Taking tests in nursing classes

CT Pixie, BSN, RN · Sep 19, 2007

I just started my RN program and we are now beginning to take our first tests of this school semester. Currently, the test questions are structured to resemble the NCLEX tests and in some way incorporate our learning outcomes for a given unit.
An example of our test question goes as follows:
A confused patient is running around your nursing unit, the confused patients daughter does not want her mother restrained, what course of action should you take?
A) Restrain one arm only of the confused patient
B) Hide restraints under the patients gown so the daughter can't see them
C) Call a physician for restraint orders, but show them to the confused patients daughter
D) Use a rocking chair.
The answer to this question, according to our teacher is D. What RN test taking skills do I need to use in order to narrow down the possible answers to they styles of questions.
Obviously, use ethics and patient safety, but what other test taking skills do I use to narrow the possible answers down to the right one?
Thanks,
Father Tod

critical thinking helps with taking tests in nursing school. Did your instructor give the reason/rational as to why the other answers were incorrect. It might help with future test taking. A and B are obviously wrong since restraining a patient (one arm or not) would be illegal without a doctors order.

As for calling the doc for a restraint order and showing the pts daughter..Restraints are only used to protect the pt from injury. Being confused and moving about the nursing unit doesn't constitute a reason for a restraint order. Not many docs would order a restraint for that. You need to find other ways to try to get that patient to 'relax' for lack of a better word, and the rocking chair might be the thing to calm the pt. Having her sit for a second my kick start her into relaxing and not running around.

Did that make any sense? I don't really know how to explain how to narrow down the answers. But just want to add, usually there are 2 blatently obviously wrong answes (a and b) and two that could be correct..but one is always more correct than the other.

NaomieRN · Sep 20, 2007

Where would the nurse find the rocking chair? lol

I have not seen on yet in the hospital. Maybe they have rocking chairs in the nursing homes?

I would have picked D, simply because the others would not make the daughter happy and restraint should be to prevent injuries and only the last resolution after trying other methods. Which in this case would be the rocking chair.

emtb2rn, BSN, RN, EMT-B · Sep 20, 2007

I agree with the 2 posts above. Always go with the least restrictive alternative unless the pt is a danger to themselves and/or others. And even then, read the question carefully...

jjjoy, LPN · Sep 20, 2007

I personally hate NCLEX style questions and think they tend to be poorly written and require way too many assumptions. Still, you have to be able to deal with them. While in reality, there may be no rocking chair available or the person may not want to sit in the rocking chair, the other choices are worse. C goes against the whole idea of nurses being able to use their own skills by just deferring the explanation. What would one do in the real world where can't assume that a rocking chair will work to calm the patient or that the nurse will even have access to one? These types of test questions don't address that.

cardiacRN2006, ADN, RN · Sep 20, 2007

Well, the first three had restraints in the question, and the 4the one didn't.

Daytonite, BSN, RN · Sep 21, 2007

1. [you need to have knowledge of the law] the law (federal medicare law) says you must try other interventions first before resorting to physical restraint. you need a doctor's order to restrain any patient.

here is the actual law from

title 42 of the code of federal regulations part 482 (medicare conditions of participation for hospitals)

(e) standard: restraint for acute medical and surgical care.

(1) the patient has the right to be free from restraints of any form that are not medically necessary or are used as a means of coercion, discipline, convenience, or retaliation by staff. the term "restraint'' includes either a physical restraint or a drug that is being used as a restraint. a physical restraint is any manual method or physical or mechanical device, material, or equipment attached or adjacent to the patient's body that he or she cannot easily remove that restricts freedom of movement or normal access to one's body. a drug used as a restraint is a medication used to control behavior or to restrict the patient's freedom of movement and is not a standard treatment for the patient's medical or psychiatric condition.

(2) a restraint can only be used if needed to improve the patient's well-being

and less restrictive interventions have been determined to be

ineffective

.

