do the really ask this on the NCLEX?

[psu_213, BSN, RN]

I took/passed the NCLEX almost 4 yrs ago--that is why I am putting this under "General Nursing Discussion" not under and NCLEX forum. Anyway, I had a very slow day at work a few weeks ago (slow day are very, very uncommon where I work). I was on the computer and I saw a program of NCLEX practice questions--I forget what the name of the program was. Wanting to see how much I forgot in 4 years, I opened it to take a few. One really stood out:

(paraphrasing) At a facility all med orders are trascribed onto the MAR and onto the pt's Cardex (Kardex? either way, I hate them). A doctor wrote an order for a pt to have a med daily for 3 days. The med was correctly transcribed onto the Cardex, but the stop date was not recorded on the MAR. On the 4th day, a nurse gave a dose of the med. Who is responsible for the med error? (A) the nurse who transcribed the order, (B) the nurse who gave the med, © the facility, or (D) the prescribing doctor.

Their answer was B (which I do agree with). My issues: first, why they heck is this an NCLEX question?? Second, their 'reasoning.' Per them: the facility is not at fault because they have a policy in place to write the med both places. Since the RN giving the med did not check the Cardex, it is her error because it was correctly transcribed there even if it was not correct on the MAR.

I am so glad I don't have to study again for that silly test! P.S. the results of the test are not silly (an RN license)...it is silly on what they test and on how they word questions.

Oh well, rant over.

[kadney183]

lol...anything goes with nclex....don't be surprise!!!

[dudette10, MSN, RN]

Eh, not the first time I've disagreed with an NCLEX-style question. I picked "the nurse who transcribed the order." The Kardex is an unofficial form of nursing communication about the patient, and it isn't a part of the medical record. The MAR is the official med administration record (hence MAR!), and during transcription, the order should go on the MAR! In the scenario, the transcribing nurse failed to note the complete order on the MAR, so she failed to update an official document with the order.

We no longer have a space on the Kardex for medication orders, and I'm grateful for that. Using the Kardex for medications was duplicative and more errors could result from it. Now, it's just physician orders and the MAR. The nurse on the shift in which the order was written updates the MAR, and the next shift is responsible for checking the original orders against the MAR. Why have a third place where things could go wrong? When we did use Kardexes for medication orders, if there was a discrepancy between the MAR and the Kardex, you had to go back to the orders anyway. 99.9% of the time, the Kardex was incorrect, and the MAR was correct because of the pharmacy double check, which doesn't happen with Kardexes.

[GitanoRN, BSN, MSN, RN]

oh! my... i took the nclexrn in my native country madrid, spain, and then i had to take it again once i got to the states in 94" i surely can't remember what questions where asked i was just thrilled that i passed on the first try

[psu_213, BSN, RN]

Well, it was just a practice question, and a silly one at that. I think the rationale should have gone along the lines of "medication errors can be the result of many factors and many individuals can share responsibility for errors, but, in the end, the primary responsibilty lies with the person that acutally administered the medication." I don't know...I just thought the entire question was stupid considering the point of the NCLEX.

[wish_me_luck, BSN, RN]

I would have thought for sure it would have been a select all that apply and would be the physician, the transcribing nurse and the nurse that gave the medication. First, a physician should tell how long to give it; second, the transcribing nurse should have picked up that there was not a stop date; and the nurse that gave it, well, they gave it and never questioned it. That's just my opinion.

[Vespertinas]

Why shouldn't it be an NCLEX question? One of the topics it and other certification exams cover is legal aspects of care. We wrangle with managing these responsibilities everyday in our practice.

[joanna73, BSN, RN]

The nurse who transcribed the order is at fault, but ultimately, the person who physically administers the medication is at fault. That's always the way it is. If you review the document for medication standards, it will say the same.

[tammica]

I just took it Monday and there were no questions like that and from what I can gather is its mostly prioritization and teaching

[AnonRNC]

So, when we administer a med, are we really responsible for verifying the original order?

[elprup, BSN, RN]

And remember with NCLEX always assess FIRST.

[Flare, ASN, BSN]

do they no longer teach that you are supposed to verify the mar and cardex against the original orders? Or was that just my nursing school that beat that into us?