Rant. Questions are killing me!

[broughden]

So as new nursing students we keep getting told time and again, "Dont read into the question."

Ok fine.

We had a question recently:

"A Native American patient has been refusing to take their medication or attend treatment, which of the following would be a proper nursing response?"

A. Something outrageously not right

B. Something also clearly not right

C. Enlist the help of a family member, to discover if their are traditional healing practices the patient may be more receptive too.

D. Recommend to the provider that the patient be referred for a consult with a social worker.

To me C was clearly not right because, discussing the patient's diagnosis and health status without permission to a 3rd party (even if its family) is a clear violation of HIPAA. While we should respect the patient's culture and beliefs, discussing his diagnosis with an outside party is still a violation.

In D we are bringing the patient's lack of compliance to the provider's attention and using a collaborative team effort (social worker) to help address and overcome the patient's concerns with both the medication and treatment.

So I answered D.

We were told the answer is C. I questioned, "How is this not a clear HIPAA violation? We were told not to read into the questions. The question doesnt state, s/he gave you written permission to discuss their care with a 3rd party."

Response: "It doesnt state you werent given permission either."

Oh so Im supposed to be able to guess when they do and dont want me to read into questions, and in which way Im supposed to be able to read into the question.

Thats about as clear as mud.

[Mrs.D., BSN]

I dont fight anything. Some professors will toss out questions, on their own, if a certain percentage miss it. But beyond that fighting it leads nowhere other than to, "Im the professor, thats why."

I just rant here semi-anonymously, to relieve stress, get feedback and learn something in the process.

Ive stopped ranting on my own facebook page because while my RN, NP and MD friends give me great feedback....the rest of my cohort are certain the nursing school will see my posts and throw me and/or any of them who respond (or click like) out of the school.

So AN gives me an outlet.

Well I doubt they care what's on people's facebooks... you never know. I think this is a good outlet let it all out. I don't post anything on FB for privacy. Not even that I was in school or became a nurse! We have ALL been there, and we each have our own struggles. When you master one thing, the next thing makes you crazy.

Good luck in school!

[Ellekat2]

I remember thinking in nursing school that "critical thinking" questions should not be tested until you had learned enough about nursing to have the background to think critically. This should be seen as an exercise to develop your critical thinking skills more than to test your knowledge.

I have to agree that the answer is obviously "C". However, why would you have to ask the family? Rhetorically to the tester, not to the student-- why wouldn't you ask the patient? Listening often brings an understanding of choices and leads to the best care for the patient.

[broughden]

I remember thinking in nursing school that "critical thinking" questions should not be tested until you had learned enough about nursing to have the background to think critically.

Strangely enough we have already taken our HESI for critical thinking. I aced it.

[Lipoma, BSN, RN]

When it comes to questions like this here's a tip that I used in nursing school, on Kaplan, and on the NCLEX.

Acknowledge the patient or family member's concern. -Restate their concern in the form of a statement- Don't choose the answer that focuses on the nurse or another patient.

Never ask yes/no questions (Do you...what are you...) especially with psych questions

Ask open-ended question (Tell me more about...how are you feeling...what are your concerns)

Never pawn off the patient to another nurse or provider (B is pawning off the patient to the provider; not therapeutic)

Never not do anything for the patient (ie: patient's BP is dangerously low..what do you do? Fetal position, call MD, or document? Fetal position first)

Always assess first unless there is an assessment finding in the question (ie: You're a school nurse when a student came to you with a cast. You noticed toes are swollen and pale what do you do next? Assess pulses via doppler, elevate leg to decrease swelling, call the provider, or document normal finding? You already have the assessment so the next step is to call the provider.

NEVER relate the patient's concern to another patient's experience...frankly they do not care lol.

Safety Safety Safety (ie: schizophrenic patient is yelling they are going to kill everyone) do you; remove the patient from the area, isolate the patient, ask the patient to sit down with the group, or administer antipsychotic?) - you'll remove them from the area (least invasive)...never isolate (unsafe) (administer antipsychotic - AFTER they are removed), keeping them with the others is also unsafe.

In your above scenario, C is the correct answer because it acknowledges the patient's concern/current status and it includes the family. Nothing in C states you are breaking HIPAA. It's all strategy.

[broughden]

All great advice!

But how does my curling up in the fetal position help a patient with dangerously low BP?

Is that the universal "preceptor help me!" position?

[Lipoma, BSN, RN]

All great advice!

But how does my curling up in the fetal position help a patient with dangerously low BP?

Is that the universal "preceptor help me!" position?

