one more thing???

[lpnhell]

I just wanted to ask everyone if they have a particular way to look at these questions on my nursing exams... all four answers are correct, but there is only one answer. Help!!!!!!!!!!!! :uhoh3: :uhoh3: :uhoh3: :uhoh3: :uhoh3:

[Daytonite, BSN, RN]

If they are questions that involve straight information about some subject, you just have to know the information. If they are asking about a process or a disease you need to know the progression of the symptoms (what symptoms come first, then second, then all the way to when you get so bad you're ready to die). Depending on what they are asking is what you choose as the answer.

For questions involving nursing interventions and some decisions about what to do first, you should try to put the situation the question is giving you in terms of the nursing process and where in the nursing process you are. Know your steps of the nursing process: assessment, determine the patient's problems (develop nursing diagnoses), plan care (determine outcomes and nursing interventions), put the plan into action and evaluate whether or not goals are being met and go through the whole process again to amend the plan if needed. Some questions will clearly be asking you something about the initial assessment. Keep in mind that you can't determine any nursing interventions until the patient has been assessed and the problems determined. Sometimes you'll be told a problem already has been determined and asked which intervention is the most important to perform first. That kind of information comes from your nursing textbook. You can sometimes figure it out if the different interventions listed are related to the symptoms and you can determine which symptom would lead to a worse situation if left ignored and another symptom addressed before it.

One thing that I know can be confusing is when questions ask about assessing patients. There are some nursing interventions that do involve assessing the patient's response to a treatment or medication or monitoring for signs and symptoms of an impending problem. These are interventions and not really part of that initial comprehensive patient assessment that is done when you first come upon the patient.

You also should know basic Maslow's Hierarchy of Needs. It will help you in figuring out which nursing interventions take priority over others. You will hear people say, "go by your ABCs (airway-breathing-circulation)". While that is kind of what I mean, the actual hierarchy in order of all the priorities is:

• Physiological needs (what the body absolutely needs to stay alive)
  • oxygen (this is the ABCs. Actually oxygen to the brain comes first, then oxygen to the lungs, the heart, then other tissues of the body)
    • brain
      
    • lungs
      
    • heart
      
    • other organs

    [*]nutrition (either oral or IV)

    • fluid
      
    • nutrients (food)

    [*]elimination (urine and feces)

    [*]temperature control (fevers)

    [*]sex

    [*]movement (physical activity which includes addressing mobility problems and immobility problems

    [*]rest (sleep)

    [*]comfort (pain control)

  [*]Safety and security needs

  • safety from physiological and psychological threats (falls, prevention of decubitus ulcer formation, anxieties and fears, confusion)
    
  • protection (fall prevention)
    
  • continuity of care
    
  • lack of danger

  [*]Love and belonging needs

  • affiliations
    
  • affection
    
  • intimacy
    
  • support
    
  • reassurance

  [*]Self-esteem needs

  • sense of self-worth
    
  • self-respect
    
  • independence
    
  • dignity
    
  • privacy
    
  • self-reliance

  [*]Self-actualization needs

  • recognition
    
  • intellectual growth
    
  • attainment and maintenance of health
    
  • autonomy

If you are asked what nursing action is most important to perform and you can place each somewhere on this hierarchy, the one that's nearest the top is the winner.

Make sure you read the root, or stem, of each question carefully. Instructors will put distracters and other information in the answer choices in an attempt to draw your attention away from what the root, or stem, of the question is asking for.

Make flashcards to help you memorize lists of interventions or lists of priorities of care. Review your flashcards frequently for just a few minutes to get maximum effect from them. This is painless learning.

[lpnhell]

Daytonite-- What do you mean about flashcards with interventions? Could you give me an example? Thanks

[Daytonite, BSN, RN]

The front side of a flashcard. . .

[mouse]What nursing interventions should be performed along with giving oral diabetic medications to a newly discovered diabetic?[/mouse]

The back side of the flashcard. . .

[mouse]

Assess the patient's knowledge of diabetes

Obtain a medication history including any allergies

Assess vital signs and blood glucose levels

Teach the patient about the symptoms of hypoglycemia and hyperglycermia

Tell the patient to check the safety of taking any OTC medications along with the oral antidiabetic medication with the doctor

Tell the patient that he should not take alcohol with sulfonylureas

[/mouse]

[chiquiraveloski]

Daytonite,

Which should be a priority....urinary retention or pain?

They both fall under the physiological needs but which one

takes priority? They both seem to be equally very important...

Urinary retention- being part of your "elimination", but

pain, also being your "5th vital sign"? i'm stuck. please

shed some light on this for me.

[Daytonite, BSN, RN]

Addressing urinary retention would take priority over pain. If the urinary retention isn't relieved, urine will back up into the kidney causing hydronephrosis and eventually renal failure. Urine sitting around in the bladder will eventually develop an infection. Eventually the bladder would burst resulting in a surgical emergency. Death would ultimately follow if this problem is not addressed. Pain won't kill the patient--at least not nearly as quickly as urinary retention will.

When you refer to physiological needs, you are talking about basic needs to keep the body alive. Without oxygen, brain cells die within moments. Heart tissue also dies without oxygen, but not as quickly. You can live longer as long as you have water and because your body will use the stores of fat and eventually break down and metabolize muscle and other protein tissues. Without food and water, you can last maybe a week or two. If your body can't get rid of its waste products, toxins build up putting tremendous strain on the kidneys and liver and resulting in their failure and your death. Do you see how these take priority? Pain just doesn't do that to the body on the same scale.

However, I realize that some instructors are teaching that pain is a top priority in some care plans over other issues, particularly if the patient's admitting problem was treated by surgery. If that is what you are being told and your grade depends on it, then follow your instructor's directions. It was not, however, how I was taught to prioritize and sequence pain.

[mrscurtwkids4]

I just wanted to post to compliment Daytonite on the thorough response that was given to this post. It is very helpful, especially when I compare what you have written to how it was explain by some of my instructors. Now that I'm graduated, I understood the basic concept of the heirarchy, but it was still a bit confusing with how they had explained it. Thanks for breaking it down into a more easily understood clump of information!

[chiquiraveloski]

Thank you very much Daytonite, for your prompt and thorough

response. This UR/pain issue have been bugging me and I now have a

better understanding/grasp of this concept.

[fleur-de-lis, BSN, RN]

My tips:

1) Before you look at the answer choices, get an idea in your head of the correct answer, then read the choices looking for a close match. This one is not fool-proof though but it helps if you are like me and start over-analyzing each of the options.

2) Go with your gut and NEVER change an answer unless you truly misread the question (like it said which is not true and you thought it said which is true)

3) Remember the ABCs (airway, breathing, circulation) ALWAYS priority.

4) Really listen in class so you can get an idea of how your instructor thinks. Some of the questions are so objective it comes down to understanding what the instructor is looking for. I taped my lectures and also took notes, then listened to the lectures again with an ear for themes and trends in what the instructor was saying. If something is repeated more than once, there is usually good reason!

Good luck!