Ethical Exam Question

mmc51264, BSN, MSN, RN · Mar 31, 2012

the same issue that we are having in mt program. I would have crossed D off too. I hate how subjective some of these questions are. The instructors either get it in their head (or it is a given rationale that they blindly follow) and there seems to be no common sense to it. We have 35/36 get and answer wrong and nothing happens. As of right now, we are in the last 4 weeks of our program and all of a sudden, there are about 2/3 of the students NOT passing. They seem to think we have forgotten how to study. Very frustrating watching a program implode. AND being a victim of it.

Frustrating as heck, isn't it? My only hope is to make through the program, the "real" NCLEX questions are better vetted, I believe.

allnurses Guide · Mar 31, 2012

[color=#333333]funnily, this was the first answer i crossed off, for sounding absurdley wrong. to me, this seems to be a dark ethical decision to place "the good of the many" above his, at least initially. i can't wrap my mind around focusing on everyone else while this man is my patient. note, this question doesn't state i'm a community health nurse, or someone else who may place a much greater emphasis on the epidemiological aspects of his visit.

so...

how does this work?

the patient tosses out the name of the partner that gave him the goods...

so, what happens then?

the std police go out and make an arrest?

i get the rationale of it. i get the "greater good" thing, in theory, but how does this work in this example?

how does it really really serve the greater good?

do they track the partner down?

do they send a postcard in the mail?

what?

so they got the name... then what?

lol

Esme12, ASN, BSN, RN · Mar 31, 2012

Let's say.......he has AIDS. He came in for testing and it is found he is positive. What would the prudent thing to do? Keep it a secret? or........ Find out who else may be exposed and get them tested.

Certain communicative diseases are reportable. That is where all these statistics come from. Just like if a kid comes down with head lice, strep throat,meningitis, measles, chicken pox the school nurses follow up with all who have been exposed and possibly infected. A huge part of a nurses job is to stop the spread of communicable diseases and possibly heading off an epidemic.

It doesn't say which should the nurse do first....the question states which is the most important. What if this guy is sleeping with half of the school....or his partnet was sleeping with half the school....should the partner be kept in the dark so they can't seek treatment? Is this individual engaging in other high risk behavior that as a nurse it is your responsibility to educate the patient about safe sex and high risk behavior dangers. as well as stop the spread of disease.

Who they are sleeping with is the MOST important and yes we notify them in the most discreet manner possible.

I hope that helps clarify the instructors position.

Double-Helix, BSN, RN · Mar 31, 2012

Remember that the when someone has been exposed to a contagious disease, such as HIV, or a similar STD, it's the responsibility of the Department of Health to notify those individuals. That includes the names of recent sexual partners who may have been exposed so that they can seek treatment. If a patient presented to the clinic with an STD, then the nurse would definitely need to get the names of recent sexual partners so that they can be notified. Note that the name of the infected person remains anonymous during notification.

While the other things are important to know, they won't give you much information about the current problem.

The date of his last sexual activity could have been yesterday, but he might have been infected weeks or months ago.

A prior history of STD's might be important, but he currently has an STD, so it doesn't really matter if he has had them before.

Finally, when the symptoms began might seem ilke a good thing to know, but what are you going to do with that information? He says the symptoms began yesterday. Okay, you're going to test for STD's, treat the patient, provide education and get the names of recent partners. He says the symptoms began a month ago. Okay, you're going to test for STD's, treat the patient, provide education and get the names of recent partners. He could have been infected long before symptoms showed up, so knowing when the symptoms started doesn't change your plan of care.

Double-Helix, BSN, RN · Mar 31, 2012

So...
How does this work?
The patient tosses out the name of the partner that gave him the goods...
So, what happens then?
The STD police go out and make an arrest?
I get the rationale of it. I get the "greater good" thing, in theory, but how does this work in this example?
How does it really really serve the greater good?
Do they track the partner down?
Do they send a postcard in the mail?
What?
So they got the name... then what?
lol

Yes, they absolutely track the partner down, if at all possible. People who have been exposed to certain communicable disease (Esme provided a good list), have the right to know that they were exposed so that they can seek treatment. No, they don't send a post card. The person will be notified discreetly and confidentially in person if possible.

