Nursing Priority vs First nursing action

[NurseLoveJoy88]

We had an exam today and I struggled with one of the answers. The nurse is caring for pt. with HF who is experiencing dyspnea , and bilateral crackles, and pulmonary edema. What is the nurses priority intervention:

Give PRN oxygen or give lasix as ordered.

The answer is apply oxygen but I chose to give lasix. I know all about ABC's and Maslow. However, the reason why I chose to give Lasix as ordered is because the sx are caused by pulmonary edema and the underlying cause needs to be addressed.

If the question would of asked what would should the nurse do FIRST... I would have picked to apply Oxygen.

There is a difference between priority and what to do first. I'm a nurse in LTC ( LPN) and I have taken care many of residents with HF exacerbation. My first nursing action for any resident with SOB secondary to pulmonary edema is to apply oxygen. However, my priority is to make sure that the underlying cause is addressed in order to prevent and treat symptoms. Most of the time that priority interventions includes getting an order for IM lasix if not already ordered.

Oxygen alone will provide temporary relief however it will not get rid of the pulmonary edema.

Please help me to understand how oxygen is a priority instead of a first nursing action. Thanks.

[steelydanfan]

We all agree the answer is O2, but because it's quicker to initiate is really the only reason. ABC's would indicate lasix as the first intervention (the purpose of lasix is to clear the alveoli of fluid, alveoli are part of your airway).

I give up.

[metal_m0nk, BSN, RN]

I am STILL completely flummoxed that there seems to be a difference between "what to do first" vs a "priority".

Apparently, the English language has undergone a sea change while I was not looking.

Tell me about it...

I've actually read a rationale for a nursing exam question that stated that one answer was incorrect because it was the nurse's FIRST action, but not a PRIORITY intervention.

Go figure...

[HealthShepherd]

I am STILL completely flummoxed that there seems to be a difference between "what to do first" vs a "priority".

Apparently, the English language has undergone a sea change while I was not looking.

Many, many English words have more than one possible interpretation.

For example, when I got up this morning, my priority for the day was to study chapters 24 and 25 for my class. However, what I did first was to take a shower. You don't think those are contradictory statements, do you?

Sometimes people use priority to mean what you do first, and sometimes they use priority to mean what is most important. And sometimes those aren't the same thing.

A nursing example: if I need to get a urine sample from my patient with a catheter, the first thing I do is gather supplies. But my priority is to maintain sterile technique. In the OP's example, I'm not so sure that the Lasix is the priority over the oxygen, but I have no problem with the idea that priority does not necessarily equal first action.

The problem is that in the extremely hierarchical culture of nursing school, the teacher's notion of what priority means is the right one. Even though the OP's interpretation of the word is equally valid, she or he is a student and therefore wrong. On the next test, the OP will know how this particular teacher uses the word priority... which will help with that teacher's next test, even if it won't help with somebody else's test (and even if it has nothing to do with understanding the course content or critical thinking).

[steelydanfan]

Many, many English words have more than one possible interpretation.

For example, when I got up this morning, my priority for the day was to study chapters 24 and 25 for my class. However, what I did first was to take a shower. You don't think those are contradictory statements, do you?

Sometimes people use priority to mean what you do first, and sometimes they use priority to mean what is most important. And sometimes those aren't the same thing.

A nursing example: if I need to get a urine sample from my patient with a catheter, the first thing I do is gather supplies. But my priority is to maintain sterile technique. In the OP's example, I'm not so sure that the Lasix is the priority over the oxygen, but I have no problem with the idea that priority does not necessarily equal first action.

The problem is that in the extremely hierarchical culture of nursing school, the teacher's notion of what priority means is the right one. Even though the OP's interpretation of the word is equally valid, she or he is a student and therefore wrong. On the next test, the OP will know how this particular teacher uses the word priority... which will help with that teacher's next test, even if it won't help with somebody else's test (and even if it has nothing to do with understanding the course content or critical thinking).

If your task is to get a urine sample, then that IS your priority; maintaining sterile technique is only one ASPECT of the task.

And I think this argument about semantics is due to be closed.

[HealthShepherd]

Ah, but now you've raised another semantic issue - how do we define a task or action? Is putting on sterile gloves an action, or just part of a bigger action? Or (as I'd argue) are they both legitimately called actions, albeit at different taxonomic levels?

Seriously though, it's easy to call something trivial semantics, but in this case, the interpretation of a word made a difference to the OP's mark (and potentially, to her future). Multiple choice questions can be a timesaver, but all too often the writers don't put enough thought into using unambiguous wording. As a result, the student's result on that question depends on whether or not they correctly guessed what the teacher meant, rather than on remembering, understanding, or applying the course content. This was part of why I hated nursing school so much... this lack of attention (and lack of willingness to consider alternative viewpoints) was so common. They may have put the nursing school in the university, but they haven't put the university in the nursing school yet.

[MunoRN, RN]

I give up.

Feel free to articulate. Is it that you don't agree that the alveoli are part of the airway? Or that the pathophysiology of pulmonary edema doesn't involve fluid obstruction of the alveoli membrane? We all agree that O2 is the answer, but the right answer doesn't mean much if it's based on faulty rationale.

[McGyverRN]

Most agree that the O2 is the first action, priority, whatever you want to call it. The Lasix "that is ordered," is either an already scheduled med or a one time dose. If it is a one time dose, the nurse would have already notified the doctor for the order. Clearly, before applyin oxygen, the nurse would not sit around and wait for the lasix to arrive from pharmacy while the pt waits in respiratory distress. If the lasix is scheduled, I would assume that the dose is not adequate to prevent the pulmonary edema, so more may be needed. In either case, the nurse would apply O2, obtain VS, then notify the MD.

Test questions can be very tricky, and they are even tricker now a days. With the "choose all that apply" options, the NCLEX has become more challenging. As others have suggested, take a review course and practice as many questions as you can before you take the boards. The key component to acing the boards is understanding the rationale behind why each answer is right and why the other answers are wrong.