NCLEX Question on Cardiovascular Medications (Nursing)

00:01 Okay, now this is going to be fun.

00:04 I want you to start to apply the knowledge that you've learned about ACE inhibitors to an NCLEX exam level question.

00:10 These are questions that ask you things from a really different perspective, and so I want you to take a look at it.

00:16 Let me show you how you break down a question.

00:19 "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.

00:30 They're taking spironolactone.

00:32 Now we told you that it's a potassium-sparing diuretic, just so you know that because we're not trying to quiz you on drug names in this.

00:39 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.

00:49 "They've just ordered captopril." Well, we know that captopril is an ACE inhibitor.

00:54 "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.

01:05 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.

01:15 All I know is they're taking a diuretic, spironolactone daily, already, and we're just starting captopril.

01:24 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.

01:34 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.

01:45 So let's look at our options.

01:47 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.

02:04 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.

02:29 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.

02:37 What about assess the patient for any history of GI bleeding? Is there any connection to GI bleeding with ACE inhibitors or diuretics? No.

02:48 So I'm going to cross that one off.

02:49 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.

02:56 Now, auscultate the patient's lung sounds.

03:00 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.

03:12 None of that really applies to just starting an ACE inhibitor.

03:16 But I'm left between B and D.

03:19 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.

03:31 That is the correct answer. Why? Because of that risk of orthostatic hypotension with the first dose of captopril, and being already on a diuretic, that puts them in an even increased risk of orthostatic hypotension.

03:46 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.

03:57 Okay, now, there's several things I did in that question that will help you on any nursing school exam and your NCLEX.

04:04 Spend a lot of time in the stem of the question, read it, break it down, rip it apart.

04:09 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.

04:19 That will help you really focused on the topic of the question.

04:22 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.

04:33 Don't just gravitate to the one that you think sounds good.

04:36 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 of eliminating all those answers one by one and saying why you're eliminating them, you have a much better odds of getting the correct answer.

04:56 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 eliminating answers to give the reason why you're eliminating the answer, if you can.

05:20 Sometimes, you hit a question like, "I don't know?" You just have to give it your best guess.

05:25 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.