Can someone help me figure out why I missed these questions?

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Specializes in ED.

I didn't do so well on my last med-surg II exam last week. I was able to review my test today to see what I missed and why. On nearly every single one I missed, I was able to narrow it down to two possibilities and I missed nearly every time. So frustrating!

Anyway, here are a few questions. Now, I don't have them written word-for-word here but I think I got the gist of them.

Patient begins to receive TPN. It is important for the nurse to

A: check blood sugars Q4h

B: check serum albumin

I chose - check serum albumin. I always underline what I think are key words in the question and I underlined "begins to receive" so my rationale was that we would want to know the serum albumin levels at the beginning of this treatment to establish the patient's baseline.

The doctor inserts 2 chest tubes connected with a Y-connector in a patient with a hemothorax. When monitoring placement, the nurse will be most concerned about:

A: a large air leak in water-seal chamber

b: 400ml of blood in collection chamber

The correct answer was B. I chose A because the question reads, "when monitoring for PLACEMENT..." In my head, I'm thinking, "this question is asking about the placement of the tube, not what is coming out of it."

Last one... and I didn't have time to write much of this one...

A patient has been recently intubated and is on mechanical ventilation and a monitor that reads continuous arterial O2. The highest nursing priority is:

A: suction Q4h and PRN

B: monitor VS and breath sounds Q30-60 minutes.

The correct answer was B. I wish I had had the time to write all of this question because I'm sure I'm missing a vital piece of info but my rationale for A was that in a lecture, a teacher said that these vents have alarms that sound when either breathing has stopped or there is a kink in tubing, etc. and I'm asking myself if monitoring breath sounds every 30 minutes is realistic so I rule out B.

Clearly, respiratory stuff is NOT my cup of tea and I really need some help with this area. I got a solid A in med-surg I last semester but I am really struggling in this class so far.

thanks for any help and clarification!

meredith

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Specializes in LTC.

Patient begins to receive TPN. It is important for the nurse to

A: check blood sugars Q4h

B: check serum albumin

I do know that a pt w/BS issues will want to have their BS checked frequently b/c TPN WILL increase blood sugars. I know this not from NS but from when my daughter was in the hospital, they checked her BS's after intiating the therapy and then after dc'ing it (b/c then the BS would drop).

A patient has been recently intubated and is on mechanical ventilation and a monitor that reads continuous arterial O2. The highest nursing priority is:

A: suction Q4h and PRN

B: monitor VS and breath sounds Q30-60 minutes.

They will likely be in a CCU simply being intubated and such. I think think though that you'd want to know whether or not settings need to be changed and so you'd check the RR frequently. But that's just a guess...we didn't go over that in respiratory and I'm in my RN year and we haven't had advanced respiratory yet.

I totally get where you are coming from though! I kick myself after every single test b/c there are at least a few in which I had narrowed down to 2 and chose the WRONG one! So frustrating...Though in the end you just need to pass your classes and get your nursing license, so don't kick yourself TOO much! I used to be a big perfectionist but I realized that in nursing I can't be a perfectionist and beat myself up over single test questions, I have bigger things to stress about!

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OK, I'll help with a few.

TPN - The major risk in TPN is rebound hypoglycemia, which is life threatening. You'd want to check the levels at the start just to make sure that was not happening and that everything with the TPN was correct for that patient.

Vent - You would never want to wait until your patient was in a bad enough situation to be setting off alarms and in that serious of a distress level. Breathing should always be monitored that frequently just to make sure. Many things are monitored that frequently, so don't let that kind of thing throw you.

Your teacher seems to be focusing on preventative nursing actions in his/her questions. So you should too! ;)

Chin up, you'll get it. :)

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Specializes in ICU/UM.

My med-surg book says clotting used to be a major issue for chest tubes. Maybe that's the rationale there? Could be an older question or still an issue in your instructor's experience.

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Specializes in Utilization Management.

"TPN - The major risk in TPN is rebound hypoglycemia, which is life threatening. You'd want to check the levels at the start just to make sure that was not happening and that everything with the TPN was correct for that patient. "

Actually, hyperglycemia is a major risk of TPN administration. You monitor blood glucose every 4 hours to make sure the patient is not experiencing hyperglycemia. Some patient's require insulin coverage because of this. Rebound hypoglycemia is what happens if the TPN bag is allowed to run out without being replaced.

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Specializes in ED.

I get what y'all are saying about the TPN and the BS check q4h. It has been beaten into our brains to really READ the question and figure out what it is asking and not to always jump to what appears to be the obvious answer.

::eyeroll::

When I read the TPN questions I'm thinking two things....

1 - the patient is to BEGIN TPN feedings. When I read begin I'm thinking that we would do a serum albumin to establish a baseline and to measure efficacy.

2 - I work on a med-surg floor and I have a pt on TPN nearly every time I work and we don't do q4h blood sugar checks. We do it HC and HS and that's it. We don't check throughout the night.

Grrr..... I'm just beyond frustrated this semester. I LOVE this teacher and she is really helpful and really seems to care. I submitted some of my questions to her tonight so hopefully I'll get some additional feedback from her tomorrow.

I am not a straight A student but I do like to see the fruits of my labor especially when I spend so much time studying. I'm fine with Bs but I think a C in this class would send me over the edge! I'm kidding really but I am so much better than this test showed!

m

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Specializes in LTC.

