Next Generation NCLEX Sample Questions

My name is Jay. I am working as a lead educator in IPASS. At the same time, you know, I'm the co founder, I pass online review and mentoring Academy. So if you have taken if you have a chance, you can also share it to your Facebook page. I was also able to share it to the iPad online, you know, our own Facebook page, right. So this is for at least a sharing of information. So for tonight, I'm going to discuss something about the next generation NCLEX specifically about a certain case study, which is a common, you know, case scenario, not really a case scenario, but you know, a common condition, and then we're just going to present it through a case, you know, scenario. Okay, so, yeah, if you have time, kindly share it to your Facebook page. If you have some group, you share it, because this is a very interesting topic. I'm not gonna say about which particular topic as we go along, you know, when I present my slides, you will figure out, you know, what's what, what's the case study all about? Okay, specifically, what's the condition? It might be a complicated condition, right. But at the end of the day, at the end of this lecture, and our lecture, we'll be able to, like, understand, specifically, you know, what's really going on with the disease process? Okay, I don't want to call it like NGN, or next generation and NCLEX, because we already started it started April one this year. So it's already a new generation and NCLEX. It's not anymore next generation, and it's already here. Okay, and I heard lots of positive feedback about it.

And I was really confident about it, because in the first place, we prepared it like way back like a year ago, even more than a year ago. And then we are doing already our critical thinking skills on our program until such time that they presented the NTN format. So that's, you know, that's why were we able to like you know, revise some of our questions, but the thing is, next generation and NCLEX are the new generation and NCLEX. So I, you know, call it, it's basically utilizing your critical thinking skills, whatever the format's would be alright, so the best way, the best way to practice your critical thinking skills, your clinical judgment is by way of case studies. Okay, so we're going to discuss about a certain case scenario or a case study, and we're going to answer questions related to the specific case study that I'm going to present. Okay. So shout out, shout out to Miss Liu is nori. She's there. Gary is also there. Hi, Kara. Who else? We got a good audience here. Can you say where are you from? Or can you like, you know, put in your chat room or your comments? Where are you from? So I can greet you. By the way, I'm here in the Philippines. I'm so glad I'm so blessed that I'm here. Of course, some reunion with our, with our family. And Mr. Jana is also here, probably from the Philippines because you say good evening, right. Miss magazine, you're from the Philippines as well, most likely to the evening. And yeah, I guess I would begin the case study. I know you're familiar with the case studies already, because you've been you know, we've been watching some of the live lectures here in Connetics.

And I, you know, again, it's my pleasure to be here in Connetics USA nurses recruitment agency, doing some of my lectures, some of our expertise in IPASS together with Emile as well and of course, together with other review centers. We're also doing the, you know, the case studies, any like related questions or topics or discussions related to new generation and NCLEX. Okay, so let's begin. I guess I can share my screen. I'm just gonna present it here share screen already. Okay. Oops, hold on. Okay. I'm just gonna like, click here, I guess hold on can you see my screen now? The first screen? I mean, the first slide is something about a slide next generation NCLEX. Can you see it? Absolutely. I'm looking at my Facebook page. Can you see nothing you're typing in? How are you guys? Miss Louisa for sure. From the Philippines. She's from Bohol. I would like also to see people from other parts of the world because sometimes I can see some will be from Africa or somewhere else. Okay, can you see my screen now? Okay, hold on. Let me just fix this one. Like this. It's been a while I haven't been to Connetics. I guess my plate is so for them so busy. The last time I was here for probably like two, three months ago. There we go. Oops. How about that? Can you see it? I guess my lifespan is kind of delay, so I don't see it yet. Hold on. There you go. I guess you can see it now. Okay, somebody from Abu Dhabi, as well. Miss Jacqueline. Hello, from Abu Dhabi. I know, it's afternoon in Abu Dhabi, if I'm not mistaken. I also work in the Middle East before I went to the US. Okay, I think it's good now, already. So next generation NCLEX.

So let me just zoom in. Okay, hold on. So next generation NCLEX, I told you earlier, I said, it's not any more next generation. And that's because it's already here. It's a new generation NCLEX. So just to give you a context, or at least a logic about next generation and based on the new generation NCLEX. Alright, so I would say that we really need to upgrade our, you know, our critical thinking skills, our nursing practice in general, because nowadays are patients especially in the, you know, in areas, especially in the medical surgical areas in an acute hospitals, patients nowadays are becoming so complex. Okay, before when you get a patient like way before, when you get a patient in a regular floor, irregular medical surgical floor, these are those are all like ECPC patients, like, you know, you can handle it easily. Right? In other words, they're not really toxic, they're not really complex. But nowadays, it's becoming more, you know, complex, because of so many comorbidities. Absolutely, I'm gonna say, like, our patients today, because of complexity. Those are ICU patients before. So in other words, the nurses, you know, the way you handled patients before, as a nurse, you cannot do it now, you cannot keep up. So, the plan, I mean, the, the NCSBN made a, like a plan for us to be able to keep up with the complexity of the patient's condition nowadays, other words, the whole, you know, healthcare conditions. All right. So that's why we have this case studies, this is where we utilize our clinical judgment, especially working in the US, you have to keep up.

