

01:20 And I know they're diabetic and they've got albuterol which is a bronchodilator, lisinopril which is an ACE inhibitor for blood pressure, methylprednisone and fludrocortisone, those are corticosteroids.

01:30 So I'm looking for something. I don't know yet which one we're talking about.

01:34 If it's the diabetes, if it's any one of those medications, but I know the topic of the question is looking at medication compliance and what requires immediate follow-up.

01:45 Well, when you look at all 4 of these statements, I know you read them before the last time you saw this question.

01:52 I've noticed that my face looks a lot fuller since taking my medications.

01:57 Well, we know that's due to corticosteroids.

01:59 My heartbeat is faster and I feel shaky when I stand up.

02:04 That could be a sign of low volume. That's also corticosteroids.

02:09 I use my inhaler when I feel short of breath after walking.

02:13 Does that require immediate follow-up? No. No, that's fine.

02:18 What about my blood sugars are difficult to control and my doctor has been -- has ordered sliding-scale insulin coverage. Does that require immediate follow-up? Well, hopefully even though we gave you 60 seconds and I know that seem probably short for a lot of you.

02:33 I hope you use this process of eliminating answer choices.

02:37 Now, which one do I feel most comfortable getting rid off? I'm gonna get rid of A.

02:42 Yes, that is a known side effect of the medication. It doesn't put the patient at risk.

02:47 Now, what am I gonna get rid of next? Right, I'm gonna get C.

02:52 We already said that one is fine. It doesn't require immediate follow-up or any follow-up.

02:57 That should be okay. But I'm left between B and D.

03:01 Now, I know that both of these have a connection to corticosteroids but where's an actual problem and where's a potential problem? In D, my blood sugars are difficult to control and my doctor's ordered sliding-scale insulin coverage.

03:17 Oh, that gives a patient options.

03:19 They can cover it so that doesn't require immediate follow-up that's why the correct answer is B.

03:26 Of these 4 statements, and remember, that's how you play the game.

03:30 It's like we're playing cards and I dealt you 4 cards.

03:32 You can't say oh, I wish I had another answer. I wish I had another card.

03:36 No, they're testing of the 4 options that you're presented with, which one is the most correct? So requiring immediate follow-up is B because we're looking at we know heartbeat is faster, I feel shaky when I stand up.

03:51 We wanna make sure the patient understands why they feel that, what they're experiencing, and assess them for dehydration.