Question

JustBeachyNurse, LPN · Apr 7, 2015

And what does your husband think is the right answer. Happy to help & guide but not do your work for you.

Fancypants09 · Apr 7, 2015

Hello fellow nursing peeps!
My husband is currently in the program and came across this question, and I would like to get your overall feeling about it:
Patient presents to the ED with c/o of NV&D for 10 days, and is now in abd and epigastric pain; What is the nursing priority?
1)Hemmocult Card
2) Serum Electrolytes level
3) Diet Orders
4) Insert Foley
Thank you in advance for your help.

Serum electrolyte levels would be very imp. Electrolyte and fluid imbalance will occur after such a prolonged period of N,V,D. Imbalance leads to CNS and cardiac issues.

nurseprnRN, BSN, RN · Apr 7, 2015

Well, cyndisextonNYRN, if you're really an RN and don't know the answer, and he can't seem to figure it out from his textbooks or come here to ask on his own, then he'd be outta luck except for someone here who graciously consented to do his homework for him. Which we normally do not do, for obvious reasons. We are thrilled to help a student who describes what he's done to help himself but who still has residual confusion or whatever, because that student has given us evidence that he isn't just asking for something he can cut and paste into his homework assignment, thus having enough time left over to watch Game of Thrones tonight.

cyndisextonNYRN · Apr 8, 2015

I'm sorry, but I take offense to your reply Grn Tea. How do we know that you are in fact an RN with all of the acronyms after your name?!?!? This WAS NOT a test question, but was a sample question used in lecture. I wanted to get a feel for what other qualified individuals thought as wel . I am in fact a registered nurse, and would like to remind you that your response is what gives truth to the phrase "nurses eat their young." Since when are students allowed to use smart phones as reference during an exam?? Before making a snap judgment, maybe gather all of the information.

DJSexton, RN · Apr 8, 2015

Honey, it's painfully obvious that some are woefully ignorant, regardless of their education. While we appreciate their extremely leading responses, the question begs of whether they practice hip shooting in their profession, since it all arrives from their mental models anyhow. If there is one thing in life I've learned it's when someone is on the attack, it's quite clear it's a coping mechanism for shortcomings elsewhere. I just hope they are clever enough to post their workplace so we know never to visit THAT town while on vacation, for fear of ever having to be in their care.

BrandonLPN, LPN · Apr 8, 2015

Well, it didn't take long for NETY to show up in this one. Also, Game of Thrones doesn't premiere until next week. Don't tease us like that.

DJSexton, RN · Apr 8, 2015

Hi Just Beachy,

Of course it leads to the electrolytes. But our instructor insisted all 29 of the students were incorrect in lecture by choosing that answer. We all knew it was right. Since we are doing med/surg II, we are covering GI disorders, and the professor said nope, it was the card (BECAUSE we were covering THAT subject). We were all just dumbfounded. Even my wife was like nope, as the question was asked, serum electrolytes was the highest priority. Thanks for your help.

TheCommuter, BSN, RN · Apr 8, 2015

Post has been moved to the Nursing Student Assistance forum to stimulate responses from those who assist students. Good luck in nursing school and best wishes.

nurseprnRN, BSN, RN · Apr 8, 2015

Hi Just Beachy,
Of course it leads to the electrolytes. But our instructor insisted all 29 of the students were incorrect in lecture by choosing that answer. We all knew it was right. Since we are doing med/surg II, we are covering GI disorders, and the professor said nope, it was the card (BECAUSE we were covering THAT subject). We were all just dumbfounded. Even my wife was like nope, as the question was asked, serum electrolytes was the highest priority. Thanks for your help.

Now, see, if you'd said that in the first place you'd have gotten a totally different response. I think it entirely likely that most of it would have been along the lines of, "Your faculty is wrong and we hate it when they confuse students like that."

The only possible rationale for checking a stool for guaiac (Hemoccult) as a nursing priority would be that all the other three choices are parts of a medical plan of care that require a physician prescription / standing protocol (what we are laboriously trying to remind everyone is NOT an "order," as we are not in the military and they are not superior to nursing). I don't hear you saying that's the faculty's rationale for their choice, so I don't think they might have thought that way. But hey, you never know.

It doesn't sound as if they're going to be responsive on this, but I think you deserve a better answer from the faculty on their thinking re this topic, because the corresponding NCLEX question that asks what the nurse should anticipate next would, indeed, be lab draws to watch for what could be life-threatening complications. I can pretty much guarantee you it won't be checking for stool guaiac.

JustBeachyNurse, LPN · Apr 8, 2015

Hi Just Beachy,
Of course it leads to the electrolytes. But our instructor insisted all 29 of the students were incorrect in lecture by choosing that answer. We all knew it was right. Since we are doing med/surg II, we are covering GI disorders, and the professor said nope, it was the card (BECAUSE we were covering THAT subject). We were all just dumbfounded. Even my wife was like nope, as the question was asked, serum electrolytes was the highest priority. Thanks for your help.

Can't say I disagree with you based upon your post. If it was everything else plus dark stool or bloody emesis I might consider stool guiac which is an instant result but you are right the altered electrolytes has the highest risk and as such should be prioritized. The logic of your instructor is rather silly as electrolytes play a huge role in GI especially with the risks of acute dehydration with nausea, vomiting, altered nutritional intake, diarrhea, altered fluid levels.

Having a positive guiac in the absence of active bleed is not nearly as lethal as a K of 7 or sodium of 100. There is an excellent explanation on critical electrolytes resulting from excess N/V in another thread.

Read here: https://allnurses.com/post8438436-num2.html

ixchel · Apr 8, 2015

DJ and cindi, I'm betting you haven't been here very long by your "woefully ignorant" initial responses to GrnTea. If you look through GrnTea's posting history, you will see that this is a nurse who spends a large amount of time explaining things in detail to people who are willing to engage in the learning process. Perhaps there was a bit more sarcasm in the post you responded to snidely, but for the fountain of knowledge GrnTea is, I'd count myself as being blessed to be in GrnTea's care.

Many, many students have been helped by GrnTea. All GrnTea asks is that you show evidence that you are trying to independently find the answer and just need a little help getting there. Had you provided the full story in your OP, responses would have been quite different. But you, OP, came across sounding like a person doing your husband's homework by googling. Please forgive me if that sounds harsh, but I am being honest. THAT is what prompted GrnTea's response, I'm sure. And GrnTea was classy enough to not fire daggers back.

That said, your instinct, in my opinion, was accurate and these professors should not be mixing you up like that. That does nothing to support your autonomous decision making or ability to pass the NCLEX.