But well, this is also applicable to Australia at the same time, Canada, because you know, and this is applicable there, you're taking the same, you know, assets of examination, if you have next generation and blacks you know, NCLEX RN Exam is the same thing in Australia and same time in Canada as well. Okay. So let's begin our case study, as we all know, case study is a new thing in your next generation NCLEX in your NTN. Okay, and then they base it from the NCSBN clinical judgment measurement model. Absolutely, this is just a fancy word of nursing process, we call it nursing process as a whole. Right. And, you know, by right, so assessment, you know, diagnosis planning, implementation and evaluation in a fancy way, we call it your NCSBN. Nursing, you know, clinical judgment measurement model. They just have to like they just did like, you know, specified more I would say more Fancy. Like I said, recognizing use, alright, so analyzing use prioritize hypothesis, generating solutions, taking actions and evaluate outcomes. Again, like I said, this is where you utilize your critical thinking, right? And your clinical judgment whenever you handle patients on a regular floor, for example, okay, a medical surgical patient, which is majority of our patients that we handle in the US. Okay, so the case study is based from this model. All right, from this clinical judgment measurement model. The first question related to the case study is something to do with recognizing use. Alright. And subsequently, the second question is related to analyzing use. The third one is something to do with how you prioritize your hypothesis. And the fourth one is how you generate solutions, again, related to that case scenario.

And the fifth one is, how are you going to take actions? How are you going, what you're going to do to that patient, your nursing interventions, and your, you know, your care how you're going to carry out your plan of care. And finally, of course, your evaluation of outcomes. These are all consistent with your clinical judgment measurement model. That's basically your nursing process. Okay, so sounds interesting, right? Okay. Like I said earlier, ng n, this NTN format special this case studies, I've been looking after the, I would say the feedback from our students, it has a very positive feedback from it. In fact, our you know, our, our passing rate was, like really skyrocketing, I would say, it's a lot better from the previous percentage that we had, okay? So it's kind of positive on your on your side, you just have to play around, you know, just have to read and read and read, practice, practice, practice. So you'll be able to, like gets, you know, what they want, you know, from their questions, okay. And when I say like, practice, practice, practice, it means to say that you're building up your knowledge. All right. And remember, your NCLEX is a knowledge exam, okay, from time to time, every step of the way, you're building up your knowledge. It's not just something about reading it without a background knowledge, you know, what's this? And what's that? related to your case study. Okay. Without further ado, this is your case study here. This is how it looks like. Okay, I made this template.

Absolutely. So it will look more consistent with what you see, when you say to exam. I would also like to say that those who are going to sit the examination soon, good luck, everyone, I know you will be able to make it. If I was able to make it, if somebody may made it, you know, your friends, you are also going to make it trust me. Okay. So it's just a matter of time, guys. So this is your case study now. Okay. So the following scenario apply. So the next six items, like I said, this is based from your clinical, you know, measurement model, clinical judgment measurement model. The first item is related to what recognizing cues, of course, you don't see that in your, in your actual NCLEX you know, record something about recognizing use, but you know, for the fact that item number one is something about, you know, the cues that you're going to gather. Okay, so you are working on er, in assigned to take care of a 35 year old woman named Courtney, a very common name in the US, you know that if you live in the US right now. So you know, it's very common, right? She was brought by her husband from a short trip from Cancun. Where is that? That's in Mexico, right? She has type one diabetes. Okay, that's the at least a brief information about this patient. So 35 year old by the name of Courtney. And then she just had a property they just newly married, okay. By his or her husband from a short trip coming from Mexico. She has basically has a type one diabetes. When you click this nurses notes, you will see you know, more of the information about the patient.

The patient was received in ER, by nine at nine in the morning history of diabetes, as it says hypertension, so 35 year old with lots of comorbidities, guys, hyperlipidemia and hypothyroidism. Most of the time the hyperthyroidism in the US is subclinical, in other words, it's like you know, almost with no symptoms, but some I mean, most of the time they get medications as well. You know, you live with Roxanne, right? The nice just pain or shortness of briefing. These are basically your assessment right? complaints of non productive cough. There's some form of a respiratory problem here. And the patient is also complaining of I mean, basing from your assessment, you assess that your patient is having coarse crackles heard in lower lobes, bilaterally patients appears weak, lethargic, but able to respond to questions ask, but in a sluggish manner. Okay, so patient claims blood sugar is well controlled. Let's see if it's really controlled. However, upon waking up this morning, the blood sugar is way too much like you know, it's elevated 385 That's too much, right? So recent glycosylated hemoglobin or a one C than two months ago was 8.8% which is very poor control. Right, but 8.8 point 8% is absolutely poor controller.

12 above is very poor control. Okay, so that's your a one C are also known as your glycosylated hemoglobin or hemoglobin. Persistent nausea, loss of appetite and abdominal pain caused her not to take her routine. Routine medications times three days in the past three days because of nausea, loss of appetite, abdominal pain, she wasn't able to take her medication so she's not complying for the past three days. I mean, you can blame her because she's she has a you know, nausea and loss of appetite and abdominal pain. Frequent urination evident despite the inability to tolerate food or liquids, the husband said she's always thirsty and feeling weak, specially for the past two to three weeks, or it's been like two to three weeks already. I guess their trip to Cancun is kind of messed up because of what she's feeling, right? And the fact that the patient has lots of comorbidities, she's really has to take care of herself. Right? So fruity and sweet smelling breath, no pen. And the point of care glucose is 400. Okay, so that's about 22.2 millimoles per liter. So based on this, you know, nurses notes, you can really see what's really going on with your patient. All right, the initial, you know, the initial information that you were able to pick is diabetes, right? Your Diabetes, and apart from that there's hypertension and hyperlipidemia. So what's really going on with this patient?

