Walkthrough: Management of Care Q1 – NCLEX-RN®

00:01 Now, we're getting ready to look at the stem of the question.

00:04 Remember, the stem is the words before the answer choices.

00:07 Now, don't worry about the answer choices right now which is why we have them off the screen.

00:13 Let's just practice focusing on the stem. Ready? Okay.

00:17 An adult child of an older client states the parent has just started displaying disorientation and slurred speech.

00:25 Which action is a nursing priority? Ugh, and the dreaded select all that apply.

00:32 Hey, don't worry. We've got you covered. I've got a strategy for you.

00:36 So let's go back and kind of break this question down, because these are the types of things I want you to practice on your end of course exams in nursing school, and you use these on your NCLEX exam when you're ready to sit for your licensure exam.

00:51 Okay. So we've got some things in here. We know from our previous discussions that age matters.

00:57 And we've got some references to age here. We have an adult child of an older client.

01:03 So that's who we're getting the report from is the adult child, so we know that we can trust what they say in NCLEX world of an older client, tells us they're geriatric.

01:13 Is that their parent has just started. Hey, that's another reference to time.

01:19 That means this is a change in the older client's status. That puts us on high alert.

01:26 So an adult child says that their parent has just started displaying disorientation and slurred speech.

01:33 Now, those terms are considered assessments. We assess whether you're oriented or not.

01:38 We listen to your speech and see if it's clear.

01:41 So anytime you see an assessment in a question, you ask yourself, is that normal or abnormal? Disorientation is not normal. Slurred speech, not normal.

01:54 And we know it's not normal for this client because the adult child told us, they've just started displaying these two assessments.

02:02 So now, it's asking us, which action is a nursing priority? Now, if this was a four-option multiple choice, there would be only one correct answer.

02:13 But this is a select all that apply. So however many answer choice options we have, it could be one up to all of them could be correct.

02:25 There'll always be a minimum of one that it should be selected, but could also be anywhere in between one of the answers or all of the answers could be selected on any NCLEX exam.

02:37 Okay. We've kind of got that out of the way.

02:40 But what I want you to do after breaking all of that up is put this question in your own words.

02:47 So how would you reword this? I'm going to pause for a minute and let you think.

02:55 Okay. Here's how I would do it.

02:56 But remember, what matters is that you do the mental gymnastics to think through this question.

03:02 Because the work it takes you to reword it into your own words will help make sure you don't miss something in the question.

03:09 So I know I've got adult child of an older client has told us his client is now displaying abnormal behaviors or assessment. So what is my priority? Well, in the nursing clinical judgement model, remember, you're supposed to recognize cues.

03:26 Well, the cues here are a new onset of disorientation and slurred speech.

03:31 When I'm analyzing those with the other information I have about this patient is they're an older client.

03:38 So what should I start to think? I'm not going to tell you now, but I want you to come up and kind of develop your hypothesis.

03:47 So we've recognized cues. We looked at age. We looked at assessment.

03:52 We analyzed them and said, "Wow, what could these possibly have in common?" Now, we're going to look at the answer choices.

04:00 Remember, because this is a select all that apply question, one or all of them might need to be selected. Okay. Take a look at the answer choices.

04:10 We have one, two, three, four, five answer choices, right? We have five options.

04:18 So anywhere from one, two, three, four, or five of them could be correct.

04:26 So if you've used that rule before like, "Oh, that doesn't look like I selected enough of them." Or, "I think I've selected too much of them." That rule won't help you in NCLEX style questions.

04:36 I can't emphasize enough. It could be one, two, three, four, or all of the questions.

04:44 So we're going to treat these like five separate questions. That's your strategy.

04:48 You've done the work. You put the question in your own words.

04:53 We know that it's a select all that apply.

04:55 So we have to look at each answer as a separate option.

04:58 Now, if you have a piece of scratch paper next to you, I'd like for you to number it.

05:02 On the NCLEX exam, you're allowed a write on, wipe off board.

05:06 So this is a strategy you can actually use in the exam.

05:10 I don't want you to get used to underlining, encircle things in the stem of the question because you won't be able to do that on testing day for NCLEX exam.

05:19 So let's stick to strategies that will take you all the way through you getting your RN license.

05:25 So just write one, two, three, four, five down on your paper for now.

05:29 Okay, and let's start with the first one.

05:32 I know the question is, what's a propriety action for an older client who has new onset disorientation and slurred speech? Well, do you have in your mind, what is your hypothesis that's wrong with this patient? So would preparing the client for a computed tomography or a CAT scan be a priority action? Well, based on your hypothesis, should that be a priority? The answer is, yes, it should. Okay. So I want you to work through the other four answer options.

