Can you explain why I got this test question wrong?

[peds4life08]

Hey everyone! I'm currently taking Med Surg 1 over the summer and we recently had our second test. One of the questions I got wrong dose't make sense to me. I spoke with my teacher about it and she told me to post online and see what people say.

The question told us about a patient that was being seen in a clinic with stress incontinence. The question asked for an outcome appropriate for this patient. According to the test the correct answer is that the patient should do kegels a few times a week. I understand the kegels help with stress incontince however, my book lists kegels as an intervention for stress incontinence, not an outcome. Can anyone explain to me why kegels are an appropriate outcome?

[Kuriin, BSN, RN]

You are correct in that kegels are a correct intervention to have a better outcome for stress incontinence. So because of that, I have no idea, either!

[Wuzzie]

How exactly was the question and correct answer worded? This makes a huge difference and is one of the reasons nursing exams are so tricky. If the answer was something along the line of "the patient states they will do Kegel exercises several times a week" then that is actually an outcome. Can you see why?

[Kuriin, BSN, RN]

How exactly was the question and correct answer worded? This makes a huge difference and is one of the reasons nursing exams are so tricky. If the answer was something along the line of "the patient states they will do Kegel exercises several times a week" then that is actually an outcome. Can you see why?

The outcome would be: patient has done kegel exercises every thirty minutes for the last week.

[Wuzzie]

The outcome would be: patient has done kegel exercises every thirty minutes for the last week.

Well sort of. How did the patient know to do Kegel exercises?

[llg, PhD, RN]

It's all a matter of perspective -- hinging on which patient goal you are focusing on.

1. If you are focusing long term ... the goal would be to decrease the incontinence ... the intervention would be the Kegel exercises ... and for the outcome, you would be evaluating whether or not the Kegel exercises were effective as a treatment.

2. However, if your perspective is short term ... maybe focusing on one or two particular clinical visits ... your short-term goal is to get the patient started on a regular program of Kegel exercises ... your intervention is "education", not the doing of the exercises themselves ... so to evaluate the effectiveness of your educational intervention, the outcome of that teaching intervention would be that the patient knows how to do the exercises correctly and is doing them on a regular basis.

Problem #1 (long term): incontinence

Problem #2 (short term): knowledge deficit regarding Kegel exercises

But something in me is concerned that you teacher couldn't just tell you that.

[Here.I.Stand, BSN, RN]

Like others have said, the interventions could be the teaching and encouragement. The outcome could be the pt's new habit of doing the Kegels.

I'm curious what the other options were, and why your instructor advised asking internet strangers vs helping you herself. I mean I/we don't mind, but how does your teacher vet us to ensure we are teaching the correct things?

[peds4life08]

Unfortunately, I don't remember the exact wording of the test. There wasn't anything about educating the patient on how to do kegels. My instructor tried to explain the problem to me but I didn't understand the reasoning, that's why she told me to ask online.

The answer I choose was that the patient would have decreased episodes of incontinence within one month. I choose my answer because it was measurable and time oriented. My instructor told me my answer was inappropriate because apparently that isn't realistic. She said that saying a patient with stress incontinence will improve within one month is like giving a recent MI patient nitro and saying he will never have another heart attack because of the nitro. I honestly don't know for sure that my answer was realistic but it was a multiple choice question and I was looking for the answer that met the criteria of an outcome as defined in fundamentals last semester. Regardless of my answer I feel like the question itself wasn't a great question if the "correct answer" was wrong.

Maybe my mistake was assuming that the patient in the question already knew how to do kegels? It seems like if the patient already knew how to do do kegels then doing kegels is an outcome but if the nurse had to teach it then doing kegels are an outcome? I guess its pretty impossible to know for sure without the actual question. =(

[NurseKylie7]

Unfortunately, I don't remember the exact wording of the test. There wasn't anything about educating the patient on how to do kegels. My instructor tried to explain the problem to me but I didn't understand the reasoning, that's why she told me to ask online.

The answer I choose was that the patient would have decreased episodes of incontinence within one month. I choose my answer because it was measurable and time oriented. My instructor told me my answer was inappropriate because apparently that isn't realistic. She said that saying a patient with stress incontinence will improve within one month is like giving a recent MI patient nitro and saying he will never have another heart attack because of the nitro. I honestly don't know for sure that my answer was realistic but it was a multiple choice question and I was looking for the answer that met the criteria of an outcome as defined in fundamentals last semester. Regardless of my answer I feel like the question itself wasn't a great question if the "correct answer" was wrong.

Maybe my mistake was assuming that the patient in the question already knew how to do kegels? It seems like if the patient already knew how to do do kegels then doing kegels is an outcome but if the nurse had to teach it then doing kegels are an outcome? I guess its pretty impossible to know for sure without the actual question. =(

Are you familiar with goals vs outcomes and writing nursing care plans? I found this example somewhere on this forum when I was confused about this as well:

"Example 1:

Diagnosis - Anxiety

Goal - Patient will have decreased feelings of anxiety

1 Outcome - By (date) patient will verbalize what anxiety means to him/her

2 Outcome - By (date) patient will write down times that he feels anxious"

Therefore in your case:

Diagnosis- Stress Incontinence

Goal: Patient will have decreased episodes of stress incontinence (something along those lines)

Outcome- Patient will perform Kegel exercises......(keep in mind that it usually has blooms taxonomy such as will verbalize, demonstrate, perform, etc)

Hope that helps!

[KelRN215, BSN, RN]

Your nursing intervention is to teach the patient to do Kegel exercises X times per week. The desired OUTCOME is that the patient actually does them. Therefore it is an outcome.

[catamounts303]

Kegels are intervention and outcome is continence of urine. You will never ever use this stuff in practice.

[marlena.erika]

Unfortunately, I feel that the textbook was wrong. Kegals are an outcome, due to the squeezing nature of the balls, which strengthens the lady partsl muscles. Surgery is a last resort for stress incontinence, as stress incontinence is only temporary. Hence the word "stress". But again, I could be wrong and anyone is invited to correct me. Thanks