I'm a CNA in a LTC nursing home. Sometimes (esp for testing purposes) you have to forget what they do where you work and do what is book right. It's the same way where I work and I've had some problems testing b/c I think "they don't do that at my work." But there is by the book and there is real world and often the 2 aren't the same in regards to what is done. YOU have to find a happy medium in your nursing practice! Example: By the book: The pt HR should be taken before giving a beta blocker. Real world (at my work): They give the CNA a list of vitals and administer the beta blocker after receiving the HR of the pt from the CNA My way: Take the HR before administering...what if the CNA was wrong, it's an assessment and CNA's really can't assess (although they do w/out realizing it, and their "assessments" are so important to the care of the patient, b/c they spend so much time w/them), but what if the pt's HR dropped in the time the CNA took it and then I gave the med. It's my butt! I'm not a practicing nurse yet though, but that's just how I think, about things.

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Specializes in Complex pedi to LTC/SA & now a manager.

For the vent question, a key would also be checking the BREATH SOUNDS. Breath sounds that are abnormal could indicate that a patient needs suctioning, if there was a loss of breath sounds this would indicate an emergent condition. Vital signs can also indicate signs of infection & stress.

As far as the chest tube placement, the 400cc would be more important as this could be indicative of active bleeding, a sign of impending shock...

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Which is "more concerning" regarding a recently placed chest tube for a hemothorax - 400 ml blood in the collection chamber or a large air leak? My first thought is one would expect signficant blood drainage from a hemothorax so 400ml of blood already in the collection chamber doesn't necessarily seem a problem. Meanwhile a LARGE air leak sounds like a potential problem. And the question does specifically use the words "monitoring placement".

In the real world, a quick glance around would give you a bunch more info than you're given in the test question. You'd know if the patient is sitting up chatting with their spouse or turning pale and gasping. You'd be able to see if there were any marks on the chamber indicating how much blood was already in the chamber at what time.

If the patient looked good and the markings indicated that 380ml were in the chamber 2 hours ago, then 400ml blood in the collection chamber in and of itself won't be very concerning, whereas a large air leak would merit some investigation.

If the patient is really having internal bleeding, it seems likely that you would have already noticed that the patient was looking bad as you walked over to the bed before you even had a chance to see any blood in the chamber. One wouldn't give a second thought to an air leak if the patient may be bleeding internally.

But for test questions... you only have what little information they give you. Which is "more concerning" - 400 ml blood in the collection chamber or a large air leak? Ugh!

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Specializes in CNA.
I'm a CNA in a LTC nursing home. Sometimes (esp for testing purposes) you have to forget what they do where you work and do what is book right.

For testing purposes, you always do what is "book right." I had a devil of a time on my first two HESI tests because I tried to approach them as "real world."

Huge mistake. It isn't real world, it is exam world. I bought a couple NCLEX study guides and dramatically increased my scores on this type of test.

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Specializes in ED.
Which is "more concerning" regarding a recently placed chest tube for a hemothorax - 400 ml blood in the collection chamber or a large air leak? My first thought is one would expect signficant blood drainage from a hemothorax so 400ml of blood already in the collection chamber doesn't necessarily seem a problem. Meanwhile a LARGE air leak sounds like a potential problem. And the question does specifically use the words "monitoring placement".

In the real world, a quick glance around would give you a bunch more info than you're given in the test question. You'd know if the patient is sitting up chatting with their spouse or turning pale and gasping. You'd be able to see if there were any marks on the chamber indicating how much blood was already in the chamber at what time.

If the patient looked good and the markings indicated that 380ml were in the chamber 2 hours ago, then 400ml blood in the collection chamber in and of itself won't be very concerning, whereas a large air leak would merit some investigation.

If the patient is really having internal bleeding, it seems likely that you would have already noticed that the patient was looking bad as you walked over to the bed before you even had a chance to see any blood in the chamber. One wouldn't give a second thought to an air leak if the patient may be bleeding internally.

But for test questions... you only have what little information they give you. Which is "more concerning" - 400 ml blood in the collection chamber or a large air leak? Ugh!

Apparently, a lot of people had an issue with this test question for several reasons - 1. because of the same issue I have with the wording of "more concerning when assessing for PLACEMENT of tube" part, and 2. because there is no time parameter set for the 400ml finding. If the nurse measures 400ml over a shift, that isn't a significant finding. If it is in a 2 hour period it IS but the question did not specifically ask that.

The teacher threw out 5 questions but a few of us have issues with about 5-6 other questions and we have some page numbers to back up our rationales. There were also some contradicting info between the book and the lecture slides provided.

I really like this teacher but I hate all the questionable wording of test questions like this. We had another question that said something like,

"There is a tornado and 100 people are injured. You are the triage nurse, which of the 4 patients in the ED would you see first?" The patients' injuries varied in need but the correct answer was the one that indicated reverse triage but a LOT of people including me, answered the 'normal' way to triage. We argued that the question never said that all 100 people were at YOUR ED.

This is just the gist of the question but it definitely did not read that all 100 patients were in ONE ER or brought in at one time.

m

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I had real problems with test-question wording myself while in school. Some instructors would tut about critical thinking and prioritizing and studying when everyone missed certain poorly-worded questions. It was so frustrating!

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