Trend: Traumatic Injury – NCLEX-RN®

00:01 Hi, I'm Professor Lawes.

00:03 And in this part of our video series, I'm going to walk you through the top strategies for answering a trend question on the Next Gen NCLEX.

00:11 All right, ready? Now first, we're going to start with a picture.

00:16 Now we start our series with a picture, because I want to remind you really important that you use the strategy of picturing what's going on in the question.

00:26 Now, that might feel kind of silly to you.

00:28 But I promise in my experience, students who take the time to actually stop and imagine the situation, the setting, the patients, they do better on their questions.

00:39 So let's get started with this one.

00:41 I have a 5-year-old client walks into an urgent care center, accompanied by a parent.

00:47 Okay, that's not much to go on.

00:48 But that's what we know, pediatric patient, they came in with a parent.

00:54 Now I'm going to break down some of the nurses documentation at the timing.

00:58 We'll go back and look at after we get done with this, I'll show you what this will look like in an actual NCLEX exam.

01:05 But first, I want to laser focus you on these entries.

01:09 So you have a good feel for what we're dealing with.

01:12 So 1109: that is 9 minutes after 11 in the morning.

01:17 Here's what was documented.

01:19 5-year-old client with no past medical history presents accompanied by a parent.

01:24 For the parent accompanying the client, the client had lost balance while playing and the parent grabbed the client's left arm to prevent the client from falling.

01:34 Afterward, the client began crying and has not used the arm since.

01:39 Can you always read it through once.

01:41 Now let's go back through and check for my comprehension and understanding.

01:45 I know I have a 5-year-old client, they have no past medical history.

01:48 So this isn't a diabetic kid or anything else that we know of, just a straight up, regular, 5-year-old client and with their parent.

01:57 The parent tells us that the child was playing, lost their balance.

02:01 When the parent grabbed the client's left arm to stop them from falling, the client began crying and has not used the arm since.

02:09 Okay, we're done with the initial note.

02:12 Let's go on to the next one.

02:15 1115: Client is acting age-appropriate.

02:19 Now that's always important with pediatric patients, that you look at them developmentally and see how they're responding.

02:25 So this note says the client is acting age-appropriate, is guarded with stuff that's normal for a 5-year-old, especially when they're hurt and clinging to the parent.

02:35 Again, age-appropriate.

02:37 They're letting you know these behaviors are going on.

02:40 But it's not over the top.

02:42 This is normal what you would expect with a 5-year-old client.

02:45 While attempting to assess the client's arm, the client pulls away cries and verbalizes pain.

02:52 Okay, this tells us, this little one their arm is really painful to be moved or assessed.

02:59 Now I'm going to be worried if they have an arm injury.

03:02 My first thought is going to be perfusion.

03:04 Do I have good perfusion in the arm? Look what we have here +2 radial pulses bilaterally, brisk capillary.

03:12 So we've got really good responses here because it's less than two seconds so we're good.

03:18 They've done cap refill, they've checked the pulses.

03:21 The arm is being well perfused but it's still very painful for the child.

03:28 Now at 1145: Provider, that would be the health care provider at the bedside is manually manipulating the client's arm.

03:35 The client has been diagnosed with a radial head subluxation.

03:40 Now that's a super fancy term for some people call it nursemaids elbow.

03:44 I know when I was little, I had this multiple times, it's that elbow joint gets dislocated.

03:50 So that's what we're dealing with otherwise known as a radial head subluxation.

03:57 The entry at noon says, "The provider reports manual manipulation was successful." That means they've restored that elbow joint.

04:08 Okay, now that we've worked through each one of those things, let's review what this will look like when you're taking the NCLEX exam.

04:14 A trend question looks like this.

04:17 Left side of your screen is all the information that you have to answer the question with and on the right side of the screen, you have the actual options that you'll have to interact with.

04:27 Now you see on the left side, there's those tabs.

04:29 And you know that when you're taking the exam, not under video, but when you're taking the exam, you can click on those tabs to look at that information.

04:38 Now let's take a look at what the questions on the right will look like.

04:42 You see that you have those boxes where it says, "Select Response" and a drop down arrow.

04:47 When you click on those, you're going to have options.

04:51 So let me just show you what it looks like.

04:53 Click on that first one.

04:55 There you go, you see your three options that you have here.

04:59 Now based on that answer then you'll move on to the second one, pick from those options.

05:04 And then finally, to the third one.

05:07 That's why this is called a trend.

05:09 You're with the same patient.

05:11 You're picking an option or a strategy and intervention, and you move on to the next one.

05:15 And finally on to the next one.

05:18 So let's take a look at these and now break them down.

05:21 We've read through all the notes for you.

