Test question help

  1. Hello everyone!

    I'm a first semester nursing student. We had a test question worded similar to this the other day. I'm curious to know what you all would have chosen.

    A terminal cancer patient asks says to you that God is punishing her because she is in so much pain. The priority nursing diagnosis would be

    A. Pain related to ineffective analgesia

    B. Spiritual distress related to belief that God is punishing her with pain.



    I chose A, and got it wrong. The choice of ineffective analgesia led me to believe that she was on the wrong med, needed a stronger dose, needed to have it more frequently, etc.

    I thought if I could do something to relieve the pain, she wouldn't feel she was being punished because there was no pain. On the other hand if she said God is punishing me with Cancer, then B would have seemed the correct answer.

    It also asks priority, to me getting her out of pain would take priority over having a clergyman come to speak with her. Not that her spirituality isn't important, but the pain needs to be relieved FIRST.

    Also pain is the fifth vital.
    Those were my thoughts, any other?
    Thanks
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  2. 25 Comments

  3. by   llg
    I would have chosen B -- and the more I think about it, the more I think that B is the better answer.

    You don't know that her pain med is ineffective. The question does not indicate that she is currently in great pain. If you look only at the question itself (and not read anything into it), she could be sitting there (in no pain at the moment) talking very calmly about how she hates that she needs so much pain meds to stay comfortable. The pain meds might working just fine, she just doesn't like taking them.

    Also, note that the question does not give you any indiction (e.g.symptoms or statements) that she is currently in pain or that she is on any meds at all, for that matter. To assume that she IS on pain meds, has taken them recently, and that they are ineffective is adding a lot of assumptions to the questions that aren't really written into the question.

    The patient IS expressing her spiritual distress directly. In fact, it is the actual "topic" of the sentence. So, on a test ... that's the right answer.

    I hope my analysis of the question helps,
    llg
    Last edit by llg on May 7, '03
  4. by   gwenith
    I would take THIS question to the head of department. In a round about way it is discriminatory. Not everyone is religious and do not put the priorities on spirituality that this answer requires. The actual answer is to see to both. You ring the MO for better meds and the chaplain for spiritual comfort.

    I cannot see where you lecturer was going with this. Was she using this question in a test to teach you to place a higher priority on spiritual matters? If she has done so, what she is doing is educationally unsound - to the nth degree. A test is for measuring the level of learning it is not to teach new information.

    This is a poor question on many levels.

    If you take to the head of department don't go in with guns firing - just go in asking if she could clarify something for you. Act puzzled - state that you don't feel comfortable with the expected answer - but you accept why you got it wrong and don't want the mark changed. Outline your rationale for your answer as you have written it. You won't get a reversal of your mark and you most probably will not get any form of back down on this BUT I will bet that that question never sees light of day again!!!!!
    Last edit by gwenith on May 7, '03
  5. by   llg
    It's not really a question about pain or religion. It's really a question about logic, evidence, and critical thinking.

    It indicates to the teacher whether or not the student jumps to the conclusion that the patient must need another med -- even though the question gave no indication that the patient was even on medications, let alone that the meds are ineffective. The "desired" response to the situation is for the student NOT to jump to that conclusion without any evidence of ineffective medications.

    Also, when the patient so blatently states that she is in a spiritual crisis, it should not be ignored regardless of the nurse's personal religious beliefs -- NOT that you were suggesting otherwise, gwenith. You stated that both problems should be addressed.

    I agree with gwenith that both problems should be addressed. However, the only problem for which there is evidence to support a definite diagnosis is the spiritual one. The pain one may not exist -- and the nurse would have to do more investigation before she would have the necessary evidence to make an ineffective pain med diagnosis.

    llg
  6. by   warzone
    llg-

    Assuming that was the exact wording of the question, except for "asks", then I believe your logic is wrong.

    When the patient says, "God is punishing her because she is in so much pain", it means that she is 'in' pain. "In" is a present state of being. I don't think you would be jumping to conclusions if I said, "I am in my house", and you literally believed I was currently inside my house.

    You also cannot jump to the conclusion that she does not feel that she deserves or has warranted the punishment. People of different religous faiths often feel they are meant to go through hardships, struggle and endure to the end. Maybe, there is no spiritual crisis, just venting.

    Overall though, I think it's a bad question and poorly worded. Sounds more like Psychology question to me.
  7. by   CountrifiedRN
    Good points from both sides, but I would have chosen B because she does not state what type of pain. Maybe it is emotional pain, not physical pain.

    Oh, I'm SO glad I'm done with these types of test questions! (Until the NCLEX, anyway!)
  8. by   Tim-GNP
    Everyone has given really good answers to your question on both sides.

    Personally, I think the question is poorly worded. Your response seems to follow the same logic that I teach my students---- in the framework of Maslows Hierarchy of needs. Obviously, the physical needs must be met before we can ascend to higher level needs [like spiritual distress].

    The question [again, assuming it is worded the way you wrote it], indicates that the patient is presently experiencing pain. That should be treated first.

    The truth be know, however, both answers are correct... like many questions in nursing exams. The trick is to find the BEST of the correct answers. In this scenario, the patient has two concurrent needs--- physical pain, and spiritual distress. BOTH must be addressed... however, the lowest level need should take precedence.
  9. by   Good_Queen_Bess
    I also think it's a rather ambigious question. My first thought would be that surely a nurse would just ask further questions ABOUT the patients pain before acting upon either a or b. Just because she asks about God punishing her doesn't mean she's religious. I say "Oh God" often enough, but I'm atheist. Also, it depends on what analgesia she has had recently! Spirituality is important to recognise, but the question isn't that black and white, neither is the answer. Stupid question really IMO.
  10. by   USA987
    As a former Psych nurse I would have chosen B....
  11. by   yannadey
    Nptobee by any chance are you enrolled at BCC in the Bronx? the ? brings back memories. of a ? worded similiar that we argued over with the DON of our program had it thrown out because 99% of the class choose A.
    I would have choosen A. thinking priority is Pain. not her spirituality.
    When I'm in pain & ask God why I know I'm not in spiritual distress I'm just having unbearable pain & need stronger meds.
    Last edit by yannadey on May 7, '03
  12. by   nptobee
    Thanks for all of your respones, they've helped me to think about it in a different way.

    Yannadey, I attend PGCC in Largo, MD.
  13. by   yannadey
    Prince George comm coll. have a friend currently enrolled in the RN program.
  14. by   jenac
    I would have picked B also. Interesting responses. I agree that Maslow's Heirarcy would have come into play here. But, that is based on the patient having immediate pain, which is really not specified here.

    I agree, the wording is off and misleading. Spirituality is individually important- but pain is much more prevalent in the immediate implementation of interventions. The patient in question might be in so much pain-she cannot focus on her spiritual health here. Her immediate physical needs would than outway her spiritual ones, althougth it does need dealt with.

    If this were a true life scenerio-I would assess the pain level first, and deal with it as immediately appropriate. Than the spirituality.

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