Ethical Exam Question

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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:

"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?"

A.) The date of his last sexual activity

B.) A prior history of STDs

C.) When the symptoms began

D.) The names of recent sexual partner

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.*

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.

I'm very curious to hear some opinions on this! Thanks smile.png

Thank you to all of the people who left the great posts explaining the question so clearly!!! I am certain that I just experienced a paradigm shift LOL So...this is what they mean by critical thinking:rolleyes:

wow the rationals and explanations in this thread are awesome. I hope I can carry them with me like a little voice in my head as I complete school. Thanks guys

So my thinking was it would be good to know when the symptoms began. My thought was just because someone comes into an STD clinic does not necessarily mean it is an STD. Maybe he has something else. Guess it is hard to tell when you are supposed to read more into the question and yet you are supposed to read them carefully. I did not assume he had it but if I did then I would say get his partner list. Guess it is experience to guess correctly? I think students are probably reading it like I did then?

Specializes in Mental Health, Hospice Care.
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.:D

Absolutely, look for those key words that Esme has pointed out.....the devil is in the details when it comes to NCLEX questions....slow down and read it again before answering....

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
So my thinking was it would be good to know when the symptoms began. My thought was just because someone comes into an STD clinic does not necessarily mean it is an STD. Maybe he has something else. Guess it is hard to tell when you are supposed to read more into the question and yet you are supposed to read them carefully. I did not assume he had it but if I did then I would say get his partner list. Guess it is experience to guess correctly? I think students are probably reading it like I did then?

The question didn't say what to do first it said what is most important overall.

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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]

just curious- if the op is saying that 28/30 students answered the question incorrectly, and you're saying that answering questions such as this incorrectly means the student is not prepared for nursing, then are you suggesting that this class as a whole is past of the group "who can't"? i don't think she is "ignoring it at [her] peril" - she is here asking and trying to understand the rationale.

Hi,

I'm not a nursing student ( I start in September) yet, so I not sure what the real, correct, right & true answer is ;) But just a guess for me the answer is to report the STD to the health department along with the other partners. I saw a special a few years ago on the AIDS virus. Scary stuff.

Blodeuwedd

Specializes in Maternal - Child Health.

The accurate and timely reporting of STDs is integral to efforts to assess morbidity trends, allocate limited resources, and assist local health authorities in partner notification and treatment. STD/HIV and acquired immunodeficiency syndrome (AIDS) cases should be reported in accordance with state and local statutory requirements. Syphilis, gonorrhea, chlamydia, chancroid, HIV infection, and AIDS are reportable diseases in every state.

from: http://www.cdc.gov/std/treatment/2010/std-treatment-2010-rr5912.pdf

When in doubt, seek out an authoritative source.

My greatest concern for this student and the 28/30 classmates who answered incorrectly is that they apparently have no understanding of a very basic and universally applied concept of public health. Arguing for an additional point on a test misses the fact that your class has not been taught or has not learned vital information.

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
Just curious- if the OP is saying that 28/30 students answered the question incorrectly, and you're saying that answering questions such as this incorrectly means the student is not prepared for nursing, then are you suggesting that this class as a whole is past of the group "who can't"? I don't think she is "ignoring it at [her] peril" - she is here asking and trying to understand the rationale.

You will find when you start nursing school, in the summer I believe, that nursing is unique in and of itself and the methodology of testing is different. We are taught that it is the subtleties and the obscure that you will find the answer you seek. It will be that one miniscule detail like a decimal point, that tiny little mark on their skin, that brief statement that may make the difference in a patient outcome or making that fatal error.

In any case scenario there are many right answers and there could be multiple MOST important solutions. The trick is learning which is the most critical to do first and not every scenario will begin or end with the same answers as no two people are the same. You don't get many second chances to change your mind or do it over again. I think it is the difficulty with these types of questions that some have great difficulty passing the boards at the end of school and then complain that they can't pass their boards, taking them multiple times (another sore point but that is another post).

It really gets me annoyed that the students are taught to a test and not necessarily to what they will need on the job in real life. But, if the entire class failed...... is the question flawed, did the instructor fail to teach , or are the students not paying attention to detail that will harm someone in their near future.

It's that extreme attention to detail with a deep sense of responsibility and ownership of one's actions and failures that makes a good nurse.

Good luck in school!:D

I was taught, you fail=your fault, class fail+teacher fault.

If it were clear in this question that the patient had HIV/AIDS, I'd have gone with the "correct" answer. However, it's not clear what he's got at this point, though those symptoms don't scream life threatening. I know they often occur together, but we are ALL taught not to assume on questions.

This is a crappy question. I'd have answered the way you did.

Specializes in MPCU.

what i think the experienced nurses are saying is that it was a simple question with an obvious answer. it is likely an std, the correct answer is the same, whether or not the patient had hiv/aids.

what is the differential for "profuse, purulent urethral discharge with painful urination?" i can only think of a couple that are not std's: uti or foreign body (like a splinter). any other guesses?

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