Reposting Tonsilectomy question...

Nurses General Nursing

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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?

Regarding ASA poisoning question; I'm pretty sure the exact question said; A 15 year-old comes into the ER with a fever and possible ASA overdose. What is the first thing the nurse would do?

A. Apply cooling blanket (this was listed under interventions in my school packet)

B. Administer activated charocol via N/G (also listed in packet)

Again, I choose A, but the correct answer is B. I meet with instructor this week to see the test, so I will recall the exact question word for word then and post it here. Daytonite, you are very knowledgable and I always learn alot from your posts, but I to believe this is an unfair question. Nothing I can do about it though.

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Regarding ASA poisoning question; I'm pretty sure the exact question said; A 15 year-old comes into the ER with a fever and possible ASA overdose. What is the first thing the nurse would do?

A. Apply cooling blanket (this was listed under interventions in my school packet)

B. Administer activated charocol via N/G (also listed in packet)

Again, I choose A, but the correct answer is B. I meet with instructor this week to see the test, so I will recall the exact question word for word then and post it here. Daytonite, you are very knowledgable and I always learn alot from your posts, but I to believe this is an unfair question. Nothing I can do about it though.

Before you can critically think about the situation you have to know what you are thinking about.....

It is a very poor question. You just don't have the information you need to be able to critically think about the situation. How high is the fever? Certainly you would not put a cooling blanket on someone with a temperature of 100.0.

Here is the issue. If someone is toxic on Aspirin they will have more than just a fever. Fever will not be expected at therapeutic levels (if anything it should lower a fever at therapeutic levels)--generally it will take longer than an hour before significant toxicity will occur (with aspirin tablets). So is the fever related? We don't know. If the fever is related to aspirin toxicity then again they are going to have more effects. Furthermore if the fever is related then we have already had significant absorption.

Again it is controversial but here is what I would suggest in this scenario.

Obtain vital signs, if they are hypotensive we may be in trouble. Mental status? again if it is altered we are in trouble. ABG and ASA level Stat! IV access stat! I would expect the respirations to be increased with aspirin toxicity (unless we are really late). Should we start IV fluids with bicarb?

Urinary alkalinization? Based again on the AACT statement "Based on volunteer and clinical studies, urine alkalinization should be considered as first line treatment

for patients with moderately severe salicylate poisoning who do not meet the criteria for hemodialysis"

In the end, I know this is has been long, but giving charcoal via NG tube is treating the poison, not the patient. It is not thinking critically, it is thinking poorly. By instituting this "as the first thing" the nurse would do you are wasting valuable time and delaying other treatments that are more effective.

Also be really really careful with giving charcoal down an NG, you are really starting to add some significant risks, such as aspiration, without a proven benefit.

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

Here's the situation. Let's get the OP through nursing school tests and the NCLEX in order to get a license so they can put all this knowledge into practice. It isn't going to happen if they can't fathom out the correct answers to these questions be they written well or not. The NCLEX questions are written this way and reviewed by panels of nurses. They will ask for the "first thing you would do" and wrong responses will cost the applicant $300 and the agony of having to take the NCLEX again.

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The original question in this post was a great example of critical thinking and what to expect on the NCLEX. This second question is not. You can critically think all day but if you do not understand or know what you are thinking about it will not do you any good. You have to know the rationale for your actions.

You are right, the NCLEX questions and answers are reviewed by nurses and there will not be incorrect interventions (as the right answer) on the NCLEX.

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I met with my instructor today regarding the two exam questions. I explained why I chose the answers I did and she said it is good that I'm thinking this way but still my answers are wrong. As for the ASA question, it was asked exacly how I worded it in my previous post, and again charcol was the correct answer because the question did not say how high the fever was. Oh well, on to the next test today. Can you please answer my questions I posted in the students general forum. Thanks.

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Well we tried! :banghead:

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Yes. I still don't understand why charocol was the answer,but oh well. On to the next questions LOL. Did you read my new post with questions? Thanks, I really appreciate the help from you and Daytonite:bow:.

Well we tried! :banghead:
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Yes. I still don't understand why charocol was the answer,but oh well. On to the next questions LOL. Did you read my new post with questions? Thanks, I really appreciate the help from you and Daytonite:bow:.

Well the rationale is that charcoal will absorb (actually adsorb, think of magnet not sponge) the medication. But in the age of evidenced based care, it hasnt shown to improve patient outcome.

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