I'm taking this from memory, the question stood out to me.
A stable patient on the medical unit in a hospital unexpectedly dies. The nurse needs to inform the significant other on the phone. What statement does she make?
1. "I'm very sorry, but your loved one has died."
2. "Can you come to the hospital right away? The client is not doing well."
3. "The HCP has asked me to call to report the death of your family member."
4. "May we discuss organ donation and your loved ones wishes?"
This probably didn't seem too interesting a question so I'll just give the answer now :)
The answer is 2! I think it's from the Saunders comprehensive but I'm not sure I only saved the picture of the answer rationales. The rationale for this is 1 and 3 believe it's a danger to tell of the death over the phone and 4 is a "backward" way to tell. The reason this question stuck with me is because I thought "what if the SO says no they can't come right away" then do we tell them "I lied and he's dead" do nurses get in trouble for that? Also I'd be rushing to get there thinking I'd have one more chance to say goodbye. But anyway 2 is the answer for nclex.
New vignette - There have been times when I've really almost had to reach thru the phone to grab to twist the family's arm that it was necessary for them to come in. So I'm just as gentle as I can be with my #1 answer.
You wait for the 'gasp', then the silence, then the sobs with questions. At least they know what has happened - no surprises when they drive in. It seems more cruel for them to arrive to be told "Oh, he died just after I called you". You then have to make sure the falsehood is well choreographed with time of death for the certificate and other details (esp other staff present). My greatest concern is that they are safe - I don't want them becoming overcome with shock for an MI or CVA occurring at home or worse, while they're on the road (and possibly killing someone else on the road).
Answers #3 & 4 are just cold & unfeeling.
Answer #2 just leaves them up in the air, wondering & fearing the worst. I have concerns re their anxiety & stress levels and their ability to drive safely.
Sorry, but I believe your Saunders is WRONG, WRONG, WRONG! They're telling you to tell a lie. How ethical is that??? Like there are times when you're supposed to be OK lying??? Nope!
"Sorry, but I believe your Saunders is WRONG, WRONG, WRONG! They're telling you to tell a lie. How ethical is that??? Like there are times when you're supposed to be OK lying??? Nope!"
I agree, the Saunders rationale sounds really wacky....
After receiving report, which patient should the nurse see first?
1) Mr. Jones, a 57 year old man with a history of pancreatitis, going through alcohol withdrawal and has a heart rate of 107.
2) Ms. Smith, a 87 year old with COPD who is recovering from hip surgery and needs to ambulate in the hall.
3) Ms. Brown, a 24 year old admitted for sickle cell crisis who is complaining of body aches and wants pain medication.
4) Mr. Thomas, a 82 year old admitted for pneumonia whose oxygen saturation reads at 95% on oxygen at 3 liters per minute via nasal cannula.
*I thought it would be a good idea to start a thread where members could post NCLEX style questions for us to learn from and discuss.*
In real life I'd see patient #3 first. Reason being- I already know he needs pain meds. Grabbing them from the pyxis and administering them will take me about 90 seconds. If I enter patient #1's room, I don't know when I'll be coming out. 107 is hardly a HR to get that excited about when you consider that normal adult HR is generally considered to be 60-100.
In real life I'd see patient #3 first. Reason being- I already know he needs pain meds. Grabbing them from the pyxis and administering them will take me about 90 seconds. If I enter patient #1's room, I don't know when I'll be coming out. 107 is hardly a HR to get that excited about when you consider that normal adult HR is generally considered to be 60-100.
I agree that it's definitely 3. In addition to what was said, you go with who is the most unstable and has the least expected outcome. COPD is chronic, Hip surgery has predictable outcomes, 95% O2 is ok for pneumonia in an 87 yr old. Tachycardia is expected in Alcohol withdrawal. The thing to know about alcoholics is when was the last drink. Yes, at NCLEX Memorial Hospital, pain is psychosocial. However, this is actually the result of a circulatory issue. Sickle cell crisis is not a stable condition. They need fluids first. Until they receive the fluid and pain management, they are not stable.
While I really don't believe in needing to see a patient suffer or die, in order to earn your "experience" badge, you really need to experience taking care of a sickler in crisis in order to understand why this is priority.
I would go with #1 as he is most likely starting to rack up points on CIWA (alcohol withdrawal scale) which can ultimately lead to debility or death if not attended to.
I agree that it's definitely 3. In addition to what was said, you go with who is the most unstable and has the least expected outcome. COPD is chronic, Hip surgery has predictable outcomes, 95% O2 is ok for pneumonia in an 87 yr old. Tachycardia is expected in Alcohol withdrawal. The thing to know about alcoholics is when was the last drink. Yes, at NCLEX Memorial Hospital, pain is psychosocial. However, this is actually the result of a circulatory issue. Sickle cell crisis is not a stable condition. They need fluids first. Until they receive the fluid and pain management, they are not stable.
While I really don't believe in needing to see a patient suffer or die, in order to earn your "experience" badge, you really need to experience taking care of a sickler in crisis in order to understand why this is priority.
While pain is a physiological sign of sickle cell crisis, giving pain medicine is not going to treat the problem. Oxygen and IV fluids will. The elevated heart rate is still priority. If the sickle cell patient was having shortness of breath, you would see them first.
michlynn, BSN, RN
175 Posts
Technically, according to the AHA, it's now CAB. Patient #1 would be first priority, alcohol withdrawals can progress into something ugly real quick.