NCLEX Pharmacology Questions and Tips for Nurses

All right, good morning everyone. Just making sure that you guys are hearing me if you guys are here with me today joining me in this Live Show. Can you please say hi and hello in the comment section. We are streaming live today for Connetics College. This is an activity that we do in partnership with Connetics and aspire RN. This is happening every Monday 7am Central Time 5am Pacific time. We're also streaming live in the Philippines. Right now I think in the Philippines is nine p right we are waiting for more people to join the show. My name is Dr. Nurse Paul and I will be hosting the Connetics college show today this show is hosted in partnership with Aspire RN and Connetics USA. a recruitment agency in the EU as a and for those who do not know while we are waiting for many people to join us today, Connetics USA has partnered with Aspire RN to provide scholarship for NCLEX classes. So if you guys are interested to join our NCLEX review classes and get a scholarship opportunity, please visit the link that we will be posting right now. It's here on your screen right now it's Cusa.link/AspireRN and this will lead you to a link where you will fill out your information and our recruiters from Connetics USA International Nurse Recruitment Agency will contact you to get your pre qualified This is a scholarship program in partnership with Connetics USA and Aspire RN is an NCLEX prep course company, which I own.

I'm the CEO of Aspire RN and we've had great success in helping Connetics USA nurses, and many nurses around the world pass their NCLEX we are specializing in foreign graduate nurses in preparing them to pass the NCLEX exam. Thank you guys for those who are online I Sani Hi Mark thank you guys for tuning in. They are in Facebook and LinkedIn. We also have Fiona on YouTube tuning in today while waiting for many other people. I'm still sharing it on my social media and my team both Connetics and Aspire RN are streaming this live on our Facebook channels, YouTube, LinkedIn and many other websites. Give me a few seconds. I'm gonna turn off my camera for a few minutes so I can set up my computer I forgot to set the charging dock so my computer might die in the middle of the class so please continue to invite your friends can you please share this to your to your page right now and tag your friends so we can bring them in and they can join us today I'll be talking about pharmacology and I will be flashing different questions that we will answer together later. I'm going to be rationalizing those questions and see this course that we are going to get right I'll be right back please don't go let me just turn off my microphone and I will be right back Okay. Alright, I'm back.

Thank you guys. Hello juvie. Hello, Jean. Hello Anna Marie. Hello jet and thank you guys for joining to mana. Hello Charlotte Lowe says Maria thank you guys for joining today. Please continue to share this on social media we are live on Facebook. For those who are not aware we are Connetics College. This is a partnership of Aspire RN and Connetics. You as a aspirant as an ethics prep company Connetics USA is a foreign recruitment agency for the USA helping nurses to come here to the United States and we have partnered to create Connetics college will reduce free live classes every Monday 5am Pacific Standard Time 7am Central Standard Time. And every first Monday is Aspire RN, who will be hosting the show and we are doing free and NCLEX classes hosted by yourself doctor by myself. Yours Truly I'm sorry, I'm doctor nurse Paul, please follow me on my social media at doctor nurse ball on Facebook, Instagram, and Tiktok for more information about the free classes that I do every Saturday. Thank you guys for joining me today. Today we're going to be talking about diabetes and the latest pharmacology. This is pharmacology tips. Part Two, the first part I did a couple of months back if you go to my page, doctor, nurse fall or Aspire RN Facebook page or Connetics USA Facebook page, you will see in the videos that we did. I had my first class in pharmacology tips in the past and this is the continuation.

And I like pharmacology. I know a lot of students don't like pharmacology but this is one of the major parts of the NCLEX about 12 to 17% of your NCLEX exam is about pharmacology. And today I'm going to talk about diabetes mellitus medications, the new medications that we're using, and some of the NCLEX questions that I'm going to be flashing later. You're gonna help me answer those questions. Please continue to share these on your page. Thank you guys for joining. If you guys are here today and live with us, can you please comment your location and what time it is right now and your current location. And while waiting for the responses. I'm streaming live from Euston, Texas, and it's 7:08am here quite gloomy and a little cold it's already fall season and I apologize if I sound a little congested I was feeling under the weather I just came back from my Europe trip two days ago and because of the cold weather in Europe, about 40 degrees Fahrenheit I get easily got a got colds coughs and colds and congestion and I'm still trying to recover I thought it was gonna recover fast that unfortunately I'm still struggling with congestion but I'm feeling a lot better.

So I apologize if you will hear me hear me a little congested and I was really trying my best to like not cough today but we will try thank you guys for joining we have shell from Philippines it's 9pm in the Philippines as well as skate Sani is in the United Arab Emirates it's 530 and Maria is in Cebu, Philippines. Reg is in Singapore I believe that same time as in the Philippines. Audrey is in Zimbabwe 3pm Thank you for joining exactly as in UAE and Elsa is also in Singapore. mullein is in Oman. It's 5pm They Yan is in Saudi Arabia 4pm And she said belated Happy birthday Seve Thank you it was my birthday two weeks ago that's why I went to Europe to celebrate my birthday. And can you is in Gunnedah it's 4pm. Today Mara no is in Philippines and Jenny as well. Ernesto is in Davao Philippines. It's 9pm. Jane in Philippines. Thank you guys for joining today. Please keep sharing the link to the show so more people can join us today right now if you guys are looking towards fulfilling your American dream and you guys who want a scholarship opportunity for NCLEX classes and employment in the United States, please do visit the link that we are about to flash right now on your screen. It's seeing you as a doc link slash Aspire RN. This link will lead you to a form that you will fill out so our recruiters from Connetics USA and Aspire RN can reach out to you and get you started with your American dream.

