NCLEX PREP: MUST KNOW PRIORITIZATION STRATEGY

[Music] hello my friends it's dr sharon with clinic reviews i'm back to do five more nclex style questions and i'm excited today because i am going to be teaching you a really important prioritization strategy this is a strategy that you probably should expect to get between three to five questions on the nclex so let's go ahead and get started so the first question the rn is caring for a client with major depression which of the following statements by the client is most concerning i've been sleeping 12 to 14 hours every day i've lost 10 pounds since i started feeling so bad i have started losing my hair i just don't enjoy doing anything anymore all right so let me teach you how to read this question here's the thing you have one patient and you have four different symptoms of that one patient one listen if you're keeping notes or if you're like how do i differentiate between different prioritization strategies here's what you write down one patient four different symptoms and you have to say which one you are most concerned about it doesn't always say most concerned sometimes it says which is which is your highest priority which are you going to report to the health care provider it could which is most important but the key is you have one patient with four different symptoms you don't have four patients and you're trying to decide between four patients that is not what it's asking you it's saying one patient four symptoms the other thing it's not doing is not telling you the four symptoms and then asking you which order you would implement first there's another type of nclex question that says you have a patient with these symptoms and the symptoms are in this in the question they're not in the answers the symptoms are in the question and they tell you the symptoms and then they say which order would you implement first that's a completely different type of question i'll do those some other time okay but these you have one patient and then it says which are you most which assessment finding are you most concerned about which statement are you most concerned about and the the assessment findings or the statements are in the answers not in the question so the way you read this is you say all right and and they have one patient they always tell you what the diagnosis is they could say schizophrenia they could say major depression they could say heart failure they could say diabetes it wouldn't matter one patient with certain diagnosis and then which symptoms are you most concerned about when they do that what you're saying is which symptom is unexpected did you get that which symptom is unexpected that's the one you're most concerned about so what you should know is that three of these symptoms should be expected for a patient with major depression one of them isn't expected for a patient with major depression i'm most concerned about the one that's unexpected for a patient with major depression all right let's look at these answers again and maybe it'll be more obvious i've been sleeping 12 to 14 hours every day well we know sleep disturbances is common for people with major depression either either they sleep less or they sleep more this looks like they're sleeping more so i say well that's expected with major depression i've lost 10 pounds since i started feeling so bad well we know eating disturbances are common for people with major depression either they eat more they eat less typically they eat less anorexia is very commonly associated with major depression so if they're eating less they could lose weight so i go well that seems to be expected if they're eating less i'm not i'm not that concerned about that but you know what let me keep it on the list just in case there's nothing else that would be more concerning because maybe maybe right maybe three i started losing my hair i've started losing my hair i can't think of any symptom associated with major depression where they would start losing their hair i can't think of any any reason at all that they would start losing their hair so i got to keep that on my list that's like not expected i just don't enjoy doing anything anymore okay that's expected that's expected and don't say well if they don't enjoy doing anything more they could be suicidal you're right they could be but it doesn't say that does it and you only know what they tell you so i expect them to not enjoy doing anything anymore they're depressed that's what depression is okay it's depressed mood all right so i have to choose between two and three they've i've started i've lost 10 pounds or i've started losing my hair i can rationalize very easily why two is expected because i know they have appetite disturbances so i am going to pick three i've started losing my hair and that is the correct answer because that is the one that is unexpected all right next question the rn is caring for a client with generalized anxiety disorder who recently started taking lorazepam which of the following statements by the client is most concerning so we have a patient with a known disorder they have generalized anxiety disorder and they say they recently started taking lorazepam now if you don't know what lorazepam is um it's a benzodiazepine uh the drugs that end in pam and lamb lam pam and lam are benzodiazepine so it's a minor tranquilizer um and so they've started taking a minor tranquilizer to help with the generalized anxiety disorder which of the following statements by the client is most concerning so i immediately say to myself i have one patient with a known problem which is generalized anxiety disorder who's also taking lorazepam i got to keep that in my head and they want to know which which statement is most concerning so i'm going to say well the statement that's unexpected is most concerning so let's