Dispute test question??

HalfBoiled, BSN, RN · Oct 12, 2018

If the question was asking "What would be your first intervention?"

Nasal Cannula would make sense.

You are able to contest that question to your professor if you have other classmates with the same thought process and selected answer.

allnurses Guide · Oct 12, 2018

Nasal cannulas are usually right there, available and easy to put on immediately, while you look for the cause of the low reading. I have had patients with very low sats that did just fine with a cannula.

(Another answer is check the monitoring equipment to see if it is an accurate reading and not a malfunction.)

Another thing, don't over think a problem. Simple solutions are often the right ones.

Miss.LeoRN · Oct 12, 2018

I learned early on in school that fighting questions never really helps. If you're struggling to the point where the one or two points you might get from a question "saves" you then you've got other issues to figure out rather than argue questions. On the other hand.. yes, I know there are some really, really, really bad questions. The worst are when your professors make up their own. This one seems like it was made up by the professor as a SATA usually isn't a "what would you do *first* style question. After all picking what you would do *first* implies a single task. But, I've literally had questions marked wrong with a professor telling us she "never said/taught that" yet in her very power point there it was as an answer. You'll get the hang of nursing questions and how to read them, what to look for. So, let's go back. You have a patient with PAO2 of 52. What needs to be done? What does this patient need *right now*? The patient needs O2. Okay, what are your options for O2? You want to put him on a mask but the only option is an NC? Well then, NC is it because the number one thing the patient needs at this point is O2.

Here's a scenario: I'm just informed that the patient's PAO2 is 52. What do I do? First thing is put the patient on NC because it's the easiest and most readily available. Typically at my hospital/on my unit we keep NCs at the bedside just in case. At this point the patient is likely experiencing some hypoxia. The patient is probably combative, hallucinating, and agitated. I've had patients with a PAO2 in the 50's; getting a mask on them wouldn't have been easy, nor would have trying to get them to keep it on. If the NC isn't working; the next step up would be an oxymizer. At this point, respiratory is usually at bedside, the doctor has been called, and there's probably a stat chest xray on it's way up as well as stat labs because something is going on with this patient. If the patient continues to worsen vs. improve, then we break out the mask and if need be the patient goes on a close-obs so they aren't pulling it off every few minutes.

RNNPICU, BSN, RN · Oct 12, 2018

Yup, NC would be a first line intervention. Although the level is low, the question is not asking you to think deeply about what 52 means, the questions is having understand that it is a low level and oxygen may help the situation. Starting with the least invasive first, which would be NC. You can't read to deeply into the actual level of 52. Recognizing an abnormal number, then begin your intervention, the NC. You are looking too much into what the 52 means. All it means in these type of questions is that it is low and requires a Nurse to intervene.

kbrn2002, ADN, RN · Oct 14, 2018

Something you'll learn as you progress, don't overthink the answer. If no other oxygen delivery method was listed as a choice then the cannula is the choice. You can't not choose O2 as an appropriate intervention, so the way it's delivered is going to be included in that SATA somehow.

Horseshoe, BSN, RN · Oct 14, 2018

A SATA question on a recent exam listed a patient's PAO2 as 52. I don't remember the question but we had to reply with what the interventions would be. One of the responses was to give oxygen via nasal cannula. I didn't select this because my thoughts were that if a patient's PAO2 is this low, then a more intensive intervention would be called for, such as oxygen via rebreather mask, not cannula. I did bring this up to a professor and he said you would start with cannula and go from there.
Agree or disagree? I, unfortunately, haven't found any information that says exactly what you would do in this scenario.

Just curious which answer you DID choose and am wondering how you would support your argument that this was the correct answer rather than the NC option.

student_B, ADN, RN · Oct 14, 2018

I learned early on in school that fighting questions never really helps. If you're struggling to the point where the one or two points you might get from a question "saves" you then you've got other issues to figure out rather than argue questions[...]

I learned this from reading posts on AN while I was in pre-nursing, and it holds true in my year and a half of experience. I think a big part of it is that these questions are not like math problems that are strictly formulaic. With nursing the questions are perception and judgement based, and students come at the question from different background experiences that can affect perception of the question. I feel the same way about these tests as you do, but we can only learn the info as best we can and utilize test-taking strategies (search these boards).

Since we don't have the full question, could the answer have been something like assess airway for clearance before administering O2? Administering O2 can be tricky with things like COPD, but 51 is significantly lower than I think would be ok for an advanced case of COPD.

*just reread the OP. Yep, that looks like one of those questions where one book says start with NC, and another source says go right to 100% non-rebreather. I.e., I just took an ATI exam that states a 22ga IV cath is too small to use for blood products while my Lewis Med-Surg book states 22ga and larger is acceptable for blood (clinically I've seen 20ga and larger for blood). I wish there was an international standard for these kind of things...

Medic_Murse, BSN, RN, EMT-P · Oct 14, 2018

Tackle the patient and put a pillow over their face!

"Shhhhhh....go to sleep!"

Chrispy11, ASN, RN · Oct 14, 2018

As you get further they're going to drive A B C into your head. Airway, breathing, circulation. You were thinking in the correct direction, just read too much into it. As others said, you need to do the simple things first.

Only once in school did they change a disputed question. There were four exams plus a cumulative final every semester. The question in my case wasn't even a SATA. It was a question by a flighty professor whose lectures were horrible and said things that contradicted the text. That was the case with the changed question. I got an extra point and didn't bother to dispute it (others did), having tried once in the first semester and getting nowhere. In my case a point or two wasn't needed. In the end, I understand the flighty Professor is no longer there.