im Wrong? PLZ tell me

[MaleNurse25]

i am currently in lpn-medical surgical 1 and i have a full story about my entry into lpn to this point which helps explain my aggitation and persistance with this but please, someone review these example questions of what i have to deal with. i have setup conference with the lpn advisor with my issue. these type of questions are some we had on our test that i am recalling. please note: i am aware how the instructors want students to initiate critical thinking-i know most nursing questions have more than one answer but student chooses primary/most important; so what am i complaining or talking about? here are a few questions of what i tried to memorize before she took the test back up after we reviewed our grade and test. some questions are from review. the answer option in bold is the answer she said is right and marked right on scantron. the answer option in blue is what i chose; i will include my rationale why i chose it with reason. please-someone tell me how her answer is possible (red why i picked my answer, then think-then tell me) i have researched to try to prove myself wrong because she couldnt-she basically ignored it and moved on. maybe she didnt wanna be told wrong while students are present. here we go!

question 1:

for a patient who is being discharged on digoxin, the nurse should include which of the following in an explanation to the patient on the signs & symptoms of digoxin toxicity?

a. poor appetite

b. constipation

c. halos around lights

d. tachycardia

my rationale: look at the grammar first- "which of the following"-this seems to say *may be one including more to explain to patient-if no-then question is phrased wrong leading to currupting the concept. now to the second part that kills me.."signs & symptoms" -unless i was taught wrong since able to read- dosent the s at the end of a word mean plural-more than one? my favorite last part!! ***sure "poor appetite" is correct..so is halo around eyes!!! i reviewed both to see which one was in order of importance to explain first i guess-after researching everywhere (books,internet ect) i found no order. ~why in the world would a nurse explain just one sign&symptom to look for concerning toxicity? i'd tell all that applied. question should either have been rephrased/constructed better-or add at end of question [select all that apply] to corrospond with "following".

question 2:

a patient is being taught the actions of digoxin, which is an inotropic agent. the nurse defines an inotropic agent as a medication that has which of the following actions?

a. decreases heart rate

b. increase heart rate

c. increase conduction time

d. strengthens heart contraction

my rationale: simply put-im teaching the actions of digoxin. definition of agent is

inotropic agent= any of a class of agents affecting the force of muscle contraction, particularly a drug affecting the force of cardiac contraction; positive inotropic agents increase, and negative inotropic agents decrease the force of cardiac muscle contraction.~a & b are both correct for action of digoxin. where the effect is a pos or neg inotropic is not stated. if she wants ther order of action to be explained to patient then "d" (her stated answer) is 2nd. the hr is decreased 1st. heart contraction after. reference site: http://en.wikipedia.org/wiki/digoxin scroll down to mechanism of action- its cited 3/4 of way down just after parasympathetic nervous system.. please-tell me something to back up her answer "d" and/or explain how i am wrong (have proof-not opinion).

last question...my favorite. this is a question; im pulling from memory, which was on my cardiac exam today.

question 3:

a patient comes in hospital with mi (myocardial infarction) and the nurse needs to determine the patients pain integrity (or word was intensity) to come up with a pain management plan. which is the best way for nurse to do this (or it was "which is the most effective/accurate way)?

---i only memorized my choice & instructors stated answer---

a. monitor vital signs during a pain occurance.

b. assess pain subjectively stated by patient for integrity(or)intensity.

my rationale: http://en.wikipedia.org/wiki/myocardial_infarction states that 1/4 are silent; no pain symptoms. this question has pain present...(( [color=olive]with me so far? )) ..*drum roll* ~choice a-is considered correct by instructor and the scantron grading. uh oh..here it comes.. pathophysiologcally, pain can cause increase hr, increased excitatory (anxiety), ect..which vitals signs can detect. why did i choose b? since pain is included & is being scaled by choice a: vs or choice b: subjectively, and pain management is about to be created--**pain has been taught to be detected and measured as subjective collection of the pain level by the patients own mouth. pain is subjective. yeah it creates pathophysiologic effects; seriously...everyone knows pain is best measured & graded by subjective information. please tell me how a is right over b

my conclusion: what's my point? why are you so worked up?

