Walkthrough: Health Promotion and Maintenance Q2 – NCLEX-RN®

00:00 First, let's start with the stem of the question. Remember, those are the words to the question that are before the answer choices. Now, I know you are going to want to look at the answer choices but don't do it, stick with us, follow your plan, and this is how you're going to raise your exam scores. So let's go back up to the stem of that question. A client is admitted for the management of uncontrolled gestational diabetes. The client calls the nurse to the room due to a sudden nosebleed and is very concerned about it. Which is the best response by the nurse? Alright, that's time 1. The first time 2 you're just getting a feel. Now trust me, if you have ADHD or even if you don't have ADHD, a stressed brain reading through that long of a question, you're going to get lost. So we need to go through it a second time before we look at the answer choices. Okay, so a client, I got that, that's the NCLEX way of saying patient, but a client is admitted for the management of uncontrolled gestational diabetes. Now, when you're taking an exam, you most likely won't have scratch paper but with us think about that first sentence. What's most important? We know they're admitted for the management of uncontrolled gestational diabetes, so there's a diagnosis. We're thinking about what is that? Well, that's someone who has developed diabetes when they're pregnant, that's what gestational means, and it's not well controlled. So that's what they have come in to the hospital for. Next sentence. The client calls the nurse to the room. Okay, we got a picture of that. Now, why did they call the nurse to the room? Due to a sudden nosebleed. Okay, that word right there, you always want to pay attention when there is a timeframe, like this it says "sudden." That means this is a change, it just started. This is not a chronic thing as far as we know, we just know it's a sudden nosebleed. Now, the patient is very concerned about it. So here's what I know to do. Patient is concerned about something, they have called me to their bedside. My job is to be therapeutic and to keep them safe. This is asking me which is the best response by the nurse. Alright, that last sentence can change everything. So what is this telling me? Yeah, prepare myself. Right? Which is the best response means there is likely more than 1 correct answer. So, don't waste mental energy on that, just know we're looking for the best response and that's for this particular patient. In this particular setting, what will keep them the safest? So what's particular about this patient? Well, we know they're pregnant, they have uncontrolled gestational diabetes, they're admitted to the hospital and now they have a sudden nosebleed. Okay. So, what do I do for a client who has uncontrolled gestational diabetes is admitted and now has a nosebleed that came on suddenly? That's the kind of work I want you to do before you look at answer choices.

03:18 Now, remember, it's longer because I'm walking you through step by step, teaching you how you want to do this on your own. Remember we took it one sentence at a time, we looked at any diagnosis, we looked at why the patient was admitted then we recognized aaahhh we've got an abnormal assessment, sudden nosebleed.

03:40 So we need to know what's the next best thing to do. Okay, so I know you're going to feel like this is what students always say "this takes forever" only in the beginning. Because as we're teaching you these skills and you practice them, you will get much quicker. Now, in case I've done too much talking in between now and looking at the answer choices, I want to pause right here and let you look back at the stem of that question and put it into your own words. Alright, now, we're ready to look at the answer choices. Now, this one is just a 4-option multiple choice. I know I say just but at least it isn't the select all that apply ones that none of us are really fond of. So let's walk through our next steps. We've put the words of the stem of the question into our own words. Now, we're going to look at each one of the answer choices. Nosebleeds are common during pregnancy. Do you have a family history of leukemia? Your blood pressure must be incredibly high.

04:46 I will notify the healthcare provider right away. Now, pause the video and I want you to use the strategy of eliminating 3 answer choices and selecting the final one that you feel is the best response by the nurse. Remember, as you're eliminating answer choices, write down 1, 2, 3, 4 on a piece of scratch paper. Then I want you to cross through them as you eliminate them and say why. Give the rationale of why that answer is incorrect and at the end you'll have your best answer to this question. Ready? Alright, do this next part on your own. Welcome back. Have you committed to your answer? Okay, good. Now listen, there is no judgment here but if you don't do the work of walking through this question on your own, we're not going to be able to help you change your test taking skills and get stronger.

05:50 So, let's take a look at this. Sometimes I don't always go 1, 2, 3, 4. Right? I don't necessarily go in order because sometimes I see an answer that I just want to start with or I'm not sure where to start with or to be honest I'm just getting bored with taking questions. So in this one, I'm going to go ahead and start with answer choice 3. Your blood pressure must be incredibly high. Well, when we're thinking about that, there is a connection between high blood pressure and nosebleeds.

