NCLEX Question on NMBs (Nursing)

by Rhonda Lawes, PhD, RN

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    00:00 Okay, let's practice with some of these questions. The healthcare provider has ordered a pancuronium drip. That means we're going to put that medication in an IV and have it going continuously. So, the healthcare provider has ordered a pancuronium drip. Underline pancuronium drip. Now, this is for a patient who has developed ARDS. Underline ARDS. That's a diagnosis. Following pneumonia. That's another diagnosis. And is now on the ventilator. Okay, so you've got a picture. It's most important for the nurse to take which action before starting the infusion. You know the things we recommend when you look at a stem of a question like this. Now, you're the nurse. That's who you are. The healthcare provider has ordered something. It's pancuronium which is a drug. So, right in there we already know pancuronium is a neuromuscular blocker. Good. So, we have a patient that's going to be on this drip. We know what we know about this medication. Ahh, they're not going to be able to breathe. We want to watch them closely for a low blood pressure or not low blood pressure, keep that in mind, and now we know that it's after ARDS and pneumonia. So, they were sick with pneumonia. We know that ARDS is worse than pneumonia. These are lungs that are really, really struggling. Does that make sense for a healthcare provider to order a pancuronium drip for a patient whose lungs are really, really struggling? Yeah, because we know you give neuromuscular blockers when you want to really power somebody down, so we can focus on healing. All the patient's energy goes to healing instead of fighting the ventilator. Now, good thing we know they're on a ventilator. That's good because we know they can't breathe on their own. Always the last sentence of the question you want to read multiple times. So, it is most important, right there tells me, huh, there could be more than one right answer because it's asking me to prioritize. It is most important for the nurse to take which action before starting the infusion. Ahh, so what's most important for me to do before I start the infusion? Well, first option, teach the patient to, wait a minute, I forgot a really important step and this is usually the one that students are most resistant to do. It's take the question and put it in your own words. Now, this one will pay off huge for you if you'll take the time to do it.

    02:36 So, I would say for someone who's got really bad lungs, ARDS, and pneumonia, I'm going to start a pancuronium drip, and they're on the ventilator. What's most important for me to do before I start the infusion? Well, these questions are always tied to safety, so it's something.

    02:53 I don't know if it's about ARDS. I don't know if it's about the pneumonia. I don't know if it's about the vent or pancuronium, but I know that those are the variables that make this patient unique. So, first of all, teach the patient deep breathing exercises. Is that most important? Okay, well they're going to be on neuromuscular blocker and on the vent. They'll have no control of their breathing. Will they? But I looked at administering lorazepam intravenously.

    03:22 Well, that's kind of a sedative, right? That's what lorazepam is. So, that would make sense.

    03:28 Assess the patient for presence of a gag reflex. We give neuromuscular blockers. How does that impact the gag reflex? And then check if the patient is allergic to aminoglycosides. Okay, I've read through all the answers. Now, I'm going to start eliminating them. So, which one do I want to get rid of first? Yeah, I'm going to get rid of the deep breathing exercises because they're not going to have any control of their breathing with a neuromuscular blocker. What do I want to get rid of next? Yeah, good idea. Right? It doesn't have anything to do with this question. It was just a distracter for us. It doesn't matter if they have an allergy to aminoglycosides because we're not giving that medication. Now, I'm down to the last two.

    04:17 You know these two. The ones people always say, I always get it down to the last two and then I pick the wrong one. Well, when you get down to the last two, go back up to the question, make sure you're clear, patient's ARDS, bad lungs, on the vent, pancuronium, neuromuscular blocker, completely paralyzed, awake but complete paralysis. So, it's most important for me to do what before I start the infusion. Well, I know I'm going to have problems with breathing and maybe blood pressure, can't remember, can't remember, but I know they're on the vent, so that's going to be covered. So, is it give another drug or is it to check a gag reflex? Oh, wait a minute. They're not going to have a gag reflex, so it absolutely has to be B is the correct answer. Okay, now that may have seemed like forever for you, but I promise if you will make yourself do the work, be disciplined, and eliminate answer choices and say why you're eliminating them, you will see your test scores change dramatically.

    05:24 Sometimes when I'm taking a test question more often than I'm comfortable with, I have to eliminate an answer, and I'm not exactly sure why, that's okay. I just have to keep control of my mind and not allow myself to go south like, oh that's it, I'm going to get this wrong, I'm going to get that wrong, I'm going to fail the test. Stop that kind of talk. Just stay focused on one question at a time, one answer at a time, and eliminate the ones to the best of your knowledge that you think need to be eliminated but force yourself to say why if you can.

    About the Lecture

    The lecture NCLEX Question on NMBs (Nursing) by Rhonda Lawes, PhD, RN is from the course Peripheral Nervous System (PNS) Medications (Nursing).

    Author of lecture NCLEX Question on NMBs (Nursing)

     Rhonda Lawes, PhD, RN

    Rhonda Lawes, PhD, RN

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