If you qualify with our criteria Sorry about that. If you qualify with our criteria, you will get a scholarship program that is sponsored by Connetics USA and a US employer where you will take the classes we aspire are in for NCLEX. Right. And thank you Chris ZIL, for greeting me happy birthday. It was really a fun birthday in Europe. And I was really looking forward to doing that. You know, during the pandemic, we really couldn't go anywhere because of the restrictions to travels and quarantines but I'm happy that we're back to normal when I traveled to Europe. Everything was back to normal just like you're in the United States and there's no need for quarantine. Anyway, I think we're back start by the way for those who do not know me, my name is Paul milieu. And you can call me doctor nurse ball. That's my social media handle and Facebook, Instagram and TikTok.

I push out videos every Saturday, I do live videos, live vlog every Saturday 8am Central Time. And I do a lot of different shows. I have the USA nurse series where you can learn a lot of stuff. Without to be a nurse here in the United States the opportunities to issues and concerns what you need to know about being a nurse in the United States. And also my highlights of the show. The doctor nurse ball show that I do every Saturday is the secrets of the next generation and clinics for all we know next year, April 120 23. We will have a new set of questions and scoring system, which I've been discussing on my show the doctor nurse ball show both in YouTube and Facebook every Saturday at 8am and tonight or today, I'm going to give you a preview of a sample questions that's related to my topic today of the next generation NCLEX. Assuming that you're gonna take your exam next year past April 120 23. You might want to know how these Next Generation NCLEX questions are going to be done or are going to be implemented right. Without further ado, let's discuss diabetes mellitus and have some updates with diabetes mellitus. In the year 2022, the American Diabetes Association updated the diagnostic criteria for us to diagnose diabetes mellitus.

Right the HBA wants their glycosylated hemoglobin should be above 6.5%. Before HB a one c should be above 7% Back in 2020, to be considered diabetes mellitus, but American Diabetes Association updated it again now everybody with an HB a one CFM 6.5% is diagnosis diabetes mellitus. Or we can also check the fasting blood glucose and it should be above 126 milligram and random blood glucose should be above 200 milligrams in order to die diagnosed diabetes mellitus, there should be two tests that will be performed to confirm that so if you're doing fasting blood glucose, you may want to check HB a one see, if we're doing random blood glucose, you may want to check HB a warranty again, right so two times and the goal of course for diabetes mellitus, which we'll be talking about pharmacology today is to decrease the blood glucose and decrease the HB a one C, which is the main medical treatment goal, or the reason for this is to prevent complications. Diabetes, diabetes does not have a cure, but we can control it. It does have a lot of chronic complications both in the macro vascular and micro vascular structures in the micro vascular structures, for example, it can cause nephropathy so it can damage to the kidneys and a lot of our end stage renal disease dialysis patients here in the States or actually, they have diabetes and it's caused by their diabetes right over time.

It can also lead to retinopathy damages to the eye or neuropathy damages to the nerve. So you'll see patients with diabetes with decreased pain sensation and they get injuries, eventually leading to amputation because of this problem. And then macrovascular complications like congestive heart failure, hypertension, heart attack, and so many other complications because of diabetes. And then there's the acute emergency complications like diabetic ketoacidosis and H H S or high personal or hyperglycemic nonketotic syndrome, or coma, it can lead to coma, and welcome to those that are joining if Yoma is coming from Nigeria. Oh silly is saying hi, she's joining us from LinkedIn today. I can see all your comments from all the social media that we're sharing it to and ask gar is joining from Pakistan all right for those who are coming late don't worry this class is recorded and you're gonna see this later uploaded to the social medias channels of Aspire are in doctor nurse fall and Connetics you as a with VENA just came in from the Philippines. Thank you for joining. All right and let's continue the management for diabetes mellitus it's easy to remember diabetes mellitus DM, we also use the mnemonic B and for the management diet and exercise very important we tell them to do low carb diet, low carb, meaning we want to focus if they need carbs for energy, we want to focus on good carbs, alright are the macro carbs, the carbs that will be not increasing the sugar acutely? So those are the complex sugars like vegetables and fruits, right? And we want to tell them to avoid simple sugars like candies, pastries, right. And medical exercise is also equally important.

You know, muscles don't need insulin to use the sugar from the blood. So we wonder how to let the muscles keep using those sugar from the blood without the help of insulin. And we already know in diabetes, there's problem with insulin balance with insulin control with insulin resistance. I'm not going to discuss the pathophysiology of diabetes. Today I'm going to focus on pharmacology. And of course the next management will be medical management. While diet and exercise are equally important. medical management is very important in diabetes. Like I said there's no cure, but we want to control it as easy or as early as we can to prevent those long term complications more people are joining joy is from Kenya. Nikki is from Makati City, Philippines. I love Bacall. It's one of my favorite cities that I love in the Philippines. And she know Nia is joining us from Nigeria. Thank you guys for joining. And let's continue for diabetes. We're going to talk about the pharmacology today. And don't go don't leave June in because towards the end, I'm going to be flashing different types of NCLEX style questions. And you will you want to answer that with me. And we're going to check your scores later. Right. For the pharmacology for diabetes. We have two major two major types, right.

