people think when they go to nursing school that they are there to only learn nursing and that is wrong. in med/surg you are exposed to patients undergoing the major surgical experience and those having major medical conditions. in most cases the patients end up hospitalized. in the old days, and i mean "the old days", part of nurses training involved actually going to the or and being scrub nurses, setting up instrument trays and the sterile fields and assisting the docs with the actual surgery. that doesn't happen anymore as these jobs have been replaced by central service technicians, or techs and scrub nurses who are specially trained. but there is a special section in your nursing textbook
about the patient undergoing the surgical experience. there is special generalized pre-op, peri-operative and postoperative things that need to be done for them. in addition, depending on the specific surgical procedure being done, there will be specific things that will have to be looked after in each patient as well.
with medical diseases that you cover you will need to know the underlying pathophysiology that is the cause of the disease and it's sign and symptoms, how the doctor tests for and diagnoses the disease, what treatments (medications and therapies) the doctor orders for the disease and finally how this impacts the nursing care as well as what nursing care is going to be involved. if you do not learn all of that as well as what medical and nursing treatments (interventions) have priority then, yes, your grades will be less than stellar.
some time ago i put together a critical thinking flow sheet
for nursing students to help people with this. it is attached to the end of every one of my posts. all you need to do is click on it (it's a link) to open the file, which you can then copy, and download to use.
for tests you also need to have an understanding of the nursing process. the nursing process is a 5-step problem solving method that nursing has adapted for its practice. it can be used to help work through all kinds of problems that come up whether in the clinical area (as will happen when you are a working rn), on a test when you are trying to answer a question, or when determining a patient's problems when writing a care plan. memorize and learn the steps and how to make them work for you because it is the best weapon you have to passing nursing tests and the nuclex. this nursing process is not foreign to you. you've been solving problems in this way as you've become an adult--you just never called it "the nursing process". it is an extrapolation of the scientific process. think about it. what steps did you go through the last time you had a flat tire, the electricity suddenly went out and you needed light, you lost something or a plan you had went wrong and you had to adapt and change gears? when you start thinking about what goes into how you determine problems and making decisions about them, you are beginning to learn how to think critically.
- assess the situation (collect known data from every possible source)
- determine the problem (make a list of the abnormal assessment data)
- planning (write measurable goals/outcomes and interventions)
- implementation (put the plan into action)
- evaluation (determine if goals/outcomes have been met; if not, go back to #1 and begin again)
some helpful threads on allnurses that you should check out: