Walkthrough: Reduction of Risk Potential Q11 – NCLEX-RN®

by Rhonda Lawes, PhD, RN

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    00:00 The nurse is caring for a client who is diagnosed with hypertension, hypercholesterolemia, and congestive heart failure. Awesome. That's a triad. The patient has been prescribed atorvastatin, furosemide, and amlodipine. The client reports, whoah, and this is my first time to the question I know, "the client reports." That's how they do. So, the client reports being confused, feeling dizzy, and might have taken an extra doses of the prescribed drugs. Whoah, excellent. So, which action does the nurse perform first? Alright, lot of words there. Lot of information for us. So let's go through one sentence at a time. Start with the first sentence.

    00:48 The nurse is caring for a client who is diagnosed with 3 things. Right? And so you see me use my fingers? I actually, well like if I'm sitting taking a test, I will put my fingers like on my leg and say 1, 2, 3. That works for me, doesn't mean it has to work for you but when I'm stressed that helps to focus my brain that I know this person has 3 diagnosed problems. So you know hypertension, heart; hypercholesterolemia, heart; congestive heart failure. Okay, so they got a pretty significant heart history. Now, they've been prescribed medications. Well, look at that, it's like a match set. They have been prescribed 3 medications. I've got a statin, furosemide, and amlodipine. Now, by this time you might be starting to sweat a little bit, right, because you're like "Oh my gosh, that's like 3 diagnoses, 3 different medications. Do I recognize those?" Calm down. Take a breath, it's just one sentence. So I know there is atorvastatin. Right? That's a statin. You might remember that is furosemide, I can't for sure remember what that is. And amlodipine. Whoah, okay I'm not sure. If you don't know, what's the number 1 strategy? Stay calm, keep reading, look for context, and look for patterns. The client reports being confused. Well, we know that's abnormal. That's assessment.

    02:09 Feeling dizzy, well that ain't normal and might have taken extra doses of the prescribed drugs. Okay, so we don't know really what's causing it but the question isn't asking me that, it's asking me "Which action does the nurse perform first?" Okay, that last sentence is what focuses me. So I know, because I've been practicing the whole point of NCLEX or nursing exams is keep this particular patient in this particular setting the safest. So what's particular about this patient? Oohhh, they got 3 cardiac diagnoses. They're on 3 medications and now they have abnormal assessment. So, what do confused, feeling dizzy have to do with maybe taking an extra dose of one of those medications? We're not sure that that's going to be an answer choice but that's the feel, that's what we're looking for.

    03:06 I'm looking for "What do I do first for a client with this cardiac history, on these medications, who has some abnormal assessment?" So, which do I perform first? Luckily, this is a 4-option multiple choice. So we're going to be able to eliminate these and know that just one answer is correct. Okay, so we're going to bring the answer choices in. I want you to write down on your paper the number 1, the number 2, the number 3, and the number 4. As you're reading through these answer choices, ask yourself this question that you reworded "Would this be what I did first for someone who has this abnormal assessment? It's in or it's out?" Right? That's what you want to do but if it's out you say why. If it's in, you also say why. The extra step of making yourself really own up to why you're putting it in or taking it out besides "Ahahaha I don't know" which is what my brain kind of does when I'm stressed. That will help your brain remember "Oh, we've done this before. This is how we do questions." And sometimes the answer is going to be "I'm not sure but I think this answer is a better answer over that answer. I can't exactly say why and if I hang out in this question longer, I'm likely not going to come up with a better idea of why I'm saying why so I'm going to select my best answer, know that I did my best, submit it, go on and remember it's just one question." Good. Okay, so keep all that in mind, go back, do the work, pause the video, and then come back and we'll walk through it together. Hey, welcome back, okay. I know, there's a thousand other things you'd rather be doing than answering questions but this is what's really going to pay off for your future. So, you want this long term, it's just hard to make those decisions in the short term. Right? I'm with you. Okay, so we've got 4 answer choices. You have read through all of these. Right? But let's pretend like we're kind of working through it the first time. Now, commit to your answer, no free loaders, make sure you have picked the answer that you're going to choose. Number 1, discontinue IV fluids and restrict all oral fluid intake. Okay, would that fix them being confused, feeling dizzy, and maybe taking an extra dose of the prescribed drugs? Is that what would keep them the safest? Sure doesn't seem like it but let me read through this number 2.