I think my slides got a little bit messed up because of the app that we're using. Right. We have the Oro and injectables the orals should be on the one column and the injectable should be on the other column for the oral so we have the M That's for the injectables, we have a GI before we only have insulin as injectables, but now because of reason development, and medical, you know evolution we have many other medications now that we can use for diabetes. For oral we have DM that's injectables, we have AGI for the DM bats, we have DPP four inhibitors McGlinn and NINDS biguanide, otherwise known as Metformin, we'll give you examples later. Alpha glucosidase inhibitors thiazolidinediones TZDs. So familiar es SG LT two inhibitors or sodium glucose cotransporter, two inhibitors. And for the injectables, we have a GI Avellino mimetic GLP, one agonists and the most popular one, right. So hold your horses. I'm going to show you examples. Thank you guys for joining. We have Suzu, who just came in from the bow and Victoria is saying, Hi, Mara, so is saying good morning from New York. I think in New York. It's about 8am. Right now, and we're all over the world today, guys, thank you for joining and continue sharing this to your friends and classmates.

So we can join, we can have them join the class to today, right? And we're sharing this across our social media. But new please follow me on my social media at Dr. Murray's fault, because I do live classes every Saturday as well. 8am Central time, right. And I do classes about secrets of next generation NCLEX there, and you will see my schedule of live glasses there on my page. So please follow me on my social media. Thank you, Gina for joining us today. Now, look at the screen. I'm not going to go into details here but there are so many different ways how a person gets hyperglycemia and this is very important for diabetes. We need to understand that in diabetes. The main problem is sugar, but it's almost not always about insulin. It can be because of decreased incretin effect which can increase the carbohydrate or sugar absorption in the gut, you see the interesting picture there. And then at the bottom of it on the right side, the liver, the liver can also produce sugar through what we call glycogenolysis or gluconeogenesis. Or the kidneys can also cause increase in sugar in the blood hyperglycemia by preventing the sugars from coming out in the urine. The muscles can also contribute to Nyberg glycaemia. By preventing muscle uptake when you say uptake, the glucose will move to the cells for utilization for energy. So muscles are very good and utilizing glucose.

They don't need insulin to do that. But sometimes those glucose molecules cannot enter the muscles and this can contribute to hyperglycemia. Otherwise, there's also brain and pancreatic influences to causing hyperglycemia such as increased pancreatic glucagon secretion or decreased pancreatic insulin secretion. Decrease pancreatic insulin secretion is something we see in patients with type one diabetes mellitus. So you don't need to really understand all of these this is, you know, for another class, it's for endocrine pharmacology for diabetes, but I'm letting you know that there are different ways of how a person would have hyperglycemia right. So there are different influences, pancreatic, influence kidney or renal influence and muscular uptake. And even the brain is involved in that. Now, if we know these principles of how the sugar goes up, then we also know how to medically manage them by inhibiting or agonizing this enzymes, right. So for example, the Emily mimetics the guidelines, the insolence and sulfonylureas, all act on the pancreas, they can either increase the insulin production like so familiar, yes, or decrease the glucagon secretion by pancreas.

On the other hand, the GLP one agonists and DPP four inhibitors act on the gut, right, so they decrease I'm sorry, they increase the incretin right to make you feel full, so you don't want to eat in grittiness. You're one of your enzymes are hormones that control your satiety. And when you don't eat when you feel full, and you don't want to eat, then the sugar will not increase because you're not going to eat. Or we can also use the Alpha glucosidase inhibitors, which will decrease the absorption of carbohydrates from your bloodstream in your indices. And then you have Metformin, which controls the liver from preventing glycogenolysis and gluconeogenesis. As well as your SG LP two inhibitors thiazolidinediones TZDs, improve muscle uptake of sugar, it moves the sugar to the muscles keep muscles using it to reduce the sugar. So what I'm saying is if we know how the sugar increases in the body, technically, we also know how to medically treat it by using medicines, or drugs, right. And going back to our mnemonic earlier for the oral medications or as we call this oral hypoglycemic agents, we have the DM bats remember, and DPP four inhibitors is widely being used here in the States. Now, we have the glyphed in sitagliptin, Lena clipton, one of the distinct features that we need to know about DPP four it can lead to pancreatic cancer.

