Walkthrough: Pharmacological and Parenteral Therapies Q1 – NCLEX-RN®

00:01 A nurse provides care for a client who is diagnosed with a stroke.

00:05 Which condition is the most significant risk when using alteplase therapy for this client? All right. Let's get to work. We've got a lot to unpack here.

00:14 Because first, we've read the question all the way through.

00:17 Next, we want to start picking it apart and looking for key clues in the question.

00:24 So a nurse provides care for a client. Okay. We know they've had a stroke.

00:27 They tell us, "Diagnosed with a stroke." So I'm already thinking stroke, worst case scenario, what am I concerned about? Which condition is the most significant risk when using alteplase therapy for this client? Okay. So we're looking for the worst possible thing, the worst case scenario for a client who's had a stroke, and receiving alteplase.

00:54 Now, here's the trick. You have to know what alteplase is, right? Have you heard of that drug name before? If you have and you know what kind of drug it is, this is going to be a lot easier to answer.

01:07 But before we do that, I want you to keep in mind that when you take your NCLEX exam, there's a high, high probability that you're going to come across a drug name you don't know, or a diagnosis you don't know. It's okay. Just stay calm.

01:24 So we're going to walk through this one, put it into our own words before we look at those answer choices.

01:29 And I'm going to cue you as to what the medication is. Let's bring the answer choices in.

01:34 Okay. We're looking at these.

01:36 I know I'm looking for the most significant risk that is connected to alteplase therapy.

01:44 So my options are clotting, bleeding, blood vessel rupture or hypertension.

01:51 Okay. If I don't know what the drug name is, I'm just going to have to give it my best guess by eliminating three other options, and then, moving along as I say. But if you remember alteplase is a thrombolytic.

02:07 So here's a good strategy as you're going through these rationales with us.

02:11 Remember, we encourage you to have a notebook and just write down quick notes on things you're learning as we're walking through these rationales together.

02:19 Alteplase is a thrombolytics. So we know, what are the risks for thrombolytics? Remember, that's the drug that's going to try to blow up a clot.

02:31 So is our biggest risk clotting, bleeding, blood vessel rupture or hypertension? Please select your answer. And then I'll walk you through the whole rest of the question.

02:50 Okay. Let's start working through these. Do thrombolytics cause hypertension? No, they don't. So I'm going to eliminate number four, because I know that thrombolytics don't cause hypertension.

03:06 What about clotting? Do thrombolytics cause clotting? Well, they really mess with the bleeding. I'm not sure on that one.

03:19 I'm not going to say anything. Let's look at what else we can look at.

03:22 What about blood vessel rupture? No. There's no connection between thrombolytics and blood vessel rupture, so I'm going to eliminate that one. Now, I'm stuck with clotting or bleeding.

03:36 Well, alteplase can blow up clots, right? Just dissolves them.

03:42 That's why we give them to patients with ischemic strokes.

03:45 So is clotting or bleeding going to be our biggest issue? No, it's not clotting because we know that patients on thrombolytics, wow.

03:54 They don't clot very well for a while after receiving that therapy.

03:58 For example, when we go to draw lab work, you have to hold pressure for an extra-long time on someone who's had a thrombolytic.

04:05 So number two is the correct answer.

04:08 The most significant risk when someone receives a thrombolytic is bleeding.