It increases blood return to the heart and improves circulation to the vital organs. Overall, it improves systemic vascular resistance which leads to improved blood pressure.

ahha, I see what you're saying! I shortened the response because I'm too tired. I meant place the patient in left later position with knees flexed. It's been a loooong day

[broughden]

I was joking! It was a joke. LOL

Get some rest!

[AspiringNurseMW]

If it says "enlist the help of a family member", then that family member is present and available.

Unless it specifically says otherwise, NCLEX is a perfect world. If one of the answers lists a person, a medication, a provider, a family member, etc, then that thing/person is there and available. The assumption therefore would be that you have to: go find that person, get an order for the medication, etc. So, the saying, dont assume/dont overthink still applies. You just have to recognize where your **starting point** is.

For example, an answer would have to specifically state "get an order from the provider for xx". Then and only then is when you know that you do not have that thing available to you.

It sometimes takes a while for people to understand that concept.

Bottom line, there is no use arguing/getting annoyed at it. That is just how NCLEX questions work. NCLEX questions want to determine your critical thinking, and having to get an order/medication/person/supplies is not that. Its how its always been and its not going to change, so its something that requires getting used to. Best way to get good at it is to practice more NCLEX questions and read the rationales.

[Chrispy11, ASN, RN]

In nursing one I had the same issues. I was told there is right and then there's more right. When you understand this statement, you'll understand why many are explaining C. It's training for future tests. It boils down to what others have said. You never do nothing and you never pass the buck.

It was my experience to keep HIPAA in back of your mind but you never consider it unless directly asked a question about it.

Best of luck to you.

[pro-student]

While it is true you should avoid reading into a question, there are a couple of other important things to consider when answering questions for nursing/NCLEX.

1. You always have an order or approval for the options listed unless stated otherwise. They are not trying to trick you into violating scope of practice or HIPPA. There's only so much you can say in a question so a good ground rule is that they are trying to test you choice of the available options.

2. A nursing action is nearly always preferable to passing the buck. While collaboration is an important part of heathcare, they are testing you on nursing care and not if your can identify they appropriate person to pass the situation off on (e.g. social work). This does not apply when there is a clear indication that you need to contact the physician/provider to report something, request or clarify an order.

3. You always have everything you need to preform the actions. They are not testing you on te availability of resources. If something is an answer choice, assume you have the equipment/supplies available unless stated otherwise.

4. Imagine you can only conplete the action in question and then your shift is over. Don't assume an answer is correct because you could justify it by doing x, y, and z later. Obviously you wouldn't abound the pt but the best choice won't require subsequent actions that aren't listed and shouldn't need to be justified. This will help a lot with prioritization questions when you get those.

While some of these might sound like reading into the question, they are better thought of as the way a nurse reads a question. They don't always match up with the real world but they line up with the way your instructors are thinking when writing questions.

[adventure_rn, MSN, NP]

In nursing one I had the same issues. I was told there is right and then there's more right. When you understand this statement, you'll understand why many are explaining C. It's training for future tests.

Precisely. NCLEX 'logic' follows its own set of rules and critical thinking steps, and you can only learn it by practicing (and probably being unsuccessful at the beginning, like most of us were). D is 'correct,' but not the 'most correct' by NCLEX logic (i.e. assessment before implementation). Drove me nuts until I got the hang of it, but as you go through school it becomes second-nature (as you can see from the masses leaning toward C, even though it's a poorly written scenario).

Wait I know this one! Its a NCLEX prep question!

You are supposed to contact the patient's family to discuss natural or homeopathic remedies that may be safely used as part of the patient's treatment plan!

Broughden, I get the sense from the comment you made on the School Nurses forum that you're still feeling a little salty, so I made you something:

[Serhilda, ADN, RN]

Psychosocial and cultural sensitivity questions can be pretty predictable after a while. In this case, before I even finished reading the question or all the answers, I knew C would be correct. You have to consider what the professor is attempting to test you on before answering. This is a topic of culture given they specified the patient is a racial minority, not a question assessing your knowledge of involving other staff. Also, now that I'm an RN, my first thought was "why the heck would I pass this on to a social worker so soon??" In the real world, you wouldn't contact a social worker to figure out why they're noncompliant. That's your job. If they have unmet needs contributing to noncompliance, then you would consult them.

The response to any errors found in a question though will always be "don't read into it" because quite frankly, it's difficult to write NCLEX style questions without some degree of subjectivity and vagueness. I felt NCLEX was pretty straightforward and objective so I wouldn't worry about it. Until NCLEX, try to think like the professors and ask yourself what subject you think they're trying to test you on.