Walkthrough: Pharmacological and Parenteral Therapies Q8 – NCLEX-RN®

00:01 A client with rheumatoid arthritis reports an increase in symptoms.

00:05 The client's medication is changed from oral prednisone to oral dexamethasone.

00:10 And the patient asks the nurse, "What is the reason in changing the medication?" Which explanation by the nurse best explains the change? Okay. Here's a lot of real estate in this question.

00:23 If you're like me, one of these questions kind of overwhelmed me, because, frankly, I almost get bored in the middle.

00:29 So let me teach you some strategies and ways you can keep your head in the game.

00:34 Let's start back up at the top.

00:35 So, a client with, I've got a diagnosis, rheumatoid arthritis.

00:40 So I'm thinking, what is that? I've got a quick run through what the problems are for a patient.

00:45 But then it says reports. Oh, oh, a client reports.

00:50 I know that has to be really important to the question.

00:53 Now they tell me an increase in symptoms.

00:57 Well, they have an increase in rheumatoid arthritis symptoms, that is not what we want.

01:02 So first, I have abnormal findings.

01:05 I know I'm going to need to do something in this case.

01:08 So just documenting about it would not be the best thing.

01:12 The client's medication is changed from oral prednisone to oral dexamethasone.

01:19 Okay, those are two medications. So you're going to try and think, why would we go from oral prednisone to oral dexamethasone, for a client who has an increase in symptoms? You have an idea? Well, then that client asks the nurse, "What is the reason in changing the medication?" Which explanation by the nurse best explains the change.

01:42 Okay. So, if I put the question in my own words.

01:46 How do I explain to a patient with rheumatoid arthritis who has increasing symptoms? Why the healthcare provider changed from oral prednisone to oral dexamethasone? So do those things on your notes when you pause the video.

02:00 Make sure you write down RA.

02:02 And what are some quick symptoms for that? Write down oral prednisone, oral dexamethasone.

02:08 See what you remember about those drugs, before you look at the answer choices.

02:14 Then restart the video. Look at these answer choices.

02:19 Select the one that is your best answer by eliminating three others.

02:24 And then we'll come back and walk through this question all the way through to the end.

02:36 Welcome back.

02:37 Okay. Now, this one, is it's could it be in the farm section.

02:41 This might be in a safety section.

02:43 You don't always know where you're going to see drug names.

02:47 So keep that in mind.

02:49 I know that the pharmacology part of the NCLEX exam is a specific percentage of the exam.

02:55 But drug names show up in multiple client need categories on the NCLEX.

03:00 So don't let it bother you. Don't worry about it.

03:03 Just take each question at a time.

03:06 So the key to this question.

03:08 Let's say you don't remember anything about a difference between prednisone and dexamethasone? What would be your strategy to answer this question? Well, hopefully you recognize that those were some type of steroid.

03:22 Okay, so let's start with that.

03:24 And we'll first work through all four.

03:26 So, dexamethasone has better anti-inflammatory properties than prednisone.

03:32 Okay, at least we're talking about anti-inflammatory.

03:36 And I know that goes with steroids. So okay, that seems okay.

03:39 You are changed from a mineralocorticoid to a glucocorticoid to decrease the risk of edema.

03:47 Okay. Let's think through that.

03:51 You're changed from a mineralocorticoid to a glucocorticoid to decrease the risk of edema.

03:58 Okay, so doesn't mineralocorticoid have an increased risk of edema? It does. Remember? Mineralocorticoid will cause you to have it's like aldosterone that tells your body to hang on to sodium, so you'll hang on to more water.

04:16 But here's the deal.

04:17 I'm going to have to go back and figure out what type of corticosteroids these drugs are? Oral prednisone versus dexamethasone.

04:28 And if I don't remember right now, let's come back to it.

04:31 Dexamethasone will not make you gain weight, but prednisone may cause significant weight gain.

04:37 Oh-oh. They are really trying to figure out if I know the difference between these two drugs, aren't they? Don't worry, the medications are similar.

04:45 They just have different brand names.

04:48 Okay, well, that one we can get rid of, right.

