test question!

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So the question asked, what is the FIRST thing the nurse should do if the dressing on a patient who is one day post op abdominal surgery, is saturated in bright red blood. Answers were between a) alert the physician. B) assess the wound. C) take vitals.

Opions??? My first thought was risk of evisceration...

Please excuse grammar in this post; i'm typing from my phone.:-)

Thanks!!!!

Alert the Physician before taking vitals or finding out anything other than the patient is bleeding?

I can see it because how is taking vitals gonna fix the problem? While you got get your stuff to get the vitals, sit there getting the vitals, etc..patient is bleeding and/or dying. It depends on how it's worded

I can see it because how is taking vitals gonna fix the problem? While you got get your stuff to get the vitals, sit there getting the vitals, etc..patient is bleeding and/or dying. It depends on how it's worded

Vitals will tell you what the problem is (in this case how critical the problem is). Getting a pulse and BP takes just a few moments. If they need assistance before the few moments that a BP and pulse will take, then it's a RRT or a code, not a phone call to the Doc.

Assessment before intervention.

Just telling the Doc that the patient is bleeding doesn't give them an idea of how critical the problem is.

Specializes in Emergency Dept. Trauma. Pediatrics.
I can see it because how is taking vitals gonna fix the problem? While you got get your stuff to get the vitals, sit there getting the vitals, etc..patient is bleeding and/or dying. It depends on how it's worded

That is exactly what the paper we were given stated.

They said the NCLEX wants to know that if you could only pick one thing you would pick the right thing. In this case, if you could only pick one, you would call the Doc. Even though we know in real life the doc would want the vitals and you might do the other things.

Our teacher stressed this again today, since we are nearing graduation. She said with questions like this, (when you are taking NCLEX) pretend that you could only pick one and what would be that one most important thing be over the others.

They said if you're in school, you chose vitals. Because they always stress the vitals. In NCLEX world, you alert the physician, and in real life you do all 3 simultaneously.

Great, like i need to be more confused. hahah

Specializes in Emergency Dept. Trauma. Pediatrics.
Great, like i need to be more confused. hahah

That is how I felt when I read this paper my teacher gave me. LOL But in a way it makes sense, so when I go to take boards I will keep that in mind.

I'm thinking about this but I remember at the beginning of nursing school our teacher telling us that the course exams and the NCLEX are asking us about NURSING functions and that calling the physician isn't exactly a nursing function. So, now I'm more confused!

I'm thinking about this but I remember at the beginning of nursing school our teacher telling us that the course exams and the NCLEX are asking us about NURSING functions and that calling the physician isn't exactly a nursing function. So, now I'm more confused!

Don't over-think, stick to the basics.

The first step in the nursing process is assessment. The only assessment choice given that we can do (since we can't remove a primary bandage one day post-op without an order) is to collect vitals.

It just so happens, if this were to happen in real life you'd still need to be able to give the Doc some vitals when calling them... because otherwise they can't assess the severity of the problem (ie just saying that the patient bled through their bandage doesn't give enough information and trust me, they'll ask you for vitals) and unless you were able to get some help from someone else....you can't get vitals and call the Doc at the same time.

As a senior, I've been doing hours of NCLEX questions per week since June...and there are times when the correct answer has been to contact a practitioner (MD, NP, PA) so don't automatically discount it. I've found that trying to out-think the test mechanics just lead you in circles. Stick to nursing basics for your prioritization and you'll be fine.

Specializes in Emergency Dept. Trauma. Pediatrics.
I'm thinking about this but I remember at the beginning of nursing school our teacher telling us that the course exams and the NCLEX are asking us about NURSING functions and that calling the physician isn't exactly a nursing function. So, now I'm more confused!

We just had a question on a test today that Contacting the physician was one of the answers. I got 100% on the test. Their are times that contacting the physician is the thing you need to do as the nurse. Everywhere I have done clinicals you page the doctors and they call back. In real life, I would page the doc, take the vitals while I am waiting for them to call.

I have also done tons of NCLEX practice questions and this has been an answer many times too. ;)

Vitals will tell you what the problem is (in this case how critical the problem is). Getting a pulse and BP takes just a few moments. If they need assistance before the few moments that a BP and pulse will take, then it's a RRT or a code, not a phone call to the Doc.

Assessment before intervention.

Just telling the Doc that the patient is bleeding doesn't give them an idea of how critical the problem is.

It's more than just the basics though. That's why I said it depends on how it's worded. Once you start doing NCLEX review questions and you run into questions like this..someone has a bloody dressing(a few HURST questions were about this exact scenario), vital signs may not be the first thing you do. I've been through the NCLEX review and already taken the thing. Most questions will give you a scenario that's vague like a bloody dressing and give you the answer of "take vitals, call the doc, re-assess, etc." Taking vitals will not fix the problem, it delays treatment(even if it's just a few moments)...never delay treatment in the eyes of the NCLEX people. Even if it takes just a few moments, in the NCLEX people's eyes...you're saying that you want your patient to bleed just a little bit longer so you can tell the doctor your vitals. Like others said, pretend you can only pick ONE thing and go home. You learn in school that the answer is most likely not to call the doctor, in NCLEX review stuff, that answer is correct much more often. The NCLEX people don't care if the doctor gets mad, they only care about YOU and what you do to fix the patient..you can't say on the NCLEX or a nursing school test "what if the doctor gets mad at me"

