Rant. Questions are killing me!

Possum_RN · Oct 8, 2018

Yeah, as soon as I saw C, I was like "thats it!", but not because I would actually do that in real life....only because I just passed nursing school and know how to answer nursing questions. Answering nursing-school-questions is just one of those skills you have to pick up to survive, as frustrating as it is.

As others have pointed out, C is the closest to an assessment/ data-gathering response.

I had a question in OB/Peds that still haunts me to this day. The gist of it was that a mother and neonate arrive to the small regional hospital where you work via ambulance, the baby was born in transit. Upon assessment, the nurse realizes that the neonate has "multiple congenital abnormalities". What do you do?

According to my program director (who wrote the question, despite teaching not a single class at that point in the program), you separate the mother and infant; admit the mother, send the baby to the closest large hospital with a NICU. I answered that you admit the mother and neonate....my reasoning being that the baby needed to be properly assessed before transport anyways...what were the "congenital abnormalities" anyways? I assumed we HAD a NICU...the "small regional hospital" where I actually worked in real life had one, after all. But apparently I was to assume (for once) that this was not perfect-nursing-world. Bear in mind we did not learn anything about pre-transfer stabilization and preparation until two semesters later in Med/Surg II......

Anyways, I mean to convey my total empathy for dealing with terribly-written nursing questions. I'll be muttering angrily about that neonate and mother in the ambulance when I'm in the nursing home one day :roflmao:

Horseshoe, BSN, RN · Oct 9, 2018

Maybe you missed my first sentence?
I was not longer speaking in context of the question. But speaking in terms of real life practices.
Hence my final statement that....

If you are a student, how is it that you can speak with such utter certainty about what actually happens in "real life practices" of medical facilities with regard to how nurses are disciplined or fired?

And I agree that the correct answer is C.

In "real life practices," you are going to turn to the family who is in the room and ask them about cultural issues that might help the patient. No HIPAA violation, because no PHI has been revealed.

If no family is present, you are going to look through the chart to find the person the PATIENT has designated as their go to person and ask them about cultural practices. Every chart I have ever seen has a patient release of information in it. No HIPAA violation, no getting fired.

In both of those scenarios, you have used your critical thinking skills and assessment tools to help improve the patient's compliance and your own understanding of their issues, rather than passing the buck before doing a single thing to solve the problem yourself.

If you spend this much time debating and defending these NCLEX style questions, you will waste a huge amount of time. If you want to pass NCLEX, you have to figure out what it is that they want. Once you do that, these kinds of questions are ridiculously easy. You can spot the "best" answer from a mile away.

KelRN215, BSN, RN · Oct 10, 2018

Maybe you missed my first sentence?
I was not longer speaking in context of the question. But speaking in terms of real life practices.
Hence my final statement that....

I didn't miss it, you added a lot of nonsense details to the scenario in your OP in an effort to convince yourself that your answer was right (it still wasn't) and then said that a nurse who did what the correct answer was would be fired. You're wrong about that, as those of us who have worked as nurses for many years have already told you, but by all means continue beating this dead horse. Nurses who are immediately fired for HIPAA violations typically have done something egregious, like posted a picture of a patient's genitals on social media.

I've been on the receiving end of unwanted sharing of my information more than once and no one was ever fired over it. Once, my Neurologist called and left a message for my mother on my home's answering machine saying he wanted to talk to her about me (I was 19 and had explicitly stated that I didn't want providers speaking with my parents any longer). I intercepted the message and called him back to say he didn't have permission to speak to my mother and that I was a legal adult. The second time, I had ended up in the ER after having a fainting episode at a clinical and the ER, doing a follow-up call, again called my mother's phone number and left a message saying that they were calling to check on me because I had been seen in the ER for fainting. No one was fired. Someone has to make a big stink about these kinds of things for them to even be noticed.

