[WeeBabyRN]

Originally Posted by julsywulsy

Our instructors told us that the correct answer is to call for the cast-cutter.
This is just one example of what I feel are badly written test questions. Does anyone have any suggestions on how to handle this? I think out of each exam we face around 15 questions that are written so poorly that it is almost impossible to figure out what exactly they want you to be "critically thinking" of.
I usually dont make a big deal out of things like this but it is getting to the point that my grades are dropping and its not because I am not studying.
Any suggestions or reassurance is greatly appreciated!!!

It sounds like your first reaction was to choose answer C, the cast cutter, but you talked yourself out of it by saying there wasn't enough info. Don't overthink the questions. I used to do that and get so mad at myself when I got those questions wrong. Nursing school tests are tricky and you will learn how to take them.

[truern]

I also chose C because of the worsening pain after medication.

The posters that said NOT to rely on personal experience in answering questions are dead on. That was ONE experience out of, what, thousands? millions? The answer should be what fits the norm, not what happened in your individual case. There was a student in my class who was forever basing her answers on her husband's extensive medical experiences....well, he was ONE patient, not the majority.

[DanaR85]

I also went directly to C bc of the pain becoming worse 30 min after pain meds given. Like a lot of the other replies have said, they are trying to get you to critically think. They want you to recognize the s/s of compartment syndrome, but they do not want to ask you in a direct way. Honestly, I think it just takes time and practice(LOTS of practice)to get used to questions like this. I always read the question twice before looking at any of the answer choices. That way, I fully make sure that I understood the question and what exactly it is they are asking. Then, I think in my head what I would do, or what I think the correct answer is. Then after that, I look at my answer choices. More often then not, what I was thinking is one of the choices. Or, I will see one of the other answers and suddenly it will click that that one is the right answer. I know it sounds like a time consuming process, but I swear its not.

There is a fine line between thinking critically and 'jumping the gun" and I think that may be part of what they are trying to teach you. Always remember the nursing process and/or Maslows and you will know if you are jumping the gun or not. In this case you were not bc you know that they patient had worsening pain 30 min after getting pain meds. That being a major s/s of compartment syndrome,you DO have assessments and reason to call the MD. If one of the choices is notify the MD, always make sure that in the question it states that you have assessed a problem and already done any interventions that are w/in scope for nurses. I had a teacher who made that make sense to me when she said "You aren't calling the MD to chat. When you call, you need to have already done your part."

Hang in there. It does get easier to think in the way that they want you too. Do as many NCLEX practice questions as you can and trust your gut. Most of the time, your gut is right on track. Good luck!

[muffie]

c,first choice

[ancella marie]

As I read your question, I immediately eliminated both B and D. I'm left with just A and C. But because of the background information that the patient is experiencing increased pain I dropped A because it clearly makes me think that a complication is arising. People after cast does not experience increasing pain. It may feel hot but not increasing pain. I agree that test strategies would tell you to be cautious of options that would opt to call the doctor but presence of complications as manifested by increasing pain would need the immediate attention of the doctor.
I have encountered a similar question in different NCLEX question, not in exact words but the same thought - and yes, the answer is to call the doctor. I hope this helps....

[Daytonite]

Originally Posted by lankenau07

. . .the problem that I run into is my instructors seem to contradict themselves, first they tell us not to read into a question and other times they tell us to critically think. I can always get down to at least two answers that could be right but my problem is prioritizing...HELP...

Hi, lankenau07!

