Okay, now this is going to be fun.
I want you to start to apply the knowledge
that you've learned about ACE inhibitors
to an NCLEX exam level question.
These are questions that ask you things
from a really different perspective,
and so I want you to take a look at it.
Let me show you how you break
down a question.
"The nurse assesses a client who is taking --"
Stop right there. Okay, so what
do I know about this client?
Not much, right? I just know they're
taking some medications.
They're taking spironolactone.
Now we told you that it's a
just so you know that because
we're not trying to quiz you
on drug names in this.
So, "I'm assessing a client who's taking
a potassium-sparing diuretic daily,
and the health care provider has just
ordered --" Hey, that matters.
"They've just ordered captopril."
Well, we know that captopril
is an ACE inhibitor.
"Which of the following is the most
important action for the nurse to take?"
Hey, the rule in NCLEX is
patient safety is always first.
So for this particular patient
in this particular setting,
what keeps them the safest?
So what's particular about this patient?
I don't know if they're male,
female, young, old.
All I know is they're taking a diuretic,
spironolactone daily, already,
and we're just starting captopril.
So what do I know about a patient
that's just starting captopril?
Well, they're about to get their what?
Their first dose of captopril because
it's just been ordered.
So which of the following things is
the most important action
for the nurse to take?
Well, it's the one that keeps
this particular patient
in this particular setting the safest.
So let's look at our options.
I think you already know there's
probably going to be 4, right?
So we've got assess the patient's heart rate,
educate the patient to take the
first dose at bed time,
assess the patient for any
history of GI bleeding,
and auscultate the patient's lung sounds.
Okay. Well, these are all
pretty good answers, but let's
take a look at that. We know --
what do we know is a risk for
a patient on a diuretic
and starting an ACE inhibitor
for the first time?
Well, is heart rate our most important thing?
Well, ACE inhibitors don't really
directly decrease your heart rate,
so I'm going to say "no," and I'm
going to cross that one out.
What about educate the patient to
take the first dose at bedtime?
That seems kind of weird, but I'm gonna
leave it in. I'll come back to it.
What about assess the patient for
any history of GI bleeding?
Is there any connection to GI bleeding
with ACE inhibitors or diuretics?
So I'm going to cross that one off.
So, so far, I've crossed off the
first and the third answer,
and I hope you're doing the same
thing along with me in your notes.
Now, auscultate the patient's lung sounds.
Well, I auscultate a patient's lung sounds
in case I'm worried if they are
wheezing, or there's fluid volume overload,
or they may be have a pneumonia.
None of that really applies to just
starting an ACE inhibitor.
But I'm left between B and D.
Which one is going to be the best?
Why would I want the patient to
take the first dose at bed time?
Ah, first dose,
ACE inhibitor, I get it.
That is the correct answer. Why?
Because of that risk of
with the first dose of captopril,
and being already on a diuretic,
that puts them in an
even increased risk of
The reason we want them to take it at
bedtime is so that they are already
horizontal. In case they have real issues
with a low blood pressure,
they're going to be safe and warm
and snug in their beds.
Okay, now, there's several things I did
in that question that will help you on
any nursing school exam and your NCLEX.
Spend a lot of time in the
stem of the question,
read it, break it down, rip it apart.
Think about what's particular
about that patient,
what's particular about the setting
we were sending them home,
and what keeps them the safest.
That will help you really focused
on the topic of the question.
Then as you look at the 4 answer choices
or however many there are --
but usually, it's 4 -- and when you look
at those 4 answer choices,
force yourself to eliminate answers.
Don't just gravitate to the one that
you think sounds good.
People often tell me, "I just go with my
gut, and that always works out better."
And I was like, "If that does, then
you'd be a 4.0 student," right?
So, if you force yourself to do the work
all those answers one by one and saying
why you're eliminating them,
you have a much better odds of
getting the correct answer.
So, as you're eliminating answers,
cross through them,
and if you're taking online tests,
you can use a piece of scratch paper.
Usually in most test settings,
particularly, in the NCLEX, you'll have
a write and wipe off board,
but write down the letters
1, 2, 3, 4, or A, B, C, D,
whatever the order of the questions are,
and force yourself as you're
to give the reason why you're eliminating
the answer, if you can.
Sometimes, you hit a question
like, "I don't know?"
You just have to give it your best guess.
And I always tell students, when
that happens to you,
don't let it get in your head. I say, "Elsa
that." You know what that means?
Let it go. Just go on to the next
question. Keep moving.