2. [you need to read the question carefully, the issue is confusion and hyperactivity of the patient not safety--you need to know the principles of the nursing care of confused, hyperactive patients--what interventions can you take for a confused and hyperactive patient] the question states that the patient is confused and running around the unit. that is the problem you have been given to deal with. it does not say anything about safety, so that is not even an issue.

3. [eliminate answers that don't apply] therefore, choices a, b, and c which involve the use of restraints are out of the question as solutions.

4. by default, d would be the answer.

i can also tell you from a very practical point of view and having worked in long term care that one of the strategies we used with wandering or hyperactive patients was to place them in reclining chairs or bean bag chairs that allowed them to retain some activity, but kept them put (they couldn't get out of them).

x_coastie · Sep 23, 2007

a confused patient is running around your nursing unit, the confused patients daughter does not want her mother restrained, what course of action should you take?

a) restrain one arm only of the confused patient

b) hide restraints under the patients gown so the daughter can't see them

c) call a physician for restraint orders, but show them to the confused patients daughter

d) use a rocking chair.

take your time to read/understand the question and each answer.

a) restrain one arm only of the confused patient----this one doesn't even make sense to me, why would you only restrain one arm? the pt would most likely get hurt by twisting her arm or something else. it doesn't follow proper restraint technique and you can't restrain without a physician's orders. this answer is only meant to distract you. move to question (b.

b) hide restraints under the patients gown so the daughter can't see them. ------ if you hide the restraints, you can't check them for proper fitting and all the other things you should be looking for. no physician's orders, and some of the same problems from answer (a.

this answer is only meant to distract you. move to question (c

c) call a physician for restraint orders, but show them to the confused patients daughter------- this is the best one so far, but restraints are only the last option. keep this one in mind and move to (d

d) use a rocking chair.---using a rocking chair sounds kind of goofy and as someone else said "where would you find a rocking chair in a hospital" , but the pt is not a danger to anyone so this answer represents the only option that is not using restraints. the rocking chair is symbolic of any option that a nurse uses to occupy/entertain the pt.

hope this helps, i am only in my first semester of the rn program. the test taking portion is the easiest for me. clinical is more difficult for me than some (i was just cruising the form for help during clinical.)

best of luck

Athenas83 · Sep 25, 2007

I would pick D because he's not combative, and you have to exhaust everything before going restraint route. The rocking chair may distract/calm him. That's definitely what my adult health/fundamentals professor would say.

beth66335, BSN, RN · Sep 26, 2007

a confused patient is running around your nursing unit, the confused patients daughter does not want her mother restrained, what course of action should you take?
a) restrain one arm only of the confused patient
b) hide restraints under the patients gown so the daughter can't see them
c) call a physician for restraint orders, but show them to the confused patients daughter
d) use a rocking chair.
take your time to read/understand the question and each answer.
a) restrain one arm only of the confused patient----this one doesn't even make sense to me, why would you only restrain one arm? the pt would most likely get hurt by twisting her arm or something else. it doesn't follow proper restraint technique and you can't restrain without a physician's orders. this answer is only meant to distract you. move to question (b.
b) hide restraints under the patients gown so the daughter can't see them. ------ if you hide the restraints, you can't check them for proper fitting and all the other things you should be looking for. no physician's orders, and some of the same problems from answer (a.
this answer is only meant to distract you. move to question (c
c) call a physician for restraint orders, but show them to the confused patients daughter------- this is the best one so far, but restraints are only the last option. keep this one in mind and move to (d
d) use a rocking chair.---using a rocking chair sounds kind of goofy and as someone else said "where would you find a rocking chair in a hospital" , but the pt is not a danger to anyone so this answer represents the only option that is not using restraints. the rocking chair is symbolic of any option that a nurse uses to occupy/entertain the pt.
hope this helps, i am only in my first semester of the rn program. the test taking portion is the easiest for me. clinical is more difficult for me than some (i was just cruising the form for help during clinical.)
best of luck

no patient with one arm restrained is going to stay restrained if they can get up, this answer is just ridiculous! :lol2: