Rant. Questions are killing me!

  1. 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.
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    About broughden

    Joined: May '09; Posts: 567; Likes: 1,554
    from FL , US

    62 Comments

  3. by   Mrs.D.
    I know it's tough, and it's good that you are thinking things out.

    If you notice in option C, nowhere does it state that you are giving patient information to these people (probably what our teacher meant about reading into the question). You are just asking visiting family memebers if there is anything the patient likes to do at home to help with sickness. If they're visiting, or you have their contact info provided by the patient, then they are already aware the patient is sick in the hospital. You do not need to divulge any information.

    In my opinion, option D shirks responsibility to someone else before you've even tried to figure it out on your own. Part of our job is culturally competent care. If you pass off this task to a coworker, you would never have learned the valuable information that family could give you. As a rule, when you've got another culture in the question and there is an opportunity to learn about that culture in the answer, pick that answer-that's what we would do in real life too!


    When I read the question, it was clear to me that the answer was C, and this is my rationale.

    I hope this helps some. Good luck!
    Last edit by Mrs.D. on Oct 3 : Reason: little something extra..
  4. by   chare
    Quote from Mrs.D.
    [...]
    When I read the question, it was clear to me that the answer was C, and this is my rationale.
    [...]
    Concur, for the reasons provided.
  5. by   WanderingWilder
    Quote from 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.
    When I had questions that I didn't have a clear answer to I would ask myself what is it that they want to know that I know. This question specifies a Native American. So they are looking to see if you know that Native Americans may not follow traditional medicine. Answer D does not relate to culture but question C does.

    The answer is almost never going to be to pass the responsibility to another person, so always really think it through if that is the answer you want to pick. Whether its to call a doctor or a case worker, there is usually something that you are going to do first.
  6. by   Luchador
    Quote from 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.
    Ya. I'm in my first semester and these "critical thinking" questions are simply poorly written and vague. I know because I was a teacher for quite a few years.

    We had a question in the last test that we all challenged. "A pt says the dr. told her she has a sinus rhythm and asks what that means. Which is the best therapeutic response?"

    Everybody choose "It means your heart is working as it should be working."

    But the correct answer was "It means your SA node is firing normally and triggering the ventricles to contract."

    Most pts won't know wtf the SA node is. Just ridiculous.

    If they really wanted critical thinking the test would be 10--15 written short answer questions instead of 70 multiple choice.
  7. by   203bravo
    Quote from Luchador

    We had a question in the last test that we all challenged. "A pt says the dr. told her she has a sinus rhythm and asks what that means. Which is the best therapeutic response?"

    Everybody choose "It means your heart is working as it should be working."

    But the correct answer was "It means your SA node is firing normally and triggering the ventricles to contract."

    Most pts won't know wtf the SA node is. Just ridiculous.

    .
    Simply stating that "your heart is working just as it should" actually minimizes the patient's concern and is the reason that this would not be the "best" choice.

    Quote from Luchador
    If they really wanted critical thinking the test would be 10--15 written short answer questions instead of 70 multiple choice.
    This would not prepare you for the NCLEX.
  8. by   adventure_rn
    Quote from WanderingWilder
    The answer is almost never going to be to pass the responsibility to another person, so always really think it through if that is the answer you want to pick. Whether its to call a doctor or a case worker, there is usually something that you are going to do first.
    Agreed.

    In addition, the answer for what 'what to do next' questions is almost always to assess. The C option has some assessment-ish qualities in it (i.e. assessing what cultural practices are important to the patient), which is why I'd immediately go for that one--when in doubt, assessment is usually the answer. Of course, the best way to assess would obviously be to ask the patient instead of their family members, but I don't write these ridiculous quetsions...
  9. by   broughden
    Quote from Mrs.D.
    I know it's tough, and it's good that you are thinking things out.

    If you notice in option C, nowhere does it state that you are giving patient information to these people (probably what our teacher meant about reading into the question). You are just asking visiting family memebers if there is anything the patient likes to do at home to help with sickness. If they're visiting, or you have their contact info provided by the patient, then they are already aware the patient is sick in the hospital. You do not need to divulge any information.

    In my opinion, option D shirks responsibility to someone else before you've even tried to figure it out on your own. Part of our job is culturally competent care. If you pass off this task to a coworker, you would never have learned the valuable information that family could give you. As a rule, when you've got another culture in the question and there is an opportunity to learn about that culture in the answer, pick that answer-that's what we would do in real life too!


    When I read the question, it was clear to me that the answer was C, and this is my rationale.

    I hope this helps some. Good luck!
    You are assuming that family is even visiting in C. Again I would have to assume something that is not given in the answer or question.

    I understand your point on D. Simultaneously though I feel the provider should immediately be told a patient is not following their medication nor even their treatment. Rather than "hoping" a more traditional medicine approach may finally get them to take it.
    Last edit by broughden on Oct 3
  10. by   broughden
    Quote from Luchador
    Ya. I'm in my first semester and these "critical thinking" questions are simply poorly written and vague. I know because I was a teacher for quite a few years.

    We had a question in the last test that we all challenged. "A pt says the dr. told her she has a sinus rhythm and asks what that means. Which is the best therapeutic response?"

    Everybody choose "It means your heart is working as it should be working."

    But the correct answer was "It means your SA node is firing normally and triggering the ventricles to contract."

    Most pts won't know wtf the SA node is. Just ridiculous.

    If they really wanted critical thinking the test would be 10--15 written short answer questions instead of 70 multiple choice.
    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!
  11. by   RNNPICU
    Quote from broughden
    You are assuming that family is even visiting in C. Again I would have to assume something that is not given in the answer or question.

    .

    Well in the NCLEX and testing world, things are perfect, so yes, the family would be visiting. Again, reading into the question too much. Don't try and apply what happens in the real world. The NCLEX is the "perfect nursing world". This means that you would have family to talk to, supplies at easy access.

    When I read the question, my first thought was C because, one this is not something you would delegate to someone else. Remember, you have to assess first before you can recommend. You are assessing patient history and cultural beliefs in answer C.
  12. by   edmed323
    NCLEX: don't pass the buck, don't do nothing, don't leave the patient, don't say "don't worry", don't assume anything that is not given in the question
  13. by   hurricanekat
    So take my opinion with a grain of salt because I don't start school until January .... but - we have a unique group of people where I live. I learned very early on with them they have some interesting thought processes. When I read that question - my immediate thought was answer C simply because I do not understand their culture and their family member will. Maybe sticking toothpicks under their toenails and lightening them on fire is a common practice for whatever ails this person and they would immediately respond to a treatment that is familiar to them. I completely chalked this question up to a culture thing and HIPAA didn't even cross my mind. I also didn't spend more than 0.2 seconds thinking about it after I finished reading answer D.
  14. by   broughden
    Quote from RNNPICU
    Well in the NCLEX and testing world, things are perfect, so yes, the family would be visiting. Again, reading into the question too much. Don't try and apply what happens in the real world. The NCLEX is the "perfect nursing world". This means that you would have family to talk to, supplies at easy access.

    When I read the question, my first thought was C because, one this is not something you would delegate to someone else. Remember, you have to assess first before you can recommend. You are assessing patient history and cultural beliefs in answer C.
    But thats my point! LOL
    You say Im reading into the question but IMO everyone else is by assuming things about the family we havent been told in the question....
    Like they are there.
    Like the patient gave us permission to speak to them.

    The question doesnt say they are there. It doesnt say the patient is okay with us contacting them. We are being asked to assume all these things.
    You cant say, "Dont read into the question."
    While also saying, "Hey assume all this crap we havent stated."

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