Can we take a look at Can I take a look at your comments here? Can you can you type it in? Like what's your initial diagnosis on this patient? Okay, Gunner, the days that you're gonna tell yourself that I'm not a doctor, I cannot diagnose. I'm only a nurse only a nurse. Right? That's what you're going to say. And you know, before, you know, we have to keep up with the, with the medical condition of the patient, it's okay to say that this is the diagnosis of my patient, because whenever you know, what's the diagnosis of your patient, the medical diagnosis, you will also know what you're going to do as a nurse, right? You have to keep up with the doctors that you know, that surrounds the I mean, that leads the whole team, right? As a nurse, as a bedside nurse, you are going to know what's really happening to your patient and be able to intervene, you know, in the most specific and the safest, you know, interventions that you can give where you can offer a render to your patient. Okay. Somebody said like, I guess most of you said, like diabetic ketoacidosis, I'd be thinking to ask ketoacidosis is a complication. I guess you're getting it right. Okay. But we have to take a look at other, you know, informations basing from the history and physical profile right here, the vital signs and laboratory. Okay. So, before we answer the questions related to this, you know, to this information, okay, to the item number one. Okay, everybody's saying like DKA. But the question is, how far are you in understanding what's really big A? Well, I don't have any time to discuss the pathophysiology or DKA piece you are, I mean, you you have a background about that. If you are going to pick your examination soon, for sure. I'm expecting that you are really equipped with this diabetic ketoacidosis some very, very common, you know, question in your NCLEX or should I say a common case scenario?

They might give you a case scenario like this, okay. You're diabetic ketoacidosis is a complication of your diabetes, one for diabetes type one, okay, from the word itself, diabetes, DKA. keto acidosis. Your patient is producing lots of ketones, keto acidosis with On one acids in our body, okay? We don't want us it's in our body because our body our cells or tissues are designed, okay not to live in an environment which is an acidic environment, we are not designed to live in that kind of environment. Okay. And all I would say like, principle wise, I mean, basically, this is absolutely basic all forms of metabolic waste products are in the form of assets, okay. In all forms of metabolic waste products are in the form of acids, there you go assets, assets, assets, we don't want that, you know what, because your patient is not producing insulin, okay? Absolutely, your patient is not producing insulin, as we all know, insulin is the protein component is a protein chemical that transports or facilitates the your, your sugar facilitates the diffusion of your, of your sugar from this area to this area, talking about your cells, okay? It basically transports your glucose here into your cells, okay? Again, your glucose at the same time your oxygen is needed in the formation of your ATP. That's how you live, you know, in every single cell, okay, because of the absolute lack of insulin, it's not produced anymore by your pancreas, in your type one diabetes, you're not able to transport again, your sugar into your cells, okay? And your cells becomes hungry, you know this very well in your, you know, in the basics about your diabetes case.

And the problem is that, whenever you have no sugar anymore in your, you know, in your cells, the body tends to compensate, it tends to get more energy coming from other sources, for example, from your lipids and from your proteins, okay? The problem is when you have a byproduct, okay, coming from your lipids, of course, the substrate or the byproduct is your ketones, and these are acids, what did they tell you? All the metabolic waste products are basically acids, and we, you know, our tissues ourselves, don't want acids in your body. Okay? They are just not simply, you know, they, they're not designed to live in that kind of environment. So we don't want acids. Okay, so I guess this is DKA. Right? It's very obvious guys. And the usual trigger for your DKA is what infection, okay? The usual trigger for your BPA is infection. type one diabetes mellitus is an autoimmune disorder. Okay? It's an autoimmune disorder. Okay. It's an autoimmune disorder, that whenever you have stressors, and most of the time, our stress or our infections, okay. When it's triggered by infection, that's the time that you're gonna have, like, you know, complications like DKA, diabetic ketoacidosis. Okay, so I guess we're getting it right now. But we have to take a look at other informations relevant to, of course, to this case scenario, and the questions that they're gonna ask you. Okay, let's take a look at the next slide. Any other questions? Good morning is Arlene, you're from Jamaica? Good. Yeah. Good morning there in, you know, in Jamaica. Okay, so let's move on. So let's take a look at other I mean, the next slide.

The nurses note, is there already historic physical, mean physical profile agnps. The vital signs? Let's take a look at the vital signs. We're entertaining the conditions, I mean, the medical condition on this scenario, which is the DKA, specifically, right? Your diabetic ketoacidosis. The temperature is one or two, it looks like the patient is having, you know, infection, right? Fever, okay, the heart rate is one or two. And respiratory, everything's like elevated guys. And the blood pressure is going down. Okay. And the SPO two, or the auto saturation is 91%. The good thing about it is that you know, the patient is on room air, the patient don't need the oxygen. But anytime this patient might need oxygen, all right, and the weight is 79 kilograms and the height is five, nine. So let's, I mean, more relevant is your vital signs. Okay, what do you think what makes the patient having heart rate of one or two? Is it something related to the sepsis or the infection that the patient is experiencing? Or what or is it something about the DEA, okay, in your DNA, you know, for the fact that patient is, of course, elevated blood sugar, right? For sure the patient will have polyurea Okay, increase urine output, all right, whenever you have poly urea, definitely you will have polydipsia Alright, so I would say like poly urea, right poly urea. And you also have your polydipsia these are the very common you know, you know this back in college, you will know this very well polyuria polydipsia. What else polyuria polydipsia. And of course, you have your body figure, right. So, these are just simply, you know, I mean the basics about diabetes, the three piece that you know, back in the college days, right? So, in polyuria, polydipsia and poly failure, your patient is losing too much water, dehydration, right? Probably because of you know, your infection at the same time, more specifically because of DKA. Right.

So your patient is losing lots of fluid volume. So these are the signs of fluid volume loss, your patient will have elevated heart rate, your patient will have elevated respiratory rate, and the blood pressure is already going down. Right. So dehydration due to DKA. Very good. All right. So let's take a look at the other. The other slide before we go with a question. Okay, so this is something about the agnps say agnps. That's history and physical profile. Okay? The medications, the patient has a head remember the patient has a history of hypertension. So he's taking and his ace inhibitor, you know, you're listening Lisinopril, devata Roxanne, a patient, if you remember the history the patient has, has a hypothyroidism we don't know if it's subclinical or really like, you know, clinical kind. And you also have your atorvastatin because of hyperlipidemia. The patient is also getting insulin glargine or your Lantos. That's the brand name. Your patient is not getting a regular insulin shot, but the patient is getting apparently metformin, a p a p o, you know, a pill for diabetes, an oral hypoglycemic agent, right? So these are the things that that can support, you know, your diagnosis, okay, that can support your answers as well. Let's take a look at the laboratory findings. Okay, definitely the glucose is way elevated, your beta hydroxy butyrate is your ketones, okay? This is the most specific ketones and most reactive when you get them, you know, from a blood draw your beta hydroxybutyrate is a form of ketone for is a critical result.