06:24 Alright, so I'm not sure, I'm going to leave that one in. Let me go to number 4.

06:30 I will notify the healthcare provider right away. Well, that would be something that says wow there is nothing else I can do for you, this is an indication that you are in trouble, you're in danger, and there's something that we need to do for you that's outside of my scope of practice. Number 2, do you have a family history of leukemia? Whoah, okay, that's a big jump. This person is already very concerned. I can say right now that would not be my first response to someone who is pregnant and has a nosebleed. So I'm going to go ahead and eliminate number 2. So see my first answers I'm not really sure about but number 2 I can look at that and say wow. This is way over the top. If I ask a pregnant patient this client, I'm going to cause them to have extreme worry. Now it is true that leukemia can cause nosebleeds, but it's not the most likely cause so there's no reason to throw them into the panic. She's in the hospital, she's already had lab work drawn. If she had leukemia, we likely would have seen some other signs.

07:43 So, I can cross out number 2 in my rationale. Why, why am I crossing out number 2? Well, I'm saying that this is too big a leap, I have obviously better answers that I can do so I'm going to get rid of number 2 because that would just overstress my client. Now, looking at number 1, nosebleeds are common during pregnancy as either is that true or not true and then I've got number 3 and number 4.

08:14 So here is what they're actually testing in my knowledge. Do I recognize that nosebleeds during pregnancies are emergencies or are they common? That's the choice you have to make. There you say "Okay, so what do I do if I don't know the answer to that?" You have to just do your best. Those 3 and 4, wow your blood pressure must be incredibly high. I would likely have to call the healthcare provider for that. Right? I would need to do something. Number 4, I will notify the healthcare provider also indicates I think it's an emergency. But hopefully by now you know that nosebleeds are common during pregnancy. Number 1 is the correct answer. Now, why do pregnant women have nosebleeds? Well, it's just massive changes to their body when they're growing a human. Right? So they've got this extra blood flow everywhere because of the baby including their mucous membranes.

09:16 So, they have this extra estrogen levels because they're growing a human.

09:22 Usually it's benign, they don't have any effect of that but the increased blood flow can also cause gingivitis and nasal congestion. So, this is not uncommon and not a sign that anything is wrong or something needs to be done outside of my scope of practice. I can help the patient clean themselves up, put pressure on their nose, take care of that bleeding. I'm hopeful it will go away fairly quickly. If it's more severe, there are other steps we can take. Now remember, 1 is the correct answer, I just explained why. 2 is an incorrect because this would cause extreme worry in the client and it's really jumping to conclusions. We don't have information that would tell us that. Now, when you looked at number 3, I wouldn't just say wow, you have a nosebleed so you must have high blood pressure. That's not thinking through very clearly. If I thought it was caused by high blood pressure, I would need to take a blood pressure first. I had no information in that stem, they told me that might be a problem. So, nosebleeds can be caused by hypertension but we really didn't have enough information to make that connection that's why we eliminated that and that's the why behind it especially when you know the most likely cause is just simply the extra blood flow to the mucous membranes during pregnancy. Now number 4, why did we get rid of that? Call the healthcare provider.

10:53 On an NCLEX exam and hopefully on your nursing exams, what's being tested is what the nurse can do within their scope of practice. There wasn't any reason to contact the healthcare provider here. Right? Because number 1, it's not an emergency. I promise you if you call physician with this being the only symptom and everyone else knows that a nosebleed is a common part of pregnancy, it's not going to go well. Even so, anytime you have a question about a patient's status or assessment, ask a supervisor, go ahead and contact the healthcare provider.

11:31 But we're not talking about real practice, we're talking about test questions.

11:36 Now, go back to the stem of the question. Does this answer make sense? So, what do I do for a client with gestational diabetes admitted to the hospital, has a sudden nosebleed? Would it make sense for my best response to be nosebleeds are common during pregnancy? Of the 4 answer choices, that absolutely is the best choice and it's also therapeutic. You're reassuring the patient, this is not an emergency or a problem, this happens. Alright, good job. Let's move on to the next question.