05:23 So you got a feel for what the story is.

05:25 We showed you what the question looks like on an NCLEX exam, what you'll see on your screen.

05:30 Now we're going to work through how do you answer these questions, the best strategies.

05:36 Okay, so the question is the nurse offers what option to the client? If the procedure was successful, the client should be able to, that's Option 2, and during discharge the nurse educate the parent about Option 3.

05:51 So we're clearly going to start with Option 1.

05:54 The nurse offers blank to the client.

05:58 So when you click on that drop down what do we see? I'm going to offer passive range of motion, analgesic administration or sticker pictures? Okay, now remember where we are, this is, after the client has been assessed, we know the arm hurts, they have good pulses, the health care providers come in, and they've done manual manipulation and they said it is successful.

06:20 My job as a nurse is to go in and make sure everything is good to go.

06:24 Educate, talk to the patients, assess them, before they go home from the urgent care.

06:29 So an Option 1 passive range of motion.

06:33 Hey, let me give you a tip.

06:35 Passive range of motion is not usually our first choice on any NCLEX question, because we want to keep the patient as independent as possible.

06:44 Now this 5-year-old, there's no reason you would have to do passive range of motion.

06:49 Remember, passive range of motion means the caregiver does all the work and there's no reason to do that on this 5-year-old.

06:56 And you want to be really careful on other NCLEX questions that you try to keep the patient as independent as possible.

07:03 And if they can participate, you want them to.

07:06 Now, analgesic administration.

07:08 Hey, after you put that elbow back in the socket, they're not going to need any pain medication, so I can get rid of number 1, I got rid of number 2.

07:18 Now, I'm down to sticker pictures.

07:20 Okay, think about the age of this client.

07:23 They are five. Would they like stickers? Yeah, but what would that have to do? Well, even if I'm not sure it seems age-appropriate.

07:32 I know it's not passive range of motion.

07:35 I know it's not give them medication.

07:37 So I'm going to go with sticker pictures.

07:40 Sometimes that's going to happen to you on the NCLEX.

07:43 You might not be fully sure why you're picking an answer, but you've eliminated the other two.

07:49 And that one seems like your best choice of the options that you have.

07:52 So we're gonna go with sticker pictures.

07:55 Now let's look at our options for Option 2.

07:59 Now, it says the question.

08:01 If the procedure was successful, the client should be able to...

08:06 Okay, so now I'm looking for the option that tells me gives me the best information that the procedure was successful.

08:13 Is it grasps the stickers with the affected arm? So the kid needs to reach out to grasp the stickers.

08:20 Well, that would mean that elbow is working, right? Use the affected arm after resting it for a few days.

08:27 There's no reason to rest it.

08:29 Once I've manually manipulated it's ready to go, so I'm gonna eliminate option 2 in option 2.

08:35 Third one, follow up outpatient with orthopedics.

08:38 Oh no, that's way over the top.

08:41 Once you have that manipulated back in, the kid should be good to go.

08:44 So number 2, hey, this is starting to make sense why number 1 was the right answer.

08:50 We know that sticker pictures are age-appropriate.

08:53 You're not going to need pain medicine and they don't want passive range of motion for an active 5-year-old kid, no reason.

08:59 So sticker pictures, have them grasp the stickers with the affected arm.

09:04 See how picturing that in your mind helps you pick the right answer.

09:08 Now we're ready for the third part.

09:10 During discharge, the nurse educates the parent about...

09:14 Okay, so I'm looking for based on what happened to this 5-year-old.

09:18 What's the most important thing I can educate the parent about to keep this child safe? My first option, how to avoid lifting the child by the arms.

09:28 Okay, does that have any impact on keeping the patients safe? It does, right? Because if you pick the kid up by the arms, you'd risk knocking not out of joint again and having that elbow subluxation again.

09:41 What about the second option? Alternating doses between acetaminophen and ibuprofen.

09:46 Well, why do we give those to children? Well, in this case, it would be for pain and we know that child doesn't have any more pain since already been manipulated and fixed.

09:54 So it's not the second one.

09:57 What about the third one? Applying ice at home to the affected arm.

10:01 Hey, that's not necessary.

10:02 So let's go back up to the top, make sure that makes sense.

10:06 During discharge, the nurse educates the parent about...

10:09 Remember, we're in an urgent care.

10:11 How to avoid lifting the child by the arms, that makes sense.

10:15 That's what's going to keep the child the safest.

10:18 So you go back and look at our options on what you have there.

10:23 The nurse offers what? They offer stickers.

10:28 What should the client be able to do? To grasp those stickers.

10:31 And finally, we want to educate the parent about not picking the child up by the arms.