The good thing about your next generation NCLEX is that, you know, in a traditional NCLEX, they're not gonna give you the normal values, they're not gonna give you the reference values, but this time, these days apart from the partial scoring, they're gonna give you the reference values. You don't need to memorize all those stuff. Okay? It's already given. So if you take a look at this one, you're a beta hydroxybutyrate, as the ketone is elevated, okay, so it's elevated. Oh, I love from the Middle East from Doha. Of course, I know. She's my former co clinical instructor back in the days back in the days, all right, what blood cells is 9800 It's not really elevated, right? But I guess the patient is also having some form of infection because you know, fever is there, right? But you cannot say that the patient is septic at this time around, you have to have lots more information to conclude that this patient is having success. But again, the problem here is more on the VA, it's just you know, the infection is just the trigger for the dka. Like I said, the most common trigger for your DKA is your infection. Okay, your Bo n is 30 and your creatinine is 1.5. This means to say that your patient is really dehydrated, that's the dehydration whenever you are losing lots of water, of course your bill and agree and it will be elevated. Okay, not necessarily your creatine but definitely I would say like you know, you will be when will be elevated, okay, your potassium is 3.1 in DKA it can rise and it can decrease. You can have hypokalemia or hyperkalemia. Remember when you have acidity in your in your blood, okay? It gives a lot of hydrogen ions and one part I mean one way of compensating it is to exchange it with the hydrogen ions. I am talking about potassium, that's why your potassium will be elevated as well. Okay, so you're giving too much of your hydrogen ions that makes your blood so much acidic.

In exchange of your hydrogen ions in exchangeable hydrogen ions, your potassium goes into your serum, okay, it goes into your serum, causing elevation of your potassium causing hyperkalemia that's in the presence of your acidic, you know your acidity. And that's because of our ketoacidosis. Like I said, in your DKA, you can have hyperkalemia or hypokalemia, or hypokalemia is because of your too much urination, you're losing too much electrolytes, including your potassium. And remember, whenever you have hype or hyperkalemia, you always have to check for your heart rhythm and heart rate. Okay, it's something to do with cardiac monitoring. Okay, your sodium is a little is it elevated? Not really. Okay, this is absolutely normal. Sorry for the technical issues. Your TSH is okay, the dimer is elevated. Okay, your patient is prone to develop clots, okay, your C reactive protein is 11. Probably this patient is already having some form of a chronic infection. Okay. And your troponin is negative, I would say that culture is spending the UAE s o ketones is positive. So this is basically the Ka right? urine culture is also pending and your ABGs. This is what this one is acid. The PCO two is alkalosis. I'm not going to teach you about ABG. This time, I'm just gonna read it like real quick. Bicarbonate is 16, which is acidosis. So this is basically your metabolic acidosis. Okay. Remember, your ketones are metabolic products. And these are acids. That's why I will call it metabolic acidosis. Simple, right? Okay, the P O two is okay. Which is a T. All right, and the patient, there you go, some respiratory problem, the patient is positive for flu.

And we don't know if it's flu A or B. All right. Flu B is more like I would say like more severe, you know, than your flu way. Okay, most of the time, your patient will get through a. Okay. Instead of like the flu be anyway, regardless, patient is having Pacific infection positive for flu, that, again, will contribute to your you know, to your DKA. Let's take a look at the question this time. All right. So you were able to gather the information, I will take a look at the x ray first on the X ray showed it's very consistent with flow. All right, bilateral pulmonary interstitial markings that makes it you know, you hear some crackles. So intersection markings is very consistent with flow, either flow a or flow B. All right. When you say like consolidation that's very consistent with your pneumonia. All right, a fluid error level for example, is very consistent with your probably your abscess, your pulmonary abscess, your pulmonary infiltrates is also you know, very consistent with your pneumonia or your CHF. But when you talk about interstitial markings, it's very consistent with your flu. Okay, I think I have a separate discussion about that in your you know, in your pneumonia, thinking about what kind of X rays this what kind of, you know, finding is this in relation to what disease condition, you know, it's related. Okay. So the question is related to this scenario, item number one, which for laboratory findings require immediate follow up. Okay, so what's your answer here, guys, so this is what we call a short SATA in, select all that apply with letter N. Because traditionally, we only get like SATA. The good thing about the new generation these days, you will get partial scoring. But before you don't get any partial scoring. And like I said, this is a different setup, because they're going to tell you how many how many items you are going to pick. Or how many you know choices you're going to pick. All right.

So which for which poor laboratory findings require immediate follow up related to your case scenario, guys. Come on. Come on. I wanted to see your answers guys. Ratio. Where are you from? Probably from the Philippines. Miss gentleman is also watching Miss ricin. Oh, thank You that thank you for that. Thank you for asking for your comment. All right, what's your answer? Come on. I want to see your answers. Come on. I want to see your answers. Okay, I'm not gonna I'm not gonna proceed if I don't see your answers. Come on. So needs immediate follow up. Blood sugar, about your blood sugar, blood sugar, definitely. I'm going to answer that. Okay. I'm going to click it. Okay. Siri after protein. This is a sign of a chronic infection and the patient might have a chronic infection or a chronic inflammatory response. The patient might have probably like, you know, an autoimmune disorder where basically your, you know, your diabetes and autoimmune disorder. That's one cause or etiology of your type one diabetes, I would not answer this one, this does not need an immediate follow up. So 124 And five, let's see, do like I said, it doesn't need an immediate follow up. Okay. abg, I would say, yes, for the abg, your patient is having metabolic acidosis. Right. And we don't want that. The good thing about is it's compensated, if you remember, if you look, if you look at the abg, it's acidic, but you know, it's compensating. All right, it's compensatory. Okay, your, your buffer system is working, all right, but you have to monitor that, okay? Think about your DKA.

