Prioritizing help

[douxmusique]

Hello! I am looking for a bit of direction in figuring out how to seriously get the hang of prioritizing and assessing. I am about to finish Med Surge I and I am getting really frustrated with the tests. I feel like I am studying for whole concept understanding, but when we get to our tests (one every class) I feel like all of our study material (texts and ppt) doesn't cover any of the priority and assessment concepts.

I know a lot of this stuff is up to me to figure out, I just am not sure what the absolute basics are. One week our instructor lectured us for choosing anything other than "assess BP" because we are constantly told that's most important, and then this last quiz we chose that answer and the correct answer was auscultate lungs. Of course none of this was in the text and we are responsible for knowing it and we're grownups we can figure it out, I get it. I just feel like everything is pretty gray. For example- the answer is always assess BP/hemodynamic stability, except when its not. And then the only way I find that out is when I get test questions wrong. Another example from our text was the symptoms of pneumonia- fever, cough, yellow-tinged sputum. Often patients don't exhibit these symptoms. So, again, those are the symptoms except when they're not.

I know these question come from test banks and the instructors aren't out to fail us through their own intentional actions, but I do wonder where the missed memo was on figuring this stuff out. Our instructors have said multiple times "Well, this is a throw away question to me- these two answers don't even fit and this other one is wrong because xyz. That's easy." Trouble is we haven't been nurses for 25 years, not even for one day!

I'm totally passing my classes mid-high 80s, but I'm someone who generally gets A's and I'm not doing that right now. It is driving me absolutely nuts. It's very discouraging to feel like no matter how hard I study or how well I know what to do and what's going on I'm still always going to be wrong. It's even more discouraging to see my hardworking classmates staying behind to repeat the courses because things just aren't clicking for us.

Does anyone have any good tutorials/videos/sites for figuring this stuff out? I am definitely grabbing a NCLEX review book after the holidays , but until then some tips and encouragement would be appreciated.

[SunshineDaisy, ASN, RN]

I always went by ABC's first, then safety and then Maslow's. This book is pretty good Prioritization, Delegation, and Assignment: Practice Exercises for the NCLEX Examination, 2e: Linda LaCharity, Candice K. Kumagai, Barbara Bartz: 9780323065702: Amazon.com: Books

[douxmusique]

Yeah. I get the whole abcs and maslows. When it comes down to choosing between two answers for specific conditions.... like auscultate lungs or check pulse ox, it seems like the answers change depending on the problem and I feel as though I have a firm grasp on the content so how can I decide which one is best, you know? Super frustrating.

[HouTx, BSN, MSN, EdD]

PP is correct - "ABC" is the appropriate way to prioritize but when you are choosing between 2 "A"s, give a higher priority to the one that is most central... so, auscultation would have a higher priority than pulse ox. There are many factors that can affect peripheral oxygenation, but movement of air in the lungs is always essential. At this point in your education, test success is highly dependent upon your ability to integrate ALL of those irritating pre-reqs (A&P, Micro, Chemistry, etc) into your reasoning ability.

If it was easy, anyone could do it

[emtb2rn, BSN, RN, EMT-B]

To build on what houtx said, when it comes to the abc's (non-coding pt that is), it's all about airway, airway, airway.

[acerbia]

Yeah. I get the whole abcs and maslows. When it comes down to choosing between two answers for specific conditions.... like auscultate lungs or check pulse ox, it seems like the answers change depending on the problem and I feel as though I have a firm grasp on the content so how can I decide which one is best, you know? Super frustrating.

Your answer will change depending on what the question is asking you. Airway is always number one though, even if someone is bleeding out. If they can't breathe, it doesn't matter if they're hemorrhaging. But if they can breathe, you can work on the hemorrhage or whatever else is going on. Stopping a hemorrhage won't matter if they can't breathe

[fetch, BSN, RN]

If they can't breathe, it doesn't matter if they're hemorrhaging. But if they can breathe, you can work on the hemorrhage or whatever else is going on. Stopping a hemorrhage won't matter if they can't breathe

Whoo boy was that a hard concept for my class to grasp! Endless discussions with the teacher, "well what about [incredibly specific situation]?" And I struggled with it myself, don't mean to sound like I'm criticizing my classmates. We're so used to thinking gushing blood = super emergency stop it up right away no matter what! Can I blame this on TV shows? I think I'm going to blame it on TV shows.

Also OP, it sounds like you are having your first experience with the bane of every nursing student ever: "B and D are both correct answers, however D is more correct." If you've got a good grasp on Maslow and ABCS, that's a good start! You now have to begin integrating information from your other courses and chapters to help you understand where to go from there - and discarding information that isn't actually helpful.

If you provide the exact questions that you struggled with and all the answers, maybe we could help you work through them and find the key words that will guide you to the best right answer.

[SunshineDaisy, ASN, RN]

Yes! Same here! We always want to stop the gushing blood first and forget the airway. I blame TV too:D

[KelRN215, BSN, RN]

The answer is not always assess BP/hemodynamics. Far from it. If your patient is in respiratory distress, you're certainly not going to go reaching for the BP cuff. If your patient is seizing, BP is the least of your worries. (There actually was a sentinal event at my old hospitals many many years ago where a patient died after a prolonged seizure because while everyone tending to him was focusing on treating his seizure, no one happened to notice that he wasn't breathing.) This is the part of nursing school where critical thinking comes into play. Can you give us an example of a question you had trouble with and the answer choices?

[douxmusique]

I dont know the exact questions because we arent allowed to write them down, just reference pages and im cramming so much into my head right now I dont remember everything exactly.

Everything you guys are saying is helpful and reinforcing everything im trying to put into practice with my classes. Thanks. Its just frustrating trying to learn all this at the expense of my grades I guess. I did better on a test today focusing on a few of things so theres some hope there.