So that's one of the things we need to remember about them. And then we have neglected nights like Repaglinide, one of the oldest diabetes medication biguanide, Metformin is perhaps the most popular and in fact, Metformin is the primary medicine that we use to treat diabetes, because when you use Metformin, it can reduce the HB a one C, two as much as 2%. All right, going back to what we talked about later, how do we diagnose diabetes again, what's the level of HV a one C, where we say this is diabetes if the HB a one c is greater than which amount is greater than which amount, you remember, is greater than 6.5%. If it's more than 6.5%, that diabetes and metformin can reduce the HV a one C level by 2%. So if there are 9%, we can bring them down to 7%. The maximum dose spent for network Foreman is about 2000 milligrams, or two grams per day. And the most common complication with Metformin is nausea and vomiting. But it can also cause eventually lactic acidosis vitamin B 12 deficiency because it prevents absorption of food and nutrients. So, but still the best medicine, right for diabetes and it's super easy to prescribe. It's cheap.

It's the primary Medicine recommended by the American Diabetes Association. So that's what I write for my patients newly diagnosed with diabetes, or even if they have pre diabetes, and they're already obese, I can start writing them from it for me, I'm a nurse practitioner, so I write medic medical prescriptions as well to my patients under my care. And then we have alpha glucosidase inhibitors Acarbose. We rarely use it now. But it's still out there. Dz are glitter zones. We rarely use it. It's cheap. It's easy to prescribe, but there's a complication with the glitter zones pioglitazone, particularly rosiglitazone, they can cause congestive heart failure. So as prescribers we wonder, be concerned with what are their heart function, if their heart is already guarding the Gallic or as cardiomyopathy or has risk for CHF. We don't really use good zones or tz DS. We have other medications that we can use, and they're better at preventing CHF. We do not want to use tz DS because of its complication. CHF. And then sulfonylureas is one of the oldest medicines for diabetes, right? This will help reduce I'm sorry, increased the insulin secretion from your backgrounds. Let me just drink a little sip of water or coffee. My throat is drying up, like I said, coughs and gold today, but I didn't want to miss this class.

All right, I want to make sure that I'm able to attend this class for you guys. And I believe that this helps a lot of nurses. We've seen great success with kinetic Scout College and the bassinet surely do not want to miss this. That's why I rested the whole day yesterday to be able to attend a class today anyway. So for nearly three years, the most popular is glipizide. The most common complication for sulfonylureas is hypo glycemia. If any of these medications on your screen will cause hypoglycemia. It's the sole for Neil because they increase the insulin production of the pancreas. For this reason, it does not work for type one diabetes mellitus, because they don't produce insulin, but be careful. It's so familiar. Yes, they're cheap. They're easy to prescribe, but they also cause hypoglycemia. So make sure to tell patients to eat snacks 30 minutes to one hour after taking the medicine and then one of the new medications we're using now here in the states are the SG LT two or sodium glucose co transporter two enzyme inhibitors are the kind of glucose in or empagliflozin, right? And it's also very good at preventing weight gain most of your diabetes medications like sulfonylureas in Saline, neglecting it can cause weight gain. But SG LT two is one of those medications that can cause weight loss. And we know that adversity is usually a comorbidity for diabetes, right? And that's SDLT.

Two can also cause pancreatitis. Another concern that we see here is patients usually complain of UTIs phone call your phone call urinary tract infections, right. So that's a problem. So that's the DM that's, again, for the DM that's what's the primary medicine that we use for diabetes? What's the number one medicine that we prescribe, or we always start patients with diabetes with this medicine? What is that medication? Anyone? Anyone, which in this screen? is the primary medicine for diabetes? Can I see your answers in the comments? And we're gonna have a question and answer later. Very good. Diane, she said metformin and Maria. Mariah said, Bye. Goodnight. Jane said Metformin. Very good, Arlene. And here are the answers coming in right now. Yes, Metformin is our priority. Medicine and all of these are oral medications. Right? And among the medications on your screen right now, which is the one that is more likely to cause hypoglycemia, more likely to cause hypoglycemia. Anyone so waiting for the answers. Thank you guys for participating. We're almost done with the lecture and we're gonna go to the question and answers in a bit more likely. to cause hypoglycemia or so for Neil. Very good besides Google fonts is a brand name very good.

And among their medications on the screen, which is more likely to cause congestive heart failure, congestive heart failure, congestive heart failure, I mentioned that earlier. congestive heart failure. It's the TZ DS. Very good. The thiazolidinediones it's such a long name. We'll just use the name DS. Very good. All right, going back to sulfonylurea. So you guys are correct or a lot of people are participating. Right? If you know that, when they take this medication, they can have hypoglycemia. What nursing intervention or what health teaching do you tell your patient after taking the medicine? After thinking they're so familiar? Yes, that can cause hypoglycemia. What do you teach your client to prevent hypoglycemia? What do you teach them? Anyone intervention on the screen on the comment section right now. Anyone? Tell them to wipe, take snacks or eat within 30 minutes after taking the medicine because it can cause hypoglycemia, very good. And some patients are pretty good with monitoring their sugar. So these are oral or oral medications and most common that you can encounter is Metformin. But then glyphosate also comes out in the NCLEX as well as pioglitazone, right. And let's talk about the injectables inject tables are the most popular ones in Saline, but you have a GI Emily no mimetic from limited or brown Lynn tide is it's actually one of the newer medicines, but it's a little expensive.