RNNPICU, BSN, RN · Oct 12, 2018

I didn't miss it, you added a lot of nonsense details to the scenario in your OP in an effort to convince yourself that your answer was right (it still wasn't) and then said that a nurse who did what the correct answer was would be fired. You're wrong about that, as those of us who have worked as nurses for many years have already told you, but by all means continue beating this dead horse. Nurses who are immediately fired for HIPAA violations typically have done something egregious, like posted a picture of a patient's genitals on social media.
I've been on the receiving end of unwanted sharing of my information more than once and no one was ever fired over it. Once, my Neurologist called and left a message for my mother on my home's answering machine saying he wanted to talk to her about me (I was 19 and had explicitly stated that I didn't want providers speaking with my parents any longer). I intercepted the message and called him back to say he didn't have permission to speak to my mother and that I was a legal adult. The second time, I had ended up in the ER after having a fainting episode at a clinical and the ER, doing a follow-up call, again called my mother's phone number and left a message saying that they were calling to check on me because I had been seen in the ER for fainting. No one was fired. Someone has to make a big stink about these kinds of things for them to even be noticed.

If they are calling your mother, she must be on some kind of emergency contact sheet. Make sure that the contact sheet is updated with a correct person to call.

KelRN215, BSN, RN · Oct 12, 2018

If they are calling your mother, she must be on some kind of emergency contact sheet. Make sure that the contact sheet is updated with a correct person to call.

This was many years ago when I was still in college and my mother's home phone number was also my home phone number. The situation with my Neurologist was a bit of a gray area because I was 17 when I was diagnosed with my brain tumor/seizure disorder so for a period of time, my mother was the correct contact but the situation I referenced happened 1 1/2 years later when I was 19. The doctor knew I didn't want anyone speaking to my mother, though, but took it upon himself to call her anyway because I'd stopped taking my AEDs on my own. He didn't call to find out if there were any cultural reasons for my decision or any traditional practices I'd rather use but to tattle on me. I never went back to him again.

RNNPICU, BSN, RN · Oct 12, 2018

This was many years ago when I was still in college and my mother's home phone number was also my home phone number. The situation with my Neurologist was a bit of a gray area because I was 17 when I was diagnosed with my brain tumor/seizure disorder so for a period of time, my mother was the correct contact but the situation I referenced happened 1 1/2 years later when I was 19. The doctor knew I didn't want anyone speaking to my mother, though, but took it upon himself to call her anyway because I'd stopped taking my AEDs on my own. He didn't call to find out if there were any cultural reasons for my decision or any traditional practices I'd rather use but to tattle on me. I never went back to him again.

Ahh, got it. SMH at that MDs decision to call.

emmjayy, BSN, RN · Oct 13, 2018

Bingo! Being a great clinician or mid-level practitioner does not necessarily make you a great professor!
I also taught for years prior to this and share the same opinion you do about the wording of some of the questions.
If you want to know if Im sympathetic to cultural concerns and will be a culturally concerned nurse then ask me a clear question where the family is involved.
Dont ask me if Im going to break HIPAA to go ask their medicine man or tribal elder about some other practice they may prefer. Because Im never ever going to break HIPAA due to your badly worded question!

IMO this is not a badly worded question. The answer is very obvious. As you get more used to nursing style questions, proper answers will begin to stick out to you. This is a situation where you did read too much into the question. If the question had been about you identifying HIPAA violations, the professor would have made that more obvious in the stem/answer choices (e.g., saying something like "show the family member or friend the patient's chart and ask them what they think of the care being provided" or something ridiculous like that).

You'll learn that "cultural competence" answers are pretty much always the correct answer when you get a question about a patient who isn't a white American, unless they fall into an ethnic group that is more likely to have specific medical issues related to their ethnicity and the question relates to those medical issues. Certain words will trigger you to block out irrelevant answers. For example, I hadn't even gotten to the answers while I was reading your question and I already knew the answer was going to be "Find out about the patient's beliefs/customs" because it was a.) about a certain ethnic group and b.) no specific medical issues were identified in the stem of the question.

Re the bolded part: Real life doesn't work this way. You won't always have family members available to speak to. It's perfectly fine to ask people at the bedside about what the individual likes or is comfortable with as part of your assessment. It's not like you're saying, "Hi Random Friend, we've been pumping your pal here full of x, y, z drugs for the past few hours in an attempt to deal with x, y, z issues caused by x, y, z health choices he's made for himself. What cultural practices or beliefs does he have that we could integrate to help him out?" You just say, "Hey, are there any practices or beliefs that this patient has that we should know about?" That certainly does not violate HIPAA :cheeky:

WHICH · Oct 13, 2018

A and B eliminated. We don't want to answer a patient with those...