~~ i have seen these type of questions since nursing fundamentals (one of lpn 1st quarter class). 06/18/2006 i recieved lpn acceptance letter. i was working fulltime-great paying job-been there near 4yrs. lpn program is req full time. i resigned w/ 2 weeks notice. praised& congradulated by co-workers. lpn fundamentals class begins and i remember seeing these certain questions. not typical "questions usually have all right answers, choose primary/important" but like questions above. lowest grade i made in clinicals and case study was a 96. i failed that class by 2.2points due to unit quizes..classmates remember me complaining by a question leading to saying that half pint is 240 which threw the final cc intake calculation off. pint is 500ml, 250 is half. --so i failed along with few others-complaining seemed fruitless. i had to wait 1 year to be evaluated & put into the possible acceptance pool (never a garantee id get back in) my plan and spirit was crushed. during the 1 yr wait i got a job in a hospital (also college for doctors/interns) and while working i had to watch my former classmates continue on-their clinicals on the 3rd quarter just happened to be at my hospital. i watched them with envy & strong disapointment. still, had high hopes and kept saying how angry i failed by 2 points. presently-i got my acceptance letter around august. finished the class is failed last year-oh you know i still carried a grudge and anger towards the system.-im now in 2nd quarter "medical surgical". so really, why these complaints? *consider my rationales to each question. by medical text book i learned and just proved. sometimes i think i may not have really failed by those 2.2 points last year because of the question developments but thats last year & old news. let's say there is a student in a class that possess ability to be the best nurse in the world, who knows the material to the core but fails test by choosing a right answer (like me, that can be proved) marked wrong- & makred answer thats right is but 2nd place or rediculous. if there is so many students lined up waiting for acceptance when only 24 out of 300+ get in... ((gap)) we have such a shortage of nurses..... think my little complaint of these questions should be let go and move on? notice the gap over there in the middle? ~my story here just might be one of the many contributing factors thats creating the coagulation in the middle. some great critical thinking students are failing. some by lack of knowledge or devotion ect..-understanding, maybe true. failing by right. graded by favor. no discussion or factual rationale with proof so-to-speak? i spent alot of time writing this-i am so aggitated by this (maybe just couldnt stand it anymore and my bottle filled up and spilling over) hell, maybe im wrong. instructors havent attempted to prove me wrong. please..tell me.:angryfire:sniff:

[Fig77]

Man, I can see what exactly you are saying. But I can also see why your instructor's answer is more correct in a sense as well. I k

For example, for the first problem both you and the instructor are correct - equally. from http://www.nlm.nih.gov/medlineplus/ency/article/000165.htm

digoxin toxicity Symptoms

• Confusion
  
• Irregular pulse
  
• Loss of appetite
  
• Nausea, vomiting, diarrhea
  
• Palpitations
  
• Visual changes (unusual)
  
  • Blind spots in vision
    
  • Blurred vision
    
  • Changes in color perception
    
  • Halos or rings of light around objects
    
  • Seeing lights or bright spots
    

for the second problem, yes inotropic - being positive agent as well as negative agent. But in this problem we are specificially referring to the digoxin - that doesn't specifically decrease the heart rate, but rather decrease the electrical impulses. Digoxin does increase/strengthen the contraction. it says halos of light around object, and yours around light?

My suggestion is to talk with your instructor and go thruough each answer one by one. That way you will get a chance to see from your instructor's view point and give your rationale behind why your chosen answers are correct or more correct.

[MaleNurse25]

in referance to my question 2: i thank you for your comment but it offered no insight to contradict-disproove why i chose my answer.

however- yesterday came my moment of clarity-i finally figured out what my issue & probelm was. my answer was right-pathophysiologicly as well as the systematical flow of the drugs actions on the heart.b]

im greatful to be thinking as hard as i do but all in all. i was thinking too much.

i was focusing on the literal actions so much i bypassed the intentions of what the question is asking...im telling a patient the actions of that medicine. i can not explian in grave details to a person who has no medical education. if i told them my answer "decreases heart rate-id have to go into the full tells on how it ends with final purpose that results in muscle contraction. the "strengthens heart contraction" choice basically sums it up very simply.

[MaleNurse25]

hmm glancing at the signs & symptoms under visual- i guess loss of appetite would be the right choice because "unusual" is placed after "visual changes"...... where as "loss of appetite" is a definate.

ironic how it took alot of agitation. lack of rationale (explanation) on the test's correct answers...

only i was able to disprove myself.

question 3 still boggles me.... but i will let it go for the sake of retaining my sanity.

[talaxandra]

The problem with multiple choice questions is that there are often two right answers but one is more right. In the first two examples you gave, as you now know, you picked the less right responses - it's annoying but learning from that will certainly help you in the future.

The third question is a little less clear. I've looked after many patients whose MI did not affect their observations but who sustained significant myocardial damage - the key is symptoms rather than signs, and I'm far more likely to treat ischemic pain with a report of intense pain/tightness/shortness of breath than a change in vitals. Frankly, by the time you see an alteration there the patient's already sustained a butt load of damage. I'm far more likely to use the vitals to make sure the anginine I'm giving isn't compromising the BP (thereby reducing blood flow to the already labourng heart) than to check how effective my pain plan is.

On an unrelated but relevant note - please consider using less formating in your posts - the size changes, bolding etc made it harder to read and I ended up skipping everything after "my conclusion."

[Rednights]

#2.

I was taught Dig had a inotropic (force) and chornotropic (time) action.

My drug book says it too.

"... resulting in increased cardiac output (positive inotropic effect); increases force of contraction; decreases heart rate (negative chronotropic effect)"

(Skidmore-Roth, Linda. Mosby's 2010 Nursing Drug Reference, 23rd Edition. Mosby, 062009.).

