NCLEX Question on BUN (Nursing)

00:00 Hi, welcome to our series in interpreting lab values.

00:04 Now in this one, we're gonna take an NCLEX level practice question and I'm gonna walk you through step-by-step how you can start raising your test scores in answering these questions.

00:14 Okay so here it is, Mr. Miller has been diagnosed with COPD, CHF and stage 3 chronic kidney disease.

00:23 Wow, that's a what.

00:24 Okay, he's come to the emergency department with complaints of shortness of breath and severe swelling in his legs, which of the following assessments would you anticipate? Okay, I want you to go ahead and just do your normal process and answer that question.

00:37 So put us on pause, pick out which answer you're gonna go with and then restart the video when you're ready to walk through it.

00:48 Okay, welcome back.

00:50 I hope you took the time to answer the question the way you normally do on an exam and I'm gonna give you some other recommendations for you to consider.

00:57 I work with NCLEX students, tutoring them for years and these are some of the things I've learned that have been the most successful for them and it's easy for you to do too.

01:07 Now look what I've done there, there's no answer choices.

01:10 This is the hardest thing for people to do but I'm gonna ask you to ignore.

01:16 You have to put your hand up on the screen, put something over where you don't see it.

01:20 I'm gonna ask you to ignore the answer choices because you're going to get a much better answer if you'll just looked at the stem of the question first.

01:30 I'm gonna show you what I want you to be looking for in the stem but the stem is what we call the words before the answer choices.

01:37 So we've already read through this, you know this question.

01:40 what are the types of things you should ask yourself? First of all, what are the diagnoses that you see? Ugh, this guy like most of our patients has three of them, right? So underline COPD, CHF and CKD stage 3 Now I know in an NCLEX test, you're taking it online, you won't be able to underline that but I want you to have this in your notes to remind you that that's something you focus on.

02:08 So underline those three diagnosis in the test.

02:11 So we've got them there in a different color, just so you can see that Next thing, what diagnosis do you see? Then you want to look at what setting are you in.

02:21 We're in the emergency department.

02:23 So underline emergency department, you'll see that we have that highlighted, by a different colour but setting matters.

02:30 So I'm gonna do things differently if I'm a school nurse at a picnic versus a meeting in an emergency department or in a hospital.

02:38 So make sure you're aware of what setting you're in.

02:42 Next up, what assessment data do we have? We've got a lot but any time you see assessment data, you always have to ask yourself is it normal or abnormal? So if I see a number, is it high, low or normal? If I see a description, is that normal or abnormal? because we want to make a connection to the diagnosis to let us know if that patient is in trouble.

03:06 So look at the assessment data we have, complains of shortness of breath and severe swelling in his legs.

03:13 Yeah, we're real clear that both of those are abnormal, right? Looking back at diagnosis COPD, CHF, chronic kidney disease - those kind of go along with that, right? Now we're gonna look at the information in the answer choices.

03:30 So we've got four options here, these are all assessments so I want to look at each one first of all and see, is that BUN high, low or normal? So I want you to work through all four of those and write a letter down, is it high, low or normal? You can use arrows, you can use letters but I want you to see, can you make a call on each one of those assessments? Okay now, for any abnormal lab work, does it tie back up to the patient's diagnosis? Okay, so I know a normal BUN is 7-20 (mg/dL), this is 18 (mg/dL) so I'm gonna cross that off because that's a normal value.

04:16 Now a GFR that's 45 is little bit low, right? that's not normal and that does have a connection because we know that he has chronic kidney disease.

04:26 What about that potassium? Well it's slightly low, what does that have to do with his diagnosis? What about his blood pressure, is that high, low or normal? Again, it's a little low but not usually significant, is it? So I know I've gotten rid of the normal value, I have three left that are a little bit on the abnormal side.

04:50 I'm gonna get rid of that potassium.

04:52 Not a strong connection there and they haven't told me about other medications that they're on so if I thought he was on dig (digoxin), that might make it a little more complicated but that was not given to me in the stem of the question so I'm gonna get rid of potassium.

05:05 Now I'm stuck with GFR and blood pressure.

05:08 Make sure I'm asking myself that last sentence of the question.

05:12 It's asking me which of the following assessments would i anticipate? so would I expect somebody with COPD, CHF and stage 3 chronic kidney disease to have lower blood pressure or lower GFR? Right, I would expect them to have a lower GFR.

05:32 Patients with these diagnoses generally have a higher blood pressure.

05:36 So the correct answer is B, a GFR of 45 milliliters a minute, so what I want to encourage you to do is discipline yourself to wait to look at the answer choices until you've broken down the stem of the question.

05:51 First think, then look.