Your DKA has a three primary, you know, management, they were going to take care of, for example, the fluids, right? The insulin, right, but we're going to go with this one in the next slides. And of course, your potassium. Okay, these are the things that you need to remember, in other words, monitor for fluid status of your patient monitor for blood sugar, because you're giving insulin and they also monitor for your potassium, that's also in relation to your immediate management. Okay, so ABG has something to do with your, of course, your, with your ketoacidosis, your patient is giving lots of you know, hydrogen ions, that's because of your ketones, you have to take care of it as well. And remember, when you were too much acidic, you're gonna have some CNS depression later on. Okay, so your mental status will decline because of the acidity because your brain cells doesn't want, you know, too much assets. And everything else in our body. Okay, your agency. It's just too high, but it doesn't need an immediate follow up. Okay. So it just means that your patient is I would say, like, it's not really controlled. Okay, it's not really controlled. Your D dimer? I would need a follow up on that one, because D dimer is a sign that your patient is developing or potential for developing some clots. Okay, if you take a look at the D dimer, it's elevated, right? It's elevated your potassium, I would say yes. Okay. Bu N. Not much. I guess the BU n is I mean, that's part of your basal metabolic panel, though. But the bill and is just a, you know, a normal, I mean, not a normal Bateson and dissipated effect from your, from your polyuria, you know, from your ketoacidosis from your DKA. Sodium is normal. So I would not it doesn't require.

So for now, yeah, for we need for your beta hydroxybutyrate. I'm going to answer that. So how many? How many answers here, I think is already like five. Okay, so among the five choices that I made, I need to I need to eliminate one, I need to eliminate one. So I would think I would still follow up the blood sugar, definitely ABG I would think the diamond needs to be followed up. Okay, the patient or the doctor might order some form of imaging, you know, to detect if there's really gluts especially in the lungs, your pulmonary embolism, potassium, I would try to up that cardiac monitoring definitely. And your between your ABG and your beta hydroxybutyrate, I would go with your beta hydroxybutyrate. It's a critical sign that your patient is really you know, having DKA it needs to be monitored in the ICU, the patient might be in an insulin drip. Okay, so I would answer one. So one by six and nine. See you though. I mean, you cannot answer the question. If you don't know, what is beta hydroxybutyrate. If you don't know what's a D dimer, all right, if you don't know how to read ABG. And then again, like I said, you're gonna build your knowledge up and up and up. Okay, as you go along, but you cannot build that up. If you don't start the well. Okay? And please do not underestimate your NCLEX. It's challenging kind of exam, but it's very doable, right? It's very doable. If she or he was able to make it. You are also going to make it. I'm pretty sure about that. Okay, so let's see. And then you just have to submit I mean, click the submit button, and then well, there's a there's a partial scoring. That's what they said. So who knows, you can have some, like probably three out of four. You can have points for that. Okay, so ace and kg What time is it now? Am I am I?

Oh, it's April. I only have like 15 minutes left. This isn't a one hour lecture. You know, case study is a case study. You have lots of information going on there. You know, I can discuss it probably two hours, three hours. For hours, but my time is very limited. So I would move on to my next slide. Okay, let's move on to our six, analyzing cues. So we need to analyze so well it's already given basing on the nurses notes. The question is related to analyzing cues, right? Click to Mark, if the below findings are consistent with DKA, or influenza disease. This is what we call matrix. This is another new thing in your NCLEX. I like this matrix, just have to click and click and click whichever is applicable or consistent with the disease process. Okay? It's either DKA or influenza, right? The influenza is actually triggering your DKA alright, but the question is related to the findings, is it consistent with DKA or influenza fever NGO's is consistent with your influenza, nausea, vomiting, it could be in your in your influenza, it could be in your DKA. Right? In polyurea, DKA is there abdominal pain is there, you know, in your DKA cough is in your influenza, lung crackles is your influenza, muscle weakness can be both Alright, elevated blood sugar is in your DKA definitely elevated bu n is more specific or consistent with your DKA you don't necessarily have you know, elevated bu N in your influenza in Kenya can be related to the ODK are consistent with your DK and your influenza. That's how you play around. That's why I like this ng n. Right? So okay, to keep no I think it's just it's, you can also find it in your DKA. Remember, your patient is trying to compensate. Because of too much acids, you know, your body is trying to compensate.

Eliminate that acids in your body by doing one by doing more breads and breads and breads to eliminate the acids in your body, you know your customers Britain, right? And what else? Of course, you know, polyurea well, right, I'm not gonna dig in with each signs and symptoms or with each findings. Why do you have this? And why do you have that? Because we're running out of time already. Right? Abdominal pain, why this always like abdominal pain, your DKA you know why? That's because of the thickening of your liver capsule. Right? Because your liver is trying to compensate for the missing insulin signal, right? I'm not gonna dwell in your insulin signal thing, you know, kind of mechanism in your DKA, you know, just loosening law, I mean, you're basically losing your insulin signal because there's no more insulin. So it tends to compensate by producing lots of metabolic processes, for example, like gluconeogenesis glycogenolysis, thereby increasing all your sugar. Okay, but the thing is, you don't have the insulin that gives signal to the receptors that are in your liver. So it means to say that there is no counter regulatory mechanism that counter acts your hyperglycemia. Okay, so your DKA is basically hyperglycemia. Now, when your liver is subjected to that kind of mechanism, it's going to like hypertrophy. And what they see is your your liver capsule is thicken, that causes the abdominal pain, right? That's one you know, that's one reason actually, there's probably like two or three reasons why you have your abdominal pain. But that's one thing that is very, you know, very significant.

