Walkthrough: Physiological Adaptation Q6 – NCLEX-RN®

00:01 A nurse provides care for a client who has a history of Addison's disease.

00:05 After the initial nursing assessment, which symptom is concerning for the nurse? Select all that apply. Oh, okay.

00:14 Don't worry about this. I promise you can do this.

00:18 But you'll notice that we don't have the answer choices up there yet.

00:21 And I did that on purpose.

00:23 I want to make sure that you get into the practice of learning the skill of not looking at the answer choices, until you really spend the time and energy to break down the stem of the question, the words that appear before the answer choices.

00:36 So let me show you some of the things that you should look for.

00:39 First, it says a nurse.

00:41 That's you. And that would be an RN, since you're taking an NCLEX RN Exam question.

00:46 So a nurse provides care for a client who has a history of Addison's disease. Okay, that's a diagnosis.

00:54 Anytime you see a diagnosis in a question you want to ask yourself, hey, what's the worst thing that can happen? How would I recognize it? What would I do about it? Well, we know with Addison's disease, that means they don't have enough steroids, right? Because people usually remember, Addison's disease means you need to add steroids.

01:13 And it's a problem with the adrenal glands.

01:14 They're just tanked out.

01:16 So I know somebody with Addison's disease is not going to have enough of the normal hormones that are put out by the adrenal gland.

01:25 So I'm going to watch for signs of that.

01:27 Now after the initial nursing assessment, that's just kind of a blah, blah, blah, filler statement.

01:31 Which symptom is concerning to the nurse? Remember, the topic of the question is that diagnosis, Addison's disease, select all that apply? Well, the best strategy with this is take a look at the answers.

01:44 Write the same numbers on your -- write on wipe off board or your scratch paper.

01:49 So in this case, you would write down 1, 2, 3, 4, and 5.

01:56 Now we're going to work through each one of these answer choices and either say yes or no, true or false.

02:02 But we're going to treat each one of the options as a separate question.

02:06 Topic of the question, what would be concerning for a patient with Addison's disease? So look at number one.

02:13 The client's urine output for the last two hours is 1000 milliliters.

02:18 Okay, our strategy whenever you see a number involving assessment, ask yourself, Is it high, low, or normal? 1000 milliliters in two hours is way too high.

02:31 Is there any connection to that Addison's disease? Oh, yeah, absolutely.

02:36 You don't have enough aldosterone telling your body to hang on to water.

02:40 So I'm going to circle number one. I'm going to keep it in.

02:44 Because the topic of the question is what would be concerning about patient who has Addison's disease? Number two, the client states, "I have to start cooking now because my spouse will be home from work soon." Okay, this statement is indicating that they're not oriented.

03:00 That's not a normal assessment, right? That's an abnormal assessment.

03:04 And does it have any connection to Addison's disease? It does, because they're confused.

03:10 You have all kinds of electrolyte imbalances in Addison's disease.

03:14 And if they're telling you they're confused, that could be a sign that they are not in homeostasis, or in balance.

03:20 So I'm going to circle number two.

03:22 And when I finished this, I'll check those boxes on my computer screen.

03:27 Now number three. The client's pulse rate is 128.

03:32 And the blood pressure is 80/50. Okay, those are pretty extreme.

03:38 These are numbers in an assessment.

03:40 So I always ask myself high, low, or normal.

03:43 128? High, right? 60 to 100 is normal.

03:48 128 is high, right? This is an adult.

03:51 Blood pressure 80/50 is very low.

03:56 What connection would that have to Addison's disease? Well, in Addison's disease, you lose lots of fluid because you don't have the right hormones to tell you to retain fluid that you need.

04:08 So you put out all this urine and when you have less volume on board, you're gonna have lower blood pressures.

04:15 This is a sign when it's way above 100. And way below 100.

04:19 The heart rate above 100 blood pressure below 100.

04:23 This is a sign that the patient is hypovolemic.

04:26 This abnormal assessment is clearly connected to Addison's disease when it's not under control.

04:33 So so far, we've selected one, two, and three.

04:37 Would I be concerned about this heart rate and low blood pressure combo? Absolutely.

04:42 Now let's look at number four.

04:44 The client lost 11 pounds or five kilograms within the past week.

04:49 Now, that's a number and it's an assessment information.

04:52 You know what you ask yourself, is this high, low, or normal? That's very high for one week.

04:59 Usually the average would be one to two pounds a week if somebody was trying to work on losing weight.

05:04 So this client has lost 11 pounds in one week.

05:08 And does that have any connection to Addison's disease? Absolutely. It could be a sign of severe water loss.

05:15 So, so far we've selected every one of the first four answers.

05:20 Let's look at option five.

05:22 The client experiences dizziness when trying to stand.

05:26 Okay, that when you get dizzy when you stand up, that's usually called orthostatic hypotension.

05:33 Now, the causes of that could be certain medications or low volume.

05:39 So since we're not, we don't really have information about the medications that they're on.

05:43 But we do see that someone with Addison's disease if they have low volume that could be causing this orthostatic hypotension, or the dizziness when they stand. So I checked all five.

05:57 Now, the next step you want to go back and look at which symptom is concerning to the nurse? Select all that apply for a patient with Addison's disease.

06:07 Would I be concerned for a patient with Addison's disease if they showed number one? What about number two? Number three, number four, number five? Yep, those all checked out is I checked through my work.

06:24 I've got all five selected. I know that's possible on the NCLEX exam.

06:28 That all of the answers could be correct and should be selected.

06:31 So I'm going to put that into my computer and move on to the next question.

06:36 Good work. I know that select all that applies are a little nerve wracking, but I promise slow and steady will win the race.

06:44 Just work your way through them and keep coming back to practice more questions with us.