Didnt do well on my First Test =(

darcicat · Sep 18, 2009

Im a little hesitant to answer hahaha what if I get them wrong too!?!? Here goes:

For #1 I would have put B - draw lines through the space because you never go back and "fix" a chart. Both nurses made mistakes in this situation. The nurse who forgot to document AND the nurse who left blank space.

You usually see that question framed from the point of view of the nurse who finds that the one before her didn't finish charting. The right answer is for the new nurse to continue charting right below and not leave any space. The nurse who forgot can come back the next time and finish the charting after where the others have written. You have to remember that the chart is legal document and leaving any space gives room for it to be altered.

That being said A is wrong because you are altering the chart, C is wrong because that still leaves space for it to be altered, and D is wrong because you never say a mistake was made in the chart, that happens on an incident report. You say "X drug ordered, Y drug given, patients HR is 75 etc etc..." So in this case saying you fouled up, made a mistake, or forgot and drawing arrows is inappropriate too.

B is the only one that gets rid of the empty space, is neat clean and orderly, and doesn't change the legal record.

darcicat · Sep 18, 2009

I don't like question 8, but unlicensed persons cannot assess or teach. Those belong to RNs alone. So documenting the nursing process...no. That belongs to the nurse. Can't give any type of medication at all...so C is out. A routine physical exam requires assessment so D is out. So that leaves B - take vitals every 15 min after a blood transfusion. Well yeah, they can do that, but you had better be in the room checking on them still and assessing for reactions. But NCLEX world, they can do the task. So B.

darcicat · Sep 18, 2009

14. D - The only time that you will see which people are on is to make sure the knowledge and skills of the staff fits the specific needs of the patients. None of the others seem relevant. A is a trick, you wouldn't need to know WHICH nurses/aides are on to distribute the work evenly. That should be done no matter who is on.

darcicat · Sep 18, 2009

43 - Appropriate reimbursement for services being denied. Remember this mantra "if it's not documented, it hasn't been done." So the only way that the insurance will reimburse the claim (pay for your time, the catheter, etc.) is if the nurse writes down that she did it. So if s/he forgets to write it down (in other words s/he forgets to "claim" that s/he did the procedure), the insurance company has no way to know that it was done, and therefore no reason to pay for it.

darcicat · Sep 18, 2009

So here is my advice, keep reading your rationales. Keep asking questions and figuring out why you got wrong what you got wrong. You will see similar questions in the future. All the way up through the NCLEX. Fundamentals is hard because you are learning to think again, learning to think like a nurse, but really it is common sense. Because of that - ALWAYS STICK WITH YOUR FIRST ANSWER. That holds true for the NCLEX too. More often than not your gut is right.

However, you do need to think through the questions. I tried to write how I thought about the answers and decided. The main thing is that you think about each answer choice and how it applies to the question. Does it seem relevant? There are of course obvious wrong choices (You'd never get fired for forgetting to document ONCE) cross those out immediately so that they don't distract you.

Then think about what the words mean in the answers/questions. What does Negligent Care entail? Well you neglected your patient's needs. You did something bad and you should have known better. Ok, maybe this could be right. But was there damage to the patient? This is a legal term, and usually you need to have damage to the patient for it to be a valid claim. No, the question doesn't say that the patient was harmed. So, this one doesn't work 100%. Maybe only 50%.

For C...well the patient almost never sees their chart, so they have no idea what you write or don't write, so that can be crossed off too.

At that point if you understand how insurance billing works and that documenting means that you get paid, D is 100% the right answer. You would only know that if you read about it/discussed it.

JennNJ83 · Sep 18, 2009

thanks for posting this, i have my first applications test Wed :) Don't worry, you'll do better next time!