So it's not usually commonly used in primary care, or in patients being managed with diabetes. Pretty expensive. We have GLP one receptor agonist it looks like a pen. Just like your insulin, the pen, insulin pen or GLP one bands, we have glucoside, liraglutide exact inside, I'm using the generic names, because that's what will come out in your NCLEX and GLP. One is also good with promoting weight loss for patients with obesity and diabetes. And in fact, we are using GLP one now for best the management, regardless of diabetes, it's now FDA approved for best the management, quite an expensive medicine. If it's not covered by diabetes, I believe the medicine is about 1500 US dollars, right? There's no generic forms yet. Because it's, you know, it's what you call this medication is patented, patented, right? So they cannot we cannot use it for 30 years until the bid. The license of the manufacturers expire, right. So right now we're using the branded names, right? And it's pretty expensive, a lot of insurance are covering it.

If you're outside the states, your insurance might cover it right and then of course we have insulin, the rapid short, intermediate and long acting insulin, perhaps the most common NCLEX question will be about the insulin right. And then of course, those are your AGI, injectable medicines. So we teach them how to use it's usually coming in the form of Ben we store it in the fridge and we take them out, put the needle in and then we tell them how to inject it to the tissues or to the subcutaneous tissues, you can turn the tip Alright, the other end the turnstile where you can choose how many units or milligrams you want to give right? And usually GLP ones it comes in one month supply, very low dose it's pointing five to one right and these are the medications we use for obesity and diabetes because they promote weight loss Metformin as a moderate weight loss effect, SG LT two and DPP fours and GLP one now are being used for best the management because they promote weight loss LCL D two DPP four ng LP and forgot to put GLP Alright, please write it down. GLP can also promote weight loss or a GLP alright. Are you guys familiar with this medicines?

Anyone working in the medical for telemetry floor or taking care of endocrine patients? These are very common medicines if they're admitted to the hospital right? Depending on how bad or diabetes is we can give them dual or triple treatments, which means they can take two to three diabetes medication, they may be on Metformin and GLP, one and insulin or they can be taking metformin and the Juval, DPP four, D to one, or DPP four and GLP. One. So, different combinations, the goal is to lower the a one C level, alright, and what's our goal a one C level, again, a one c should be lower than, lower than a one c should be lower than one to prevent diabetes, right? It shouldn't be lower than 6.5 actually should be lower than 5.7%. Right. I know a lot of Filipinos, my folks here we are addressed for diabetes, you should be taking your HB a one C tests yearly. Right? The screening for diabetes, especially if you have strong familial genetics of diabetes, even if you're not a Filipino, both my parents family have diabetes. My mom has diabetes, my dad has diabetes. And I took my genetic tests and have strong risk for diabetes. So every year I take my a one C I'm currently at 5.3 and 5.4. Getting closer, but if you hit 5.7 to 6.4, you're pre diabetic, you need to start diabetes, diet and exercise management.

Very important to sorry about that to do weight loss. All right. 6.5 is already considered diabetes in 2022. All right, sorry about that, guys, my throat is drying up. Like I said, I've gotten congestion today. But I want to attend this class. I don't want to miss it. Alright, so these are the medications we use for best study. And then we have in Saline, right we have rapid acting as part and lispro. We have short acting, the other name for short acting is regular, which is human in our novel in our human log, our users always are, and Novolog are. And then the intermediate, we know this as NPH. It's the only cloudy installation out there. And the long acting, we have GYN, write that down in your notes. The blog guide is the most common the Lantis I'm not writing today, I usually write on my lectures when I do my lectures with my students and aspire RN and they do pharmacology class for eight hours. So it's two days of four hours each. Today is only one hour to give you an overview of what it is like if I do my classes and of course to help you guys with your NCLEX if you're going to take it soon. But Glar guidance Lantis it's one of the most common entrance question, write it down Lantis you have to remember, it comes in a pen, right, just like what we talked about earlier.

And it's usually clear. And you know what I like with Glar game. It does not have a beak effect, right the Lantus it does not have big effects, so therefore, there's no need to worry about eyebrow glycaemia. Your concern is in the peak effect, like rapid acting peaks at one hour short acting peaks at two hours, intermediate acting peaks between four to 12 hours, some of them can be within 16 hours right? There can be a hypoglycemic reaction, I'm sorry, I need to clear my throat there can be a hypoglycemic reaction during the peak effect. So for example, after you give short acting

insulin, I'm sorry, for example, regular insulin and after two hours, the patient started feeling tacky carded Bill diaphoretic we jittery that's a sign of hyperglycemia tell them to eat something drink cola or soda for simple sugars or eat something to increase the sugar like candies, right? We're looking at gun bills to prevent hypoglycemia. So when giving insulin, you have to teach them about the duration, the onset and the big, particularly the peak effect because that's when the hyperglycemia reaction happens, right? And I don't want you to memorize this. Just familiarize yourself with the table. This is not definite. It's just an estimate or approximate. Right. But again, what I liked about Glar gang, the long acting Lantis is it does not have a peak effect, which means there's no risk for hypoglycemia. All right. And, again, which type of insulin does not have a big effect or does not cause hypoglycemia? Let me see your answers and while we're about to wrap up, which one does not cause big effect it's Desktop App APK factoring does not cause hypoglycemics Glar game, the brand name is. That's right. Thank you. I'm starting to get very congested already. But thank you guys for bearing with me. And we usually I've mixed or premix in Saline like regular and NPH.

