I always was successful in my Nursing fundies class as well as my pediatrics's class, and maternity class. This summer I started Med Surge and I study the same way I did for previous nursing classes and I am having such difficulty. With this Med Surge class is considered Med surge Part 1 (out of 3 parts) and because it is a summer semester it has been fast pace, only 6 weeks. So we have 2 Unit exams and 1 Final exam. My unit 1 and unit 2 exam are worth 30 and 30 % of our grade so our Final exam is worth 40%. Passing in our school is considered a 77. My first exam I got a 70, My 2nd exam I got a 78 (but originally it was a 75 until they threw out a question) ...so next week is the final and I am terrified because Ive done so much studying and it just doesn't seem to be good enough, I have met with peer tutors, also the professors for extra help. The professors have suggested I be tested to see if I need accommodations for while I take my tests. However I still can't grasp why I was successful before and now having such difficulty. I was never an A+ student but I never seemed to "fail" at things.
Any Advice, tips is greatly appreciated. I struggle with anxiety and this class has effected my performance at my job so much, I use to never have panic attacks and now I just seem to worry about not making it through to the Med surge part 2.
The first question is seeing if you 1) recognize 'coffee ground emesis' as gastric bleeding. (The blood from the stomach bleed partially digests, so looks black, curdled, and lumpy--very much like coffee grounds.) When a patient has GI bleeding they can lose a lot of blood but it's hard to know how much loss there is. If they lose enough, their blood volume decreases--the consequence of less blood volume is lower blood pressure. And, with less blood, they have fewer RBCs carrying O2 and nutrients, so the body compensates by circulating the remaining blood faster--so the blood is moving to the lungs, back to the heart, around the body at top speed to keep the cells and tissues oxigenated (higher pulse rate). So, if this is your patient, you want to access whether the BP is normal (or low) and whether the pulse is normal (or high). Remember the nursing process steps: Assess, Diagnose, Plan, Implement, then Evaluate. Before you can do anything, you have to determine if and what problem you're dealing with. (Hint: if 'assess' is in one of the answers, that is often the right answer!)
Question 2 is a bit tricker. But, I'd pick D (encourage the wife to be observed for suicide). You're right that she has not threatened suicide, but there are three reasons I'd pick that answer: first, young adults often do commit suicide when a close friend or relative dies who was also young. Second, it's the 'better safe than sorry' rule: sending her home to an empty house is much riskier than admitting her for evaluation. Third, the answer D has that word 'assess' in it! You haven't determined her state of mind or emotion, so she needs to be assessed!
NCLEX questions can be difficult because more than one answer can seem so plausible! But, always go for the 'access' answer (unless the question gives you enough information that you know you're further along in the nursing process), and pick the most prudent answer (safety is the goal). The other point to remember is priority--a head bleed is worse than a broken finger, chest pains are a potentially bigger problem than a foreign object in the patient's eye (death is worse than blindness!) So, consider these points when choosing an answer... nursing process, safety, and priority.
These questions definitely are tricky! I took 2 practice NCLEX quizzes online a while back. I scored "half right" and "half wrong" on one of them, but I didn't think it was too shabby for not having gone through an actual nursing program, let alone taking any pre-requisite courses. However, if/when I trudge through my program and get to that point, I would, of course, have studied like a tyrant beforehand...
ETA: by encouraging her to express her emotions we would be able to assess her suicide risk better IMO
Reread the question. It describes her as 'crying hysterically'. When you take the NCLEX you need to be able to create mental images in your mind. As a former psych nurse, I can assure you the writer of this question has in mind a person so distraught she is incapable of communication, unable to comprehend instructions, and in the first stage(s) of grief. The word 'hysterical' is key. (NCLEX questions are very precise in their wording.) A quick verification of my definition of 'hysteria' or 'hysterical' describes a person overcome by emotion:
hys-ter-i-a
(h-str-, -stîr-)
n.
1. Behavior exhibiting excessive or uncontrollable
emotion, such as fear or panic.
2. A mental disorder characterized by emotional
excitability and sometimes by amnesia or a physical deficit, such as paralysis,
or a sensory deficit, without an organic cause.
The DSM-IV (and soon-to-be-published DSM-V) address normal and abnormal grief and the impact it has on the patient (and in the case of this NCLEX question, the patient you are dealing with is the hysterical widow). Since I'm not at work and don't have access to journal articles, I'll quote Dr. Stephan Diamond in Psychology Today, "One danger in such cases is the very real risk of suicidality, which increases with clinically depressed individuals in general, and especially in someone who has recently lost a significant other."
