priority nursing questions

jjjoy, LPN · Oct 20, 2010

I'd choose #1 because of the three choices,it's the only "independent" nursing intervention without any need to collaborate (eg check with physician or reference a PRN order) prior to carrying it out

Mandychelle79, ASN, RN · Oct 20, 2010

For that one I would call the physician. Patient went from pain free to in pain, swelling and running a fever. Classic signs of infection.

I dont know of any sites that deal with those type only, but if I see any I will post them here

msjaxson125 · Oct 20, 2010

I would go with adm tylenol,Take care of the pain first, elevate arm, then call md if all interventions are not working,,let us know what the answer is,,,keep pushing!!

pippylockstocking · Oct 20, 2010

Hey all,
Are there any good websites that give NCLEX questions with priorities? I seem to have a little trouble with these questions sometimes and would like more help with them
ex. A ct is 2 days post-op for an ORIF of the right arm. He is now exhibiting pain, fever of 102, and swelling. What is the priority nursig intervention?
A. elevate the arm on a pillow
B. administer Tylenol
C. notify physician
see, whenever I choose notify physician sometimes it is wrong and sometimes it is right. I just need more practice with these types of questions. Thanks for any help!

I would say the answer is Notify the Physician... you have post-op infection going on... for answers A & B they are both correct too, but you need a physician's order to do those things... and they are not as important as notifying the physician... that is where the "priority" comes in... You have to say what is the MOST important.

pippylockstocking · Oct 20, 2010

Also want to add, that if your Surgeon would be downright ****** at you if you did not notify him of temp greater than 101, increased pain, and increased swelling.

decembergrad2011, BSN, RN · Oct 20, 2010

This is one of those times when notifying the physician is actually the right answer. MOST of the time that is not the correct answer, but this situation is beyond the scope of practice for a nurse. We cannot diagnose an infection, a doctor must do that, so when we see the signs of infection, they should be notified.

As someone else said, elevating the arm and administering medication (and always assume you DO have the order for a medication if it's listed amongst the answers) are still good things to do, and most likely you would notify the physician and they would tell you to do that if you hadn't already. But because of the likelihood of post-op infection, you need to give a heads up to the doctor.

BacktotheBeach, ADN, BSN, RN · Oct 21, 2010

Get this book, amazon or half.com are pretty cheap. It is great!

Prioritization, Delegation, and Assignment by Linda LaCharity

isbn 978-0-323-06570-2

Amber0515 · Oct 21, 2010

yeah, the answer was to notify the dr because its sign of infection...my teacher said that it would have been any of the others if the fever was not in the equation. but yes, these questions always get me! do they ever confuse anyone else? is there a trick to not choosing the "wrong" answer?

pippylockstocking · Oct 21, 2010

Amber, these questions are designed to get you to critically think. They seem like they are "trick" questions, but really it's not difficult once you get the hang of it. You want to work at seeing the Signs & Symptoms. This is going to come from your Assessments. Then you want to work at knowing what is normal and what is abnormal. Once you know what a normal assessment is, then knowing what is abnormal is easy. Now you also what to look at what is going on with this patient. The question said this was a 2 day Post-op patient. So right there are already thinking one of the major Nursing Diagnoses... "Risk For Infection". You also know this is an acute change right? Meaning... the patient was not febrile before the surgery was he? Probably not, since surgeries would be postponed if the patient was sick. Now you also have swelling around the surgical site. Some swelling might be normal if this was a fresh post-op that just came to your floor about 2 hours ago. But after 2 or 3 days? You would expect swelling to be decreasing not increasing, right?

So there ya have it... it's all in looking at What is going on with the patient? What are the potential dangers? Using Nursing Diagnoses as your guide for interventions... and looking at the 3 answers... all answers seem right... but there's always one BEST answer or one that is MORE important in priorities. Know what I mean?

Post another question from your book, and I'll see if I can help you figure one out.

jjjoy, LPN · Oct 21, 2010

Thanks for an interesting discussion. I can agree that notify the physician is priority.

The thing is, I remember getting burned on other test questions where "notify the physician" wasn't the "best" answer because the question was asking about "nursing care" - or something like that. It never was made clear to me because we never had enough time to review tests and really figure out the ones we got wrong. So I just remembered that "notify physician" usually wasn't the right answer for test-taking purposes.

So anyway, based on my test-taking experience, critical thinking led to me ask if "notify physician" is a "nursing intervention" since no nursing care is being directly delivered to the patient. Critical thinking would also lead me to ask what "priority" means here. Does it mean "what's more important in the bigger picture?" or "which would you do first if you had mental telepathy?" I mention mental telepathy because critical thinking tells me that to notice the symptoms, the nurse is at the bedside and it would make sense to elevate the arm prior to leaving the room to make the call to the physician. And if someone were just passing those observations along to the nurse, the nurse would first go assess the patient themselves before calling the physician, right?

When applied this way, critical thinking becomes "overthinking" and "reading too much into the question". Sigh!

Amber0515 · Oct 22, 2010

Thanks for an interesting discussion. I can agree that notify the physician is priority.
The thing is, I remember getting burned on other test questions where "notify the physician" wasn't the "best" answer because the question was asking about "nursing care" - or something like that. It never was made clear to me because we never had enough time to review tests and really figure out the ones we got wrong. So I just remembered that "notify physician" usually wasn't the right answer for test-taking purposes.
So anyway, based on my test-taking experience, critical thinking led to me ask if "notify physician" is a "nursing intervention" since no nursing care is being directly delivered to the patient. Critical thinking would also lead me to ask what "priority" means here. Does it mean "what's more important in the bigger picture?" or "which would you do first if you had mental telepathy?" I mention mental telepathy because critical thinking tells me that to notice the symptoms, the nurse is at the bedside and it would make sense to elevate the arm prior to leaving the room to make the call to the physician. And if someone were just passing those observations along to the nurse, the nurse would first go assess the patient themselves before calling the physician, right?
When applied this way, critical thinking becomes "overthinking" and "reading too much into the question". Sigh!

Exactly! That is how I feel! I always think "well, it diesnt seem serious enough for me to call the dr....so now I have to narrow it down.." and sometimes thats where I go wrong, I def overthink. They tell us to think of the NCLEX hospital as the "perfect world" and that we must assume there is already an order for things to be done. I just need to focus more on which is the best answer in each situation because each question like this is always different.