Why you have your abdominal pain. Alright. So let's move on. Let's move on to your next question. Okay, so item number three is related to your prioritizing hypothesis, priority prioritizing hypothesis. Now, this is something about what he called this one, like. Drop down, right? This is something new as well. So this is what we call this drop down. So to complete the following sentence by choosing the following options the client is at high risk for you just have to click the drop down, you know, this arrow is drop down arrow, and your option should be this one. Option two, is this option three, is this an option four is this okay? The client is at highest risk for developing one. These are the options here just need to answer one. Okay. And then the client is highest risk for developing I would say like fluid volume deficit. Alright, so fluid volume deficit, we'll see how we go. How we go about this case study. You just have to play around guys, but of course it's backed by your word, your knowledge, okay. You cannot just simply play around and then okay, I'm going to answer this and this and that. It has to be based on the knowledge that you were able to build up, okay, so option number two, as evidenced by what I would say like the cardio hypotension and the kidney. And, of course, this is related to the vital signs, your fluid volume deficit. This is basically your nursing diagnosis, and it's evidenced by the teacart hypertension and the kidney patient might have you know, hypovolemic shock because of too much losing water, nausea, vomiting, in other you know, symptoms related to your fluid volume deficit, but in in option two, it says like teacart, hypertension and the kidney.

So, these are the signs of fluid volume deficit. The nurse should first address Courtney's what elevated renal panel, sepsis hypovolemia and the kidney I would say like hypovolemia. So I would say here hypovolemia because again, it may lead into hypovolemic shock, okay, loss of circulatory volume, which will lead into like, you know, profound shock, okay. And the fluids later on will work or, you know, you need some form of basal pressors. And the fourth question still drop down. It's either acid base imbalance, hyperglycemia, electrolyte balance and abdominal X ray. So, the nurse should first address Courtney's hypovolemia. And I would say hyperglycemia, because that's the main problem, right? So that's your hyperglycemia you address this? Okay, what did they tell you about DKA? fluids, all right, your fluids. Next thing would be your, your insulin. And last thing is your potassium. Okay? Because your potassium will have like, you know, it's either high or hyperkalemia. Again, related to the disease condition. So the client is at highest risk for developing fluid volume deficit. It's a priority, as evidenced by the vital signs your topic cardio, hypotension and Kibriya. You know, your teacher is always telling your hypo archeparchy You can use that you can utilize that knowledge. All right, and the nurse should first address coordinates hypovolemia. And of course, the main reason why we are discussing this the main reason why this patient is admitted to the hospital is because of the hyperglycemia course related to your DK Are you still with me guys? Very good. Vanessa Joy said like hypovolemia hypokalemia hyperglycemia. Kosmos respiration Mr. James said like for the patient and having the Empire who came from a vacation can cool Why not a bit instead of potassium ABG already includes electrolytes and bicarbonate confirming the diagnosis of acidosis.

Why not ABG instead of potassium. I don't really get what you're asking here, why not ABG instead of potassium ABG already includes electrolytes and bicarbonate confirming the diagnosis of acidosis. When you're not only getting your, you know, your electrolytes, mint or abg, you can also get your B MP, it's part of the protocol that we're doing. Okay? Remember, guys, we cannot just simply do your ABG app anytime, right? So you can have a baseline after four hours, you can do your abg, but not like every hour, but you can do your BMP every one hour every four hours, which includes your potassium as well. Again, we are actually scared about the potassium here. Okay. So like I said, the primary management is fluids, your you know, your insulin at the same time, your potassium because it goes up and down. It goes up and down. In other words, it's basically imbalanced. All right, that's why you have to like really monitor your production. We're kind of scared about your potassium. Okay. so, I guess we're done with this one. fluid volume deficit, your vital signs, hypovolemia and your hyperglycemia. Okay, let's move on. So this is another matrix, the fourth among the six generating solutions, all right, something to do with your generation of solutions. Click to indicate whether each interventions listed below is either expected or necessary or not expected or unnecessary in the care plan. Okay, your intervention is continuous cardiac monitoring. Of course, it's expected, right? Remember, you're talking about potassium, right? So point 45 Sodium chloride solution.

Yes, it's expected. It's either you know, point 45, a hypotonic solution, or your NS as an isotonic solution. Okay. Again, you're talking about fluids. You're trying to like you know, resuscitate your patients fluids. Remember your patients also having fluid volume deficit, a hypertonic solution. For example, you're having some cellular dehydration already, because of too much dye erasing because of DKA hyperglycemia. Yeah, where are you going to do a hypotonic solution can increase the size of your cells, right? So lower concentration, higher concentration, right? By giving a hypotonic solution here in your serum, you're going to do what? Osmosis right there osmosis movement of lower concentration and or higher concentration when you're giving a hypertonic solution here, right? When you give it a hypotonic solution in, of course, in your serum, it's intravenous, you are trying to move your fluids from a lower concentration into a higher concentration. So it promotes movement from here to here. So in other words, when you have ascended or dehydration, it tries to like, there you go. So movement from here to here from a lower concentration, look at my drawing here at the top of your, the upper right corner. So movement of lower concentration into a higher concentration by giving your hypertonic solution your half saline, right? Since you have cellular, you know, dehydration already, you're trying to increase the size of your cell by moving this fluid from a lower concentration into a higher concentration. Okay, so, of course, you need to know what's the basics about hypotonic hypertonic solution and isotonic solution isotonic solution is okay.

