Walkthrough: Pharmacological and Parenteral Therapies Q6 – NCLEX-RN®

00:01 A client who's diagnosed with diabetes is prescribed beta blockers and is receiving discharged teaching from the nurse.

00:07 Which client statement indicates understanding about the teaching? Alright, so I've read through the question once completely.

00:14 Now, I'm gonna go back and break it down.

00:16 So, a client who was diagnosed with diabetes is prescribed beta blockers.

00:22 Well, that's a diagnosis and a medication.

00:25 So, I know I want to slow down and think about, "Alright, I have a diabetic patient. They're getting beta blockers.

00:30 Do I remember anything about that combination?" Now, write yourself a note, if you think you do.

00:36 The next purchase tells me they're getting discharged teaching.

00:40 And the very last sentence is the one I want to laser focus on to make sure I'm answering the question correctly.

00:48 Because in NCLEX world, they could ask, which client statement indicates understanding that way, I'm looking for the answer that is right or safe for this patient.

01:00 If you see which statement indicates the need for further teaching, that means I'm looking for something that's wrong or unsafe.

01:07 They think like, okay, that's obvious, isn't it? It really isn't.

01:11 This is a challenge that students face with getting used to these types of questions.

01:16 So I've had many a conversation with my students talking about that last sentence, particularly making sure you're looking for something wrong or unsafe, or something that's correct, and the safest for your patient.

01:31 So, in case I've got you kind of spin in, let's look at that, again.

01:34 We have a diabetic client, who is beta blockers.

01:37 I'm looking for correct information or safe information about beta blockers with diabetes.

01:52 So let's start at the top.

01:54 Remember, you could start whatever number you want.

01:56 It doesn't matter.

01:57 But I'm going to start at the top.

01:58 It helps me to go through it in the same manner.

02:01 To relieve my shortness of breath, I can lie down or relax.

02:07 Okay, that's not really a diabetic thing and the beta.

02:10 Okay, I'm not sure. Let's leave it in, I'll come back.

02:14 I will take my medication only if my heart rate is above 50 beats per minute.

02:21 Okay, slow down when you're looking at those.

02:23 And I know the rule is, anytime I see a number that's high, low, or normal.

02:27 So, this is beats per minute, that's 50.

02:31 Oh, that's too slow in NCLEX world.

02:33 Remember, NCLEX world is the perfect world.

02:36 So normal is 60 to 100.

02:39 So you need your heart rate to be above 60 for testing.

02:45 Now, in real life, cardiovascular surgeon or cardiologist may prescribe something different.

02:52 But that's not what they're talking about in an NCLEX question.

02:55 You consider normal is 60 to 100 beats a minute.

03:00 So, I can cross off number two.

03:02 Because I know on an NCLEX exam, they should, if their beats per minute is less than 60, we should hold the medication.

03:11 Now, because I have diabetes, I should monitor my blood glucose regularly.

03:18 Well, that's a good idea.

03:19 I don't feel comfortable getting rid of that.

03:21 But it seems kind of odd.

03:23 Like wouldn't a diabetic know that? Alright, let me look at number four.

03:27 Number four.

03:28 "I have to stop taking my maintenance medications for diabetes, once I begin taking beta blockers." Oh, no. No, no.

03:35 No, no. No, no. No, no.

03:37 Because beta blockers are not going to help maintain a blood sugar.

03:41 So, nope. Let's cross off number four.

03:45 Now, I bet you're thinking "Yeah, this is exactly what happens to me." I can eliminate two, and then I get stuck with those last two.

03:53 And I have to pick between them.

03:54 Welcome to NCLEX world into testing.

03:57 That's how most of us feel. And you know what? You're right on target? Because that means you're eliminating answer choices.

04:05 You're saying, why.

04:06 And then you're making the best possible decision.

04:10 So, you hear me kind of talking through these things.

04:13 All those thoughts in your head, normal.

04:16 You should be having that conversation in your brain.

04:19 Because that indicates you're thinking through the question.