    05:39 Insert a central venous pressured catheter and measure the central venous pressure. Okay, I want you to picture what that looks like. You have a patient who tells you "Gosh, I'm kind of dizzy" and they seem to be confused and they may have taken an extra dose of their medication. Is the first thing you're going to do, which action does a nurse perform first? Are you going to put in a CBP, a central line? No. That one's kind of ridiculous. When you slow down and you think about it, a patient tells you "Hey, I'm feeling kind of weird." You're like "Get the central catheter team in here, let's put in a central line, let's get and put it." No, you're not going to do all that. Now that sounds silly when you stop and picture it, but when I'm stressed, I really have to make myself stop and picture what that answer choice literally means. So number 2, you're gone. That is way over the top. That's not the first thing I would do. Remember, first, the other F word. Right. So we know that we have the potential for more than 1 answer to be right in these 4 options, but only 1 is going to be the highest priority to do first.

    06:46 So number 2, you're out, we explained why. Okay, uhmm number 3, assess the systolic and diastolic blood pressure using a sphygmomanometer and cuff. Okay, what is a sphygmomanometer? Ahhh, that's that big fancy word for blood pressure cuff. Right? That's the dials that go on the arm to help you really measure blood pressure. So that's what it's saying. If they say they're dizzy and they seem confused, they may have taken extra medication. Assessing their blood pressure is going to help us assess circulation. We like circulation because it gets oxygen around to all the tissues. So, I'm keeping number 3 in. That seems like the best thing to do first because we know there's always priorities of "How's their airway? Are they able to breathe?" And then circulation, that is a top priority. You know that from CPR. Right? So, 3 has to do with circulation, I'm leaving it in. Number 4, assess systemic vascular resistance using a sphygmomanometer and cuff. Okay, assess SVR. Well, that seems kind of extreme. Number 3 does seem like a better answer, but there's another problem with number 4. SVR is not assessed with a blood pressure cuff. Right, you have to have a PA catheter in here into the right atrium, to the tricuspid, into the right ventricle over to the pulmonary artery.

    08:13 We're not going to do that for somebody who says "I'm a little dizzy and I feel confused." So why is number 4 out? First of all, SVR would be not our first action and secondly you can't assess SVR with a blood pressure cuff. So, out and out. So, so far we've gotten rid of 2 and 4. Now, we're back to number 1 and number 3. Well, number 3 is the one that really addresses the first priority. Number 1, discontinue intravenous fluids and restrict oral fluid intake. That would be if somebody was fluid volume overloaded. Nothing in the question tells me they're fluid volume overloaded. In fact, feeling dizzy and being confused, those are 2 things that go along with poor circulation. They're not being perfused. Their brain is not being perfused. Some reason their blood pressure could be lower, that's why that's where I start first. Check the circulation by checking their blood pressure. Number 3 is the best answer. Okay, how'd you do? Did you get it? You know what I say, celebrate. Because there's so many hard things in nursing school. When you get something good like that, you got to celebrate it and pause and recognize it. We spent enough time being yourselves up in nursing school. If you didn't get it right, you know our drill. Think through the answer choices. What caught you off guard? Did you know what a sphygmomanometer is? Did you know central venous pressure? Did you picture what those answer choices look like? Those are all strategies that you can take from this question and use on other questions. Okay, that's what we're looking for but you have to do the time right now. Pause, reflect, think about why you got the question right, why you got it not right or incorrect, and make some decisions. Think about "Hey, I'm seeing a pattern of what I'm doing in answering choices and this is where I need to change." That's how the rockstar is doing. You don't have to be the 4.0 student in your class. All you have to be is someone who is willing to be consistent, put the work in, and take the time to reflect on "How did you rip apart that question? What can you do better on a similar question?" Not content, format. Okay? If it's a content thing, you know you write that in your notebook and you keep reviewing that on a regular basis as we recommend. So good work, hang in in there, this was a long one but you did a good job just by putting in the effort to try to answer this question to the best of your ability. Now, don't stop here, come back and do another video with us.

    About the Lecture

    The lecture Walkthrough: Reduction of Risk Potential Q11 – NCLEX-RN® by Rhonda Lawes, PhD, RN is from the course NCLEX-RN® Question Walkthrough: Reduction of Risk Potential.

    Included Quiz Questions

    1. High cholesterol
    2. High blood pressure
    3. Low heart rate
    4. High heart rate
    1. Congestive heart failure
    2. Pancreatic cancer
    3. High blood pressure
    4. Tachycardia
    1. High blood pressure
    2. High cholesterol
    3. Low cholesterol
    4. Low blood pressure
    1. 88/50 mm Hg
    2. 180/110 mm Hg
    3. 120/60 mm Hg
    4. 115/65 mm Hg

    Author of lecture Walkthrough: Reduction of Risk Potential Q11 – NCLEX-RN®

     Rhonda Lawes, PhD, RN

    Rhonda Lawes, PhD, RN

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