Instructors make up your mind! (or please at least know the answers to your own exam)

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Specializes in Critical Care, Trauma, Neuroscience.

Ok so I'm sure this topic has been done to death, but seriously I have to get this out. And maybe someone can knock some sense into me and tell me that I'm being unreasonable for some reason I have yet to think of... Maybe this is all for the betterment of nursing students everywhere. I don't know.

So is it just me, or have you all noticed that with nursing exams, different instructors have different opinions on the "most correct" answer...? One will say one thing and another will say something different. Or the book will say one thing, and then the test answer will directly contradict it. And then when you try to argue it, they will act like you were supposed to read their mind - like it was common sense for you to know that the answer to that specific question was beyond the book?! It's sooo frustrating!!!! I'm not upset about my grades.. this is not a rant about that. I'm doing okay in that area. I'm just frustrated at the lack of consistency - I want to be able to know for certain that the information I'm learning is correct! I know it's about critical thinking, but I don't like nit-picky, direct inconsistencies!

Let me give you an example. I'm not sure how your nursing school does things, but with mine, we have like 2-3 lecture instructors plus a clinical instructor. Usually they will switch off and on for different lectures depending on their "specialty". This semester, we have had one instructor the first half of the semester, and now a different one for the 2nd half. So we are doing a lecture on cancer and this Instructor A has some practice questions for us, but they are from the Instructor B's powerpoints... The answers for the review questions were online in the Instructor B's notes from her powerpoints so as Instructor A starts going over the questions, we all figured we knew the answers, but we were happy to be able to discuss the rationales, etc. We were shocked when Instructor A gives different answers for about half of Instructor B's questions. She tells us that she is giving us the "right" answer... because such and such. Here is an example of a question (these are not actually from a test, so I think it's okay to post it online...?):

1. Which of these patients would be best for the oncology charge nurse to assign to the intensive care unit RN who has floated to the oncology unit today?

A) A 22-year-old patient with acute myelogenous leukemia who is scheduled to receive chemotherapy

B) A 31-year-old patient with ulcerative wounds caused by breast cancer who requires frequent dressing changes

C) A 60-year-old patient with metastatic prostate cancer who needs frequent pain assessment and treatment

D) A 72-year-old patient with colon cancer and a new colostomy who is experiencing severe body image changes

Instructor A says that the correct answer is C because you would want to assign the wound care pt to an lpn... (assuming you have an lpn around?! I thought we weren't supposed to assume anything about the question...?); Instructor B says the correct answer is B because the intensive care nurse would have experience in assessing skin and wounds and in doing complex dressing changes.

Another question:

1. Situation: Your patient is admitted to begin combination chemotherapy for colon cancer. The chemotherapy agents that he will receive will cause significant nausea. He is eager to get started on the chemotherapy regimen and also anxious about the potential nausea. What medication would you expect to give this patient before chemotherapy to decrease the incidence of nausea?

A) Morphine

B) Ondansetron (Zofran)

C) Naloxone (Narcan)

D) Valium

Instructor A says the correct answer is B (everyone immediately chose this answer). But Instructor B says correct answer is C because it prevents CIN by blocking the 5-HT3 receptors in the brain (chemo trigger zone) and in the intestines. This action prevents serotonin from binding to the receptors and activating the nausea and vomiting centers.

Anyway... there really is no point to this post except that I'm getting really frustrated with the inconsistency. This is just a small example. there are probably way better ones, but this just happened this morning so it's fresh in my mind. This has been happening all semester. Half the time, you ask for a rationale for a test question, and the answer is "you just know that... it's obvious" when the book says otherwise.

Ok, rant over. I guess I just have to get better at reading the instructor's mind. :idea:

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Specializes in Pediatrics.

As an instructor, all I can tell you is they we do disagree amongst ourselves frequently. Sometimes our egos (and our perceived "expertise" in a particular area are what drives us to not back down on certain answers. I know this doesn't help you, but I will be the first to agree with you.

FWIW, I agree with the zofran (I worked in onc for years and never gave narcan for nausea. A

I also agree with giving the float nurse the pt with dressing changes (and the stem, as you stated it here, says the float is an RN- who incidentally can handle that anyway).

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Ive dealt with this issue several times in the last two years, but if we were able to show them in the book why we chose a certain answer, than most of the time we got that point back. I think that with our school, this stems from instructors not making their own tests and using tests from previous instructors and classes, etc... But I definitely would've picked Zofran as Narcan is most widely used for Morphine anedote... Not to say it couldn't be indicated for nausea, just that they don't teach us that in nursing school so why would a student pick that answer??

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Also, on the first one, I chose B. I chose this answer because all of the other three answers were dealing with cancer related issues that the oncology nurses would be use to seeing, and B was dealing with pain assessment and the such which every nurse is familiar with.

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Specializes in Critical Care, Trauma, Neuroscience.

Thanks nurse educate! I do feel like a lot of times when we ask the instructors a question, they feel like we are challenging their knowledge, when honestly we are just trying to understand the rationale! I would not at all think less of them if they told us they needed to double check or rethink something! That would be better in my opinion! Or it would be good to have a discussion to understand the thought process behind the test question rationale. At least speaking for myself, I know that I honestly just want to learn... and I also want to understand what they want on the darn tests LOL!

Yes, it is our school's policy to give us the test answer if we can back it up with the book as a reference. I have done this multiple times this semester, and there is no rhyme or reason to WHY they will give back the questions they will or wont! The first test, I challenged 3 answers, and got them all back. The second, I challenged 4 questions, and got 2 back, but they were all equally backed up with quotes, page numbers, etc. The 3rd test, I challenged like 6 and got 3 back. I always challenge all the answers I get wrong unless I honestly know I was just grasping at straws when I answered it. But usually, I answer a question with a part from the book or powerpoint in mind to back myself up.

Yeah, I also definitely chose zofran! Apparently narcan was in one of the obscure charts in the book, and we were supposed to memorize it. And patient B makes the most sense because the ICU nurse would have more experience with wounds! But InstructorA was saying that you should save that pt to be delegated to a lpn, and let the ICU nurse do pt. C because pain assessment is a general thing, a universal skill all RNs should know.

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My experience was similar lelafin. I can only commiserate. :heartbeat

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Specializes in Hospice / Ambulatory Clinic.

IDK Although pain assessment is a general thing there are many nurses not comfortable with managing pain at the level an oncology patient might need. I would assign patient B with the dressing changes to the ICU nurse. Never give an answer based on an assumption. If you have to assume assume that you and the ICU are all you have for the 4 patients listed.

I think for the other question if its a straight forward question like you'll find on the NCLEX then Zofran would be the answer but if its a tricky oncology specific question C might be the answer.

Just tuck all those little bits of info in your head. It'll make more sense in practice. Until then I would refer to the NCLEX study guides as all NCLEX questions have to be verified in 3 different accepted nursing texts before they are allowed in the test. (This info I got from a nurse who is on the question writing committee)

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