read the statements i've been so sleepy lately i can barely stay awake at work my mouth is so dry i have to keep water bottle with me all the time i've started to eat an apple every day to help prevent constipation my hands have been tremoring so much it is hard to sign my name okay well generalized anxiety disorder but they've started taking lorazepam which is a minor tranquilizer and i know minor tranquilizers have um anticholinergic side effects i've done a different video on psych drugs um and so you might want to watch that where i talk about side effects psych drugs and side effects i think is what it's called so i know that dry mouth blurred vision bladder retention constipation and drowsiness are side effects of psych drugs so i'm keeping that in mind right all right i've been so sleepy lately i can barely stay awake at work well this is a minor tranquilizer so that's kind of expected actually now i may need to do some teaching about it to you know like maybe you shouldn't take it right before you go to work but um you know we may need to do some teaching about it but that doesn't concern me my mouth is so dry i have to keep water bottle with me all the time well that's expected that's an anticholinergic side effect they're taking a psych drug i know psych drugs have anticholinergic side effects so i'm not worried about that i've started to eat an apple every day to help prevent constipation well that's fine constipation is an expected side effect of psych drugs so that sounds okay to me my hands have been trembling so much it is hard to sign my name so you might say well that's expected if they have generalized anxiety disorder well not really i mean if they were having a panic attack i would maybe expect some hand tremoring maybe severe severe anxiety but not generalized anxiety disorder and particularly not after starting lorazepam a minor tranquilizer so this is unexpected and you know when i look at something like that i go you know that just doesn't seem right to me i mean i can understand why they'd be sleeply i can understand why their mouth would be dry i can understand why they'd be constipated but i just doesn't make any sense to me why their their hands are tremoring so if i'm going to pick the unexpected finding i have to pick four i have to and you could probably sit here and rationalize with me why one of the others are right but what i'm teaching you is how to read questions on the nclex i am teaching you how to read them because it's not just about what you know it's about understanding the question and what it's looking for okay next question you're caring for a client with schizophrenia after completing their morning assessment which the following findings should receive the highest priority all right so again we have one patient with a known diagnosis and we say all right you're going to find the following you're going to find the following assessment data and which one do you care is is most worrisome highest priority whatever and so i'm saying to myself i'm looking for the unexpected finding unexpected client has crackles in the right posterior lung base well that's not expected with schizophrenia all right next one client refuses to take a shower in the morning well that's actually expected with schizophrenia is part of the negative symptoms associated with schizophrenia schizophrenia has positive and negative symptoms positive symptoms are things like hallucinations delusions um it's psychosis so positive symptoms are the the things that they they the symptoms they have that you wouldn't expect right so they have new symptoms or or they put i i kind of at like adding it right positive symptoms think of a a plus sign plus that's a plus sign um think of it as a plus sign think they're symptoms they're adding on and then they have negative symptoms these are things you're taking away so negative symptoms are things they're not doing that you would expect them to do and positive symptoms are things you you don't expect them to have but they're doing so negative symptoms for schizophrenia are things like not bathing not eating um not interacting with other people whereas positive symptoms are things like psychosis delusions hallucinations hearing voices and so forth so i go well they're refusing to take a shower that's actually expected with schizophrenia three client exhibits a narrow narrow ideas of reference ideas of reference are type of delusion which is expected with schizophrenia client states he's hearing voices a hallucination again it's expected with schizophrenia so um i have to pick number one because that's the only one that's not expected and you could say well if they're hearing voices that's a problem well it's a problem but it's expected problem right that's why they're here that's why we're taking care of them because we would expect them to hear voices we expect to have a high of ideas of reference and refusing to take a shower these are the positive two three and four positive and negative symptoms that i expect with schizophrenia one i don't expect at all okay i don't expect it at all so i'm gonna have to pick number one and that is the correct answer all right next question now i decided to move into um non-psych stuff just to show you that this applies also in non-psych questions it's the same strategy but non-psych issues so you're caring for a client with type 2 diabetes which the fine lab values is of most concern so i say i have type 2 diabetes i'm looking for the lab value that is unexpected unexpected with type 2 diabetes morning serum glucose of 154 little high but that's expected with type 2 diabetes glycosylated hemoglobin is 7.6 little high but that's expected with type 2 diabetes serum potassium is 4.9 that's actually high normal normal potassium is 3.5 to 5.0 so you got to know normal values make sure you