Walkthrough: Physiological Adaptation Q10 – NCLEX-RN®

00:01 The nurse assesses a client who has a diagnosis of hypertension.

00:05 Which findings concern the nurse? Ooh, select all that apply. Don't worry, we can do this.

00:14 So let's break down this rather this short question.

00:17 So the nurse assesses the client. We know the client has a diagnosis of hypertension, so which findings concern the nurse? Alright, that's what we're looking for.

00:29 What we know about this client is that he have a diagnosis of hypertension, so I'm looking for concerning assessments.

00:37 Bring on the answer choices, there they are, all five of them.

00:41 Remember to ask yourself, is this concerning with- for patient with hypertension, for each one of the five answer choices.

00:50 Write down the number 1, number 2, number 3, number 4, number 5.

00:54 Only the numbers on your scratch paper and eliminate them one at a time or choose to keep them in, but make yourself say why you're eliminating the answer or keeping it in. Ready? You're on your own, take all the time you need.

01:11 Remember, this is not a timed test when you're working with us, so take all the time you need that's productive to pick your best answer.

01:20 Then come back and I'll walk you through each step.

01:30 Welcome back. I know a lot of students break out in a sweat when they see some of these assessments, but I'm going to talk to you about these, we'll walk you through the rationales, and I don't want you to focus on if you got this question right or wrong.

01:43 I want you to think about your thought processes.

01:47 Now there's a big fancy word for that, it's called metacognition, that's just thinking about your thinking, and that's what it takes to raise your performance on test taking questions.

01:58 You want to think about your thinking, so let's do it together.

02:02 Number 1. Would it concern me to hear an audible split S2? Oh, wow. It's heart sounds, this is usually what makes nursing students really nervous.

02:15 Am I concerned about this? No. I'm actually really not.

02:19 When you have a split S2, it means those valves, the aortic and pulmonary valves, aren't as synchronized as they usually are.

02:26 Because they usually, they click closed at the same time in systole.

02:31 When I hear an audible split that means they're a little off synchronization.

02:36 I'm not really worried about it, not a big problem.

02:39 I would note it, but it's not a big problem.

02:42 So audible split S2, that's kind of a the tiny mis-synchronization of the aortic and pulmonary valves closing.

02:52 Not a big deal.

02:54 Number 2. Audible crackles in bilateral lung bases.

02:58 Whoa, yes. I'm concerned about that because audible crackles means things are not going well internally, right? The pressure's building up, the patient might be fluid volume overloaded, maybe it due to that high blood pressure causing problems.

03:15 Uh-huh, number 2, I am concerned. We're going to need to do something about that.

03:20 Number 3, bilateral trace lower extremity edema. Okay, bilateral means it's on both sides.

03:29 Trace lower extremity edema means just a little bit.

03:34 This isn't telling us that the heart is necessarily failing or they're going into congestive heart failure.

03:40 You can end up with bilateral trace lower extremity edema, let's say if you're maybe [prof loss 03:46] standing in front of the camera, working with questions with you.

03:50 That's why I have my compression socks on.

03:54 If they're a fun color, I'd show you, but trust me, I've got them on.

03:58 So bilateral trace lower edema is not a big deal.

04:02 You may had too much salt that day, you might have stood on your feet a whole period of time.

04:07 Don't worry about it, I'm not concerned. So 1, not concerned; 2, yeah, I'm concerned; 3, nope.

04:16 I'm not concerned. Just remember me, standing in front of the camera for you.

04:20 Now, number 4. Ooh, headache pain 7 out of 10. This is going to get my attention.

04:27 We know they have a diagnosis of hypertension when they have a headache pain and that's a pretty significant headache, 7 out of 10.

04:35 We're going to follow up on that, because you're concerned.

04:38 Number 5, a PR interval of 0.22 seconds.

04:44 Uh, oh. Look, they started the question and ended the question with something that usually makes students nervous. PR interval.

04:54 Do you know how to measure one? Hey, check out our ECG series if you don't.

04:59 Could you remember what a normal PR interval was? Remember it's up to 0.20. Now this is outside of that, it's larger.

05:10 Meaning it's taking a little bit longer for the electrical impulse to make it to the atrium, so, we know this is a little bit of a prolonged PR interval, we call this a first degree heart block.

05:24 Am I concerned? Nope, it's not that big a deal.

05:29 So what I'm most concerned about, let's go through one more time, audible split S2, no.

05:35 We know what that is not a big deal. Number 2, yes. We selected that.

05:40 Number 3, that's out, bilateral trace lower extremity edema.

05:45 Could be lots of causes for that. Number 4, that's in.

05:49 Headache pain 7 out of 10, we need a follow up because of the hypertension, right? We want to make sure this patient doesn't develop some really serious neuro consequences like a stroke.

06:00 And number 5, first degree heart block, no big deal.

06:04 But remember, if you feel like, ooh, ECGs, that's so hard.

06:09 It's really not. Check out our video series on those.

06:13 So, now it's time to think about your thinking.

06:15 If you missed anyone of these answer choice, leaving them in, putting them out.

06:21 If you missed any of those options, think about what happened.

06:24 For example, in number 1, did you not know that an audible split in S2, what that meant? What about the PR interval? Maybe it's been a while since you studied ECGs or you've never studied ECGs.

06:38 Those would be knowledge problems. Can you do anything about that? Oh, yeah. Audible split, I gave you a little bit of information in your notes.

06:48 If you want to learn more, make sure you look that up.

06:51 PR interval 0.22, if you didn't know what that was, well, we've got a whole series for you if you want to learn how to do ECGs.

06:59 Now, if you missed options on 2, 3, and 4, ask yourself why? What was I thinking? Is that correct or incorrect in my thinking? Did I apply something or misapply something? Thinking about your thinking is going to help you make better choices.

07:17 So pause, push the pause button on the video, and then I want you to think about all those things, make notes on your notebook, and then come on back and do another question with me.