Walkthrough: Reduction of Risk Potential Q10 – NCLEX-RN®

00:00 When the client is taking atorvastatin, which serum lab testing is monitored? Select all that apply. Alright. I know you much prefer a 4-option multiple choice. Right? That's what we're looking for, but I promise you we can help you get better at this.

00:20 I'm not saying we'll ever help you love them, but I'm going to help you not be so afraid of them. It just takes practice, so stick with us. Now, that's a pretty short stem but you still want to take the time to put it into your own words. See those mental gymnastics that your brain is doing helps you really clarify so you don't get confused as easy. You don't want to get a sucker punch and end up missing an easy question. So, I've got a client who's taking atorvastatin. Which serum lab testing is monitored? Well, that's a statin. Remember what that drug is? Now, if you didn't know that, you'd have to kind of think through. Oh, look at the answer choices which you don't have right now, but you would look at the answer choices and see if there's any kind of pattern. But if you have absolutely no idea what the drug is, the best you can do is keep your mind under control. Don't let automatic negative thoughts go in, don't start beating up on yourself, just own it. "I have no idea what this drug is, I'm gonna do my best and this is one question, I'm gonna do my best and I'm gonna move on. I'm not gonna beat myself up. I'm not gonna talk about 'I'm gonna be the one, I'm gonna be the one who doesn’t fail, who fails the test, who doesn't pass the NCLEX." All that stuff, nonsense. Just own it because you should anticipate on an NCLEX exam you will see a question with a drug name or a diagnosis or something you have no recollection of. It's okay. Just keep it together, do your best and remember it's only one question. Now for this one, let's say you knew that this was a statin. We use that to control, hope you said cholesterol. Good job. So we know that these drugs can be kind of hard on certain areas of the body. That's what we're looking for. We're going to monitor for a potential negative effect of the statin. Right? Because this is not a drug that we do a serum level to make sure it has the right therapeutic range. We just do lab work to monitor for a potential adverse effect. Now, I'm going to bring on the answer choices in just a second, but before I do write down on your scratch paper or your write on wipe off board if you're really a go getter. Write down just the numbers; number 1, number 2, number 3, number 4, and number 5. Then, we're going to bring the answer choices on, I'm going to ask you to pause the video, do the work yourself. Remember we put the question into our own words. Right. So I'm looking for something that would monitor that I would take with the patient who's on a statin. So, what is it I would monitor for a patient who is taking a statin? I'm going to ask myself that question 5 times. So, press pause, here come the answer choices, do the work and then come back and see as we walk through it together.

03:07 Remember, you taking the time that you need to be thorough and as you eliminate an answer choice saying why is what's going to help you be better at select-all-that apply questions. See you in a couple of minutes. Hi, welcome back. How was that for you? What did it feel like? Anyone get annoyed at this? Yeah, I do too. I have to really work at keeping my head in the game. So, when we're thinking about statins, we've got these 5 options here. So my first job is what I'm going to do is say "What is an LDL?" That's kind of a cholesterol test. What is an alanine aminotransferase? Oh, that's an ALT so I know that measures a liver enzyme.

03:57 White blood cell count tells me we'll look at that for things like infection or inflammation. Carbon dioxide is a waste product of the cells. Right? So it's always present in my body, that's what travels back up to my lungs and I get rid of it. And creatinine kinase means there's some kind of muscle damage. We'd have to do another test to tell exactly what kind of muscle damage it is, but that's what I got.

04:22 Now let's take and think through. What do I know about statins? What are they particularly hard on? So, statins don't have an impact on carbon dioxide.

04:35 I'm going to get rid of that one first. But that's number 4. Yeah, it's totally okay.