know those serum creatinine is 2.1 a little high but not expected in type 2 diabetes not expected to have a serum elevated serum creatinine that actually indicates that they're having some kidney damage associated with their type 2 diabetes and i don't like that i don't like that at all that's unexpected that's a problem so i'm going to have to be most concerned about the serum creatinine of 2.1 now i want you to remember this is something that mark talked about when he talked about um in his video on strategies for passing nclex or how to pass nclex he talked about how you don't memorize answers from question data banks or question banks because the answer is only right because of the other answers right so you can't say to yourself do not say to yourself well i gotta memorize that a serum creatinine of 2.1 is always my greatest concern if you say that that's wrong serum creatinine of 2.1 is not always your greatest concern in fact i would go so far as to say is the serum creatinine of 2.1 is not usually your greatest concern but it's the question that's and the other answers right so the fact that the other answers are expected makes four your greatest concern it makes a creative 2.1 your greatest concern because 2.1 is the only unexpected finding and you also look at the context of the question we have diet type 2 diabetes if they said your patient has an acute kidney failure which of the following is your greatest concern or if they have acute kidney failure serum created a 2.1 is expected i'm not picking that one right i'm not picking that one so you've got to understand that that the correct answer is based on the context of the question and and the other answers so you have to learn how to read the question and know what you're looking conceptually what you're looking for i'm looking for the unexpected symptom i'm not just looking for a creatinine level i'm just looking for the unexpected symptom so the correct answer is 4. all right last question client diagnosed with major depression has sleep and appetite disturbances and a flat affect and is withdrawn the client's been taking fluvoxamine 50 twice daily for five days which client behavior is most important to report to the next shift okay now i am showing you how this question is completely different than the other four because you could read this and go oh which behavior is most important all right but this the context of this question is completely different here they give you the symptoms in the question did you notice how in the other questions they didn't give you any symptoms all they did was give you a diagnosis that was it here they give you a diagnosis and symptoms they say sleep and appetite disturbance flat affect and withdrawn sleep disturbance appetite disturbance flat affect withdrawn they've been taking an antidepressant for five days which behavior is most important to report to the next shift so when you get a question about reporting to the next shift you have to look and see what this it's either according to the diagnosis if they give just a diagnosis and no symptoms then you're kind of like okay i'm looking for the unexpected finding that's what i have to report to the next shift but when they give you symptoms you're looking for a change to the normal so you say well they have been having sleep disturbance appetite disturbance flat affect and withdrawn since i know these are the four things they've been experiencing what i'm going to report to the next shift is something that changes a changing assessment a changing assessment okay so something that is changed from sleep disturbance appetite disturbance flat affecting withdrawal so let's see which is which is different clients flat affect well that's exactly the way it's been i'm not reporting the same thing that's no big deal client interacting with a visitor says it's withdrawn but it doesn't say that he doesn't interact but i'm okay i'm gonna keep two there as a possibility client sleeping from 2300 to six so they just slept seven hours straight well they've been having sleep disturbances so this seems like a change if he's been having sleep disturbances and now he's sleeping seven hours straight i'm like uh that could that's different so i'm gonna keep three on there clients spending the entire evening in her room well she's withdrawn so client spending the entire evening in her room is expected it's a change i'm sorry it's not a change it's the same i'm looking for something that's a change so is interacting with a visitor more of a change or is sleeping from sleeping for seven hours at night more of a change well it doesn't say she refuses to interact with visitors says she's withdrawn but it doesn't say she refuses to interact with anybody and it specifically says she has sleep disturbances so i'm gonna have to go with what most closely reflects the data in the question and clearly they've had sleep disturbances and so i'm gonna have to pick the one that shows they're no longer having a sleep disturbance i have to pick three i have to pick three and three is the correct answer all right so one of the key things about answering nclex questions is understanding the strategies for answering them what we do in clinic reviews is we focus on these kinds of things this is not a specific strategy that we teach in clinic reviews but we this is we teach so many strategies like this how to read questions how to interpret questions so if you want to get more things like this we strongly recommend you come to a clinic review you can find them at clinicreviews.com we have online reviews every month and in person reviews monthly almost monthly so we'd love to see one of our reviews and good luck on your nclex thanks for watching

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Length: 18min 13sec (1093 seconds)

Published: Tue Aug 23 2022