For the ortho-post operative patient I believe that teaching usage of the incentive spirometer is correct. There are many ways took t this question and I do remember a question like this from my Kaplan practice tests.
First, assessing the wound is an assessment, not an intervention.....
Second, after surgical intervention the worry is on breathing pattern and oxygenation (ABC). This is due to inhaled anesthetics and/or pain. This can happen either immediately after surgery and later during care.
The remaining options can be thrown out because of either an assessment or not important at this time.
I'm trying to stay in NCLEX world.. I don't want to add things to the questions that aren't there. If the patient was bleeding out into the sheets, the question should tell you that. I don't really think it's a good question in the first place.
I'm not participating in this anymore. You made up that question and as I stated more information is needed. Yes, the HR of the patient is high, it's going to be. They are in withdrawal. It's slightly high though, and as I stated the sickle cell crisis person is in pain due to the crisis. You even stayed that. You are expecting people to read into your question which you cannot do. You go off the info you have at that moment. Your rationale for the answer to your question requires someone to read into info that is not there. Therefore, I will not answer these type of questions anymore.
When people decide to make up their own NCLEX style questions, most of the time misinformation is given. Your thought is in the right place, but I don't need anyone to mix me up on things. I do know the patho of sickle cell and alcohol detox. I also think your rationale on a heart rate of 107 is off. I will stick to ATI for my test rationales and my nursing dx book.
Oh please, please, PLEASE tell me how you can make up NCLEX questions and expect to know what NCLEX is looking for.
You don't know how the NCLEX lady thinks. You aren't the one who writes the test. How do we know your answers are, in fact, accurate? You're coming up with your own rationales. When your rationales may very well be flawed.
How many times have you gone through an actual NCLEX book and thought out the rationales for each answer and STILL got the question wrong, even though your rationale sounded really good?
Ok. I promise to drop. I just know the amount of misinformation that is out there. For those who don't understand(and are interested in learning) why anyone coming in with vaso-occlusive crisis should always be a priority... It's a circulatory emergency. Risks include stroke, ischemia, necrosis, loss of vital organs and extremities... spontaneous abortion.
I think the thing that bothers me the most is that someone(a nurse, potentially treating these patients) will assume that it's simply a psychosocial issue - whether at NCLEX Memorial Hospital or in real life. It is not about reading into questions or leaving things out - not matter how poorly the question is composed.(sorry creator of these questions) The NCLEX wants to know what you would do in any given situation, with as little or fragmented information sometimes. It's about safe practice - you know, not allowing someone to loose a limb - its actually negligence, if something goes south.
I've taken care of sicklers and have also seen nurses put off their initial assessment because they clearly didn't get why they were there in the first place. It is parity to any chest pain or the "worse headache of my life" - take no chances - the NCLEX knows this, too. They are not gonna give you those choices and expect you say "it's psychosocial, the 5th vital sign, duh!"
My advice is to avoid this - both RNs and students. If you want to do NCLEX prep, use a more reliable source than allnurses.com
Here is a snippet from the American Family Physician's website - not from my janitor's manual... :
The vaso-occlusive crisis, or sickle cell crisis, is initiated and sustained by interactions among sickle cells, endothelial cells and plasma constituents.1Vaso-occlusion is responsible for a wide variety of clinical complications of sickle cell disease, including pain syndromes, stroke, leg ulcers, spontaneous abortion and renal insufficiency.
Acute pain in patients with sickle cell disease is caused by ischemic tissue injury resulting from the occlusion of microvascular beds by sickled erythrocytes during an acute crisis. Chronic pain occurs because of the destruction of bones, joints and visceral organs as a result of recurrent crises. The effect of unpredictable recurrences of acute crises on chronic pain creates a unique pain syndrome.2,3
Acute bone pain from microvascular occlusion is a common reason for emergency department visits and hospitalizations in patients with sickle cell disease.4 Obstruction of blood flow results in regional hypoxemia and acidosis, creating a recurrent pattern of further sickling, tissue injury and pain. The severe pain is believed to be caused by increased intra-medullary pressure, especially within the juxta-articular areas of long bones, secondary to an acute inflammatory response to vascular necrosis of the bone marrow by sickled eythrocytes.5 The pain may also occur because of involvement of the periosteum or periarticular soft tissue of the joints.
I don't understand this thread...so we're just um debating the answers to questions someone made up? And who may or may not be an NCLEX question writer?
I don't understand this thread...so we're just um debating the answers to questions someone made up? And who may or may not be an NCLEX question writer?
The original purpose was for practice NCLEX-style questions.. and some of us found it helpful in our line of thinking while studying for upcoming exams such as exit HESI and NCLEX.
The writer is not an actual NCLEX test author, but simply rewording some review questions as not to violate copyright... but the debates over "real life" nursing has thrown it all off the original purpose, so it's pretty much a dead thread at this point - except those that want to keep debating the first question. :)
Thank you. I'm not going to violate copy write by copying questions word for word. I see nothing wrong with making up/revising questions. My goal was for people to learn. If you don't feel like you are benefiting then avoid the thread. I think a lot of good points have been made and I appreciate everyone's input. I welcome other posters to add their own questions.
The original purpose was for practice NCLEX-style questions.. and some of us found it helpful in our line of thinking while studying for upcoming exams such as exit HESI and NCLEX.
The writer is not an actual NCLEX test author, but simply rewording some review questions as not to violate copyright... but the debates over "real life" nursing has thrown it all off the original purpose, so it's pretty much a dead thread at this point - except those that want to keep debating the first question. :)
I see. Well, I don't think it's a dead thread then. the real life nursing debate looks like it has ended. we can come out of hiding now. I would like, however, the answers to the questions...which has yet to be posted (at least I don't think it has, I've skipped over a few of the lengthy responses because of the real worldedness of it (I know, not a real word) which as we know does not apply to Saint NCLEX Medical Center.
A heart rate of 107 in an ETOH client is indicative of every stage of withdrawal. Also, your rationale on why client #1 should be a priority is wrong. Tachycardia in an ETOH client has nothing to do with circulation issues. Tachycardia in ETOH clients are caused by increased activity of the autonomic nervous system.
What's funny is that you're talking about circulation in client #1, when client #3 clearly has a circulation issue with the sickle cell crisis.
Call me a cynic, but I'm guessing your rationales aren't in line with the folks that make the NCLEX.
rob4546, BSN, MSN
1,024 Posts
For the ortho-post operative patient I believe that teaching usage of the incentive spirometer is correct. There are many ways took t this question and I do remember a question like this from my Kaplan practice tests.
First, assessing the wound is an assessment, not an intervention.....
Second, after surgical intervention the worry is on breathing pattern and oxygenation (ABC). This is due to inhaled anesthetics and/or pain. This can happen either immediately after surgery and later during care.
The remaining options can be thrown out because of either an assessment or not important at this time.