We can also mix it right if we have to, but we rarely mix it now because it's already pre mixed from the vial okay. And of course, the fast acting one is rapid Be careful because it can have an onset of 15 to 30 minutes and peak in one hour. So it works really fast. Okay. So they can have hypoglycemic reaction within one hour Be very careful right. Now, things you need to remember with insulin. I will use the mnemonic insulin okay, I n s you li N letter I. When giving insulin you need to inject it at room temperature. Gold temperature can cause pain. It can also cause lipo dystrophy inject that room temperature do not inject it gold letter N. Never massage or apply heat, never massage or apply heat. Why? Because it can increase the absorption rate. That's why you're putting it sub q for slow release. If you massage the area after a sub q injection, then it will increase the absorption and can cause hypoglycemia never massager. Apply heat letter as we give it sub q. When you give sub gain, you use a subcutaneous needle. And how long is the subcutaneous needle it's usually 5/8 of an inch five over eight, it's short, you do not use the one inch needles, you can also use half inch one over two or five over eight, right short needles. If you've seen it, the insulin syringes are short. And you can do 90 degree stores to subcutaneous area sub q sub q, even the back end sub q fats, right? Or fatty layers. And the only insulin that can be given through IV is regular insulin again, what's the only insulin that can be given through IV? What's the only insulin that can be given through IV that is?

Regular interleaving very good after mute my mic every now and then to clear my throat. I don't think you guys want to hear that. But the others are sub q whether it's Lantis, or mph, or rapid like lispro You do not want to give them regular IV because they're not stable to be given IV sub q right regular gonna be given both sub q and IV right now, letter you remember units when using an insulin syringe, you have to remember the syringe should have units, right? Remember when if you're working as a nurse, you already know this insulin syringe and that tuberculin syringe looks the same, same size, same length, right? And there are so many nurses that have mistakenly used tuberculin syringe versus the insulin syringe. That's why here in this state's insulin syringe as part of the National Safety goal of the Jayco or JCI, Joint Commission. All right, we now need to do double nurse or to nurse verification when giving in saline. How many nurses need to verify that to nurses to prevent medication error because there's so much medication errors in Italy or in the United States.

And I've seen quite a few nurses have errors with this even with do nurse verification. I mean, I work in the ER we inject regular insulin all the time through IVs or it's one of our emergency medication, right? So do nurses need to verify why the most common error stems from using the syringe right? When you use insulin syringe you have to remember it has to have units right? That tuberculin syringe just What am l milliliters, right? It's point 1.2 until 1.0 ML units the insulin syringe showed them 510 1520 up to 100 units 100 units. One ml they're the same. All right, same size, same length. The difference is in the unit of measurement, right again, insulin syringe what do we see the insulin syringe to make sure it's the insulin syringe right? Is it units or ml units or ml? Alright units are Emma let me just reply to this important message before we finish this right All right, very good units. And then of course l lipo dystrophy risk, which means it can lead to like, you know, the fats become hard and scarred right it will prevent absorption of insulin. So to prevent lipo dystrophy, which is a major complication of insulin, please make sure to rotate the sides right rotate the sides. So we usually have charts telling them do not use the same side, rotate it go to the left, go to the right, go to the back part of the triceps and to the back part in the scapula. Those are fatty areas and need to monitor hyperglycemia Can you guys give me some symptoms of hypoglycemia before I proceed to the next slide? I think the next slide will be the questions. Alright, can you guys give me symptoms, some symptoms of hypoglycemia anyone? Anyone? Then Stuckey cardio what else jittery or shaking, sweating diet freezes.

What else? dizziness, weakness, fouler. irritability, right? fainting. All right. Those are the different signs of hypoglycemia and what's your management? I'm sorry about that. What's your management for hypoglycemia? I already told you some forms of management's earlier. We give them what? Simple sugars example. Coke, or soda. What else? Orange juice? Glucagon, pills, candies, fruits. Usually it's so that because it's easier to drink, right? You need to give them simple sugars right. Now, are you ready for questions? All right, simple sugars. Okay, are you ready for questions? All right. Question number one. Record your answers. Okay. This is a select all that apply question. All right. When preparing to treat a patient with diabetes mellitus, the nurse knows which of the following medications can be given IV select all that apply. Sorry about that. I'm waiting for your answers, guys. And remember, it's a select all that apply.

