Walkthrough: Physiological Adaptation Q8 – NCLEX-RN®

00:00 Hey, let's do this thing. Here's a select-all-that-apply question. I want you to start changing your thinking about these questions. Don't dread them. You can do this and how you approach them, the type of attitude you approach them with, really matters to your brain. So, don't look at it as something awful. Know that hey this is just an opportunity for you to demonstrate your skill and get the payoff for all that studying I know you've done. So let's start here. The nurse is caring for a school-age client whose parent states the client has breathing problems. Which assessment finding is consistent with pneumonia? Okay. Now, we look at this question, the nurse is caring for a school-age client that tells me particular, this is a school age kid, think about 6-12 years of age. And the parent states the client has breathing problems. Okay. The age matters, the parent tells are having trouble breathing.

00:59 Which assessment finding is consistent with pneumonia? Uh, okay. Well, what I need to look through when we bring the answer choices on is to look through each one of the assessments and determine "Is this an assessment finding that's consistent with pneumonia in a school-age child?" Is this assessment finding consistent with pneumonia of a school-age child? Answer 2. Is this assessment finding consistent with pneumonia in a school-age child? Number 3. Yes or no.

01:30 Is this assessment finding consistent with pneumonia in a school-age child? Number 4. Yes or no. One more time, is the assessment finding consistent with pneumonia in a school-age child? And number 5. Again I know how annoying it is to walk through that process, but it's the key. If you treat every select-all-that-apply, each answer choice is like a different yes-no question making sure the question you're asking lines up with the stem, you've got this. Then it becomes much more straightforward. So, let's show you the answer choices. There you go, you have 5 options. Use your scratch paper, write down just the numbers; 1, number 2, the number 3, the number 4, and the number 5. Don't write out the answer choices.

02:21 Eliminate these answers as you go through one at a time, asking yourself that question for every answer choice. Now, why do I reprimand that? Because I've seen so many students that for the first half of the question they're looking for the thing that's consistent with pneumonia, the last half of the question they look for things that are inconsistent with pneumonia, and they get the question wrong for no good reason. Make sure you're consistent with the question that you're answering at each one of these 5 options. Ready? Pause the video, take all the time you need to do your best and apply the strategies, and I'll see you back when you're done. Hey, welcome back. Alright now, let's walk through this. We know that we're looking for the assessment findings that are consistent with pneumonia in a school-age child. So let's look at number 1. Is a respiratory rate of 19 breaths a minute consistent with pneumonia for a school-age client? No, that is a normal breaths per minute. Right? So when you look at a number, you always ask yourself, "19, is that high, low, or normal?" That is within the normal range. Now, normal can be like 16-20, 16-22. Here's the thing that will make you crazy. Have you had that experience in your pediatric course. They list one set of vital signs or lab values and then when you go to another course they list a different set of it. Yes, that can happen. People usually get kind of panicked when they're thinking about taking their NCLEX. Now, we can't help your nursing school change that policy, but I wish every nursing school would have a consistent policy for vital signs and lab work. But what I can tell you is on the NCLEX they're not going to make it raise our clothes. Right? They're going to give you a pretty clear indication of what's going on with this patient. So, for this one, respiratory rate of 19 breaths a minute for a school-age child is normal. This is not consistent with pneumonia because if a client has pneumonia, they're not able to oxygenate very well so they breathe faster usually because their body's working harder to get oxygen enough to try and get it to the rest of their body. If they're breathing a lot slower than normal, wow, we know they have worn out. So, on this one, we would expect it to be outside of the normal range, 19 is not outside of the normal range for respirations per minute for a school-age child so we're going to eliminate that one. Number 2, temperature of 38.8 that's degree Celsius or 101.8 Fahrenheit.

05:10 No matter what you're in, Celsius or Fahrenheit, that indicates a fever. Now pneumonia is an infection so we would expect the body to spike it up. Right? Give us a little bit of a fever to try to fight off that infection. So number 2 is consistent with pneumonia in a school-age child. So, number 1, we crossed out and we said why. Number 2, we left in and we said why. Number 3, pleuritic chest pain. Now, we're not talking about cardiac pain, we're talking about is it common or consistent for a school-age child to have pleuritic chest pain with pneumonia. The answer is yes. Remember, they got a lot going on in here with their lungs and so it's not abnormal for them to have pleuritic chest pain.

05:58 Number 4, intercostal retractions. Is this consistent with pneumonia? Now here's where it gets a little tricky. You're thinking I have seen a lot of kids with pneumonia and they don't always have that intercostal retractions. Well, that's a good thing because intercostal retractions are a sign like that kid is getting really tired. But could the kid have intercostal retractions with pneumonia? Yeah, pneumonia is a respiratory problem. This could be a sign that it's worsening so yes that could be happening with pneumonia. Hope it isn't but if it is, that could be consistent. You're definitely going to need to do something else to help keep that kid safe, but that's not the topic of this question. So, don't make a movie, I always say. When I'm teaching in class I'm like "Hey Spielberg, you're reading into the question." Spielberg the famous movie director. So when you try to add this whole other story on to the answer choices that really isn't there, I'm going to call you Spielberg. Stop making a movie whether isn't one. They're just asking "With someone pneumonia, could it be consistent for them to have intercostal retractions." The answer is yes. So, so far 2, 3, and 4 have been left in and we said why. Number 5. Is it consistent with pneumonia in a school-age child to have coughing with mucous present? Oh, yeah, hopefully that one came easier to you because absolutely you got an infection in your lungs, you're going to be coughing because the airway is irritated and I hope there's mucous present so we can get that junk out. Now, look back one more time. Does it make sense that we eliminated number 1? Yes, because that's normal breaths per minute and we had expect them to be a little elevated. Does it make sense that we kept in 2? Yup, that's a fever with the infection. Number 3, yup, pleuritic chest pain is coming from the lungs. Number 4, intercostal retractions, we hope it's not happening but if it is, yup that could be consistent. And number 5, absolutely.

08:05 So, we know with this select-all-that-apply, 1 we did not select. We selected 2, 3, 4, and 5 and got that question right. Good work. Now, make any notes in your notebook that you need to make that reminders, things we talked about in the rationales, review the rationales in detail, see if there is anything else you need to add to your notebook and come back and join us for another question.