Walkthrough: Physiological Adaptation Q1 – NCLEX-RN®

00:01 The nurse provides care for a client diagnosed with chronic respiratory failure.

00:05 Which information indicates this condition? Okay. So I'm looking for information that indicates respiratory failure.

00:14 Now, hey, don't miss it. Chronic respiratory failure.

00:19 Anytime you see a descriptor word like that, chronic, there's a reason that it's there.

00:25 Because in NCLEX questions, they try to keep the stem of the question, so words before the answer choices only to what is needed to answer the question.

00:34 So if it's there, it's needed. Chronic respiratory failure.

00:39 So those descriptor type words, don't let them slip by you, because they're asking me to look at which information indicates this condition which is chronic respiratory failure. Look at those last words.

00:52 Four words that usually get us real upset but they don't have to.

00:57 Select all that apply. Now, we're going to bring the answer choices in and I'm going to let you look through those answer choices and select your answer.

01:07 So go ahead and pause the video while you select your answer choices, and then I'll walk you through each one.

01:22 Hey, welcome back. Now, keep in mind, it's just all about learning how to take a test.

01:27 If we happen to teach you something in the rationales, write it in your notebook, so you can review it later. But just try and soak up and absorb the strategies that we're using to answer these questions. Okay. We put it in your own words, right? And then since it's select all that apply, we look at this as five separate questions.

01:46 So I'm going to say, read number one, does that indicate chronic respiratory failure? So let's read number one.

01:54 The nurse noticed in the chart that the client has had a PaCO2 level greater than 50 milligrams of mercury for six years.

02:02 Okay. We got a lot of numbers.

02:04 So, I'm looking in the chart, and I see they have a PaCO2 level of greater than 50.

02:10 Anytime you see a number, ask yourself, high, low, or normal? Force your brain to make a decision. Well, I know that is high.

02:20 That's outside of the normal range for CO2 and they've had it for a long time, six years.

02:27 So is this what I would see with someone with chronic respiratory failure? Absolutely. So that one, I'm going to circle the number one and keep it in, because I know that with this chronic condition, they learn to just adapt to higher levels of CO2.

02:43 Now, number two, the client has a heart rate of 148 beats per minute.

02:51 All right. So it's a number. Is it high, low, or normal? Yeah, 148 is really fast.

02:59 So is that something that we typically see with chronic respiratory failure? No. See, that's how the body compensates in an acute respiratory failure.

03:10 If the body is not being perfused, the heart says, "Hey, ho, we're in trouble here." So I don't have enough oxygen getting around, so I'm going to try and move things around a lot faster in the body.

03:21 That's why the heart rates goes fast.

03:23 But you couldn't tolerate a heart rate this fast for a chronic or long period of time.

03:29 So number two, you're out.

03:32 Number three, the client began displaying a change in mental status, disorientation, and lethargy an hour ago. Woo, we got a lot of time factors in there, don't we? So let's break that down. Does this indicate chronic respiratory failure? Well, they began displaying means it's a change.

03:52 Then they tell us a change, so for sure, you know it's a change in mental status.

03:58 Now, is that connected to oxygenation issues? Yeah. Disorientation, is that connected to oxygenation issues? Yes. And lethargy but just an hour ago. Okay. So this is telling us something is different.

04:12 Well, if this patient is chronic respiratory failure, these are all signs and symptoms when someone has an acute change.

04:21 So can you have chronic respiratory failure, and then have an acute event? Yeah, you could. But that's not what the question is asking us and here's where you really start to ramp up your test taking skills.

04:35 Okay. Don't get lost in the weeds. Make sure you're asking yourself the question, which indicates this condition which is chronic respiratory failure? You see, that's a really good distractor.

04:50 Number three, you're cranking through this question too quickly.

04:53 You're thinking, respiratory, yeah, yeah, yeah - yup, yup, that's an answer.

04:57 I circled it. You're going to get it wrong.

04:59 And you don't want to do that because you know the information.

05:02 That's why slow and steady is going to win the race.

05:07 Remember, NCLEX is a game that the more questions you get correct, the shorter your exam is.

05:14 And everyone wants a shorter exam and to pass.

05:18 So, so far, number one, we have selected. Number two, we have not selected.

05:24 Number three, we have not selected.

05:27 Number four, does this indicate chronic repository failure? The client's symptoms are manageable in an outpatient respiratory clinic? Well, would that indicate chronic respiratory failure? Yeah. We managed that in an outpatient respiratory clinic.

05:44 That's a clinic that's specific to respiratory care.

05:47 Now, if they're in an acute event, they would have to go to the hospital, not the outpatient.

05:53 So far, one of four have been selected. Now, number five.

05:56 The client's breath sounds are now clear after the nurse administered an inhaled nebulizer treatment.

06:04 Now, does that indicate chronic? Think about that.

06:08 Now, if it's an acute condition, you usually can resolve that.

06:14 That's a possibility. But with chronic conditions, you can't just fix them with a breathing treatment.

06:20 We can kind of just manage the symptoms, but we're not going to completely resolve them.

06:25 So again, they're testing your knowledge of the difference between an acute respiratory failure and chronic respiratory failure.