Test question help

[nptobee]

Hello everyone!

I'm a first semester nursing student. We had a test question worded similar to this the other day. I'm curious to know what you all would have chosen.

A terminal cancer patient asks says to you that God is punishing her because she is in so much pain. The priority nursing diagnosis would be

A. Pain related to ineffective analgesia

B. Spiritual distress related to belief that God is punishing her with pain.

I chose A, and got it wrong. The choice of ineffective analgesia led me to believe that she was on the wrong med, needed a stronger dose, needed to have it more frequently, etc.

I thought if I could do something to relieve the pain, she wouldn't feel she was being punished because there was no pain. On the other hand if she said God is punishing me with Cancer, then B would have seemed the correct answer.

It also asks priority, to me getting her out of pain would take priority over having a clergyman come to speak with her. Not that her spirituality isn't important, but the pain needs to be relieved FIRST.

Also pain is the fifth vital.

Those were my thoughts, any other?

Thanks

[jenac]

I would have picked B also. Interesting responses. I agree that Maslow's Heirarcy would have come into play here. But, that is based on the patient having immediate pain, which is really not specified here.

I agree, the wording is off and misleading. Spirituality is individually important- but pain is much more prevalent in the immediate implementation of interventions. The patient in question might be in so much pain-she cannot focus on her spiritual health here. Her immediate physical needs would than outway her spiritual ones, althougth it does need dealt with.

If this were a true life scenerio-I would assess the pain level first, and deal with it as immediately appropriate. Than the spirituality.

[gwenith, BSN, RN]

Good debate everyone but I stand on the opinion it is eduactionally unsound.

[Karina212]

I would probably have had picked B after thinking about picking A, but I do think that this is an unfair question!!

[llg, PhD, RN]

I agree that it may have been a poorly worded question. However, I'd need more information to make that conclusion. We are not sure "exactly" how it was worded on the test. Nor are we sure of "exactly" what the students have been taught about the content being tested. We're all making a lot of assumptions, here -- as is common on this and most other public bulletin boards.

I was just trying to explain the reasoning why B would probably be the "correct" answer for the test. As a good test taker myself and a nurse educator, I thought I might be able to shed some light on the reasoning that should lead to the selection of B rather than A.

A path of reasoning can always be constructed to lead to the "wrong" answers on a multiple-choice test. (That's why those other answers are called "distractors" in the world of test construction.) The paths of reasoning to the distractors need to be legitimately tempting in order for the test to discriminate between different levels of learning achievement. If there were only 1 right answer and the others were clearly wrong, it would be considered an "easy" question with little power to discriminate as everyone would get the right answer.

It would be interesting to see an item analysis on this question. An item analysis is the statistical analysis used to evaluate questions on a test. It includes overall stats such as the number of students who picked each answer and also stats about which particular students picked the various possible answers. For example, some questions might be so easy that nearly everyone gets the right answer. Most test include a few such easy questions to help the students relax and assure that the final scores are not distressingly low. However, many testers also try to include a few questions that only the very top students get correct in order to be able to identify those top students -- the ones who should get the A's rather than the A-'s. Most questions are written at the "middle level," where most students get them right, but a few students get them wrong.

As I said, it would be interesting to see the item analysis for this particular question. I suspect the test writer was trying to construct a difficult question that would tease out some of the more advanced critical thinking content. That's legitimate ... but she might have to reword the question if the exact wording threw off too many people. We would have to see the item analysis to make that judgment.

llg

[Mira]

great comments.I would have answer B.

looking back on a friend who died recently from cancer,no amount of analgesia soothed her during the terminal stages,in her case you priority is her spiritual needs(not necessarily religious but helping her coming into terms with her condition/life, and her loveones whom she`s going to leave behind).

[charissa]

havign oncology end of life experience i have to give a gentle reminder that many cancer patients will be unable to achieve total pain elimination, and some will be unable to achieve even acceptable pain relief no matter what methods or meds are used, it is usually the same few cancers each time the problem is experienced. When you get to cancer in school you'll learn about treatments and so forth. that is great. but the inevitible facts are that there are cancer pts whom will not be "Cured" or put into remission. One of the most profound experiences one can encouter is caring for someone with end stage liver or pancreatic ca until the end

[chae]

I am a student also and I would have chosen B. We are taught that a person's spirituality is primary especially when a patient is terminally ill. We have been taught to give religious counciling or arrange for counciling for that patient. TCN class = LPN.

[Spidey's mom, ADN, BSN, RN]

I would have chosen B also. Seems to me that she is in a spiritual crisis and that needs to be addressed . . . .it is HER spiritual crisis and as nurses, it does not matter whether we believe or not. I think that is what the question is getting at.

I agree with llg . . . the patient's main concern is her feeling that God is punishing her with pain. But there is no reason both issues cannot not be addressed.

I hate NCLEX questions . . . I always characterize them as "pick the best worst answer"!! arrgghh. So glad that is over for me.

Best wishes,

steph

[PJMommy]

I'm also a student and my knee-jerk reaction is to pick B. However, in my class, when greater than 75% of the class picks the same answer which isn't the "right" answer according to the instructor, then the question is tossed out because the prof assumes she/he didn't teach it well enough. What did others in the class choose?

[Edward,IL]

The test question was poorly constructed.

I am excited that you have put so much thought into it.

In an actual situation at the bedside, you will be the nurse to discuss things at length with the patient, explore her pain and her spirituality, arrive at appropriate diagnoses and bring resolution and meanig to both.

You got one wrong on one test.

Your analytic skills and effort are excellent.

Just my opinion. Edward, Il

[luvbeinganurse]

I would have picked B. Don't you just hate those kind of questions?

[canoehead, BSN, RN]

I would have gone to get her more pain meds and then as I pushed the drug/gave the pill, I would have asked her about her higher power, and what has changed in the way she looks at her life, maybe ask what gives her faith, what is still unresolved. I did A first because it takes less time, and gives immediate relief, and B second because conversation will be easier for her if she has greater pain relief when we are talking. Then I would document on the care plan what helped the most, and do that one first the next time.