So you're going to give some form of a D five W's you know, containing dextrose in your water. All right? If your blood sugar is already, you know, going down to 250 or below, okay? If it's already 250 or below, that's the time that you're going to switch your fluids from half saline or your normal saline into the five dextrose containing solution. That should be five w are you still with me, guys? Okay, so next thing is your Yeah, that's expected. I'm going to check the expected or I'm going to click it in your computer. oseltamivir is the drug of choice for your flu. It's kind of expensive medication, especially if you don't have insurance. I'm going to put that in your this is for what expected or not expected, I'm still going to put this one as an expected as expected or necessary. Because you know, this patient is having flu. How about your enoxaparin? Okay, it's expected because your D dimer is elevated, right? So you can also give me an A, you know, half a dose like you know, point five per kilogram. Okay, so half a dose, it's only prophylactic because remember, your D dimer is elevated oseltamivir your IV potassium, your potassium is kinda low. So you can expect that your sodium polystyrene sulfonate your patient is remember this is given for a hyperkalemic patient, right? Your patient is not hyperkalemic. Remember? So it's not expected. Okay, it's not expect that you're going to put it down some more. Right? You will say pry up so I don't see any infection here. infection but it's only viral infection. Alright, so you don't necessarily keep yourself dry and so on.

Okay, so not expect them. So insulin glargine bolus, no, the expected insulin here is your regular insulin. Okay, that's a standard regular insulin, you're going to give you a regular insulin in 0.0. And we're going to give a drip 0.1 unit per kilogram in an hour. Okay. 0.1 unit per kilogram in an hour. Okay. But, you know, you don't mind so much about the dosing guys, because they're not going to ask you about, you know, the dosing, it's kind of, you know, an advance knowledge already. Okay, so, so person is not expected. Again, your patient is having a viral infection, you don't necessarily give, you know, a antibiotics. insulin glargine is not given oxygen therapy. I mean, it can support your patient, I would say like it's expected 30 units mph this is I'm not gonna give this one, but I can give you a regular insulin but not your MPH. Okay, it's not a fast acting insulin, so it's not expected. Okay. So these are the answers here. cardiac monitoring suspected have saline ECS in our brain, prophylactic, you know, anti gluts or anticoagulants, except expected because your D dimer is elevated oseltamivir is expected because your patient is having flu drug of choice for flu. I will put archenemies okay, because it's a hypokalemic. So John polesden sulfonate is only given for hyperkalemic patient it's not expected you're not gonna kill your patient by you know, by causing more hypokalemia and this patient safe trial zone is Not necessarily given because it's a viral infection you don't need to give you know your antibiotics Glargine isn't given okay? It's not a regular is fast acting insulin, your auto therapy can be given. So I'm going to expect that the big event and you're not going to give other incidents apart from your regular insulin, which is a fast acting insulin, so it's not expected, you know, because here your MPH is there.

Okay, it's a it's a slow acting insulin. Alright, so let me move on to the next question. What time is it now? Are we still good guys? You're almost done. But well, we're gonna answer this item number five. Okay, so Gianelli is also watching here. Expected don't think Okay, Miss. Miss, how are you? Are you a lady or a guy or? I'm sorry. Her name or his name is patience. That's a nice name though. Okay, I appreciate that answer. Okay, so item number five taking actions you're working on ER and assigned to take care of I mean, it's the same thing. So let's take a look at the progress you know, the progress notes in at 1500 all immediate orders, pretty much the patient has already stable rounding position order to transfer the patient to medical surgical telemetry floor for further management. The patient's mental status improved and is now already an oriented what makes it what makes the patient discharging the patient is allergic because of the assets building up because of the ketone acids. Remember what I told you acids causes, you know, mental status dangerous, CNS depression, right? So the patient is now probably the blood sugar is going low. There you go. 230. Okay, temperature is 99.4 is you know, the fever is subsiding. Okay, the heart rate is doing fine, it's normal, the respiratory rate is doing good, it's normal and the blood pressure is going up. All right, from a hypotensive you know, state earlier, definitely your patient needs fluids, but this time your patient is already your blood pressure is evidently high. In other words, your fluid is working SPO two is 99%, the patient is supported with O two with at least a little supplement, one to two liters per minute. And routine laboratory test ordered and blood draws initially initiated. Okay? Glucose is okay, at least it's not 400 it's going to you know, it's going to go down and go down and go down. But you still have to monitor your blood sugar every four hours. So you're going to stick your patient right.

So expect that it's a lot of sticking every two hours or every four hours. It depends upon your hospital policy. Okay? Our goal is to bring it down to 160. All right, so book says like, you know, an addict a patient, our goal is to bring it down to 160 for you to say that the patient is really stable, and it can be managed routinely in regular floor. The bu n is normal, creatinine is normal. Potassium is already normal. And the sodium is you know, it's been like normal 138 is normal. Okay, so based on the current assessment or reassessment or monitoring and laboratory findings, which three actions would be the priority you don't need to administer potassium right. Insert for you don't need to insert Foley monitor I know strictly because it can go up and down. You know, I'm talking about your basal metabolic panel, I'm talking about your electrolytes monitor ion or strictly remember fluids insulin and potassium monitor ion Oh, strictly something about the fluids. Okay. Do you need this teaching or education at this time? Probably if the patient is really awake, and then they can you know, comprehend. They can give you a feedback as well with regards your education, you reinforce the education, and I don't think the patient needs his education. In other words, you know, because this patient is not a new diabetic patient. She's been diabetic probably for many years. Okay, so I don't need this one. So I'm going to clarify percent, I would say yeah, what did I tell you if it's 250 or below, this time, you're going to you're going to administer a dextrose containing solution in a form of D five w or D five you know, in the Philippines because if I bore in the US because I believe I've w you know, the same thing. It's containing you know, dextrose because, again, your blood sugar is going to 50 or below, you get me and lastly monitor you still have to monitor your blood sugar.

