Large percentage failing nursing school exams, why?

[tganios]

I have a question on the legitimacy of testing in nursing school. Maybe someone can help me out with advice. I am in 3rd semester of nursing school have passed all exams up until my first exam in med surg this semester. In fact only 5 people passed the exam out of 31 people and the class average was a 68. On the second exam it seemed more fair however there were two specific questions like respiratory ques (such as breath sounds) on the GI test that we had no idea would be on the test. The focus was GI. Would it be safe to say that this is being unjust and risking points of students on exams? Can teachers do this or should they give us a review sheet hinting of what to brush up on from previous semesters so we do not risk points that could have been answered correctly if we knew to brush up? From what I can remember, every semester before this one our teachers gave us a study review sheet a week before the exam esp if it contained material from previous semesters and currently the teacher we now have is stating anything is fair game from previous semesters. So how do we study things that have no relation to our exams? Where is the focus?

[nurseprnRN, BSN, RN]

"An 80 year old male complains of chronic chest pain during an office visit. He has a history of high blood pressure, diabetes, high cholesterol, syncope, and coronary stent. He complains that his chest pain increases with activity. He recently required an increase in his cholesterol medication. His vital signs are HR 118, B/P 169/85, resp 16, oxygen sat 94%. The doctor has decided to prescribe a calcium channel blocker. How would you measure its effectiveness?

A) A decrease in blood pressure

B) His chest pain has subsided

C) A decrease in heart rate

D) His cholesterol level was 203

Well...Calcium channel blockers (CCB) do decrease HR...so this is true. CCB do decrease blood pressure...so this is true. The cholesterol level doesn't answer anything. His chest pain subsided....what does that have anything to do with CCB's....they decrease HR and B/P. But the answer is (B). CCB are vasodilators. Angina occurs when the coronary arteries are spasming, so a CCB that stops chest pain is correct because.....................that is what the question was asking! It didn't matter that he had an increase in cholesterol meds. His vital signs are irrelevant. Having angina with activity doesn't matter. A decrease in heart rate could decrease the demand for oxygen consumption, but he had chronic chest pain that only increased with activity; not manifested with activity. A decrease in blood pressure isn't going to to anything for chest pain. And you didn't need to know what a normal level of cholesterol was or whether or not a CCB affects cholesterol levels at all. All that mattered was that this guy had chest pain, the doc gave a CCB, and that chest pain subsided. This addresses the question of effectiveness to his pain...not the effectiveness the medication itself."

I have to address this misconception. Angina is a result of inadequate coronary perfusion. This can happen because of vessel spasm, but it can also happen because of increased oxygen demand from increased heart rate (as with ACTIVITY) or contractility (which occurs with activity due to increased venous return and makes increased BP to support that activity). Therefore any med which decreases HR or BP will decrease oxygen demand, and therefore, angina. The answer that the angina is relieved is correct, but not just because it makes the patient more comfortable-- because it shows that there is no longer inadequate perfusion for the cardiac work being done. "Chronic chest pain" doesn't mean he has angina every waking minute; though he may experience it at rest, it means he has it regularly and often. If it increases with activity, that's a telling sign. Decreasing HR and BP will help relieve his angina, because his increased angina is caused by bumps in HR and BP (and maybe even his baseline BP and HR should be lower).

As to the original question, about third semester being harder, you bet it is. Now you are being tested to see if you remember what you learned last year and, more importantly, have you figured out how to use it in the nursing process using critical thinking. Almost all 2-year nursing programs have some students who make it through the first year, only to be unable to make that leap and so they fail at the end of their third... or fourth.. semester. If you don't want to be one of those people, don't blame it on your faculty. Put increased effort into understanding the why and how, not just the strictly factual information alone. Integrate. Understand. Be able to figure it out in a novel situation, because nurses have to be able to do that. There is no such person who "knows the material but tests poorly." If s/he knows the material and can apply it, that's the criterion for a passing grade. Testing is how we know.