04:40 You don't have to go 1, 2, 3, 4, 5. Right? You can start anywhere you want as long as I eliminate an answer choice, cross through the number 4 and say why. I'm getting rid of carbon dioxide because that's just something that is in the body and statins don't impact that level so I'm getting rid of number 4. Now I'm looking at the other answer choices. What do I want to get rid of next or is there something I want to keep in? Okay, well, LDL that is a cholesterol so I'm looking for what am I when the patient is taking statins. Yeah, I'm going to take a look at that. Right? Because I want to know "Is the treatment effective?" Ohh, so on pharmacology questions, they're going to want me to know how do I measure if the medication is doing what we wanted it to do, that means is the treatment effective and is the patient in any danger? So, LDL, we're hoping that LDL level is going down. Right? Because we want to see a higher HDL. So, number 1 I'm going to select. So, so far I've kept in number 1 and I've got rid of number 4. Now, what's next? What do I want to get rid of or what feels comfortable to me? Ah, 3, white blood cell count. Statins do not interfere with like infections or inflammation. They don't have an impact on our white blood cell count so I'm going to get rid of number 3.

06:11 Okay, now I've got left 2 and 5 to make a decision on. So, ALT, ahhhh that is a liver enzyme. Is there a connection between statins and liver enzymes? There is.

06:27 Some people, not everybody, but some people will have some challenges with their liver. It will be kind of tough on their liver that's why we frequently test all patients who are on long-term statins or when they're just starting the treatment to make sure their liver isn't suffering any damage. So, I've kept in number 1 because I want to monitor a cholesterol level with a cholesterol-lowering drug. I've kept in number 2 because statins can be difficult or hard on the liver and an ALT tells me about liver enzymes which would indicate damage. I got rid of number 3 because statins don't have an impact on white blood cells. That would tell me more about infection or inflammation and that's not what we're going after here. Number 4, we got rid off because it's carbon dioxide and that is not impacted by statins, that's a metabolic end-product so I got rid of number 4.

07:21 I only have to make a decision on number 5. Creatinine kinase. Now that's an enzyme but it's not really going to help us know about well how the liver is doing.

07:32 The ALT is specific to liver enzymes. That is the organ we're worried about. So 1, 2, and 5 are the ones that I selected for test that would be monitored. Look at their cholesterol level, number 1, and possible damage to their liver number 2, and number 5 creatinine kinase is going to tell me "Hey, there might be some damage going on." Right? That's what those enzymes are, but it isn't as specific as ALT.

08:03 Alright? So you do it one more time, check your answer choices, make sure everything makes sense to what the question was asking then you hit submit and move on.

08:12 What I don't want you to get in the habit of doing is change your answer choices.

08:15 Whoah, number 1 is in, number 1 is out, number 3 is in, number 3 is out. The more you start doing that, you're really going to confuse yourself. So, I recommend that you not use the computer screen as your practice paper. That's why the scratch paper is where you're working things out and you make sure when it's on your scratch paper you've got it the way that makes sense to you then transfer your answers to the screen. Now that's just my recommendation, but I found when students use the computer screen, the clickie, clickie, clickie, clickie, clickie, clickie, clickie, clickie, clickie change answers they really tend to get confused. So, that's a recommendation. You do you, you choose what works best for you, but it's usually a more consistent and systematic way to approach it if when you're checking your answer choice up there, boom, you do it once, review it just to make sure it's lined up and then move along. But you find what works best for you so try it on your practice questions, see which strategy works for you then check back and forth to see if that is the best strategy for you or it really isn't working out. So spend some time reflecting on this question. Did you get it right? Yes. Take a victory laugh.

09:28 Did you get it wrong? No problem, this is where you grow, this is where you get stronger. So take a look at the answers. What did you possibly miss while you're going through that? What threw you off? Did you eliminate an answer that should have been kept in? Did you keep an answer in that should have been eliminated? Here's where you kind of do the detective work of how your brain works. Then, is there anything from the rationales you need to add to your NCLEX notebook, something that you want to remember. You want to remember that, yeah you can do an ALT to check on the liver and the L stands will help remind you that it's liver, that helps you stick in your brain. Whatever things you can gain from going over the rationales with us whether I'm with you on video or you're reading through your Q bank questions, those are the nuggets that you want to put in to your notebook and that will supercharge your studying whether you're getting ready for an exam in nursing school or the NCLEX. I promise, that is what I see successful students do on a consistent basis that do really well on their exams.