<9780323066518>

<9781416046639>

[MaleNurse25]

http://en.wikipedia.org/wiki/Digoxin"inhibition of the Na+/K+ pump leads to increased intracellular Na+ levels, which in turn slows down the extrusion of Ca2+ by the sodium-calcium exchanger that relies on the high Na+ gradient. This effect causes an increase in the length of Phase 4 and Phase 0 of the cardiac action potential, which when combined with the effects of digoxin on the parasympathetic nervous system, leads to a decrease in heart rate" -as cited from http://en.wikipedia.org/wiki/Digoxin Under "Mechanism of Action" section.

Basicaly; digoxin DOES slow Heart Rate now in order for the blood to build up in L-Ventricle to create a stronger beat at the end that packs a better punch.

Naturally I decided to dig deeper...

After a few minutes of collected research on the effect of this drug and its theraputic purpose "stronger muscle contractions".. Without calcium channel block aide, digoxin only increase contractility minimally.

:cheers:

[Rednights]

I'm sorry, there's a very small chance you're going to get credit on question #2.

I'm going to emphasize what I posted again since you're still going to fight for it.

Digoxin has a dual action of INOTROPIC and CHRONOTROPIC.

Test taking wise, you're teacher is just going to point out the keyword INOTROPIC. This deals with FORCE, NOT HEART RATE, therefore the answer being Strengthen Heart Contraction. I cannot break it down any further. This question is not multi-dimensional nor requires further analysis. It is BASIC DEFINITION.

We understand Digoxin decreases heart rate, but that's because it's also has a CHRONOTROPIC property.

Since you love citing Wikipedia I will too.

http://en.wikipedia.org/wiki/Inotrope

http://en.wikipedia.org/wiki/Chronotrope

You know what? After reading your post. Here's another basic explanation why #1 is wrong.

You're teacher purposely threw you off. Here's why.

You're anwser was ...

"Halos around LIGHTS"

The correct anwser if she wrote it correctly (but she didn't on purpose) would be

"Halos of light around OBJECTS"

You know why she didn't write it correctly? If she did then that question would be bogus and the question would have to be dropped since two anwser are correct. The anwser you choose is NOT CORRECT based on the fact that ...

The Halos form around OBJECTS not LIGHT.

Here's my citations ...

"visual illusions (white, green, yellow halos around objects)"

(Kee, Joyce Lefever. Pharmacology: A Nursing Process Approach, 6th Edition. Saunders Book Company, 102008. 55.5.2.3).

<9781416046639>

[Music in My Heart]

I didn't read your whole post (your liberal use of colors, font sizes, etc was very hard on the eyes) but...

As to question number 2, it's not even a matter of "better or worse" answer... it's a simple definition: "The nurse defines inotropic as..." The fact that it was dig had no bearing on the question.

Inotropic = strength

Chronotropic = rate

[MaleNurse25]

I withdrew completely from the LPN program and my Tech college. I am accepted into the undergraduate pre-med doctorial program at our University college.

I took into consideration the comments my Instructors said to me, two of them were "*myname* your thinking too much and too deep" (my original is example) and "*myname*, you know what your problem is..your thinking like a Doctor in a nursing class"

Since I wanna be a Dr in the end. Made sense.

[almostfearless]

I've looked at #3, and I believe that what they are going for is that when you do a VITAL ASSESSMENT, you are searching for not only the pain level, but all possible CAUSES. We are being taught that part of your assessment of vitals INCLUDES a pain scale assessment.

In the Digoxin question, they are asking specifically what inotropic means, not the whole effect of the drug.

It makes sense that you would overthink those. You just mentioned that you were aiming for Doctor, and I feel that could be quite suitable for you since doctors are more sternly clinical in their thought. Nurses must go a step further and be abstract about the way they think. Not so much "Educate about all of the possible toxicity symptoms" but more of "What education is *most* beneficial to my client?"

I hope that makes sense or that I'm not speaking out of turn. I wish you the best, and congrats on Med School!

[MaleNurse25]

In your response to my #3 Question, that is the best answer that makes sense. Yes-patients response to rate pain is obviously important. The vital answer im assuming covers all aspects needed to compose a "pain management program", the pain scale which is included along with vital numbers that determine the fluctuation & how hard the pain is throwing the body's systems off wack which may dissrupt upcoming testing.

I would not have been so angered if only the "right" answers were explained in full rationale.

Thanks for the input. I just decided to jump straight into Dr now because apparently my instructors made it clear that-yes, critical thinking is needed, but your thinking further & deeper than a nurse would.

best way to put it is a baseball metaphore- Im up at bat. The entire field is Nursing & Patients. I hit the ball over the fence (homeRun). Where the ball went is great but does no good if the patient cant reach it (understand things).

As for the Digoxin -Inotropic Question- It is true it is stateing its an Inotropic. Yes it does not say whether its Positive or Negative Inotropic because that is irrelevant info because All in all, both my answer & theirs are right. Both are the Inotropic actions. Digoxin simply can not work without decreaseing the HR to what ever extent the doseage is. Do you concur?

(Im not worried or furious with these questions any longer but I do enjoy the debate of these)

Some info on study done of Digoxin in detail..

http://nels.nii.ac.jp/els/110002580761.pdf?id=ART0002842807&type=pdf&lang=en&host=cinii&order_no=&ppv_type=0&lang_sw=&no=1257304996&cp=