~Mi Vida Loca~RN, ASN, RN · Sep 18, 2009

Hi everyone. I took my first fundamentals test and I didn't do as well as I expected . I read the chapters and studied the study guide that she gave us. I remember the entire study guide too!! But I think my problem is I cant apply it to situational type questions or I overthink because I noticed that some of the answers I got wrong were BECAUSE I changed it.... I guess I'm not used to these type of questions. They are not straight forward and require critical thinking I think. Here are some of the questions that I believe I SHOULDVE gotten right. Oh yes, another thing, I'm not using you guys to answer questions or anything. I do HAVE the answers/rationales to these questions. I just wanted to know if we were on the same page "/. So if you guys could help me by answering 1-2 questions of the list and giving a rationale of why you thought it was the answer. I have the answers if someone wants it posted to any of these problems. Well anyway feel free to answer and give a rationale, it would be most helpful. Thanks everyone.
1. A nurse forgot to document care provided to a client and returns the next day to complete the documentation. Upon review of the nurse's progress notes section of the record, the nurse sees that a space was left for her documentation. What should the nurse do?
A. document in the space provided.
B. draw lines through the space and sign her name
C. leave the blank area alone and document at the end of the section, out of sequence.
D. write and explanation of why she didn't document in the blank area and draw arrows to her entry about the client's care.
8. An example of a task that can be delegated to an unlicensed assistive person would be:
A. documenting nursing process on the nursing notes.
B. Taking vital signs every 15 minutes on a patient receiving a blood tansfusion.
C. administering routine tylenol to a patient.
D. a routine physical exam of the patient.
14. The RN is planning the assignments on a client-care unit of the hospitol. The nurse checks to see which nurse and nurse aids are scheduled to work the shift. Why did the nurse do this?
A. to make sure the work is evenly distributed.
B. to give the nurses extra time to document.
C. to plan for a meal break.
D. to match the clients needs with the knowledge of the staff.

25. Which type of information would be the most informative and should be given in a shift report?
A. vital signs are BP 120/80, pulse 72, respiration 16
B. Client is alert and in good spirit.
C. chest x-ray taken 2 days ago and was negative.
D. client voided 400cc of yellow urine 4 hours after the urinary catheter was removed.
43. You are working as a home health care nurse and forgot to document that you changed your client's catheter. This would most likely result in which of the following?
A. being fired from your job.
B. an incident report filed agianst you for negligent nursing care.
C. a client complaint.
D. appropriate reimbursement for services being denied. (i didnt understand this answer)

I am a new RN student with no previous medical experience so I am not 100% sure my answers are right, If Daytonite sees this she usually gives great feedback to these things,

anyway on the first one, we learned you never leave space after and this was really pounded into us. So I would cross it out initial my name and chart in the next available space or where ever the new remark goes.

The next one, out of the options the vitals are the only things on the list CNA's can do where I am and I am assuming a CNA and UAP are same sort of thing??

On the third question what I bolded is the only thing that makes sense to me since as was pointed out, work should always be even.

A client voiding after cath removal is very important information, vitals can change so much so quick it's something that can be looked in the chart to see what they were but you will be doing your own vitals anyway, and those vitals were in the normal range. The clients demeanor is great info but again can change and you will reasses also and the xray results can be looked up in the chart. That first void after a cath is always importnat so the most relevant IMO

The last one, as stated, if it wasn't charted it didn't happen so their might be trouble with reinbursement when it wasn't charted.

Gonna..B..A..RN! · Sep 19, 2009

Hello How are you ......I took my first test today and I did not do so well either.....I read all of your questions and the rationales that were given and they all make sense after reading the rationale but while you in the middle of the test I was thinking straight textbook so the application part of the test is what getting me .....I just know that we cant give up and know to strive and do better next time.......I study for hours and hours at a time I have kids and I never see them because I am studying all the time and to get a grade that is not passing drives me crazy......Hang in there!

rickelli · Sep 19, 2009

I am curious to know the correct answers that you have. I think everything that all the others have said sound great. Just curious how they compare. Thanks---Kelli

CardioNRS~DAWN · Sep 19, 2009

Don't be discouraged, it happens to the best of us. I am a third semester Nursing Student and I can remember my first fundamentals test. :cry: I passed it by one point. My suggestions to you would be to connect with a "good" study group and practice the nxclex style questions that's included on the cd in your fundamentals book. There are also test taking books that can assist you in your way of thinking in order to break down the questions and understand the rational behind them.