C. Why is correct? There is no violation of confidentiality. The patient declines drugs. The person has a different approach to treating or managing its injury or illness. For example, there are people who believe you can heal their injury by blowing on it or you rub your hands together and put them closer to their injury by 2 inches or whatever distance they prefer. The family members are included in the care unless the patient wrote it down that he or she doesn't want any family members to be contacted. In this question, it did not ask about his or her status with family. You get to pick one of those choices.

You aren't violating HIPAA.

D. Wrong. It's for mental health concerns.

Recall that not everyone believes in drugs. I personally take drugs when it's really needed. If I can tolerate pain, I refuse in order to protect my liver. So, would you refer me to a mental health professional because I did not want my medication even though you can objectively see it that I'm in pain? Aren't you curious to ask my family who may be able to help me out?

missmollie, ADN, BSN, RN · Oct 14, 2018

Bingo! Being a great clinician or mid-level practitioner does not necessarily make you a great professor!
I also taught for years prior to this and share the same opinion you do about the wording of some of the questions.
If you want to know if Im sympathetic to cultural concerns and will be a culturally concerned nurse then ask me a clear question where the family is involved.
Dont ask me if Im going to break HIPAA to go ask their medicine man or tribal elder about some other practice they may prefer. Because Im never ever going to break HIPAA due to your badly worded question!

If the question states that you ask about Native American customs or practices, then assume the family is there. Why would you assume the question is asking if you would sit down, call the family or seek out the family, then break HIPAA by giving patient information, all to figure out culture? That is not mentioned nor implied in the question.

Stop and think: You have an ethnic person you are not familiar with. Is it a HIPAA violation to google possible cultural influences or bias they may have? Is it a violation to ask non-patient specific questions about a culture to a member of the same culture? NO! It would be a violation to state "I have Mr. Jones, who is a member of (specific) tribe who is refusing x,y,z interventions needed for his explicit diagnosis. That's a HIPAA violation. Trying to understand culture to provide better care is not.

Asking about a culture shows patient-centered and culturally sensitive care. Know the difference.

JyRn18 · Oct 14, 2018

I am currently in my last semester of nursing school & it took me a lot of practice questions to not "read too much into the question." However, as I get to more NCLEX style questions I have realized that the question that is being asked won't always be within the first pieces of information given. The question that you gave was the following:

"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. "

Upon dissecting the question the first piece of information refers to the patients' culture so instinctually the eye goes to that fact and deems this a question pertaining to cultural competence. The remainder of the question asks the following: "which of the following would be a proper nursing response?" or in other words which of these answers is part of the nursing process. I see that in your examination of this question that you eliminated responses A & B because either they were unethical, illegal or non-therapeutic responses leaving you with responses C & D. Response D states "Recommend to the provider that the patient be referred for a consult with a social worker." Which as you stated "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." While this response seems perfectly suitable and acceptable as the correct answer if you review it with in the context of the nursing process (ADPIE) this may fall under the Implementation portion of the nursing process. Response #C states: "Enlist the help of a family member, to DISCOVER if their are traditional healing practices the patient may be more receptive too." Key word being discover, or in other words ASSESS. The response does not indicate that protected health information would need to be divulged in order to conduct this assessment so therefore per the wording would not violate patient's privacy

Also response D would not demonstrate cultural competence as it would be assuming that our medical practices are the only acceptable methods of healing & the RN would be advocating for her belief as opposed to the beliefs and practices of the patient she is treating.

kbrn2002, ADN, RN · Oct 15, 2018

You've obviously ruled out two responses already and are left to choose between two that might be right, but which is more right. In this case asking for a social worker referral might eventually be right, but to get that referral you should have information that can best be obtained by asking the patient and/or family questions. NCLEX loves these questions that require circular logic. By the way, there is nothing in that answer that requires a HIPAA violation anyway. You can certainly ask a family about cultural beliefs and traditional treatments without giving them information specific to the patient.

Tiffc88, RN · Oct 16, 2018

It's definitely C. You do not have to discuss the patients healthcare but u can talk to family and ask about cultural and religious views to help understand the client. Involving family can be extremely beneficial