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
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
I think the most important thing would be to treat the patient that is there, not concern yourself with other unknown people who only have the potential of having a disease. Why would obtaining a list of a patient's sexual partners be more important than properly assessing his current condition? Furthermore, asking him how long he has had the symptoms could give the nurse a starting point for asking about the sexual partners. If he's had the symptoms a month, then the nurse would need to ask the names of all partners in the last 6 weeks. If he's only had the symptoms for 1 day, then she would only need to know about the past 2 to 3 weeks. Or maybe the answer would be "I've been having these symptoms since I had my member pierced last weekend. I've never had sex." I'm glad this wasn't a question on one of my exams, I'd be pretty annoyed with it too.
Maybe, from a students stand point. As the nurse in the clinic....
First, you wouldn't get symptoms of gonorrhea from a member piercing. Second, I wouldn't associate having member piercing a priority with someone who has never had sex, so it would alert me that maybe the patient isn't being honest in their sexual activity and history of high risk behaviors. Causing me pause to investigate further.
In the real world....all of these things would be done, of course, right away. Asking about symptoms, their duration and severity of course are the first questions asked. But a nurses responsibility is to protect the public and educate the patient. He is already there seeking treatment...he's being cared for. His partners on the other hand have no clue making it imperative to find out who they are, get them treatment and stop the spread of the disease. So, over all finding out who has has had sex with and getting treatment would be a priority in my time with that patient.
I hear what you are saying and all we a re trying to do is explain why the answer is what it is....I'm not one for the present methods of question asking and critical thinking, because I happen to believe teaching what the diseases are first along with the basic what to do and the priority critical line up comes with experience. But this is a priority in this situation.
The question still didn't say what would you do first, it's what would over all by the end of the visit be the most important information to obtain by the end. Peace :paw:
This has been a very informative thread, and I have enjoyed reading all the answers. I am a first semester nursing student, and I have not had patho yet or gone too deeply into abnormal findings. I didn't know that STDs need to be reported; had I known that, I would have chosen that as my answer.
As a seasoned nurse, I think that part of the issue with this question is that younger students have no recall of a time prior to the outbreak of HIV and AIDS, and the privacy issues raised by these conditions.
It was because of the stigma associated with these conditions that many healthcare/school/employment privacy laws were enacted, most of which focus on the right of the individual to privacy and confidentiality regarding sensitive medical diagnoses. That right to privacy is sometimes misunderstood, and has led many to falsely assume that there is never a time when it is legally, ethically or morally acceptable to disclose any information about a patient to anyone.
Sounds like these students are lacking in their understanding of basic principles of public health and HIPAA.
It doesn't say which should the nurse do first....the question states which is the most important.
The question didn't say what to do first it said what is most important overall.
This is my point. The question was what would be the most important over all not the first priority.
The question still didn't say what would you do first, it's what would over all by the end of the visit be the most important information to obtain by the end.
The question didn't ask FIRST PRIORITY it asked the over all MOST IMPORTANT.
Esme, you're starting to sound like a a broken record. Think it's sunk in yet?
ptx, correct. the answer is d. this gets the inattentive students caught out, as it is a higher-level question, related to the nurse's duty to the public health/the community as patient, as in the ana scope and standards of practice.
since the other three items don't make any difference in the workup or treatment to the patient in front of them, the last answer, report sexual partners, is the answer, related to the nurse's duty to report and the nurse's duty to the community. the fact that only two students were savvy enough to either know this or pick by process of elimination does not make it a bad question.
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
Sorry, what I meant was, is it more important for the nurse to notify the partners or treat the pt?
Last time. The patient is already there being treated.......case done. The most important now is to find those who need treatment before more become infected.
Think it's sunk in yet?
:banghead:
.........
Esme12, ASN, BSN, RN
20,908 Posts
Maybe, from a students stand point. As the nurse in the clinic....
First, you wouldn't get symptoms of gonorrhea from a member piercing. Second, I wouldn't associate having member piercing a priority with someone who has never had sex, so it would alert me that maybe the patient isn't being honest in their sexual activity and history of high risk behaviors. Causing me pause to investigate further.
In the real world....all of these things would be done, of course, right away. Asking about symptoms, their duration and severity of course are the first questions asked. But a nurses responsibility is to protect the public and educate the patient. He is already there seeking treatment...he's being cared for. His partners on the other hand have no clue making it imperative to find out who they are, get them treatment and stop the spread of the disease. So, over all finding out who has has had sex with and getting treatment would be a priority in my time with that patient.
I hear what you are saying and all we a re trying to do is explain why the answer is what it is....I'm not one for the present methods of question asking and critical thinking, because I happen to believe teaching what the diseases are first along with the basic what to do and the priority critical line up comes with experience. But this is a priority in this situation.
The question still didn't say what would you do first, it's what would over all by the end of the visit be the most important information to obtain by the end. Peace :paw: