Walkthrough: Reduction of Risk Potential Q8 – NCLEX-RN®

by Rhonda Lawes, PhD, RN

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    00:01 The nurse is meeting a client who reports crushing chest pain in his diaphoretic.

    00:06 On interview, which question is the most important for the nurse to ask? Okay, let's break it down.

    00:13 What's the first sentence tell us? I'm a nurse. I'm admitting a client who reports, Ding! Anything the patient reports to me, or says to me, or communicates to me, is always important to the question.

    00:27 So, I'm admitting a client who reports crushing chest pain and is diaphoretic.

    00:35 Okay, those are two assessments.

    00:37 Is crushing chest pain, normal? No.

    00:41 And diaphragmatic? No, that is not normal.

    00:44 Now, you may be thinking, "Are you kidding me? Do I really need to stop myself and ask, is crushing chest pain normal? Is diaphoresis normal?" Here's what I'm telling you.

    00:56 It's not always obvious in the stem of the question.

    00:59 Consistency is the key. Right? If you keep using the same steps to think through questions, you're going to not miss things you might have an other questions, but aren't so straightforward.

    01:13 So, follow the same rules.

    01:16 Rip through questions exactly the same way every time.

    01:20 You're going to get a more consistent result and a higher score on your exams.

    01:25 Okay. Whether you believe me or not, yet, eventually you will, if you just discipline your brain.

    01:31 Make those new neuronal pathways, right? Make those connections between your neurons.

    01:36 Make that a path that they are very used to.

    01:40 You want a strong connection that says, "This is how I break down a question.

    01:45 So I have all the things I need to critically think through the answer choices and pick the right one.

    01:52 So, back to the question.

    01:54 The nurses admitting a client who reports a crushing chest pain, that's an assessment abnormal and diaphoretic thats abnormal.

    02:02 On interview, which question is the most important for the nurse to ask? All right, I know this is a priority question.

    02:11 I know that I'm looking for the question that keeps this particular patient in this particular setting, the safest.

    02:19 If they're reporting crushing chest pain and diaphoresis, what am I worried about? Well, crushing chest pain and diaphoretic.

    02:27 I'm worried about a myocardial infarction.

    02:30 Those are just pretty obvious symptoms there.

    02:33 So, now, you're going to have four options come up.

    02:37 Let's go ahead and bring them up.

    02:39 You're going to look for the most important one.

    02:42 And remember, ask yourself, would this question keep a patient with crushing chest pain and diaphoresis, the safest? Say yes or no, then you compare it to the other three options.

    02:54 Remember, you can start at any number you want.

    02:56 Just make sure you compare each one of the four answers to each other.

    03:01 So go at it.

    03:03 Have the numbers 1, 2, 3, 4 not the words, just the numbers on your practice sheet.

    03:08 Eliminate answers as you compare them to each other, and then come back.

    03:13 And because we want you to pause the video before you do the work.

    03:16 Come back, and we'll walk through the question together.

    03:26 Welcome back.

    03:27 Which answer did you choose? Now really, it's important that you don't come back with like on between like two and three.

    03:34 Lots of times when I'm teaching an NCLEX review students will say, "I'll take three and a half, please.

    03:38 Because I can't decide between three and four." It doesn't work that way.

    03:43 You get the most out of this time that you're investing in learning how to be a stronger test taker, by making sure you do the work, pick your answer, and then reflecting on why you pick that one and didn't pick the others? Okay, enough said. Let's get on to the questions.

    04:00 So the topic of the question was, what's the most important question, the one that will keep the patient the safest, who we think is likely showing us signs of having an MI.

    04:10 So number one. "Do you have a smoking history?" Will that question keep someone who we think having an MI the safest? Well, smoking does increase your risk for heart attack.

    04:22 So I'm going to keep it in there for now.

    04:25 Number two. "When did the pain start?" Okay, is there a connection between asking when the pain started and somebody having an MI keeping them safe.

    04:38 Actually, there is that's a higher priority than having a smoking history.

    04:43 We're dealing with the here and now.

    04:45 So for now, I'm going to keep number two in.

