Walkthrough: Reduction of Risk Potential Q4 – NCLEX-RN®

by Rhonda Lawes, PhD, RN

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    00:00 A school-age client is hospitalized for an acute exacerbation of asthma. The nurse's assessment reveals expiratory wheezes are absent. Which response by the nurse is best? Okay. Let's break it down. So, I know when I'm looking at that first sentence, what are keywords? Well, school-age client helps me know.

    00:25 Okay, so I've got a kid, they're not a high schooler but they're a school-age client, they're hospitalized for an acute exacerbation of asthma. Alright, so acute means this just happened. Right? It's an event right now, it's an acute exacerbation, and they had to be hospitalized for it. So it must have been pretty severe. The nurse's assessment reveals expiratory wheezes are no longer present.

    00:55 Which response by the nurse is best? Okay, so we got a school-age kid, they're hospitalized for asthma, an acute exacerbation. I feel when I do the assessment, expiratory wheezes are no longer present. Which response by the nurse is best? Alright, let's take a look. Did you put that in your own words first? Right, don't look at the answer choices until you do that. So, pause for just a second, put this question in your own words, practice doing that. Good. Now you're looking for the best response by the nurse. So we're looking for something that keeps this particular patient in this particular setting the safest. What's particular about this client? They're school aged, they have asthma, they're having an acute exacerbation, and now we know that expiratory wheezes are no longer present.

    01:54 Here come the answer choices. Pause the video. Write down the numbers 1, 2, 3, and 4, not the answer choices, just the numbers. And work through each answer choice.

    02:06 Eliminate 3 of them and say why and make sure that 4th one is the best response by the nurse. See you in a few minutes. Take all the time you need to answer this question well. Welcome back. Now, let's go back up to that question and see if you caught some things. We know they're school-age child. Right? Hospitalized for an acute exacerbation of asthma. When the nurse does an assessment, they recognized that wheezes are no longer present. So this is a change. Which response by the nurse is best? So what are they testing you on? They're testing you to see is this change good or bad? Is this patient in danger? Because that's what testing is all about. Will you recognize as a nurse when your patient's in danger and will you know what to do? So, you have to make a call. Right? You've got an assessment there. Wheezes are no longer present. Okay. Is that normal or abnormal? That was the choice you had to make. Now, if you look at number 1, document and improvement. Well, if you don't know about asthma, you think well they don't have wheezes anymore. Isn't that a good thing? No. No, it is not. It's a bad thing.

    03:35 That means that now we've progressed to an airway that is so locked down, you can't even hear those expiratory wheezes. So, no. Do not document improvement.

    03:47 Now let's talk about that answer or document for just a second. I want to give you some tips and strategies for other questions. Sometimes, document will be the correct answer, but never when it's an abnormal assessment. So that's what they're testing you on here. If you pick number 1, they're saying "Ahh, you don't realize that it's a bad deal when the expiratory wheezes go away." Now, I remember that you have just a little bit of information here but take this note, put it in your notebook, remind yourself of this concept so you'll be on the lookout for it in additional questions. 2, place oxygen on the client. Well, that kind of sounds like we should leave it in. Right? Oxygen can be good for asthma, so I'll leave 2 in.

    04:34 A new one had to go, but number 2, I'm going to wait. Number 3, alert the rapid response team. Now, this is a team that you call that is just one step below a code blue. So, this is wow the nurse or healthcare provider, anyone can call a rapid response, even a family member which is so cool. So, this rapid response means a group of physicians and nurses, a whole team will come together and assess that patient and help guide the next step. So, do we need to go to that level? Not sure. What about number 4? Administer a prescribed antihistamine. Well, what does an antihistamine do? Yeah, it blocks a histamine response which is some type of inflammatory allergic response. That's not what's going on here so I can get rid of number 4. This is not an allergic response going on even though I know sometimes you think well, maybe that was a trigger. Yeah. It doesn't matter.

    05:36 There is a slight connection, right, with having an allergic response and having an asthma attack, but it is not the option or the response that's going to keep this patient safest. So I'm ready for number 2 and number 3. Are they asking me what I should do first or what is best? They're asking me best. So would it be better to put oxygen on this patient or get that team in here to address it? Number 3 is the best response. Why? This is a sign of severe distress. We've got significant airway problems, it's gotten from bad to worse and that's why of these 4 answer choices, number 3, get that rapid response team in there and hopefully you already had oxygen on that client but if you didn't as that rapid response team is responding, you absolutely will. Okay. Now sit back, look at the view, look at the stem of the question, look at the answer choices. Does it make sense why we picked number 3? No really. This is where you start to learn to really rev up your test taking skills.

    06:53 Step back and reflect. Did you miss something in this stem? Would you have picked another answer if you had caught that in the stem? Is there something you need to do differently in your test taking strategies on the next question? Are you resistant to eliminating the answer choices and saying why? I can tell you, I am, I have to force myself to do it because I just want the testing experience to be over as quickly as possible because it's stressful and I worry, but that's exactly the reason why you should use that strategy of writing down just the numbers, eliminating them, and say why. That will significantly increase your odds of recognizing something you may have missed when you systematically think through every question with the same strategy. So, if it's feeling wonky to you, I get it, I completely understand but I want you to be successful. So practice this skill, you will get better at it, I promise. Take a note, see whatever needs to be added to your studying notebook so when you review this on a regular basis you'll know why a nurse needs to know this and how it would keep a patient safe. Some of you I can already tell need to write in your notebooks. If a client in an acute exacerbation of asthma, if expiratory wheezes disappear, this could be a sign of significantly worsening respiratory status. Good deal. Anything else you need to add to your notebook, go ahead and do it and then join us for the next question.

    About the Lecture

    The lecture Walkthrough: Reduction of Risk Potential Q4 – NCLEX-RN® by Rhonda Lawes, PhD, RN is from the course NCLEX-RN® Question Walkthrough: Reduction of Risk Potential.

    Included Quiz Questions

    1. Older adult
    2. Urgent care
    3. Abdominal pain
    4. Acute
    5. Assessment
    1. Is a change in assessment condition good or bad?
    2. Is the client in danger?
    3. Is the assessment normal or abnormal?
    4. Is the assessment abnormal?
    5. Is a change in assessment good?
    1. Expiratory wheezing is no longer present
    2. Expiratory wheezing
    3. Rhonchi
    4. Inspiratory wheezing
    1. Remember "how to keep the patient safe" when answering questions.
    2. Eliminating answers and answering why they are not correct.
    3. Think through each answer with the same strategy.
    4. Review questions and strategies regularly.
    5. Each question is different and requires various strategies to answer successfully.

    Author of lecture Walkthrough: Reduction of Risk Potential Q4 – NCLEX-RN®

     Rhonda Lawes, PhD, RN

    Rhonda Lawes, PhD, RN

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