Walkthrough: Health Promotion and Maintenance Q4 – NCLEX-RN®

00:00 The nurse is caring for a client who is 37 weeks gestation and has a diagnosis of gestational diabetes. The nurse provides teaching on management of the client and the infant after delivery. Which statement by the client indicates an understanding of the nurse's teaching? Okay, let's break it down before we look at those answer choices. The nurse is caring for a client who is 36 weeks gestation and has a diagnosis of gestational diabetes. Keywords, I'm the nurse, I'm taking care of a client who is 37 weeks gestation, so they're getting close to delivery and the client has a diagnosis of gestational diabetes. Now, underline the word gestational whether in your mind or on paper, but I want you to look at that. There's a descriptor word and this is something those angry owls will be looking for you.

00:54 So, gestational diabetes is different than someone who may have been a type 1 diabetic who then became pregnant. Gestational diabetes means a special type of diabetes that happens when women are pregnant. That's what gestational means.

01:09 So, make sure you pay attention to those words, those descriptor words, they make a big difference or can in the question. So I'm a nurse caring for a client who's been diagnosed with gestational diabetes and they're at 37 weeks. The nurse provides teaching on management of the client and the infant after delivery. Okay, topic of the teaching, Management of the Client and the Infant After Delivery.

01:36 Which statement by the client indicates an understanding of the nurse's teaching? Okay, cool. That last sentence is a long one here. Right? Which statement by the client indicates an understanding of the nurse's teaching? So, what I'm looking for? Am I looking for something that's wrong, incorrect, or unsafe? No, I am not. I'm looking for the statement that's regarding management of the client and the infant after delivery that is correct, that is right, and that is safe. So what am I eliminating? I'm eliminating things that are wrong or unsafe. Now they may have been painfully slow for you as I walk through it and I get it, but this is where I've seen students make multiple errors. They forget with that last statement. Are they looking for the correct, safe, and right statement? Or are they looking for the incorrect or unsafe answer. So on this one, I am absolutely looking for something that demonstrates, indicates understanding of the teaching. So now, let's look at the answer choices. You should see 4 up here. Now I want you to pause, do the work on your own, use a scratch piece of paper with just the numbers 1, 2, 3, and 4 written on them. Eliminate answer choices as you go and say why, but don't forget ask yourself whichever number you want to start with. You would say like number 3, for example. Does this indicate understanding of the nurse's teaching? On each one of those 4 options, I want you to ask yourself that answer and make yourself say why, alright. I'll see you back in a few minutes. Take all the time you need to do your best work. Welcome back. Shoosh, that was a lot of work. Wasn't it? Well, if you're not someone who is really excited about taking care of pregnant women or those that are mothers, you want to make sure that you think through this with extra caution. So, which statement indicates an understanding of the nurse's teaching? If I look at number 1, it would say "My infant's sugar levels may be high if the baby is not feeding." Okay, so let's think that through. "I have gestational diabetes, I delivered a baby, my infant sugar levels may be high if the baby is not feeding." You think that's true? No. If the baby is not eating, it's likely that their blood sugar levels are going to be low.

04:30 So don't miss that word, I can cross number 1 out because the infant sugar levels if they're not feeding are likely to be low. Particularly since that baby has had a lot of insulin running through its body, right, because of mom's gestational diabetes and treatments and all of the things that have been going on, you want to make sure that if the baby is not eating or watching them for signs of low blood sugar. Number 2, "I may be able to stop taking insulin after delivery." Huh, okay.

05:03 "I may be able to stop taking insulin after delivery." Well, gestational diabetes, we do know that they have a higher risk of developing diabetes after delivery, but not everyone does. So, number 2 I'm going to leave it in for now, let's see.

05:21 Number 3, "After delivery, I can stop checking about my blood sugar levels." Whoah, no. If you have gestational diabetes, you're going to have to keep checking your blood sugar levels up to about 6 weeks and recheck them periodically according to what the healthcare provider recommends because it takes a while for the body to adjust to delivering that baby so we do not want you to stop checking your sugar levels. So, cross through number 3 and you have the rationale as to why. Number 4, "My baby will not be affected by my diabetes after delivery." Whoah, incorrect. Right? We're going to watch this baby very closely for signs of hypoglycemia. We would expect because of environment where the baby has come from, if they have been receiving insulin. We want to make sure that that baby's blood sugar is not too low. So, it is incorrect to think that your baby will not be affected by diabetes after delivery. Back to number 2, that's the one I was kind of like thinking that it was. Does that indicate an understanding of the nurse's teaching? Absolutely. Number 2 is the most correct answer that indicates understanding. We eliminated 1, 3, and 4. Now, here are some things that I want you to get caught up on. Maybe you think, well I wouldn't teach it that way. Stop.

06:48 When you're taking an NCLEX question or any exam question, think of this as a card game, you have to play the hand your doubt. This is the question, these are your 4 answer choices. They just want you to use your critical thinking to select the best option in these questions. So, take a minute, jot yourself some notes, you can even do it in the little boxes that we provide for you or you can write it down in your notebook, but write yourself some notes. What do you learn from the rationales for the options 1, 2, 3, and 4 that you need to include in your notes so you review them on your own later?