 Welcome to Nursing School Explained, today I'd like to review this book called Prioritization and Clinical Judgment for Inclix RN by F.A. Davis. As you are well aware, starting in 2023, the next gen Inclix will take place. So you need to be ready for these alternate format questions, clinical case studies and scenarios. And today I want to show you what one of those clinical scenarios could look like. So let's look at this medical surgical case study number three in the community acquired bacterial pneumonia. So they always give you a scenario. So this is Ms. BW, a 65 year old female client, presents to the emergency department reporting a productive cough, shortness of breath and fatigue for the last week. The client exhibits labored breathing and the nurse detects the odor of cigarettes. The client reports smoking one pack a day of cigarettes for 40 years. The initial vital signs are and then you're going to get a some sort of a chart here. So here for vital signs, we have blood pressure 128 over 76, heart rate 89, respirations 24, O2 set 90%, temperature 102.9 and pain four on a 10 scale. So before even looking at these questions, just start analyzing the data here. Blood pressure looks good, heart rate looks good, respirations are a little fast. O2 set is way low and the client has a fever plus some pain. So now we know kind of try and picture what this patient looks like in real life. And let's go to question number one. In addition to the previous information, which priority assessment data should the nurse report to the healthcare professional? So now we're looking at some priority, something that could potentially kill the patient. So sputum is thick and yellow tinge, bilateral crackles in the lower lung lobes, cap refill isn't fewer than three seconds or loose brown stools times one. So right away you should be picking out option number two because these bilateral crackles could mean that the patient has pneumonia and thinking about priority, think about your ABCs. So this is a breathing problem. Yes, the sputum is kind of noticeable too, but we're more worried about the patient's breathing given that the respiratory rate and the O2 set are up. And then the scenario just continues. Sputum is BW is experienced in shortness of breath and feeling anxious, which intervention should the nurse implement? Select all that apply, everybody's favorite. So now here we have elevate the head of the bed, administer oxygen by nasal cannula, encourage fluid intake, stay with the client to attempt to calm her and request the client to take slow, deep breaths. So now we have this patient who is breathing a little fast with low O2 set and a fever and she's short of breath and feeling anxious. So what would sound good here? Elevating the head of the bed definitely is a great idea to make her breathing easier. Administer oxygen by nasal cannula to get that O2 set up, encourage fluid intake. We're not really worried about that right now. We're more worried about getting that breathing on the control. Stay with the client to attempt to calm her. Sounds like a pretty good idea. And then request her to take slow, deep breaths to help relieve this anxiety. So here we would have one, two, four and five. And then the case study continues. So we're still with this lady with MSPW. She has a chest X-ray performance diagnosed with community acquired bacterial pneumonia. The emergency department is extremely busy. So MSPW is immediately transferred to the medical unit. MSPW is admitted to the medical unit. So you're the nurse now, which intervention is required to be performed within the first 24 hours, according to CMS and TJC pneumonia core measures. And again, select all that apply. You're going to see those select all that apply quite a bit. So refer to substance abuse counseling. While she didn't really have any substance abuse besides the smoking, that's not a priority in the first 24 hours. A minister of broad spectrum antibiotic in the first 24 hours, that is a core measure, provides for smoking sensation, cessation counseling is also important, but not in the first 24 hours, perform influenza vaccination. Again, important, but not in those first 24 hours and obtain blood cultures. Yes. So we definitely should get the blood cultures before we give the broad spectrum antibiotics. But remember, it says in the first 24 hours, it doesn't say which one do you do first of all these options, because that would be obtaining the blood cultures. But here we have in the first 24 hours, select all that apply. So make sure you read your questions very carefully. So these questions in general, they're not any different from what you've seen in the past. It's just that now you have a case scenario that kind of continues and follows the patients maybe through a multitude of different units and case scenarios. But I highly recommend this book because not only is it very good and it gives you the case scenarios, but it also has a rationale for correct and incorrect answers so that you can actually learn from your mistakes as you're going through them. Remember, with Code Petra 20, you get 20% off any FADVIS products. So I'll make sure to put this in the link below so that you can get that discount and get prepared for that NCLEX exam. Good luck.