06:07 So pause the video, work through the other four answer options, and I'll come back and explain all the rationales to you.

06:22 Okay. Welcome back.

06:24 Did you take your time and work through each one of these answers? Remember, you're treating this like five separate questions and whether you're keeping it in or taking it out, you're explaining why.

06:36 Now, we already said answer choice number one. Let's leave that in.

06:40 Prepare the client for computed tomography.

06:42 The reason we did that is because we recognize the cues of disorientation and slurred speech.

06:50 We analyze them together with the patient's age, and we know that these are classic symptoms of a patient who's having a stroke.

06:57 So would a CAT scan be a priority for this patient? Absolutely. Because we want to go on and either rule out a stroke, figure out if it's hemorrhagic or if it's because of a clot like an ischemic stroke.

07:08 So number one, that is definitely a priority. We're going to check that and move on.

07:14 Now, the second one, what did you pick? Okay, let's take a look at it together.

07:20 Contact a laboratory for blood tests. Hmm, is that a priority for someone? Sure, because if your electrolytes are off, boy, that patient could display some disorientation.

07:33 Likely, not the slurred speech, but we want to be very thorough.

07:36 So, yes, we're going to draw lab work on this patient.

07:40 So, so far, selected number one and number two. How you doing? Hey, I don't want you to get discouraged.

07:46 If you are missing questions with us, it's okay, because the point here is not how many of these questions do you get right.

07:53 The point is, what can we learn from this question, which you can take and apply to other questions and raise your exam scores, and make sure you take that NCLEX exam one time before you get your license.

08:05 Let's go to answer choice three. Review all the client's medications.

08:10 Well, the topic of the question, because I ask myself each time, what I do for an older client whose new onset disorientation and slurred speech, should I look at all their medications? Well, that sounds like a - I mean, like a reasonable thing to do, right? But is this likely caused by their medications when this is a new behavior? Probably not. That's not going to be our priority. Will we do it? Yes.

08:37 But the topic of the question, the NCLEX elves that write these questions are wanting to see if you're recognizing that these cues indicate that the client is having a stroke, and so that you know the right things to do.

08:51 Reviewing their medications is not our top priority in a stroke, so you would not select that one.

08:56 Option number four, listen to the client's lung sounds.

09:01 Well, again, that sounds reasonable.

09:03 But here's what they're asking you to do.

09:06 If I'm concerned, if I recognize from the cues that I analyze them that this patient is having a stroke, our lung sound's a priority. No. That's not what's going to keep this particular patient and this particular setting the safest. Do we always assess our patients? Absolutely.

09:26 But it's asking you, can you prioritize what's most important for this patient's particular problem.

09:33 Now, we're up to number five. But before we do, how'd you do on the first four? Remember, if you got it right or wrong does not matter, because it's what you're learning through the process that's most important.

09:45 Number five, establish intravenous access.

09:50 So is that a priority for someone who is an older client with new onset, and I'm suspecting a stroke? It is. This patient is likely going to need a higher level of care.

10:01 They're going to CAT scan. We want to make sure that we have good IV access.

10:07 If we're having the type of stroke that we can give thrombolytic therapy, we're going to need to give it IV.

10:12 So absolutely, you want to make sure that you have a good and patent IV established.

10:18 So look back overall. Of the five, we selected three.

10:24 Now, if I was taking this test question, if I was a test taker, what I would do is I would have one, two, three, four, five on my write on, wipe off board for NCLEX.

10:31 I would go through each one, treat them like five different questions.

10:36 Now that I've worked through all my answers, I'm going to look at the ones that I chose to select and make sure that makes sense. So does it make sense? Prepare them for a CAT scan? Yes, because when I recognize the cues and I analyze them, my hypothesis is they're having a stroke.

10:52 Would I contact the laboratory for blood tests for a patient having a stroke? Absolutely.

10:57 Because we're going to know - need to know all that's going on.

11:00 The last one, am I going to establish intravenous access? Yeah, for someone having a stroke, we're likely going to have to do some other treatment of IV medications, I would do that.

11:10 So I'm rock solid. I know that's what I want. Last stop, what about the ones I did not include? Does that make sense with the topic of the question? Review the client's medications, nope.

11:23 I already decided that's not my top priority, and listing the lung sounds, no.

11:27 Based on what's wrong with this patient, that is not my priority.

11:31 So I'm going to select one, two, and five. And I'm going to submit my answer, move along.