Walkthrough: Physiological Adaptation Q13 – NCLEX-RN®

00:00 An 18-year-old client admitted to the hospital refuses blood transfusions. The client is willing to take blood fraction but not any of the 4 main blood components.

00:12 The nurse would anticipate which blood products will be accepted by the client for treatment. Okay, select all that apply. Now I noticed how I read that, that's not my best radio announcer voice. Right? I up, down, thinking through things. That's what I want you to do when you're answering that question in your head. You can't do it like that out loud if you're in a testing center or in a testing situation. But if you just read like anything (odd sounds) your brain can't grab on to things and that's what I want you to do. I want you to make sure that you don't miss something in the stem of the question. So, let's work through our strategy where you know when it's long like this, one question at a time. I mean one sentence at a time.

00:56 Of course, we're going to do one question at a time. An 18-year-old client that tells me they're an adult, so an 18-year-old client admitted to the hospital refuses blood transfusion. That's tricky point that I'm looking for. They're an adult. Any time I see an age in a question I always assess myself it's probably there for a reason and this question, angry owls are right them, put it in there because they want you to know this is an adult because they can refuse treatment. So, an adult client in the hospital that tells me the setting refuses blood transfusion.

01:31 That's a treatment. Can they do that? Absolutely. My job as a nurse is to support the decision. Alright. So, they have the right to make any decision about their healthcare treatment plan. My job is to support them in their decisions. Now, the second sentence, the client is willing to take blood fractions. Oh, okay. There is a nice surprise. The client is willing to take blood fractions but not any of the 4 main blood components. So here's where I pause and say "Okay, this is different than other blood transfusion questions I have seen before." They're going to take blood fractions, but they don't want any of the 4 main blood components. Here would be a really good time for me to think "Okay, what are those 4 main blood components again?" If you don't know them right now, it's okay. I keep going. The nurse would anticipate which blood products would be accepted by the client for treatment? Ahaha, because I practiced I know. Here's the deal. Students often in a select-all-that apply question, they answer the first part of the question as things that would be accepted and then they answer the last part of the question by things that would not be accepted. See what I'm saying? If you don't intentionally treat each one of the answer choices as a separate question, repeating the question, that's what I see most often when you guys come in to my office and ask me "How can I get better on select all that apply?" When I do questions with you, that's what I see.

03:03 So, don't make that mistake. It's a simple one to avoid as long as you practice and you are consistent about how you answer questions. So, if I put this into my own words, I don't have to read everything out again, I just know I'm looking for, a client is willing to take blood fractions, not willing to take 4 main blood components.

03:26 So I'm looking for what would be accepted by this client. So, I'm looking for things that would be blood fractions. Okay, are you ready? Pause the video before you do. Write down the numbers; number 1, number 2, number 3, number 4, number 5. Now those are placeholders for you that as you're working through each one of these answers, if you're eliminating that answer you cross through it and say why you're doing it. You don't have to write out why if you don't want to but crossing through a number tells you I've eliminated that answer choice, hold yourself accountable to say why you eliminate it and I promise you your scores will be better. So, pause the video, here come the answer choices, we'll see you back in a couple of minutes but take all the time you need to practice this skill.

04:13 Remember, this isn't a timed test with us, this is just to help you learn those new types of skills. So see you back in whatever time it takes you to be confident about your process. Hey, welcome back. Now let's take a look at this just to refresh yourselves. These are 5 answer choices but we kind of look at them as 5 separate answers, like 5 separate questions. So, I'm looking for what would be acceptable to a client who only wants blood fractions. Well, it would be helpful if I could remember "What are the main components of blood? What would be considered a main component?" Things like what cells. Do you kind of getting a flow there? Even if you couldn't come up with that, think of like the kind of bigger pieces of your blood for lack of a better term. Number 1, I'm going to start there just because I'm feeling like it, I can start wherever I want as long as I say why I'm keeping or eliminating an answer. That's what I recommend to you too. So, I'm going to start with number 1, immunoglobulins. So, is that one of the 4 main blood components? No. It's not. So, would that be acceptable? Yes, it is. So, this would be acceptable because it's not one of the 4 main blood components. White blood cells. Would that be acceptable? No. Because a white blood cell is one of the 4 main blood components. So, so far I've kept number 1, it's a blood fraction. I've got rid of number 2 because that's one of the 4 main blood components. Now, number 3.

06:01 Is that acceptable? Nope, that's one of the 4 main blood components so no they would not take plasma. Number 4, platelets. Is that acceptable? No, because it's one of the 4 main blood components so no way, that's out. Number 5, is that acceptable? Yeah, it is. Because albumin is one of the blood fractions not one of the main blood components. So that might seem kind of weird. Right? It's looking like what are the 4 main blood components? Well, they are plasma, white blood cells, red blood cells, and platelets. Now, if you're not familiar with that, write it down your notebook.

06:46 It's a great thing you write it down once, you'll know it. Right? So this is a little bit of an unusual blood transfusion question because the client was willing to take some parts of the blood, the fractions, but not the whole components. So, write this down in your notes. Remember these are whole components of the blood, those 4 things; plasma, white blood cells, red blood cells, and platelets. Cool. How'd you do? Stop and reflect. Did you get it right? Yes. That's awesome. When you get especially it feels like you really accomplish something with the select-all-that-apply question. I know, I feel that way. If you didn't, you know our drill. Think what caught you up. Was it content? Was it knowledge? Something you didn't know about, I didn't know what they're talking about when they said 4 main blood components or blood fractions. Well then, write yourself a note with the 4 blood components like we talked about. Also, jot yourself a note that immunoglobulins and albumin are considered blood fractions. That's content knowledge that you may apply to another question. The strategies that we have walked through you can take to any other question. Treat a select-all-that-apply question as 5 different answer choices if you have different questions. If you have 6 answer choices, then it's 6 different questions and make sure you work through it systematically, eliminating or keeping that answer choice and make sure before you hit the submit button you look at that last sentence. The nurse would anticipate which blood products would be accepted by the client for treatment so I do one more run through it. Would immunoglobins be accepted? Yes. White blood cells? No. Plasma? No. Platelets? No. Albumin? Yes. I submit my question and go on. Okay now, I hear what you're saying. Well, you have the answer choices. You're right. But I do the same thing when I'm taking my exams, when I'm taking my certification exams, I use exactly the same strategies that I'm recommending to you, I promise.

08:49 So, think yours through, make any notes you need to make in your notebook and then come back and do another question with us.