Reposting Tonsilectomy question...

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Hello, Student here. This test question is driving me crazy. I prevuosly posted this question, but reposting d/t gave wrong info in one of the answers. Question; 10 yr old pt comes up on floor following a tonsilectomy. What would be the first thing the nurse would address?

A. dark brown emesis

B. falls asleep during assessment

In my textbook it clearly states that dark brown emesis is a normal finding here. I chose B d/t how can you asume the pt fell asleep, couldn't this be a change in level of conscisness possibly from trauma from surgery? I would think that you you first further assess to make sure that that this pt is just sleeping. However, the correct answer from my teacher was A. Don't understand why it would not be B. Your thaughts?

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Specializes in med/surg, telemetry, IV therapy, mgmt.
question; 10 yr old pt comes up on floor following a tonsilectomy. what would be the first thing the nurse would address?

a. dark brown emesis

b. falls asleep during assessment

the correct answer from my teacher was a. don't understand why it would not be b. your thaughts?

"address" means "do something about". sleeping is normal following anesthesia, so you would continue to allow the patient to snooze. however, you would begin interventions to allay the emesis, wouldn't you? i would. read the stem of these questions carefully. you let part of an answer choice suck you in to thinking the question was about assessment--and it wasn't.

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Specializes in Med/Surg, Tele, IM, OB/GYN, neuro, GI.

Did you show the instrustor what the book said? When I was in school if the instructors thought it was something else and we found a different answer in the book the instructors would either accept both answers or throw the question out.

However, to me A is still the right answer because you would want to do something for the patient to prevent them from vomiting again. It's asking what you need to address. I would leave a patient to sleep but I would want to prevent them from causing complications from vomiting. Patients are usually sleepy after surgery do to the anesthesia not being completely worn off.

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I kind of understand your rationale, however I still think you should first address the "falls asleep during assesment" d/t stated above.???????

"Address" means "do something about". Sleeping is normal following anesthesia, so you would continue to allow the patient to snooze. However, you would begin interventions to allay the emesis, wouldn't you? I would. Read the stem of these questions carefully. You let part of an answer choice suck you in to thinking the question was about assessment--and it wasn't.
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I meet with the teacher monday to discuss this. Maybe I'm reading to much into the question. I know a pt would be tired following anesthesia. However as stated text said this is a normal finding, sure I would address it but falling asleep DURING assesment I think should be addressed first b/c I was told you can't assume pt is sleeping. And the fact that he was awake but then fell asleep DURING assesment would prompt me to make sure this was not a change in level of consciousnes (m/s) and that they are merely just sleeping. Ugh.....don't know about some of these questions:banghead:.

Did you show the instrustor what the book said? When I was in school if the instructors thought it was something else and we found a different answer in the book the instructors would either accept both answers or throw the question out.

However, to me A is still the right answer because you would want to do something for the patient to prevent them from vomiting again. It's asking what you need to address. I would leave a patient to sleep but I would want to prevent them from causing complications from vomiting. Patients are usually sleepy after surgery do to the anesthesia not being completely worn off.

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Specializes in med/surg, telemetry, IV therapy, mgmt.

Have you ever had surgery and general anesthesia?

Read the question again. What are you going to do for a patient who keeps falling asleep during an assessment? Stand next to him and keep waking him up? You are implying that this is a complication of the anesthesia that trumps the emesis. It's not. If this child pukes and aspirates the emesis, then we've got a serious problem. The issue isn't even about the color of the emesis. It's the fact that he's having emesis in the first place. Emesis immediately after surgery must be addressed STAT.

Post this on the General Nursing Student Discussion Forum and see what the rationales are that you get with the answers.

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Specializes in med/surg, telemetry, IV therapy, mgmt.

read the information and weblinks on this sticky in the general nursing student discussion forum:

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Specializes in MICU, SICU, PACU, Travel nursing.

Even if your textbook says its normal you would still give something for nausea right away so they dont put pressure on the surgery site, its not good when these patients throw up believe me.

When I worked in recovery and we took post op tonsils they fell asleep all the time since they had anesthesia on board, so maybe thats why. Tricky question.

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No i'm not implying that this is a complication from anesthesia, but rather a complication from possible trauma d/t surgery. s/s of trauma is change in level of consciosness. So know I would not stand there and keep waking them up, but rather wake them once since thay were just awake a second ago just to make sure they in fact are sleeping an nothing more serious. Again my textbook clearly states that dark brown emesis is common and normal findning after this procedure. And yes I wuld address this, but think LOC is important. Thanks for your help though, what your saying does make sense, but I still think I make a valid point. Maybe I'm reading to much into the questions:banghead:.

Have you ever had surgery and general anesthesia?

Read the question again. What are you going to do for a patient who keeps falling asleep during an assessment? Stand next to him and keep waking him up? You are implying that this is a complication of the anesthesia that trumps the emesis. It's not. If this child pukes and aspirates the emesis, then we've got a serious problem. The issue isn't even about the color of the emesis. It's the fact that he's having emesis in the first place. Emesis immediately after surgery must be addressed STAT.

Post this on the General Nursing Student Discussion Forum and see what the rationales are that you get with the answers.

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Specializes in MICU, SICU, PACU, Travel nursing.
I kind of understand your rationale, however I still think you should first address the "falls asleep during assesment" d/t stated above.???????

Right, but what INTERVENTION does being sleepy with anesthesia on board really require immediately in this instance??As long as they wake up and respond appropriately and have a patent aiway and good vitals, this isnt unusual in these cases. Post op tonsils kids will sleep all day long, and you WANT them to.

If a tonsillectomy starts vomiting dark emesis on the other hand you can bet I would be RUNNING to get some nausea medication stat. They can mess up the surgery site, think of the pressure from vomiting where you have your tonsils removed, and if they start bleeding out because you didnt control the vomiting its a vERY big deal and they have to be rushed back to surgery........

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Specializes in MICU, SICU, PACU, Travel nursing.

But yeah if I was in nursing school I wouldnt like how it was worded either. I think they should give you more info in the question.......

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Specializes in med/surg, telemetry, IV therapy, mgmt.

Put yourself in the patient's shoes. . .How long would you lie in bed puking before you'd get ticked off at the nurses for not doing something about it?

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