Getting horrible scores on nscbn tests

dont worry! i just passed the nclex and so did all my classmates. we all used ati and ncsbn. we all got the same score ranges as you on the ncsbn and we all passed the nclex. those are actually good :) best of luck to you! you'll do great

I just took my RN boards in 2010. I did well on the ATI tests because...

...don't flame me....

I picked the dumbest, stupidest answer available. Not the wrong one, just the dumb one.

For example: NOT A REAL QUESTION, nobody get their pants in a bunch

You have a 68 yo male patient who had a open chole this AM and is now back on your med surg floor, 2 hrs postop. Pre surgery labs included Hbg 17, BUN and creatinine slightly elevated, BNP 700. You go in to assess your patient and find they have only put out 10cc of urine in 2 hours, their skin feels clammy, and the patient is reporting they don't feel well and that their side hurts. Temp is 96.8, BP is 98/68, HR is 111, and pulse ox is 91%. Pt's history is: CVA last year with L sided weakness, COPD, CHF, DMII, CABG with stent placement, chronic renal failure. Your first thought is:

a) Increase patient's oxygen to get O2 above 94%

b) Obtain orders for 250 cc NS bolus to attempt to increase BP

c) Give patient PRN pain medicine

d) Obtain a stat BUN/creat and a H/H

Work thru it. A? Wrong. You increase the O2 to a COPDer, you're going to kill the respiratory drive. But isn't that what we're told, Airway, breathing circulation? Not this time. 91% is a banner number for a COPDer. Crank up the O2, you'll be cranking up the big old Code Blue button shortly.

B? Not only no, but NO NO. You see all that cardiac history? That BNP? Plus COPD? Can you say "fluid overload?" His MAP (mean arterial pressure) is not only above 60 (that's the point where you've got a good blood supply to brain/kidneys/eyes/etc.,), it's above 70. Forget the BP, even though we have "Keep SBP > 100" burned into our brains, it's fine.

C? In the real world, NO. In the ATI world, yes. If you're looking shocky, I want you able to tell me what hurts and how you feel; I want to know if you have a sudden change in mental status. Pain won't kill you, bleeding to death will. Technically, the BP can tolerate a small dose of pain med, so it's technically correct.

D? In the ATI world, NO. In the real world, forget the BUN/creatinine, unless he went hypotensive during the surgery and stayed there, it's a red herring. You'd better get that H/H quick. Chances are, your patient has been on long term steroids due to his COPD, and that makes tissues exceptionally prone to tearing. You're 2 hours post op and I even think you might be bleeding, I'm calling for a stat H/H.

These kinds of questions are why so many people who do good in school, pass the boards, get to the real world and feel like morons when they hit the floor -- you're being taught book stuff that doesn't match the real world. Not your fault, not the teacher's fault. We need something better, it's just that nobody's come up with it yet.