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

by Rhonda Lawes, PhD, RN

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    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.

    About the Lecture

    The lecture Walkthrough: Pharmacological and Parenteral Therapies Q6 – NCLEX-RN® by Rhonda Lawes, PhD, RN is from the course NCLEX-RN® Question Walkthrough: Pharmacological and Parenteral Therapies.

    Included Quiz Questions

    1. A client verbalizes performing an action contraindicated for a specific condition or medication.
    2. The client provides lists of expected side effects of a medication.
    3. A client demonstrates to the nurse how to properly administer the prescribed medication.
    4. A client correctly determines the actions to be performed if the medication is ineffective.
    1. “I should take this medication 15-30 minutes before meals.”
    2. “I should only take this medication if my blood sugar is below 140 mg/dL (7.8 mmol/L).”
    3. “I should inject this medication into my deltoid muscle at a 90-degree angle.”
    4. “I know this medication takes two to three hours to start working.”
    1. Eliminate answer choices and then make the best possible decision.
    2. Choose the first answer that looks correct.
    3. Select the second to last answer.
    4. Always select the answer that is the opposite of one of the other options.
    1. Beta-blockers prevent tachycardia and make it more difficult for the liver to release stored glucose in episodes of hypoglycemia.
    2. Beta-blockers cause decreased blood glucose levels in the mornings and increased blood glucose levels at night.
    3. Beta-blockers mimic the signs and symptoms of hyperglycemia, which could lead to clients not recognizing if they have high blood glucose.
    4. Beta-blockers cause cravings for sweet, carbohydrate-rich foods, which can lead to an overall increase in blood sugar levels.

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

     Rhonda Lawes, PhD, RN

    Rhonda Lawes, PhD, RN

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