Walkthrough Q1: Management of Care – NCLEX-PN®

00:01 Hi. I'm Professor Lawes. And in this video series, my goal is to help you rock your NCLEX exam.

00:09 Now, if you're watching this with us, you're studying for your NCLEX PN exam.

00:13 Good job. We need you in our healthcare system. And I've taught NCLEX reviews for a long time.

00:20 So, I'm going to give you the best tips and strategies on how you can be more successful on these types of questions.

00:27 So, are you ready? Let's get started.

00:31 Now, the first thing I'm going to encourage you to do is make sure that you spend more time in the stem of the question.

00:38 The stem of the questions are the words that you see above the answer choices.

00:42 Now, this is going to be tough. It sounds simple but it is not easy to do.

00:47 Your natural inclination is going to be the one to scan that question, look through the answer choices, pick them as quick as you can, and move on to the next question.

00:55 That is a recipe for disaster. Now, I know how fast my mind races.

01:01 I don't say it's efficient but it does move pretty quickly in lots of different directions at the same time and this is a skill I really had to practice.

01:10 So, do not look at the answer choices.

01:13 Before you look at that stem of the question and you really rip it apart.

01:18 I'm going to tell you the things that will be important for you to look for in those questions to help you get the right answer. Now, this is a select all that apply.

01:27 Nobody likes these but I'm going to give you the best strategies on how you can raise your score on these types of questions.

01:37 So, let's take a look at the wording. The nurse is delegating vital signs of newborn infants.

01:42 Now, they're delegating these vital signs, right? To an unlicensed assistive personal.

01:47 Which infants' vital signs does the nurse delegate to the UAP? Select all that apply.

01:54 Now, listen, when you're in a stressful situation and all tests are stressful.

01:58 And of course, the NCLEX is stressful.

02:00 Your brain isn't as efficient as it would be on a normal or a regular day.

02:05 So, that's why I'm going to teach you strategies about how do you rip apart this question? Well, this tells me the nurse. That means, who am I in this question? I'm the LPN. So, the nurse, that's me.

02:18 The LPN is delegating vital signs of newborn infants to an unlicensed assistive personal.

02:25 Now, is this appropriate? Can an LPN delegate to a UAP? Absolutely. So, we know we're totally in line there.

02:33 Which infants' vital signs does the nurse delegate to the UAP? Now, I got to think. Okay. What's most appropriate for a UAP to do when it comes to taking vital signs? Can they do vital signs at all? Of course they can. But they're going to do them on stable patients only.

02:53 So, I know when I look through these patients, these five patients that we have here, I'm looking for the patients that are hemodynamically stable.

03:02 Okay. So, when you're looking for who's stable, we're usually talking about hemodynamically stable.

03:07 Anything that you would take, like, respirations, heartrate, blood pressure, those in particular are going to let us know about how stable that patient is.

03:17 Something that affects their respiratory system, their heartrate, their blood pressure.

03:23 Those are going to be things that will be only appropriate for the LPN, the nurse, to monitor.

03:29 So, let's work through them. This is what I also recommend.

03:33 First of all, first recommendation was take the time in the stem. Make sure you know what the question is asking.

03:39 Put it into your own words. Those mental gymnastics will help you focus your brain.

03:44 Secondly, use your write on, wipe off board. In the NCLEX exam, they will give you a small write on, wipe off board, and you can write one, two, three, four, five in this case.

03:57 You want to work your way through each one of those options.

04:00 You kind of treat them as a yes/no, or true/false question.

04:04 And think of this as five separate questions that you're totally capable of doing.

04:11 Let's start at the top. I've used my write on/wipe off board.

04:14 I've written one, two, three, four, five to help focus my brain.

04:18 I'm going to look at option one. Is there any reason an infant with hip dysplasia could not have their vital signs taken by a UAP? The hip dysplasia. They're going to have, like, all kinds of, like, orthopedic stuff.

04:35 They're probably going to be wearing a brace.

04:37 But does that make them hemodynamically unstable? No. It doesn't.

04:42 So, should the UAP be able to take their vital signs? Yes. That's different from doing a dressing change or something along those lines.

04:50 So, number one, I'm going to circle it because I'm leaving it in. Now, I'm going to go to number two.

04:57 An infant with a diagnosis of neonatal abstinence syndrome with increased muscle tone.

05:03 Okay. That's a little bit of a long answer. So, let me make sure I'm really clear what this is.

