[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!

[Daytonite]

A. Elevate the patients arm with pillows and apply an Icepack.

Reasoning: An extremity with a newly applied cast should ALWAYS be elevated in the first place to promote circulation and decrease swelling. Secondly, the implication in Answer C is that the patient might be developing compartment syndrome. Well, you don't have enough information to conclude that. Compartment syndrome does involve increased pain, but it also includes swelling (usually massive), loss of sensation, possibly cyanosis and diminished or absent pulses. Since there is no assessment data to indicate any of that, I wouldn't assume it. The patient is going to develop some swelling of the tissues surrounding the fracture anyway due to the trauma of the injury, so this is a reason for keeping the extremity elevated. What I would be thinking is that perhaps his pain medication was not a strong enough dose. I might call the physician for more pain medication orders, but that is not one of your answer choices. Answers B and D would be OK, but Answer A would take priority over either of them.

[julsywulsy]

Thank you so much for answering this!!! I too chose this answer and got it WRONG!??
Our instructors told us that the correct answer is to call for the cast-cutter.
I am assuming that they were suggesting Compartment Syndrome but I felt there was not enough evidence in the question to suggest this.
When we disputed the answer, the lecturers almost took it personally and refused to change the answer.
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!!!

[cardiacRN2006]

My first instinct was choice C also. Chances are, they just want to know that you are considering compartment syndrome. I've found lots of nursing questions like this. They want to know that you are thinking ahead of all possible consequences.
I would have already assumed that the are was elevated. The fact that the pt is still in 'worsening' pain after your med administration leads me to think compartment syndrome.

[julsywulsy]

I see that they wanted us to answer thinking that it was CS.
However, in other questions I answered in the way that I was "thinking ahead" and they said we were "jumping the gun"... ??????
Is this just because I am new to the whole "critical thinking" realm of nursing?

[msleely]

My first choice was C. only because I was thinking of compartment syndrome. I did not pick A. because it makes no sense to put an icepack on a cast. Also, if pain medication was given and your patient is c/o pain worsening that indicates that something is wrong. Another way to think about it- would evelation of the arm really help if the pain meds didn't help....probably not. I know it would have made more sense if there was other assessment data. I will tell you I am at the end of my Senior I semester and I have realized that they like questions(like this) where none of the answers make enough sense given the information. You will encounter these type of questions a lot. I know they say calling the doctor is usually the last choice, but try to picture what is going on with your patient. I understand where you are coming from because I feel the same way after taking a test where none of the options are what I would have done. If some questions confuse you or don't make sense just try to rule out the things that wouldn't help the situation...sometimes this is easier if you know exactly why it won't help or what will end up happening with the patient. I hope this help, I have also read nursing books with tips for answering nursing style questions. It is better to be prepared for these type of questions, because most instructors already have a reason for why the question is valid.

[Achoo!]

I don't think you ahve enough info to go with C. You would evaluate CMTS, but it didn't give you that info. I agree with your answer.

[cardiacRN2006]

Originally Posted by julsywulsy

I see that they wanted us to answer thinking that it was CS.
However, in other questions I answered in the way that I was "thinking ahead" and they said we were "jumping the gun"... ??????
Is this just because I am new to the whole "critical thinking" realm of nursing?

Well, answer C didn't say cut the cast off, it just said call the dr and have the necessary supplies ready if the situation does in fact turn out to be compartment syndrome. So you aren't jumping the gun, so to speak. If it was just "pt was having pain", then I would have picked answer A (we do put ice packs on casts).. But it specifically said "worsening pain 30 minutes after med adminstration"-->which to me means "Hey there student, what are the potential complications of cast applications?".

I always think of questions like little riddles. What is the instructor trying to get from me, what do they want me to know? In this case, she wants you to be thinking ahead of what to do when you've medicated, reassessed and found the pt to be in worsening pain.

[cardiacRN2006]

Originally Posted by Achoo!

I don't think you ahve enough info to go with C. .

'Worsening pain 30 minutes after pain medication' was all I needed to hear to immediately think of answer C.

It didn't say the same pain level after pain admin. Then I might think that the prescribed meds just didn't do the trick. It said worsening pain, and so something is evolving underneath that cast.

[Rosa2Little]

I would have answered "A". There was simply not enough information provided in the question to choose "C" -- particularly if the question was "what should be the nurse's first action", as the NCLEX questions tend to do.

It was a poorly written question. It required you to make an assumption about the situation and jump to a conclusion. You'll come across professors who will throw the question out, and others who will never admit they just might be wrong. Best you can do is shrug it off.