04:51 And I think you probably already did that one. And here's why.

04:54 Generic names are what you're going to see predominantly on the test.

04:58 And those are generic names.

05:00 Prednisone and dexamethasone, those are the generic names.

05:03 So no, they don't have different brand names, because those are the generic names. They are two different medications.

05:11 So, number four, you're out of there.

05:13 Now we have to go back there and see if you can dig through your memory.

05:17 If you can't remember the difference between dexamethasone and prednisone, then you're just gonna have to do your best on eliminating two answers.

05:27 So which one did you pick? Okay, good. Now that you've committed to that.

05:32 I'm going to teach you a little bit of farm just really quick.

05:35 If this information is new to you, be sure to put it in your notebook.

05:39 So you have that in mind, you can review it later.

05:42 So this patient went from what medication to what medication? Remember, they went from prednisone to dexamethasone? Okay. It's pretty logical to think if the patient has arthritis, and symptoms are getting worse.

05:59 Wouldn't we want a stronger medication? Because one medication was not working enough, so we're adding this medication, we're trying this medication instead.

06:09 So just basic logic would tell you, huh, kind of seems like, number one could be a good answer, right? So sometimes, just slowing down even if you don't know the right answer.

06:24 Use your your critical thinking to find what you think to be the best answer.

06:29 You will never be 100% positive that that answer is the right answer on any question, because you're under stress, and it's a high stakes test.

06:39 You just do the best you can with every question.

06:42 Now, let me give you that little farm tip.

06:44 Dexamethasone is the most potent anti-inflammatory corticosteroid.

06:50 Okay, so, prednisone is three to five times more potent than cortisol.

06:54 But dexamethadone is 25 to 80 times more potent.

07:00 Okay, so we're going for a drug if we use cortisol as the gold standard.

07:03 If that was like, we'll say we'll sign it and think of one.

07:06 We know that prednisone is three to five times more potent than cortisol.

07:11 But dexamethasone 25 to 80 times.

07:15 Now, that is worth writing down for you to keep in mind, just a fun fact for you to have in your NCLEX review notebook.

07:23 But that's why the physician or the healthcare provider ordered this medication, because dexamethasone is that much more potent.

07:31 It's gonna hopefully control the symptoms of rheumatoid arthritis that have recently increased for this patient.

07:38 The patient's arthritis wasn't responding enough to that prednisone.

07:43 That's why we introduced a stronger or more potent drug.

07:47 Now, here's another tip. It's a pure glucocorticoid.

07:51 It has no mineralocorticoid activity.

07:55 Prednisone has a little bit of mineral corticoid.

07:58 But when we're dealing with dexamethasone, it has no mineral coracoid activity.

08:04 Okay, so I've given you a little bit of a brush up on farm.

08:08 Now look at your answer. Do you want to change it? Or do you still want to go with the one that you have? Okay, because we know in real life we're not doing answer changing, right.

08:18 You're always going to be consistent.

08:19 But for this one, let's just play a game and see, knowing what we just talked about, is there anything you'd want to change in your answer? Okay, number two.

08:31 You were changed from a mineralocorticoid to a glucocorticoid to decrease the risk of edema.

08:37 That's not the best answer that we have there, because that's not why we switched.

08:43 We switched because dexamethasone is going to be a much more potent, stronger antiinflammatory.

08:49 So number two, you're out.

08:51 Dexamethasone will not make you gain weight, but prednisone may cause significant weight gain.

08:58 Now both of these have cortisol like properties, right? So, they're both going to cause you to gain weight or have the potential to gain weight.

09:07 Remember that prednisone three to five times more potent than cortisol.

09:12 But that dexamethasone that we prescribed 25 to 80 times.

09:16 So they both carry the risk of gaining weight, and patients usually put it on right around the middle what everyone loves.

09:24 Number four, don't worry, these medications are similar.

09:27 We already got rid of that one.

09:29 So look at number one.

09:30 Yeah, even if you pick that, hopefully you gain a little more information about antiinflammatory medications, glucocorticoids from going through the rationales of this question.

09:40 So there you have it.

09:42 We're ready to go to the next question.