I admit when I think back to fundamentals, up till now I have learned and progressed so much. Fundamentals so far has been the only rotation where I didn't get an A on the first exam.

Things will fall into place, nursing school is a totally new way of analyzing things, but with studying and practice it will all come to you.

Good Luck!!!

Fundamentals(1986) · Sep 19, 2009

Wow Darcicat and Mi Vida Loca. All of the answers you guys picked were right.... I am very impressed. Those are excellent rationales and make complete sense. I wish I can think like that "/

Here is what went on in my mind and I'll use question 43 as an example. I picked B for my answer. For answer A, I knew being fired for not documenting once was a bit extreme so I knew it wasnt the right answer. And for answer B, I took as, the faculty found out that the nurse forgot to document and therefore was filed for negligent care which seemed like it would happen in a hospital setting. For answer C, I thought the client ratted out the RN to the faculty but it didnt seem like a big issue. As Darcicat said about the client never seeing his or her chart, I never knew they never see it. And I didnt understand D at all whatsoever. So thats why I picked B =(. I feel as if... I HAVE to have had experience in the hospital in order to know some of these questions.

For question 25

"A client voiding after cath removal is very important information, vitals can change so much so quick it's something that can be looked in the chart to see what they were but you will be doing your own vitals anyway, and those vitals were in the normal range. The clients demeanor is great info but again can change and you will reasses" This is also very good thinking and never even bothered to cross my mind "/

And also There was one question about a client diagnosed with Hepatitus Mellitus and it was asking what I should do: Wash between toes and dry it, soak in warm water, and forgot the other 2 answers. I didnt know we had to know what Diabetes Mellitus was, it wasnt in our fundamentals book neither in our study outline. To tell you the truth I dont know anything about any diseases..

And agian, thank you everyone for the replies and especially Darcicat and Mi Vida Loca thank you very much for taking the time to do each question. These helped me understand the questions a lot.

I will post up the rationales that were given so anyone reading this can compare.

1. A nurse forgot to document care provided to a client and returns the next day to complete the documentation. Upon review of the nurse's progress notes section of the record, the nurse sees that a space was left for her documentation. What should the nurse do?

A. document in the space provided.

B. draw lines through the space and sign her name

C. leave the blank area alone and document at the end of the section, out of sequence.

D. write and explanation of why she didn't document in the blank area and draw arrows to her entry about the client's care.

RATIONALE

1) A space should never be left for another nurse to chart. Blank spaces require a line through it. The nurse should state. "Late Entry"

8. An example of a task that can be delegated to an unlicensed assistive person would be:

A. documenting nursing process on the nursing notes.

B. Taking vital signs every 15 minutes on a patient receiving a blood tansfusion.

C. administering routine tylenol to a patient.

D. a routine physical exam of the patient.

RATIONALE

8) An unlicensed person may take vital signs every 15 minutes. Even if the patient is recieving blood. The RN is responsible for assessment of the vital signs. The RN remains accountable for the delegated act.

14. The RN is planning the assignments on a client-care unit of the hospitol. The nurse checks to see which nurse and nurse aids are scheduled to work the shift. Why did the nurse do this?

A. to make sure the work is evenly distributed.

B. to give the nurses extra time to document.

C. to plan for a meal break.

D. to match the clients needs with the knowledge of the staff.

RATIONALE

14) It didnt give me a rationale for this one but the correct answer is D

25. Which type of information would be the most informative and should be given in a shift report?

A. vital signs are BP 120/80, pulse 72, respiration 16

B. Client is alert and in good spirit.

C. chest x-ray taken 2 days ago and was negative.

D. client voided 400cc of yellow urine 4 hours after the urinary catheter was removed.

RATIONALE

25)Data needs to be significant and relevant. In this case, this was an evaluation of client's voiding after removal of the foley and emphasis is on safety.

43. You are working as a home health care nurse and forgot to document that you changed your client's catheter. This would most likely result in which of the following?

A. being fired from your job.

B. an incident report filed agianst you for negligent nursing care.

C. a client complaint.

D. appropriate reimbursement for services being denied. (i didnt understand this answer)

RATIONALE

14) It didnt give me a rationale for this one either but the correct answer is D