Believe me with these kinds of application problems, everyone has the same difficulty. Even I didn't choose the answer the instructor said was the correct one. My reasoning, however, was right. I just wasn't paying very close attention to the wording and meaning of the answer choices. The doctor should have been called about the increasing pain, but getting the cast cutters threw me off base and was really a red herring thrown into the problem just for the fun of it, I think. It is very rare for anyone to get 100% on these kinds of exams. There are a couple of things you need to consider when prioritizing. Often, you need to determine the pathophysiology of what is going on with the patient's disease process. You have to know what the patient is going to experience and always be thinking ahead as to what MIGHT happen. You need to know what the normal treatment modalities are that are likely to be ordered by the physician. You need to know what complications can occur and all the signs and symptoms of them. With regard to nursing actions you need to remember the chronological steps of the nursing process: (1) Assessment, (2) identification of the nursing problems, goals and outcomes, (3) Planning the care (nursing interventions), (4) Implementation, and (5) Evaluation. When it comes down to choosing between problems and those to take action on first, as in this particular question, then you start looking to systems of prioritizing such as Maslow's Hierarchy of Needs, Gordon's 11 Functional Patterns, Roy's Adaptation Model of Nursing, or even Roper, Logan & Tierney Activities of Living. The theorists of these systems direct practitioners to place their actions in a listed sequence of importance. I've noticed that most like to use Maslow as it's pretty clear-cut and defined. It takes into account the ABCs (Airway-Breathing-Circulation) of CPR.

SOLVING THE PROBLEM USING THE NURSING PROCESS. With this particular problem you have a medical condition of a broken bone in an extremity that has been casted. Your process of critical thinking with this should involve knowing what is going on physiologically in the body with a broken bone. You also need to know about casts and how they should be cared for. Why does a broken bone cause a person to be in pain? What happens on a cellular level whenever there is an injury to the body like this? Why would swelling and pain be expected? What would be the reason for inordinate amounts of swelling and pain? That gets you to the complications of broken bones and the presence of a cast—compartment syndrome. All of that is part of your assessment and data collection activity as part of the nursing process for this patient. The nursing diagnosis, or problem, is pain, and it is increasing rather than improving. Nursing interventions. . .it actually is a normal nursing action to elevate and put ice on a newly casted extremity to promote circulation and halt further swelling. RICE'ing is an established treatment for physical injury to muscles and bones. But, you also need to look at evaluation of the plan of care. Giving the patient some pain medication was an initial nursing intervention and relief of the pain would have been a goal of this action. But, did it work as hoped? Nursing process tells you in Step #5 to evaluate your plan of action. Uh-oh, the goal, which would have been relief of pain, wasn't achieved. So, you ask yourself, what is my next step? You go back through the steps of the nursing process again. This time around, your nursing interventions and planned goal/outcome is going to be different.

Just to be clear, there are four types of independent nursing actions, or interventions, that nurses can take. They are: (1) to evaluate the patient's condition, (2) to perform actual patient care, (3) to educate the patient or caregiver, and (4) to manage the care on behalf of the patient or caregiver. In this question, the nurse would have to evaluate the patient's condition and, finally, manage the patient's care by contacting the physician. The question doesn't provide an answer choice that fits with assessment of the patient's condition, but it does give a choice that includes managing his condition. So, upon evaluation of the plan of care a new nursing intervention is added: notifying the physician.

And, that is how the critical thinking and prioritizing process works. A lot of factors go into arriving at a final decision. Ultimately, it is the nursing process that leads you to the final answers. So, know the nursing process and what each of the steps is. Do you see how you kind of form a little care plan in your mind to get to the right answer?

Welcome to allnurses!

[julsywulsy]

Great reply! Good info..thanks for all your replies! I do appreciate it!

[SoulShine75]

Originally Posted by julsywulsy

Your patient just returned from having a cast set on their left arm. Your patient complains of worsening pain 30 mins after rec'g pain medication. What do you do?

A. Elevate the patients arm with pillows and apply an Icepack.
B. Offer them a cup of hot tea.
C. Call the Doctor and send for the cast-cutter.
D. Divert their attention from the pain with conversation.

How would you answer this question, based only on the information given? Please explain your rationale.

Thanks!

C ........sounds like compartment syndrome to me because the pain medication isn't having an effect. Get that cast off now!!

[GracieLVN]

This is a classic question relating to compartment syndrome. My answer would be C. Anytime there is a newly placed cast with pain that is unrelieved by medications, it is most likely compartment syndrome. Elevating the arm and adding an ice pack would futher impede blood flow.

[sephinroth]

I would say that the answers are none of the above. If a patient tells you something is wrong, the first thing you need to do is to assess again, am i right?

After further assessment, you can determine if the patient has compartment syndrome(i dont even know what that is until i read it here) and then call a doctor with a cast cutter.