All the information is in the text of the question for a new nurse to make the right choice (and remember, NCLEX questions are geared to the new grad, not clinicians with vast psych experience who can assess suicide risk in an individual in crisis). This is clearly a question where a determination is being made on your ability to make decisions impacting the safety of a patient. Never make decisions beyond your scope of practice or your ability as a new nurse.
your pt begins to vomit coffee ground emesis your first intervention for this patient would be..
a. asses bowel sounds
b.asses vital signs
c. insert a ng tube
d. contact the physician
you know, or should know, that "coffee grounds emesis" means gastric bleeding. at that point, it doesn't matter immediately whether she has bowel sounds, you can't sink an ng without a medical plan of care that includes one, and if you call the physician, what are you going to say? "the patient just vomited coffee grounds." and the question that will come from the doc then is? "what's her blood pressure?" meaning, "do i have to call the gi on-call for a stat endoscopy and order six units typed and crossed right now, or have i got time to put on my pants and get there from the on-call room at the other side of the building?" always choose the thing that gives you the most useful information. the only possible answer is b. (there are four s's in "assess," too.)
Reread the question. It describes her as 'crying hysterically'. When you take the NCLEX you need to be able to create mental images in your mind. As a former psych nurse, I can assure you the writer of this question has in mind a person so distraught she is incapable of communication, unable to comprehend instructions, and in the first stage(s) of grief. The word 'hysterical' is key. (NCLEX questions are very precise in their wording.) A quick verification of my definition of 'hysteria' or 'hysterical' describes a person overcome by emotion:
hys-ter-i-a
(h-str-, -stîr-)
n.
1. Behavior exhibiting excessive or uncontrollable
emotion, such as fear or panic.
2. A mental disorder characterized by emotional
excitability and sometimes by amnesia or a physical deficit, such as paralysis,
or a sensory deficit, without an organic cause.
The DSM-IV (and soon-to-be-published DSM-V) address normal and abnormal grief and the impact it has on the patient (and in the case of this NCLEX question, the patient you are dealing with is the hysterical widow). Since I'm not at work and don't have access to journal articles, I'll quote Dr. Stephan Diamond in Psychology Today, "One danger in such cases is the very real risk of suicidality, which increases with clinically depressed individuals in general, and especially in someone who has recently lost a significant other."
All the information is in the text of the question for a new nurse to make the right choice (and remember, NCLEX questions are geared to the new grad, not clinicians with vast psych experience who can assess suicide risk in an individual in crisis). This is clearly a question where a determination is being made on your ability to make decisions impacting the safety of a patient. Never make decisions beyond your scope of practice or your ability as a new nurse.
You are right, I didn't remember seeing "hysterical" crying in the question. Thanks :)
-st
r
-
, -stîr
Patti_RN
353 Posts
The first question is seeing if you 1) recognize 'coffee ground emesis' as gastric bleeding. (The blood from the stomach bleed partially digests, so looks black, curdled, and lumpy--very much like coffee grounds.) When a patient has GI bleeding they can lose a lot of blood but it's hard to know how much loss there is. If they lose enough, their blood volume decreases--the consequence of less blood volume is lower blood pressure. And, with less blood, they have fewer RBCs carrying O2 and nutrients, so the body compensates by circulating the remaining blood faster--so the blood is moving to the lungs, back to the heart, around the body at top speed to keep the cells and tissues oxigenated (higher pulse rate). So, if this is your patient, you want to access whether the BP is normal (or low) and whether the pulse is normal (or high). Remember the nursing process steps: Assess, Diagnose, Plan, Implement, then Evaluate. Before you can do anything, you have to determine if and what problem you're dealing with. (Hint: if 'assess' is in one of the answers, that is often the right answer!)
Question 2 is a bit tricker. But, I'd pick D (encourage the wife to be observed for suicide). You're right that she has not threatened suicide, but there are three reasons I'd pick that answer: first, young adults often do commit suicide when a close friend or relative dies who was also young. Second, it's the 'better safe than sorry' rule: sending her home to an empty house is much riskier than admitting her for evaluation. Third, the answer D has that word 'assess' in it! You haven't determined her state of mind or emotion, so she needs to be assessed!
NCLEX questions can be difficult because more than one answer can seem so plausible! But, always go for the 'access' answer (unless the question gives you enough information that you know you're further along in the nursing process), and pick the most prudent answer (safety is the goal). The other point to remember is priority--a head bleed is worse than a broken finger, chest pains are a potentially bigger problem than a foreign object in the patient's eye (death is worse than blindness!) So, consider these points when choosing an answer... nursing process, safety, and priority.