All right. Three actions will be priority monitor. I know you don't need to insert Foley. Remember as much as you want as much as you care. You don't just simply insert your Foley catheter only for you for nurses convenience, no, it's not. Chances are if you're going to insert Foley, you're going to have some form of infection hospital acquired infection, catheter UTI, we don't want that. There's so many cases of that here. I mean, they are in the US. Right. So three, five and six. Okay, and submit, you know, click Submit button, and then hoping for the best, you know, you can get points from there. Lastly, your evaluation of outcome. So the nurses notes seven in the morning, you know, routine bedside, you know, handoff report, nothing much probably happened from the nightshift. The nursing interventions rendered continuous monitoring carried out, patient remains safe and stable. The patient reports feeling better routine laboratory tests and vital signs were checked every four hours during the night and remained stable for continuity of care. Everything is I mean, the patient is saved and everything, you know, looks fine. All necessary assessment data or data for review by day shift nurse. Okay. Which findings indicate that the treatment plan is effective for oh, where's the where's the slide? Oh, okay. I think I missed the slide here. Hmm. For each client finding Click the box to indicate it is effective or ineffective. Where is that? Where is that? I think some technicalities here, it should be showing up here. Hold on. I guess which treatment plan is effective. Okay, let's take a look at the next slide. There should be a next slide on this one. What happened? There is none. Some technical glitch here. There is no more six question. So they can ask you. I'm just gonna hold on.

Oops. Okay, there should be something like the management. Hmm, it's gone. Anyway, which findings indicate that the treatment plan is effective for each client finding Click the box to indicate if the treatment is effective, or it's something about the treatment if it's effective or ineffective. So still about matrix? Okay, still about matrix? There should be like the following slides here. But I guess it's gone? Well, again, like I said, evaluation of outcomes, that will be the six out of six, you know, questions related to your case scenarios. They can give you many things, you know, many, or any formats of your NGS, for example, this is a kind of a matrix just like any other. I mean, just like other questions prior. Okay, but anyway, so I hope I can still miss labs and it's a bonus. It's a bonus question. When there is no such thing as a bonus, or you can a, the good thing is about your NTN has a partial scoring, but there is no such thing as bonus. There's what we like when we are when we're students before. Okay, so there's a kind of technicalities. There's no such thing as technicalities in Well, for some probably, but well, for sure. They're gonna give you the last question. I'm sorry for that, guys. So bizarre. What What's your question? What's your question? I'm going to enter a pain, probably two questions, and then we'll wrap it up. Okay. So Sarah, what's your question typing in so I can answer it as much as I can. You know, so Sarah, what's your question? Okay, so I guess we're running out of time. Ready? Yeah, we're, it's already 907 here in the Philippines.

Like I said, I'm gonna give you some takeaways in relation to your specialty, your preparation. I know you're kind of tired, especially if you prepare like, you know, way back like probably like six months ago or anywhere eight months ago. And then you're still having hard time in, in scheduling your exam. You want it to take already or sometimes even if you're already eight months, nine months preparing and then there is no schedule you can Okay, I think I've seen that ready, you know, random feelings when you prepare. But like I said earlier, if I was able to make it your A, she was able to make any he was able to make it why not to there is no difference with that. I also started from your from your level, it also started reviewing like, you know, during my time preparing, I was only listening to my lecture and then the way my staff, okay, it's just a matter of time. And then you're gonna tell me okay, because you're an educator. You have an experience. No, they don't have any difference. God made us with individual abilities, and I don't think that I have abilities that way, you know, above than yours, you can have abilities that's way above than mine, or your friends or your other friends. We have different abilities, guys than your brain is, you know, your brain is kinda like expandable, God made that brain to be expanded. In other words, you can gain more knowledge as long as you are interested in doing so like study, study, study, practice, practice, practice, you're gonna build up more knowledge and knowledge and knowledge. Because you know, knowledge is really what we need here. Content is what we need here.

And also in your NTN, Ghana, the base that we're going to memorize the facts, we have to understand the principles in other words to be smart, okay. And like I said, you don't just memorize the mnemonics you need to understand each part of the mnemonics. In other words, understanding the principles, not just, you know, memorizing the facts, understanding the principles, I'm gonna leave you with some. I just remember, Bruce Lee, Bruce Lee said a successful warrior, a successful warrior is an average individual. But with a laser, like focus, you know what I mean? Like, you don't need to be the brightest person. Okay? You just need to be an average individual. To get this done to get your NCLEX done. Okay, you just have to have a laser like focus on your preparation. Again, a successful individual is an average one. All right, with a laser like focus, you don't need to be the brightest person. Okay. So God bless everyone. And I hope I can do another electronics to you guys here in Connetics doing properly. Another case study with question number six already? For sure. There's probably another file with six question. So it's probably missed out. Okay. So thank you. Thank you. And God bless everyone. What's your question, Sarah, before, before I leave, we're going to give dextrose 5% for a terrific tissue course. It also it's also high. It's still high, though. But when your sugar is already stabilized, okay, we don't want to, we don't want to see it like really going down drastically. Right? So dextrose containing solution is enough to stabilize your sugar, but it's not going to go up drastically. All right, in that is to prevent you from going down, you know your blood sugar drastically. Alright. So just to maintain the blood sugar. Okay. So what else for that type is like going to a blood sugar level to normalize levels, no signs of flu. There you go. Those are the things that you need to like, remember in terms of the effective management, I guess we'll talk about the effective management. Okay, so thank you. Thank you, and God bless everyone. And we cannot do all these things without the help of our Lord from above. Okay, and see you around. Probably next, you know, discussion on in the Connetics College. God bless everyone.