05:08 This is the infant has neonatal abstinence syndrome or you've heard them called NAS babies.

05:14 That means while the mom was carrying the baby, she utilized opioids.

05:19 She took opioids. And so, the baby is born addicted.

05:23 That's what NAS is, neonatal abstinence syndrome. Is it normal for them to have increased muscle tone? Sadly, it is. It breaks my heart to see these babies in the nursery but are they hemodynamically unstable? No. They do have that increased muscle tone but that's expected with a NAS baby, so, a UAP, could they take these vital signs safely? They could.

05:49 So, I'm going to circle number two. So far, I've circled number one and number two.

05:54 Now, I'm going to number three, an infant with nasal flaring and grunting.

05:59 Okay. That's more assessment information. So, an infant, nasal flaring and grunting.

06:05 What are those signs of? Yes, respiratory distress.

06:10 Would this be appropriate for a UAP to take the vitals of an infant who is in respiratory distress? No. This infant is hemodynamically unstable. They're getting into respiratory distress.

06:26 Nasal flaring and grunting means they're having to work really hard to breathe.

06:31 The nurse, the LPN, would need to go in and see that patient, including vital signs.

06:36 Okay, so, number three, I am crossing through that on my wipe on, wipe off board.

06:41 Now, an infant with, oh, I have to tell you. This is like, one of my favorite words, hyperubinemia.

06:47 It's just so fun to say. I can remember that still when I took my medical terminology class but let's break it down.

06:53 Hyper means elevated. Bilirubin, right? That's existing in the body. That's after those little red cells are broken up.

07:02 And -emia means in the blood stream. So, this infant has elevated bilirubin levels in their blood.

07:11 So, does that make them hemodynamically unstable? Well, the bilirubin in the blood really isn't going to impact their respiratory rate or their vital signs.

07:22 What we're worried about is if it gets too high for too long, it actually can cause brain damage.

07:27 Now, that's a pretty severe case. But someone with just - when you see the infant right here, hyperbilirubinemia, we don't have any other information about them.

07:35 They're going to be hemodynamically stable. Otherwise, the question would have told us something different.

07:41 So, should a UAP take this patient's blood vitals? Yes. They're hemodynamically stable.

07:49 So, I would check that one. I would circle it. I would mark it as I want to keep it as correct.

07:56 Number five, an infant who is jittery shortly after delivery.

08:00 Now is that normal? What do you think? No. It is not normal.

08:06 If you have a baby who's all jazzed just after being born, what we're worried about is low blood sugar.

08:13 So, this baby is not stable until we can deal with that blood sugar.

08:17 He'll need to be monitored and that would be more appropriate for the nurse, the LPN to do versus the UAP.

08:25 So, now, I look down at my board. So far, I've selected one, two, and four.

08:31 Now, I go back one more time to the stem of the question and here's what I say.

08:35 What was the wording that they put it in? So, which infant's vital signs would be appropriate to be delegated to a UAP? Let me look at my answers. Infant with hip dysplasia? Yup, still solid because they're not hematomically unstable.

08:50 Two, infant with diagnose of neonatal abstinence? Correct. I should check this one because a UAP could take it.

08:57 Number three, I did not select because nasal flaring and grunting is respiratory problems.

09:03 Number four, hyperbilirubinemia happens often. It wouldn't give you any problems there.

09:09 They are not unstable, so, I said that, yes, a UAP could take this patient's vitals.

09:15 And five, hmm, this client is unstable, likely signs of low blood sugar.

09:20 So, yes, I agree with my answers. Okay. That's annoying. Why would I recommend that you do that? You're thinking, "Lady, how long is this test going to take to take?" Here's what I've seen in students most often and the number one error they make, they answer questions one, two, and three as what's appropriate for UAP and then, somewhere before number four or five, they flip and answer questions that are not appropriate.

09:52 So, focus your brain. Brains in test questions really stressed.

09:57 So, the more consistent, the more methodical you are, you're going to get better answers.

10:02 If you know the answers you absolutely want to get credit for it and using these strategies will allow you to do that.

10:10 Spend time in the stem of the question before you look at the answer choices.

10:14 Look at each answer choice as a separate question. Ask yourself yes or no.

10:19 After you've made your selection, go back and make sure that they're all consistent, that they all match and make sense.

10:27 That's it. Now, you just need to keep practicing these select all that apply questions, take what we've talked about here, and use these same strategies on the other questions.