Answer, record your answers. Okay. What's your answer? The answer is B and E humulin. R is a brand name for regular insulin and regular inserting who got this correctly? Okay, if you've answered B and E, you get two points, right? If you're taking your NCLEX before the next gen, which is before April 120 23, and you answered only B or only E, you get one point, right? You get one point. But if you're taking the next gen NCLEX, select all that apply is correct minus incorrect, right or correct, man, it's incorrect. So if you've answered one, either b or E, then your score is zero. Because you're correct is one you're incorrect is one, then your score is zero. All right. So that's a problem with next gen NCLEX. Select all that apply is already hard. But the scoring system make it make it makes it more complicated. So your score is zero. Because it's correct minus incorrect answers. All right. So zero. All right. That's the new generation that looks for your next question. So either your score is two or zero, because it's only two correct answer. The following medications may be used for the treatment of obesity in patients with diabetes mellitus. You guys are still with me. Yep, it's very hard. We're about to wrap up right now. Three more questions or two more questions answered. err Answer. Answer is, it's actually 1234. All right. 1234. My slide is incorrect. So 1234 All right, listen, to those who got 1234, you get four points. If you've only answered three correct answers, you get two points. If you've gotten two answers, you get one point. If you've only had one correct answer, your score is zero. All right? It's correct. Minus incorrect answer. I'm using the next generation scoring system. I'm just straining you guys, if you're taking your next gen NCLEX, next year, scoring system will really be different and very difficult. All right? Well, lucky you if you're gonna take your NCLEX before April wife. All right. But if you're taking your NCLEX, next year, after April one, well, your score will be affected. Right? So if your answer is 1234, you get four points. Otherwise, your, your answer should be correct minus incorrect, right? So if you get three, then you get two points. If it gets two, then you get one point. If you get one correct answer only then your score is zero. All right. Next, which of the following are correct statements about insulin management select all that apply?

Answer is very good. This is an easy question. I just did this question last night. I write my own questions, guys. I like writing my own questions. And before I used to, like do a lot of multiple choice, but I think it's easier for a lot of people. So now all my questions are select all that apply. I love select all that apply. I know that's your favorite type of questions to write. And it's always wanting to if you've only answered one correct answer, your score is zero. So your score is either two or zero. Okay. I'm sorry. That's just how it is. Right? And here is my last question. Now listen, my last question is an NCLEX. Next Generation style, right? If you want to know more about next generation NCLEX, join my show at the doctor nurse ball show on my social media account, Facebook, YouTube, Instagram and TikTok. I livestream my doctor nurse ball show every Saturday, I'm going to talk to you about that in a bit. But listen to the instructions. All right, this is like select all that apply. But you're gonna do it for column, right. So let's read instruction for each of the medication consideration below. Click to specify if the statement is consistent with the medication in each column. Each statement may support more than one medication.

So I'm only one of the few NCLEX instructors for foreign graduate nurses that do NCLEX next generation styles because a lot of nurses that are teaching foreign grads are not trained here in the US. I am trained here in the US. I'm a certified educator here as well, as well as a certified family nurse practitioner. I can do next gen NCLEX. And if you really are interested, join my classes and I'll teach you how to answer this. If you think you're gonna take your NCLEX next year, I will be helping you pass your NCLEX even with the next generation NCLEX you want to know more about it join my show, watch my previous shows about next gen NCLEX. Alright, but you're gonna do one column at a time and this is gonna be correct versus incorrect answer because it's like select all that apply. But we're going to do it column we call it matrix or table. So this is a multiple response matrix, or matrix, select all that apply. Right, each statement may support more than one medication. You're going to do it by column right McAllen. That's new regular first. Your options are one clear color do maybe mixed three monitor for hyperglycemia for maybe given IV and five no peek effect, what are your answers? Let's do regular first we're going to do by column. Okay, we're going to do by column by column.

We're going to do a regular first regular. Is it clear? Yes. Can it be mixed with other insulin? Yes. Do we need to monitor for hypoglycemia? Yes. And can we give it IV? Yes. And is there an oblique effect? No. So the answer is 123. And four. Very good. Right? Minus wrong. Okay. Right? Blindness wrong. Correct versus incorrect. So the answer is either four points. And then if your answer is only do or three, then you get the duction. Right? Is the next generation is now very complicated. Let's now go to NPH and bh. Go to mph now. Is it clear colored? Can it be mixed? Do we need to monitor for hypoglycemia? Can it be given IV? No peak effect? What's your answer?

Two answers only right? If you have more than two answers, then your score would be one or zero. It's the right minus wrong, right and compute your scores per column. So in regular how many points did you get? It's right minus wrong. Okay. Right minus wrong. So if you've got three great answer and two incorrect, that's one point. If you've got three incorrect answers, and three incorrect, the zero for NPH. The answers are only two. So if you get one correct answer only your score is zero. So it's two or zero. Right? No Lantus, Lantus was the answer. Glare color may be mixed. Monitor five glycemia. Given IV no big effect, answer, clear color, it cannot be mixed. There is no need for apologia. There is no need to give IV no big effect. That's the answer only two answers the first and the last right. Now options one and five. If you've answered one and four, then your score is zero. If you've answered one and four, that 013 And five, that 0123 And five, your score is zero to three and five, your score is zero. All right now compute your scores regular plus NPH plus lanters.

Your total score should be 45678. Points. Remember, it's right minus correct in regular you've only answered do than that zero. All right. What's your score? Anyone? This is an easy question. It's a recall type of question. Only six. All right, some people got zero points. Some people got one point I can see your answers. Guys. I can see your answers. All right. But be very careful. So here's my question to you is NCLEX. Next Generation questions are Ng and easy or difficult. I always keep getting this question. Do you think Sir, it's going to be easier? Or is it going to be more difficult? What's the answer? For me? It's more difficult, right? Because it's not only with the way it's being asked. But it's also the scoring system that makes it very complicated, right? Anyone here will be taking their NCLEX after April one next year. And this is only this is only one of the 14 types of questions before there's only six types of questions. Now there's 14. And mind you this question that I used I write I wrote this question last night, like I said, I write my own question. I'm a trained item writer, and I'm a trained NCLEX provider as well.