    04:47 I've now decided to cross number one off.

    04:51 Number three. "Do you cough up any blood?" Okay, now for somebody having an MI is there a connection between coughing up blood? No. Because in an MI a myocardial infarction, what I'm hoping to do is prevent the tissue from being dead and not being brought back to life, right? So coughing up blood is not going to help me keep that patient the safest.

    05:18 Because keeping a patient the safest who's having an MI involves preserving as much of their heart function as possible.

    05:27 So number three, you're out.

    05:29 So if you're scoring at home so far, I've gotten rid of number one and number three, because I think number two, is a better question for keeping this particular patient, safest.

    05:39 Number four. Can you tell me what medications you're taking? Okay, that's a fair question, because they're admitting the client.

    05:47 But what is the topic of the question? Most important for the nurse to ask.

    05:52 Does that mean that the nurse won't ask any these other questions? No.

    05:57 It means which one is most important? When you're a nurse, will you be able to prioritize and know what's the most important question to ask this patient.

    06:05 The correct answer is number two.

    06:08 Good deal. If you picked it, like I said, Celebrate. Take a victory lap.

    06:12 That's a cool thing.

    06:14 But let's break it down and say "Why is number two the correct answer?" Well, you can start to have tissue damage fairly quickly after that blood supply has been compromised.

    06:24 So chest pain can just be ischemia where the tissue has been deprived of oxygen or adequate oxygen supply.

    06:32 But we want to if we can restore that blood flow, we can hopefully revive that tissue and it doesn't suffer permanent damage.

    06:40 And we can use killer drugs called thrombolytics.

    06:43 And they...

    06:45 They're clot busters.

    06:46 So if you have a clot somewhere. You give a thrombolytic.

    06:50 And it will boom, blow up that clot and restore blood supply.

    06:55 The key is, these are high risk drugs.

    06:58 That I said they blow up a clot but they blow up any clot that you have.

    07:03 So I've had clients really traumatic, where we did all the screening, we didn't think they had a risk factor for it, they ended up having an inter cerebral bleed.

    07:13 And the patient sadly passed away.

    07:15 So we know it's a high risk drug.

    07:17 But when it works, it really works.

    07:20 I've seen patients have zero residual after event like this when they got to thrombolytic.

    07:26 But if it's past four hours, so make sure you have that in your notes, if you didn't know that.

    07:32 If the patient has been having the pain longer than four hours, then that tissue is gone.

    07:38 It cannot be revived.

    07:40 And there's no sense risking a high risk drug, like a thrombolytic if restoring the blood flow is not going to bring that tissue back.

    07:49 Okay, so that is key.

    07:51 If you didn't know that, please write that down in your notebook.

    07:54 That's a very commonly tested thing in nursing school and could show up on your NCLEX.

    07:59 You have to know the thrombolytics given within four hours.

    08:03 If it's been longer than four hours.

    08:05 There's no point to give the medication.

    08:07 So take a minute.

    08:09 Reflect on how you work through this question.

    08:11 Where do you think that you can improve on your test taking strategies? Is there some knowledge you want to take from this question and apply it on others? All right, after you've written yourself notes, there's making your notebook even more valuable.

    08:24 Now, let's go on to another question.

    About the Lecture

    The lecture Walkthrough: Reduction of Risk Potential Q8 – NCLEX-RN® by Rhonda Lawes, PhD, RN is from the course NCLEX-RN® Question Walkthrough: Reduction of Risk Potential.

    Included Quiz Questions

    1. Crushing chest pain
    2. Diaphoresis
    3. A burst of energy
    4. Cough
    5. Sore throat
    1. It is essential to know the length of time the cardiac muscle has been without oxygenation.
    2. It is essential to know the length of time the cardiac muscle has been with oxygenation.
    3. It is important to know how long to understand when pain medication can be given.
    4. It is essential to know the length of time the diaphragm has been inefficiently functioning.

    Author of lecture Walkthrough: Reduction of Risk Potential Q8 – NCLEX-RN®

     Rhonda Lawes, PhD, RN

    Rhonda Lawes, PhD, RN

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