Walkthrough Q2: Basic Care & Comfort – NCLEX-PN®

00:01 Let's start where we always do with the stem of the question.

00:04 Now, wait. Don't look at the answer choices yet. Hang with me.

00:08 I promise this is going to pay off for you in the end. Let's do the work in stem of the question first.

00:14 And then, we'll work through these options together.

00:17 So, the nurse, that's you, the LPN, is caring for a client who underwent hip arthroplasty five days ago.

00:25 The client is treated with an oral analgesic and reports a pain score of eight out of 10.

00:30 Considering the five-step nursing process, the expected outcome for this client is to report a pain score of four or less.

00:39 The nurse identifies which potential barriers to the client meeting this expected outcome? Select all that apply. Don't get discouraged.

00:51 We can do this but we've got to go back up to that question, really break it down.

00:55 So, the nurse is caring for a client who underwent what? Hip arthroplasty.

01:02 Hey, if I was taking the test, I'd be like, hip arthroplasty. I'd be pointing to my hip to focus my brain.

01:08 You don't have to but anything that helps focus my brain in a stressful situations, I like doing.

01:14 Now, the key thing is timeframe, five days ago. Anytime an NCLEX item writer puts a timeframe in there, it matters.

01:23 Okay. So, they wanted you to know that it was five days ago. The client is treated with an oral analgesic.

01:30 That means a pain pill they take by mouth. Now, the client's reporting, hey, anytime you have something that says a client reports "like you see there" really pay attention to that.

01:43 That's a key red flag for you when you're reading a test question, that's what the item writers want you to pay attention to.

01:50 Now, the client is reporting a pain scale of eight out of 10.

01:55 Anytime you see a number, you ask yourself that involves assessment, is this high, is this low, is this normal? Eight out of 10 if it's me, that's pretty high. So, we know we likely need to do something.

02:08 Okay. So, considering the five-step nursing process, you know what that is, right? Assessment, diagnosis, planning, implementing, evaluating, all those things that go along with that.

02:18 The expected outcome for this client is to report a pain score of four or less.

02:24 So, what is the client reporting? Eight. What is the care plan say they should be? Score of four or less. So, we're not meeting that goal yet.

02:35 The nurse identifies which potential barriers to what? To the client meeting the expected outcome.

02:42 Okay. So, what am I looking for? That last sentence is gold. Okay? You always want to make sure that's the final focus.

02:53 Miss that last sentence and you're likely to really miss the whole content of the question.

02:58 So, the beginning part is really just a lot of words to tell us what? This patient's pain isn't well-controlled on this particular oral analgesic.

03:09 Now, do we know if it's the type of medication? Are we going to look at something else? We don't know what they're asking us but we just know we're not meeting the patient's goal of having a pain level of four or less. So, we need to do something. Last sentence.

03:24 The nurse identifies which potential barriers to this client meeting the expected outcome, select all that apply.

03:31 So, now, I've got my write on, wipe off board. I write down one, two, three, four, five.

03:37 And hey, if you don't have one at home, use a piece of paper.

03:39 So, it works totally fine or you can go to a dollar store or some discount store and get a really cheap one quickly.

03:45 But it doesn't matter here when you're practicing what you're using.

03:49 It just will really benefit you if you do use it. So, number one, I know that I'm looking for a barrier, a potential barrier to the client meeting the expected outcome which is pain control.

04:02 So, number one, the client does not know how an analgesic works to manage pain.

04:08 Okay. So, I know we teach patients a lot about pain and like, how things are supposed to work and when they'll feel the benefit but is this a barrier? Okay. I don't know yet. I'm going to leave it in. I'm not feeling sure.

04:26 So, I'm just going to put a little question mark by that one and for now, I'm going to leave it in.

04:30 That's going to happen to you. You don't always know, yes, no, in, out, when you're going through it.

04:35 Give yourself that grace. It happens. Just put a little question mark by it.

04:40 Now, the client is not adhering to the prescribed physical therapy sessions.