04:22 Students who just skim the question, look for the best answer choice kind of pick it.

04:27 Those are the ones who have the highest risk of not doing as well as they could.

04:32 Maybe even failing an exam, but at least not doing as well as they could.

04:37 So which ones do we mark off? Oh, okay, we marked off two and we marked off four.

04:43 So we're picking between one and three.

04:47 So let me go back and look at this.

04:50 "To relieve my shortness of breath, I can lie down or relax.

04:54 For a diabetic patient on beta blockers." Oh, wait a minute, do you remember how beta blockers work? Now, it might be coming back to you.

05:05 Is there any connection to beta blockers or diabetes and shortness of breath? The connection is beta blockers.

05:12 Because beta blockers we use too, usually they have a lot of uses.

05:17 But usually the most prominent one is to lower blood pressure.

05:22 The problem is, you have beta receptors on your heart, and on your lungs.

05:27 Beta-1 is on your heart, beta-2 is on your lungs.

05:30 So if this medication is kind of attaching itself to those beta receptors on your lungs, they may experience shortness of breath.

05:40 So we always educate patients on beta blockers, no matter what else is going home their world.

05:45 If you experience shortness of breath, contact your healthcare provider, period.

05:49 It's not going to go away if they just lie down or relax, we're going to need to stop that medication and make a better choice.

05:57 And with certain beta blockers, if you stop them too abruptly, it can really cause some bad outcomes for your patients.

06:04 So they'll have to contact their healthcare provider.

06:07 They don't understand the education. Now we're back to three.

06:11 Okay, well, again, I wasn't really thrilled with this answer, because they have diabetes, I should monitor my blood glucose regularly.

06:17 Well, dah...

06:19 Okay, those are the kind of conversations I have in my head when I'm answering this.

06:24 This is what they're looking at.

06:25 They want to test your nursing clinical judgment.

06:30 Even if you don't like the answers that you have to choose from.

06:33 It's wasted energy for your commentary.

06:35 And really, they could care less what you and I think about the question.

06:39 So you just do your best and saying, "I would have been worded that way." But I know why I eliminated one. I know why I eliminated two.

06:46 I know why I eliminated four.

06:49 And three is not incorrect.

06:50 It just seems like kind of a silly answer.

06:53 But I'm gonna go with it.

06:54 And you'll see, three is the answer.

06:57 Now, if we did down into three, there's a little more.

07:00 Because you have diabetes, you should monitor your blood glucose regularly.

07:04 But there's also a connection between diabetics and beta blockers.

07:08 So if this doesn't ring a bell for you just jot it down in your notebook that you're using to review and study as you're preparing.

07:14 So beta blockers block a increase in heart rate, right? They also block that bronchodilation.

07:21 All of that is that sympathetic response.

07:24 That's why, that's how those drugs lower your blood pressure.

07:28 Well, with diabetics, the thing we're most worried about is low blood sugar.

07:33 High blood sugar is not good for the body, long term, but low blood sugar can be life threatening.

07:40 What are the signs and symptoms of low blood sugar? Go ahead. John, click on your notes, see what you can come up with.

07:48 Okay, you know, they feel terrible. They're confused.

07:51 What happens to their heart rate? Right. it goes up.

07:56 They feel like their chest is really...

07:58 the heart is going really faster, because that sympathetic nervous system is trying to kick into overdrive.

08:05 So your body will push out that stored glucose for energy.

08:09 Unless you're on a beta blocker, you're not going to see that increase.

08:13 You're not going to see the increase in the heart rate.

08:16 And it also makes it more difficult for your liver to let go of that stored energy.

08:20 So that's why they're saying even more often, you may take that if you are diabetic, particularly if the patient is on insulin.

08:29 So there's a much longer story behind that answer, but I wanted you just to be aware, all those feelings are normal.

08:36 Don't magnify them. Don't get sucked into them.

08:39 Just know, this is the way the game is played.

08:43 I should expect this on questions and not waste energy being frustrated with how the test goes down? All right. Ready? Yep, you are. Let's go on to another question.