Walkthrough: Physiological Adaptation Q15 – NCLEX-RN®

00:00 A client admitted with Addisonian crisis asks the nurse about the cause of the condition. Which is the best response by the nurse? See what the elves have done here? yeah, They make it sound like a client has asked you this but really they're testing your knowledge of what causes an Addisonian crisis. Now, in real practice you'll get to educate patients like this, but for now know that this is the topic, this is what they're looking for. Do you recognize what is the most likely cause of an Addisonian crisis? Now, look at that last sentence. It says what? Which is the best response by the nurse? We know that means it's a prioritization question. Students hate this, but the quicker you can get over your angst, questions on the NCLEX are most often prioritization questions. That's what you're looking for; best, first, most.

01:00 Those are the types of words, the buzz words that you'll see bolded like that and be like that on the NCLEX also so they help it jump out at you. Know that, relax, know there's likely going to be more than 1 right answer, there's no reason to rage against the machine because you know that's how the game is played. So, for someone admitted with an Addisonian crisis, I'm looking for the best response as to the cause of an Addisonian crisis. You got 4 answer choices. Write down 1, 2, 3, 4 on your sheet, just the numbers. As you're working through each answer choice, either keep it in or throw it out but make sure you say why. Right? I want you to be sure that you're not just going "heehee." I don't like that one. I want you to say "I'm eliminating this answer and here's why. I'm keeping this answer in and here's why." And you seen this strategy when I'm going through that. If you haven't yet, you will. If I'm not sure about an answer while I'm going through it, I'll kind of leave it in and then I know I'm comparing it to other answers and sometimes that also is a strategy that helps me eliminate and answer because I know this is a priority question because it says "best response by the nurse." So good luck, take the time you need going slow now. We'll help you be more proficient and faster later, just be slow and thorough because slow and steady wins the race. See you in a little bit.

02:30 Hey, welcome back. How'd you do? What answer choice did you pick? Okay, own it because it only works to the best effectiveness for you if you own your own answer and then we think through how you got there. So the best response by the nurse, number 2, let's start with that one. The beta cells in your pancreas are destroyed resulting in adrenal sufficiency. Wait a minute. That answer is like so weewee. Let's stop and ask myself am I really thinking about this right? So, the beta cells in my pancreas, I know what those are, are destroyed and that results in adrenal insufficiency. Well, the beta cells are in my pancreas, not my adrenal gland and those aren't really connected so an Addisonian crisis is not caused by beta cells being messed up in my pancreas but it still says adrenal insufficiency. Okay, do you see the kind of conversations that go on in all of our minds? Yeah, they do.

03:37 So when I get to an answer like that, I'm like I can't really focus, I'm going to leave it alone, walk on to another answer choice, I'll come back to number 2. So, I'm going to start the first again. First start, number 1. There are excessive amounts of hormones produced from your adrenal gland. Well, Addisonian crisis is not excessive hormones from your adrenal gland. It is a lack of hormones from your adrenal gland. Now, how do you get in this state? Well, there's probably likely some type of autoimmune disorder that has attacked the adrenal gland and it can't produce the hormones that it used to before it was attacked by your own body. So, excessive amounts of adrenal gland hormones is called what? Cushing's. You got it. Cushing's disease. This is an Addisonian crisis and this happens in Addison's disease. So I can clearly get rid of number 1. Remember, endocrine disorders are just opposites of each other. If I have too much adrenal gland hormone, that's Cushing's. If I have not enough, that is Addison's disease. So the symptoms are going to be directly opposite of each other. So number 1, you're gone. Number 2, still a little security, though I'm not going back. So hang on right now. Number 3, usually it results from a new physical stress in your life and the extra cortisol is not produced. Okay, so how do I answer this? First of all, I know an Addisonian disease affects my adrenal gland. That's one way I remember. I also know with an Addison's disease we often have to add steroids. What does my adrenal gland put out? Oh, those are the things that help me respond to stress. So if my adrenal gland is not working, then I'm going to need more hormones. So, usually it results from a new physical stress. That makes sense. Because if I have Addison's disease I can't respond to stress and extra cortisol is not produced. So, cortisol is my response to stress too and my adrenal gland is not working so number 3 makes good sense but I still don't rule out number 2. Okay, number 4. It results from high dose corticosteroid therapy which suppresses the function of the adrenal gland. Okay, Whooh, that one's not as easy either. Is it? Did you struggle with that one? Because it says high dose corticosteroid therapy suppresses the function of the adrenal gland. Now I know that corticosteroid therapy does suppress an adrenal gland.

06:31 Okay, so that could lead to an Addisonian crisis. The only way you could tell the difference is Addison's disease is if it has been an autoimmune disorder. Addison's syndrome is what happens when we have to give people excess corticosteroids, the adrenal gland says "Hey no reason for me to do anything cause you're getting all the steroids I make anyway so it kind of goes to sleep or suppresses itself. So, number 4 is true but he's asking for the cause of the Addisonian crisis. So, from high corticosteroid therapy, no that doesn't tell me what caused this crisis. I can have Addison's because I've had high therapy so I am comfortable getting rid of number 4 particularly when I compare it to number 3. Yeah, number 2. Okay, I can do it this time. Alright, are you ready? Let's look at it again. Because all of you are going to have answers that work your brain like number 2 does like we're using as an example here. So, how do you do it? Avoid it for a minute, work through the other answer choices, stay calm, and now say "I have a new perspective, let me go back at number 2." The beta cells in my pancreas are destroyed. Ahh wait a minute. That's diabetes. Diabetes doesn't cause adrenal insufficiency. So let me go back to number 3. I was picking between 2 and 3. Usually, it results from a new physical stress in your life and extra cortisol is not produced. This client is asking me about what caused the Addisonian crisis. Could a crisis be caused because of an extra physical stress and they can't produce the extra cortisol? Bingo, there is the answer. Okay now, some of you I may be driving nuts because I'm talking you through the process but I want you to get really familiar with, this is what you should be doing on a test as far as you have these internal conversations with yourself. The way you keep track and don't get confused as you use that scratch paper and you eliminate answers or keep them in but say why you write through those. Now, I know that that feels like ahh it's one more step. In your school, you may not be allowed to use scratch paper. That's a conversation between you and your nursing program. On NCLEX, you always have scratch paper in the form of a write on wipe off board that actually you can't wipe it off, you can write on it but you have to raise your hand, look in the camera and say "I need another board" and they'll bring you one. But you're not allowed to wipe that board off. But this is the strategy that no matter how stressed you get, you can use to refocus, realign, and raise your test score. So keep at it, it's work, it's like exercise because it is exercise for your brain and for your mind. Hang in there, you really can do this. Come back and do more questions with us.