Problem with question

[creyzi4zb12]

I have a problem with some of the NCLex questions on QT7, mainly that one issue where the patient with a repaired fractured hip struggles to get out of bed and says he has to get to clean the kitchen ASAP.

My answer would be to instruct the patient to remain in bed.

But the correct answer was to obtain ABG readings because; rationale says that fat embolism results to cerebral emboli, then to confusion, and that you should assess first.

Shouldn't the patient's safety come first?

Tnx in advanced guys!

[MrChicagoRN, RN]

If drawing ABG is an option, that tells me the patient is hospitalized. If a hospitalized patient needs to clean the kitchen, what is that telling you about their mental status?

if you don't address the underlying confusion, are they likely to listen to you and remain in bed?

[firstinfamily, RN]

Does NCLEX not know about pulse oximetry??? A non-invasive method of monitoring for decreased oxygen levels?? It would be a little too aggressive to just jump and get an ABG. It sounds like the pt is confused, so I would make sure vital signs are OK which would include a pulse oximetry level, I would instruct him that he cannot get OOB, but he most likely will not comply. I would be looking at the pain medications to see when and what he had last and perhaps this is causing some form of confusion. If the pulse oximetry is good then no, I would not be jumping on getting an ABG. Yes, it is true that hip surgery can lead to a major embolism but he would also be having some other symptoms than sudden confusion. I disagree with the NCLeX!!

[creyzi4zb12]

Thanks guys..You are right. The patient is confused and will most likely will not listen to me if I told him that.

Just a clarification tho', that wasn't NCLEX but the Kaplan reviewer test.

[LadyFree28, BSN, LPN, RN]

Does NCLEX not know about pulse oximetry??? A non-invasive method of monitoring for decreased oxygen levels?? It would be a little too aggressive to just jump and get an ABG. It sounds like the pt is confused, so I would make sure vital signs are OK which would include a pulse oximetry level, I would instruct him that he cannot get OOB, but he most likely will not comply. I would be looking at the pain medications to see when and what he had last and perhaps this is causing some form of confusion. If the pulse oximetry is good then no, I would not be jumping on getting an ABG. Yes, it is true that hip surgery can lead to a major embolism but he would also be having some other symptoms than sudden confusion. I disagree with the NCLeX!!

But remember, pulse oximetry has it's issues due to it's non evasiveness; it only measures peripheral oxygenation, not systemic oxygenation; if someone is having confusion due to a possible emboli, pulse oximetry will not be helpful at all; especially is one is compensating.

ABGs are more definitive in determining a diagnostic rationale, especially if there is a change in venous and arterial oxygenation.

[Here.I.Stand, BSN, RN]

But remember, pulse oximetry has it's issues due to it's non evasiveness; it only measures peripheral oxygenation, not systemic oxygenation; if someone is having confusion due to a possible emboli, pulse oximetry will not be helpful at all; especially is one is compensating.

ABGs are more definitive in determining a diagnostic rationale, especially if there is a change in venous and arterial oxygenation.

Plus, the OP doesn't say if this was even a choice--it wasn't an SpO2 vs. ABG question. It was a "why ABG" vs. "tell pt to stay in bed" question.

In this case, the rationale is that the pt is acutely disoriented. We need to know WHY he's disoriented because it's likely an emergent situation, e.g. fat embolus

[ThatBigGuy]

Well, if you follow the decision tree, the ABG answer wins over the "get back in bed" answer, because the ABG is an assessment, while "get back in bed" is an implementation.

Your patient has a sudden change in mental status, which probably is a fat embolus. But in order to confirm your suspicions, you need more info, more assessment. So you grab a stat ABG.

In the real world, you'd absolutely instruct the pt to get back into bed the second you see him getting out of bed. Then you'd call for the ABG. But the NCLEX is a perfect world, so you must think assessment first.

[bemma19]

All contributions here are really great and the final analysis indicates that, with NCLEX world "where all is perfect", you will have to do an assessment first to ascertain reasons for the confusion before you implement...."stay in bed".

Thanks guys