Nursing 101 Question - How would you answer this?

moongirl · Nov 4, 2006

we were taught that if you suspect compartment syndrome you absolutely do not elevate it.....

plus you had already given them meds and the pain got worse instead of better, so i would have chose "C"

MuddaMia · Nov 4, 2006

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!

Jumped right to "C"...pain worse after 30 min is a sign of compartment syndrome

MuddaMia · Nov 4, 2006

Thanks for your replies!!! Regardless of whether it was right or wrong, I am glad that you agreed the question was poorly written and that someone agreed with my answer.
I based my answer from a personal experience myself. I had a tib/fib break in my ankle and had plate & pins put in a few years ago. When I came out of surgery with my new hardware and cast, I was in excruciating pain that continually worsened (worse than childbirth) Anyway they gave me an icepack and put a pillow under my leg...

I did not think the question was worded poorly..I think they wanted you to critically think your way to "C"

Also--numero uno rule of nursing school is not to rely on personal experience when answering a test question

SanskeetRN · Nov 4, 2006

We had a VERY similar question and the answer was C. I agree with the others who stated that worsening pain after giving pain meds (and 30 min. should be sufficient to see start seeubg a decrease in pain) is a red flag for compartment syndrome. So therefore the Dr. should be notified immediately and have the tools available to remove the cast if necessary.

cardiacRN2006, ADN, RN · Nov 4, 2006

I did not think the question was worded poorly..I think they wanted you to critically think your way to "C"

Thank you! I didn't think this question was worded poorly at all.

raebabelvn, LVN · Nov 4, 2006

I would've immediately said A as well. But I only would've said that because when I broke my wrist and had a full arm cast, it hurt so much. I was told to keep it elevated with an ice pack. But critically thinking, if the pain is worsening after 30 minutes, then further action would be needed.

I hate questions like these! We get them all the time!

lankenau07 · Nov 4, 2006

Well first let me say hello to everyone. I am new to this site and already I am finding it really helpful.

In reading the question I also picked "C" I was assumming that it was compartment syndrome but 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...

Imafloat, BSN, RN · Nov 4, 2006

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!

I choose C, becaue of the worsening pain despite medication.

Imafloat, BSN, RN · Nov 4, 2006

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 · Nov 4, 2006

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 · Nov 4, 2006

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, RN · Nov 4, 2006

c,first choice