NCLEX Question on Endocrine Medications (Nursing)

00:01 Okay.

00:02 Oftentimes, students get so frustrated when they take a test.

00:06 They study, they feel like they know the information, and then they see exam question and say, "Huh?" It just seems overwhelming to them.

00:15 So it doesn't have to be.

00:17 I've taught students test-taking strategies for a long period of time, and this is what I've learned through my own frustration of trying to take test questions myself.

00:27 So, I've learned the hard way.

00:29 I've made so many mistakes that I want you to help avoid.

00:33 So, first of all, let's start with what's in that green box.

00:36 Don't even look at the answer choices.

00:38 Okay? Let's read the question.

00:40 More often than not, when I sit with students and they come in my office and they want to go over their exams, if I can get them to spend more time in the stem of the question -- that's the words before the answer choices -- spend more time in the stem of the question than they actually do the answer choices, their scores go up dramatically because here's what we do.

00:59 We skim the question, we think we know what it says.

01:02 We go to the answer choices.

01:03 We pick the one we feel most comfortable with.

01:05 Yeah.

01:06 That's a recipe for disaster.

01:08 Okay.

01:09 So, let's try and do it the right way.

01:11 It's going to feel like you're swimming through Jell-O, but I promise you as you practice these tips, you'll get faster at it.

01:21 So, "The nurse assesses a client's at home medication compliance.” So, what I'm looking for is if the patient has been compliant with their at home medications.

01:32 "Mr. Baird is a type 1 diabetic and he's been prescribed albuterol, lisinopril, methylprednisone, and fludrocortisone for 10 years." Okay.

01:43 Let's break this down.

01:45 The topic of the question is medication compliance, okay? So, I want to make sure that they're sticking with their plan.

01:52 I know that they're on albuterol.

01:54 That's a bronchodilator.

01:55 Lisinopril, an ACE inhibitor, and then I've got them on some steroids for 10 years.

02:01 "Which of the following patient statements requires immediate follow up?" That means, of these 4 statements that I haven't read yet, which 1 of these indicates that, based on what I know about this patient, this particular patient, what's going to put them most at risk, because my job is always to keep the patient safe? So, I've walked through the question.

02:23 I'm clear that I think the topic is medication compliance, and so I'm looking for something that would indicate the patient isn't compliant.

02:32 So let's look at that first answer.

02:34 "I have noticed that my face looks a lot fuller since taking my medications.” Well, they're on 2 corticosteroids, right? So we know that -- yeah, moon face, facial hair, mood swings, -- okay, yeah.

02:49 That's going to happen.

02:50 So I'm going to kind of leave that in for right now because I'm going to read through all 4 to begin with.

02:55 "My heartbeat is faster, and I feel shaky when I stand up.” Okay.

03:02 Does that have anything to do with their medications? Because the medication -- just because we're talking about corticosteroids doesn't mean the question is about corticosteroids.

03:11 So, I'm going to keep that one kind of in the back of my mind.

03:14 C, "I use my inhaler when I feel short of breath after walking.” Okay.

03:20 I know shortness of breath is a problem with beta blockers, but they're not on a beta blocker.

03:25 And D, "My blood sugars are difficult to control, and my doctor has ordered a sliding scale insulin coverage.” Okay, well, that means -- sliding scale means the doctor's defined for me if your blood sugar's, like, 200-240, take 6 units of this.

03:42 Or if it's 240-280, take 10 units of this.

03:45 That's what a sliding scale is.

03:47 So it's asking me about medication compliance and I know they're on this medications, but I'm not sure which one they're driving at.

03:55 But A, that's a normal side effect of a medication.

03:59 So, I'm going to cross through that one.

04:02 See, one of the most important things you can change about your test-taking strategies if you're not doing this is that you don't allow yourself to just pick 1 answer.

04:11 Don't gravitate to an answer.

04:13 You want to eliminate 3 other answers.

04:17 Okay? All right.

04:19 So let's look at the other options.

04:20 I've eliminated number A and I'm not turning back.

04:24 What's going to be the next one I feel like I could eliminate? Well, I'm going to get rid of C because using your inhaler when you feel short of breath after walking, that's exertion.

04:35 And it's albuterol, it's even a short-acting beta2-adrenergic agonist, that makes sense, okay? So, that's normal.

04:42 That's good.

04:43 The patient's doing the right thing.

04:46 Now in between B and D, look at those 2 answers.

04:51 Before I tell you what I'm going to do, I want you to figure out what you would pick.

04:56 Now, see, no one's ever going to know.

04:58 That's just a secret between you and your screen, but which one would you pick? Based on these medications and this particular patient, which one of these would you follow up on first? All right.

05:12 I'm going to eliminate D.

05:15 Blood sugars are more difficult to control.

05:17 We know that happens.

05:18 However, the patient is safe.

05:21 They've ordered a sliding scale insulin coverage, so they're not in any danger.

05:26 This is the one -- B is the one that I'm going to follow up on.

05:30 Now here's the deal.

05:31 You're like, "What?" Their heart beat might be faster because they're dehydrated, yeah that's a bigger issue.

05:38 That means because they're dehydrated, I need to follow up and find out why are they dehydrated? They're probably dehydrated because of the medication we're giving them.

05:46 I need to educate my patient that they need to drink more fluids so we can keep their volume up, and so their blood pressure doesn't drop too much.

05:55 But in NCLEX questions, while they met -- that may not have been your first choice, you got to play the hand you're dealt.

06:03 The questions always are "Of these 4 statements.” You don't get the chance to rewrite the question or give them your opinion.

06:10 Of these 4 statements, based on what you see about this patient, B is the best answer because we know that that happens.

06:19 We know that they do get dehydrated and they're going to have that orthostatic hypotension, puts them at a risk for falls.

06:26 It's different than D because we know that happens, but they know exactly what to do because they have a sliding scale.

06:32 That's why B, of these 4 answers, is the most correct statement that you should follow up on as a nurse.