Specializes in Emergency Dept. Trauma. Pediatrics.
It's more than just the basics though. That's why I said it depends on how it's worded. Once you start doing NCLEX review questions and you run into questions like this..someone has a bloody dressing(a few HURST questions were about this exact scenario), vital signs may not be the first thing you do. I've been through the NCLEX review and already taken the thing. Most questions will give you a scenario that's vague like a bloody dressing and give you the answer of "take vitals, call the doc, re-assess, etc." Taking vitals will not fix the problem, it delays treatment(even if it's just a few moments)...never delay treatment in the eyes of the NCLEX people. Even if it takes just a few moments, in the NCLEX people's eyes...you're saying that you want your patient to bleed just a little bit longer so you can tell the doctor your vitals. Like others said, pretend you can only pick ONE thing and go home. You learn in school that the answer is most likely not to call the doctor, in NCLEX review stuff, that answer is correct much more often. The NCLEX people don't care if the doctor gets mad, they only care about YOU and what you do to fix the patient..you can't say on the NCLEX or a nursing school test "what if the doctor gets mad at me"

and that is EXACTLY how it was explained to us.

Glad to hear from someone who has actually taken the NCLEX.

It's more than just the basics though. That's why I said it depends on how it's worded.

The question posted really is about the basics. We know how it's worded....the OP posted it in the first posting. Maybe you're thinking of a different question?

Once you start doing NCLEX review questions and you run into questions like this..someone has a bloody dressing(a few HURST questions were about this exact scenario), vital signs may not be the first thing you do. I've been through the NCLEX review and already taken the thing. Most questions will give you a scenario that's vague like a bloody dressing and give you the answer of "take vitals, call the doc, re-assess, etc." Taking vitals will not fix the problem, it delays treatment(even if it's just a few moments)...never delay treatment in the eyes of the NCLEX people. Even if it takes just a few moments, in the NCLEX people's eyes...you're saying that you want your patient to bleed just a little bit longer so you can tell the doctor your vitals. Like others said, pretend you can only pick ONE thing and go home.

Well, we could invent a new question, with a different and vague situation....I was answering the one that was posted by the OP (who confirmed that the answer to that question was vitals first).

In the question posted by the OP: Calling the doctor without having the information needed to GIVE the doctor, delays care and does nothing to fix the problem. That's why it's not the right answer and getting the vitals first is.

Now, if there's a different question you're thinking of....post it and we'll give that one a go.

You learn in school that the answer is most likely not to call the doctor, in NCLEX review stuff, that answer is correct much more often.

I didn't learn that in school...I actually mentioned already that sometimes calling the practitioner is the right answer. In this case, while it's a good thing to do, of the choices given it's not the best thing to do first.

The NCLEX people don't care if the doctor gets mad, they only care about YOU and what you do to fix the patient..you can't say on the NCLEX or a nursing school test "what if the doctor gets mad at me"

I don't believe I ever mentioned the Doc getting mad. I did say they would likely ask you for the vitals if you called (because only telling them, "The one day, post-surgical patient is bleeding" isn't terribly informative)...didn't mention anyone getting mad, as that didn't hit my priority list.

The question posted really is about the basics. We know how it's worded....the OP posted it in the first posting. Maybe you're thinking of a different question?

Well, we could invent a new question, with a different and vague situation....I was answering the one that was posted by the OP (who confirmed that the answer to that question was vitals first).

In the question posted by the OP: Calling the doctor without having the information needed to GIVE the doctor, delays care and does nothing to fix the problem. That's why it's not the right answer and getting the vitals first is.

Now, if there's a different question you're thinking of....post it and we'll give that one a go.

I didn't learn that in school...I actually mentioned already that sometimes calling the practitioner is the right answer. In this case, while it's a good thing to do, of the choices given it's not the best thing to do first.

I don't believe I ever mentioned the Doc getting mad. I did say they would likely ask you for the vitals if you called (because only telling them, "The one day, post-surgical patient is bleeding" isn't terribly informative)...didn't mention anyone getting mad, as that didn't hit my priority list.

I never said YOU said anything. The "you" I mention is a generalized you, not you. I also never said that the question the OP posted was a bad question. I agreed with the way it was worded, and the choices given, that the answer is fine. I said I could see DEPENDING ON HOW IT WAS WORDED, that calling the MD would be the first thing. There's more than 1 way to word a question, and have a different answer be correct. but once again, I never said you said anything. And like I said, real world vs. school world will be different. I've had a post-op patient bleed through and soak the bed. Real world would be I wouldn't get the vitals, I'd get an MA to do that, get another nurse to page the doc for me while I re-inforced the dressing and have someone check my chart to see what their vitals have been running.

So suppose you have someone who is actively bleeding from some kind of wound, dripping blood(maybe it has a dressing, maybe it doesn't, it's just a wound). What are you gonna do first? Call the doc, stop the bleeding, assess their wound, or take their vitals?

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