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:
I would not have been so angered if only the "right" answers were explained in full rationale.
Beleive me, I understand. The expectations aren't always laid out. I'm having the same problem at my school. :)
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.
I think your thought processes are just highly factual and scientific. Which is not a bad thing! But you have to be able to judge what's really being asked. If a patient starts asking what they will do with their dog while they are in surgery, they may actually be asking "Am I going to be ok".
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).
that's a great metaphor! I might share that with a few people I know. :)
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?
it is true that Dig slows heart rate and strengthens contractions. But is that what the question was asking? The question was asking "what is its INOTROPIC action"
And Im glad you are still willing to discuss this. Because I can guarantee you that med school will do the same thing.
(Im not worried or furious with these questions any longer but I do enjoy the debate of these)
Wonderful! Because an unexpected outcome of this discussion is that I am reinforcing some knowledge that I'm currently gaining. We had been talking about Dig in class, but this discussion has helped me to remember it's properties better. I learn by talking. :)
Here's the scoop. They are right and you will not be. Period. Learn how to take the tests by testing yourself constantly. There are plently of websites that offer testing, probably your books came with NCLEX style questions, there are tons of books with NCLEX questions. If this has been a problem for you in the past, you'd better change your tactics and soon. You spent a lot of time sending that post and being angry. Being angry is not going to open your mind to learning. Start over. Take a deep breath and learn how to take tests. Good luck you can do it!
I didnt read your entire post cause it made me dizzy, however just looking at the first question is telling me your problem. You have to think by applying and not by memory.
I dont know what theory you are following in your program but the first thing I was taught in my Nursing program was to follow OREM's Theory. If you followed OREMS Theory you would see that FOOD is third in hierarchy of Needs and must be satisfied before "Halo around lights/objects etc."
So yes, You might have read that Halo around objects is one of the side affects (thats relating it to what you memorized), but applying the material to a theory is what you should focus on and had you done that you would have seen that a Poor Appetite would have been the answer without doing any further research.
as for thinking like a doctor and not a nurse...i would NOT be bragging about that...lol.........nurses prevent doctors from accidently killing people.....i would be bragging more about being a doctor who thought like a nurse....
there would be less issues in the world with patient care....
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.
Thread from the dead. I hope before you get that MD you understand that inotropic and chronotropic are different things lol. Dig is a POSITIVE INOTROPIC and NEGATIVE CHRONOTROPIC...what's the problem? And I hope you don't write orders with varying sizes in font, or E's in the word stating.
Oh and that baseball metaphor makes no sense because you can't get the ball either. oh well
Here's another metaphor, some ppl have baby sized hands and try to palm a wet beachball(nursing)...some folks just can't grasp it.
your just starting premed....your not in med school....far from it....sound like to me you couldnt cut it in nursing school....so you ran to the next best thing....dont put down nurses because you didnt like the program you were in.
almostfearless
131 Posts
I would not have been so angered if only the "right" answers were explained in full rationale.
Beleive me, I understand. The expectations aren't always laid out. I'm having the same problem at my school. :)
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.
I think your thought processes are just highly factual and scientific. Which is not a bad thing! But you have to be able to judge what's really being asked. If a patient starts asking what they will do with their dog while they are in surgery, they may actually be asking "Am I going to be ok".
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).
that's a great metaphor! I might share that with a few people I know. :)
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?
it is true that Dig slows heart rate and strengthens contractions. But is that what the question was asking? The question was asking "what is its INOTROPIC action"
And Im glad you are still willing to discuss this. Because I can guarantee you that med school will do the same thing.
(Im not worried or furious with these questions any longer but I do enjoy the debate of these)
Wonderful! Because an unexpected outcome of this discussion is that I am reinforcing some knowledge that I'm currently gaining. We had been talking about Dig in class, but this discussion has helped me to remember it's properties better. I learn by talking. :)