Attn: RNs! Question and Suggestion Re:NCLEX.

  1. First of all, let me suggest the following. Do NOT NOT NOT use the book "Exam Cram" I spent most of my time correcting errors in the book and on the CD. They have made a lot of mistakes in wording on the CD. I found 17 errors in all! I am studying! I don't have time to correct mistakes! This will confuse and frustrate you. Also, how many things in that book were wrong that I DIDN"T realize??? :uhoh21: I wrote the company, with each one of the details of the mistakes along with the question numbers on the CD and the book. They are issuing me a full refund.

    Great. That thrills me to no end. Lovely to know I spent two weeks in a book that needed a student nurse to correct it!

    That was my suggestion.

    Now, my question. I have been using Saunders for the past four weeks. It's an awesome book and a great CD. No errors as of yet. However, I have come across a question that is disturbing me.

    The question is...

    A nurse is caring for a client after a hypophysectomy. The nurse notices clear nasal drainage from the clients nostril. The INITIAL nursing action should be:

    A) Continue to observe for drainage.
    B) Test the drainage for glucose.
    c) Lower the head of the bed.
    D) Obtain a culture of the drainage.

    Now, according to the unreliable ExamCram...the right thing to do would be to test the drainage for glucose. So, recalling that...while using Saunders, I chose answer B. However, Saunders said that was wrong! It says the correct answer is A, continue to monitor drainage.

    I clicked for the rationale and I read the following...

    "After hypophysectomy, the client should be monitored for rhinorrhea which could indicate the presence of cerebrospinal fluid leak. (Okay, I got that.) If this occurs, drainage should be collected and tested for presence of CSF. (alright, got that too!) Head of the bed should not be lowered (duh!) to increase cranial pressure. Clear nasal drainage does not need to be cultured. (Okay, so this knocks out answers C & D, Then it says...) Continuing to monitor for drainage can lead to serious complications!

    Now, am I nuts? Or does that make the answer "B" and not "A"

    Who is wrong? Me, the answer to the question or the rationale?

    This is really confusing.

    HELP????
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  2. 9 Comments

  3. by   Cherybaby
    Let me mention...I am taking my exam in ONE week and I am ready to faint. My brain feels like oatmeal! Is this normal? I am out of school for EIGHT years. Reading everything is making it all come back to me...but WOW, it is really overwhelming!

    Okay, I'll shut up now. Back to the books.

    HIGHLY recommend Saunders!!! The CD is fantastic.
  4. by   Leilah75_RN
    it was a tricky question. as a neuro nurse, what we monitor after the hyphysectomy is the presence of salty after taste at the back of the throat or a rhinorrhea. once it is present, we test it for glucose. +glucose = CSF, then continue to observe the drainage after notifying the doctor. if the drainage continues to worsen, what the doctors ormally does is to put a lumbar drain, check pressure. keep patient flat on bed with little bathroom priveledges. monitoring lumbar drainage every 2 hours. once the rhinorhea or csf leak subsides, Lumbar drain clamped for 24 hrs if no more leak drain out, no need for culture unless temp raise above 38 degrees cent. in 2 occassions. well, basicaly thats what we do (england based NHS hospital)

    PS: after hypophysectomy, client normally has nasal packs to be removed after 24-48 hrs post surgery.
  5. by   Cherybaby
    Leilah. Thank you for your response! I totally get what you're saying. It coincides with what the answer SHOULD be, which, I thought would be test drainage for glucose. However the test ANSWER is "continue to monitor drainage". When I checked the rationale as to why...it said "to continue to monitor drainage can lead to serious complications." So, I guess what I am asking...is this...is the CD question correct? Or is the rationale that it gives you correct?

    Even from what you are saying it seems to me that when you see clear drainage, you check the drainage for glucose...determining whether it is CSF or not. The book says "continue to monitor" as the answer. When you click the rationale it says what I wrote above about serious complications.

    Oy, so confused!!!:spin: My head is spinning!
  6. by   onduty23
    saunders has quite a bit of error with rational and answers. it happens quite frequently so pay attention. the correct is test for glucose. theirs is time i mark the right answer but the program so i am wrong but rationale say i am right
  7. by   Cherybaby
    Thank you so much. That is what I needed to know. You take in so much information while studying that you don't know WHAT to believe any more!

    I appreciate you taking the time to confirm my thoughts.

    Thanks again!
    Cher.
  8. by   Leilah75_RN
    checking for glucose will not harm the patient, results will only take a minute to see whether it is csf or just a simple rhinorrhea, monitoring for the leak may take minutes or even hours to full day. at lease u already have done something that might alert the physician if any. :spin: :spin: so i guess our answer is right heheheheh....
  9. by   reem23
    Quote from Cherybaby
    First of all, let me suggest the following. Do NOT NOT NOT use the book "Exam Cram" I spent most of my time correcting errors in the book and on the CD. They have made a lot of mistakes in wording on the CD. I found 17 errors in all! I am studying! I don't have time to correct mistakes! This will confuse and frustrate you. Also, how many things in that book were wrong that I DIDN"T realize??? :uhoh21: I wrote the company, with each one of the details of the mistakes along with the question numbers on the CD and the book. They are issuing me a full refund.

    Great. That thrills me to no end. Lovely to know I spent two weeks in a book that needed a student nurse to correct it!

    That was my suggestion.

    Now, my question. I have been using Saunders for the past four weeks. It's an awesome book and a great CD. No errors as of yet. However, I have come across a question that is disturbing me.

    The question is...

    A nurse is caring for a client after a hypophysectomy. The nurse notices clear nasal drainage from the clients nostril. The INITIAL nursing action should be:

    A) Continue to observe for drainage.
    B) Test the drainage for glucose.
    c) Lower the head of the bed.
    D) Obtain a culture of the drainage.

    Now, according to the unreliable ExamCram...the right thing to do would be to test the drainage for glucose. So, recalling that...while using Saunders, I chose answer B. However, Saunders said that was wrong! It says the correct answer is A, continue to monitor drainage.

    I clicked for the rationale and I read the following...

    "After hypophysectomy, the client should be monitored for rhinorrhea which could indicate the presence of cerebrospinal fluid leak. (Okay, I got that.) If this occurs, drainage should be collected and tested for presence of CSF. (alright, got that too!) Head of the bed should not be lowered (duh!) to increase cranial pressure. Clear nasal drainage does not need to be cultured. (Okay, so this knocks out answers C & D, Then it says...) Continuing to monitor for drainage can lead to serious complications!

    Now, am I nuts? Or does that make the answer "B" and not "A"

    Who is wrong? Me, the answer to the question or the rationale?

    This is really confusing.

    HELP????

    For me the correct answer is letter 'B'...Just analyse the question what is being asked,because the nurse must monitor the s/s after surgery.
  10. by   Supernerd24
    Answer is def B. I knew it before I even saw it! We have talked about that in class and I also had that as a question for the hurst review!
  11. by   iToniai
    I am using Saunders and I must say it is not without errors, I remember that question and I choose "B" and it was right. But I've had a handful of questions that I had right and it said I was wrong but the rationale made my answer right...I always make sure to read and pay close attention to the rationales and the test-taking strategies.

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