So if you guys think that you're going to take your NCLEX next year after April of 2023 partner with me, I'm going to help you pass the exam I'll make sure that you will pass your exam through my program Aspire RN, or you can also visit the link below if you want scholarship opportunity with Connetics USA and aspire are in partnership we're offering NCLEX opportunity, scholarship opportunity where we connect you to recruiters that will sponsor you and pay for your NCLEX review program and employment here in the United States. You do not have to worry about anything. The link is below sea USA dot link slash Aspire RN you're gonna get scholarship. If you qualify. We have set criteria the recruiters will contact you, but please do click this link or send me a message and my social media doctor nurse well, I'll help you get connected with our recruiters as well. Write this question that it flashed on the screen is actually easy. This is easy. I have more difficult questions. If you think you got eight over eight here. That's because I chose an easy question. All right. When you attend my classes, I do sample case questions in my secrets of next generation and CLECs. You'll see how hard it is going to be right. Aside from the scoring system, the question itself aren't confusing. There's highlighting matrixes.

Select all that apply, select and there's rational scoring rational testing. How long does it take to be approved for New York board? I'm not sure I think it takes about six to eight months when is the best time to review. Forget, if maze a target date, you need to start now comprehension building is key. Depending on how fast you study, one to two months is good enough to build your comprehension and the next three months two to three months you use to like improve your test taking skills or test drills. Alright, if you want to know more about how to prepare for the NCLEX I can help you send me and question at the doctor nurse ball in my social media. All right. Please join my show, aside from Connetics USA also do live shows every Saturday 8am. If you have questions about the Connetics USA program, I can connect you to the recruiters as well. If you're already a nurse that needs a recruiter, I can connect it to my recruiter as well and Connetics USA I'm teaming up with Connecticut US aid to help nurses fulfill their American dream, right. And if you're having a hard time passing the NCLEX, I know the passing rate for foreign graduates is only less than 50%. More than more than 50% of the people taking the NCLEX. And that's about hundreds of 1000s of people every year failed the exam. If you fail your NCLEX before and you want another chance to pass the NCLEX to get you're here to the United States, like many of us, contact me and my social media doctors for I will help you through our Aspire RN program, right and we have different programs that we offer, just contact me and I'll explain that to you.

But if you're about to take your NCLEX soon and you want a short course program, I have a 10 day review for programming called the NCLEX it and final coaching. And you can join this as well. This is only if you're taking your exam soon. But if you have two to three months to spare, just join my full program because you can take advantage of my live classes personal mentorships insurer pass guarantee and so many others, right. Some of our programs have UWorld 90 Day access as well. And do you have a promo? Yes, I do have a promo message me I can give you a 20% discount if you use my promo code and aspire are in website. And it just I can help you with next generation and flex it's a system by system review. Correct. All right. This is a system by system review, we're going to talk about all the things that you need to know to the for the NCLEX are in preparation step by step right? If this cost is too expensive for you, because again, NCLEX review programs are expensive, but I do personal mentorships that's why it's a little on the higher end, and I'm only one of the few review programs NCLEX prep courses that do personal mentorships please join the NCLEX scholarship opportunity provided by Connetics USA and aspire R and we're going to flash in the link one more time here. It's si usa dot link slash Aspire RN to join the NCLEX scholarship opportunity we have also put this in the comments section to join the anklet scholarship opportunity, type C USA dot link slash Aspire RN or message me in my social media doctor nurse ball or join my show the doctor nurse Paul. So if you join my show on November, I think 15 check my schedule on my social media. I will give out one free NCLEX review.

I usually do giveaways where viewers can join the raffle. And I pick one winner after the show. All right. Please message me or check my Facebook page for announcements. But thank you for joining this class. If there's any part of this class that you did not understand, put it in the comments and I will try to respond within the next 24 hours. Thank you guys for joining please tune in Connetics college every Monday hosted by Connetics USA in their social media pages. It's every Monday 5am pacific time or 7am Central Time 8am Eastern time. All right. And we also we have Diane here thank you Dan. She's in October passer she joined our hit final coaching class. Thank you Dan for joining us. I will be in contact with you. I want to interview you for my doctor Nurse Paul, and we've been already texting but thank you so much for trusting us by our and thank you guys for joining this class if you want to know more about the programs that I do, I've done so much free live classes on my website on my Facebook page on Connetics USA you can see my face there because I usually partner and Connetics USA will be launching a show soon about next generation networks teaming up with Connetics USA watch out for the announcement. Otherwise, you can also watch my doctor nurse Paul show. Thank you guys for joining. This show is recorded. Please tag your friends. They can watch the show later. If you have questions. Send me a message on my Facebook page, Instagram, TikTok or you can also send a message to Connetics USA and they will connect you to me. All right. Thank you guys. Have a great day. Thank you for joining the show. See you soon. Bye