04:45 Could that be a reason their pain is not at the level we want it to be? Probably, yes, because physical therapy, they can be really difficult and those can be painful but if they're not attending those sessions and they're not sticking to that regular physical therapy, things are going to get worst with a hip arthroplasty.

05:07 So, I'm going to circle number two because I think that's a potential barrier to them meeting their pain goal.

05:13 So, so far, number one, I got a question mark. Number two, oh, I'm definitely leaving that in. I circled it.

05:21 Number three, the nurse administered a dose of analgesic below the prescribed amount.

05:28 Would this be a potential barrier? Yes, it would and it would also be wrong.

05:35 We don't ever change the dose of a medication as a nurse.

05:40 Not for LPN's, not for RN's, not for anyone who doesn't have prescriptive authority and LPN's and RN's do not have prescriptive authority.

05:49 So, the nurse administered a dose of analgesic below the prescribed amount.

05:53 Yes, it would impact them meeting their pain goal and it is just wrong.

05:59 You can hold the medication or give a medication.

06:02 And if you hold it, you should notify the healthcare provider but you can't change the dosage of any medication.

06:07 So, number three, you're out. Well, are you out or are you in? What am I looking for? Ha-ha! Good job.

06:15 I'm looking for potential barriers. So, would number three be a potential barrier? Yes. So, should I select it? Yes. Excellent.

06:25 So, see how easy that happens when your mind is racing when you're looking for things? That's why I want you to always treat these as five separate questions and make sure you're asking what that last sentence is asking, so, you're in line.

06:39 Now, would number four, the client is experiencing nausea and vomiting.

06:44 Would this be a potential barrier to meeting their expected outcomes? Well, if they're having nausea and vomiting, they're not able to take oral medications.

06:54 So, yes. This could be a potential barrier.

06:58 Number five, the client is experiencing redness, swelling, and warmth of the incision site.

07:05 Is this normal? No. You do not want this to be red, swollen and warm at the incision site.

07:12 Because remember, we're five days out. This is clearly a sign of infection.

07:17 That's why they gave you a timeframe, so, you would know that after surgery, there's always an inflammatory response to try and heal.

07:24 But five days out, the wound should not be red, swollen, and warm right at the incision site.

07:31 So, could this be a potential barrier? Absolutely. So, which ones have I selected? Well, I only made a call on two, three, four, and five. Now, I have to go back to number one.

07:44 Will the medication work if the patient understands analgesia? Yes. Will it under - will it work if the patient doesn't understand analgesia? Yes. It will still work. Now, in my mind, I'd make the argument like, "Well, wait a minute." If the patient understands how it works, maybe they'll be more compliant.

08:03 Uh-huh. That's not what it asked us.

08:05 It asked us, does this impact the level of pain the patient's experiencing? Number one does not. The medication is going to work if it's administered appropriately.

08:17 That medication is going to work. So, this is not a potential barrier.

08:22 Now, two, three, four, and five. I'm going to read through them one more time just to make sure that I'm answering the question correctly.

08:29 Is number two a potential barrier to pain control? Is number three a potential barrier to pain control? Is number four a potential barrier to pain control? Is number five a potential barrier to pain control? Isn't that annoying that I just read those all to you. I get it. I think it's annoying, too, but it is the absolute best way to make sure that you didn't flip in the middle and that you're confident in your answers, so, you can pick them and go on.

08:59 Now, what I'm recommending to you is not using the screen as you're clicky, clicky, clicky, clicky, clicky.

09:04 Do the work down here, right? Do it on your scratch paper or your write on, wipe off board, so, then, when you enter an answer into the computer, you're doing it with confidence because I am president of the answer changer club. I am terrible at it.

09:21 I always want to second guess myself and so, I really had to work on that.

09:24 I don't want you to make the mistakes that I have. You teach your brain, "Hey, when we put it in the computer and we've checked it, it's go time.

09:32 We're done. All right. So, that's more strategies on how to do select all that apply questions.

09:38 Stick with us. Keep practicing.