psu_213, BSN, RN · Mar 31, 2012

[color=#333333]on a recent exam, one question (which was supposedly an nclex question) was answered incorrectly by 28 out of 30 students in our class, yet our professor remains adamant. here it is:
[color=#333333]"a man who has a profuse, purulent urethral discharge with painful urination is seen at the sexually transmitted disease (std) clinic. which information will be most important for the nurse to obtain?"
[color=#333333]a.) the date of his last sexual activity
[color=#333333]b.) a prior history of stds
[color=#333333]c.) when the symptoms began
[color=#333333]d.) the names of recent sexual partner
[color=#333333]the class majority was an even split between b and c. apparently the right answer was d. this was rationalized as a community health choice; a prioritization of preventing the spread of this std and protecting the health of his partners. it's not that the other actions won't be performed, just that this one is the *most important.*
[color=#333333]funnily, this was the first answer i crossed off, for sounding absurdley wrong. to me, this seems to be a dark ethical decision to place "the good of the many" above his, at least initially. i can't wrap my mind around focusing on everyone else while this man is my patient. note, this question doesn't state i'm a community health nurse, or someone else who may place a much greater emphasis on the epidemiological aspects of his visit.
[color=#333333]i'm very curious to hear some opinions on this! thanks

i am not a community health nurse, so i am certainly not an expert on such issues. either way, though, none of the answers jump out at me as being obviously right or wrong. part of the reason i really don't like "most important" questions, is that the person taking the test taker has the habit of turning this into what is the 'only' thing you should do. as part of a complete assessment, you would do the other ones, but for the rationales listed in the few posts above mine, i would have to agree with d.

nurseprnRN, BSN, RN · Mar 31, 2012

"[color=#333333]"a man who has a profuse, purulent urethral discharge with painful urination is seen at the sexually transmitted disease (std) clinic. which information will be most important for the nurse to obtain?"

[color=#333333]a.) the date of his last sexual activity: what earthly difference will that make to his treatment or anything else? none.

[color=#333333]b.) a prior history of stds: ditto

[color=#333333]c.) when the symptoms began: ditto

[color=#333333]d.) the names of recent sexual partners (it should be plural-- probably a typo by op)[color=#333333]" by process of elimination and because the law requires it, as part of the duty the nurse has to the public health

it's easy to get wrapped up in nclex questions if you can't keep in mind all the duties and responsibilities a nurse has. students so often get fixated on the checklist-type items, in this case, the itms that you would chart as part of your intake eval. it's very easy to not see the forest for the trees, and this, friends, is a forest question. it is designed to see if you can see the bigger picture of nursing duty to the community health. [color=#333333]

and this is why, also, so many students who have been making it through school find themselves faced with the real threat of failure in the last semester of their four-semester course of study.

this is where the rubber meets the road. this is not where you apply what you think is "common sense," because by now you have been educated to meet a higher standard, to think like a nurse. this last semester, and nclex, is where you must now be able to prove that you can think like one.

the higher-order questions are not poorly-vetted or arbitrary or mean-spirited. if they confuse you, then it's not because they are at fault. they are an indication of the very real milieu in which you will find yourselves as nurses, expected to perform at a higher standard than a lay person with a little advanced knowledge. they seek to identify who can and who can't.this final last-semester learning objective has sneaked up on you, but you ignore it at your peril. [color=#333333]

allnurses Guide · Apr 2, 2012

Thanks, Esme and Ashley!

I had never seriously thought about how that would work!

annietart · Apr 2, 2012

We had a nurse come in from our county health department to explain the rational to this question. Most STDs have to reported to the health department as they are extremely communicable. It was really helpful as she was very frank about the diseases and what they can do to a community.Check with your local health department for your reporting guidelines

classicdame, MSN, EdD · Apr 2, 2012

Remember you are in NCLEX land. Any contagious disease has to be contained. So it is appropriate to get names of partners. As for symptoms etc., the nurse deals with what is here and now. The rest is ok information, but does not change the treatment modalities.

Enthused RN, BSN, RN · Apr 2, 2012

Wow great post! Thanks OP for posting the questions and thanks everyone for the answers. I would have gone with C also but now I understand why D is the "most important."