Test question, just wanted your thoughts

Daytonite, BSN, RN · Apr 29, 2009

That was my exact way of thinking. It was wrong though!!! I am still upset about it. We are taught Maslow in Fundamentals following his theory, shouldn't we address pain? Anyway, I chose codeine, like you said, pain and cough, but the right answer was antibiotic.........[/quote']
All the choices were doctor's orders (collaborative interventions, not independent nursing interventions). It's because of critical thinking and following the nursing process. By engaging the nursing process we find the abnormal data in Step #1 of the process. By Step #2 of the process we can determine that the underlying problem is an infection. By Step #3 (Planning) we are thinking about our interventions for the problem. This question then takes a little bit of a bizarre turn and specifically challenges our knowledge of the "medical decision making" process because it is asking us which physician orders should be enacted first. The "medical decision making" process isn't much different from the nursing process except that the doctor works within a medical model of care and is often able to treat the underlying cause of the patient's problem. We assist the doctors in carrying out their orders. This question is really asking, "which order will the doctor will want carried out first?" And, I will tell you now that in the real world of nursing you will get your hands slapped if you don't carry out doctors orders by that way of thinking, especially when you work in an acute hospital. So, you not only need to know nursing priorities, but medical priorities as well! The doctor is the captain of the ship.

nerdtonurse?, BSN, RN · Apr 29, 2009

The only problem I have with antibiotic first is then you've messed up your C&S. We would give tylenol, take the sputum sample for a C&S, then give them something like Levaquin until the lab comes back. And I'd only give the codeine if the cough was bad -- after all, we want that garbage out of their lungs, not nestled down in the bases....

RN2BE1210 · Apr 30, 2009

The only problem I have with antibiotic first is then you've messed up your C&S. We would give tylenol, take the sputum sample for a C&S, then give them something like Levaquin until the lab comes back. And I'd only give the codeine if the cough was bad -- after all, we want that garbage out of their lungs, not nestled down in the bases....

That's what I was thinking also. You wouldn't want to start an antibiotic until the C&S has been done. At least that's what I've been taught. But then again as soon as I saw that temp I knew it was an infection.

nerdtonurse?, BSN, RN · Apr 30, 2009

I put this to my teacher this morning. She said "tylenol" because of C&S collection. So, while it may or may not help the OP, at least I know I'm on the same wavelength with the teacher...

E.R. Rookie · Apr 30, 2009

In the real world tylenol would be given first while your waiting for the Dr Orders. In the E.R. they may be given Tylenol and asked to sit back down.

You need to bring the fever down, antibiotics take some time to work.

I hate questions like these because things tend to happen at the same time. I can have three orders and start them all within 5 min.

E.R. Rookie · Apr 30, 2009

I put this to my teacher this morning. She said "tylenol" because of C&S collection. So, while it may or may not help the OP, at least I know I'm on the same wavelength with the teacher...

Hey I just saw your post! Sweet!

Lucky0220 · Apr 30, 2009

I also was thinking Tylenol first because of the effect on the C &S. Yet the question never mentions that a C & S is to be done. Are we to assume this? I am just out of school, but we did learn that you do not give an abx prior to the culture being drawn. Then you can give a broad spectrum abx until results come in. I have never disagreed with any answer that I have seen given by Daytonite, so I am anxious to see what she says about this!

jjjoy, LPN · Apr 30, 2009

This question is really asking, "which order will the doctor will want carried out first?"

If that's what the question is really asking, then why not just ask it? The question could describe the patient and that X, Y & Z have been ordered and then ask the student to prioritize the carrying out of orders. Another more clear question might be to describe the 3 assessment data points and ask which of the following conditions the nurse would suspect the patient may be experiencing, such as a) infection b) food poisoning c) hypoglycemia....

Asking a question obliquely doesn't test critical thinking; instead, it forces students to make an educated guess about the question is "really" asking. The student may have a very good grip on prioritization, pharmacology, etc and still get the question wrong because they think critically in the wrong direction. Thus, they know their facts, can think critically, and yet get the question wrong. The fact that other instructors and experienced don't see that the correct answer is definitely the best answer demonstrates this. So again, why not just ask the questions directly?

Daytonite, I know it's not up to you how NCLEX and nursing instructors write their questions. And students have to learn to deal with them in order to pass. You do a great job in helping students see how to interpret these type of questions. Thank you for helping so many students!

I still think, though, that that style of questioning isn't a very good measure of critical thinking, or retention of facts, or of application of knowledge. The vagueness and obliqueness of such questions can leave competent students questioning their ability to comprehend the material because they can't see why the instructor is insisting that one answer is most definitely the best when others also make sense, depending on how one interprets it.

FireStarterRN, BSN, RN · Apr 30, 2009

Pt admitted to unit c T-101.8, cough, and pain rated 7/10. Which med would the nurse anticipate giving first?
a) antihistamine
b) antibiotic
c) Tylenol
d) Codeine
I can't remember which antihistamine and antibiotic were listed on the test by brand name.
I just wondered what you guys would have chosen as your answer.

Not a very informative question.

I'd start by eliminating some answers.

You wouldn't necessarily be giving an antibiotic just because someone has a cough and fever. Hopefully a throat swab was done, plus a chest x-ray. I don't see that an antihistamine would be automatically in order. Not sure if it's good to always suppress a cough, there are some cases where you want the patient to have a productive cough. The question doesn't specify what type of pain.

Therefore, I chose tylenol. You would be addressing the fever and pain immediately while waiting to see what's next.

Daytonite, BSN, RN · Apr 30, 2009

i think that when you answer these questions part of that critical thinking has to take into account the many roles the nurse plays. the collaborative role is right up there. while we are licensed to perform many independent nursing actions we are still performing many doctors' orders as employees. you cannot deny that that is a huge part of our training. we are taught medical diseases and how the doctors treat them. in so many instances we are at the mercy of what the doctor is going to do. this question is one of them. and that is one of the drawbacks of these application questions. it is up to the person answering the question to figure out what principles need to be applied in order to answer the question correctly.

Lucky0220 · Apr 30, 2009

Actually, this is one of those stupid "mind reading" questions, IMO

XYcsccSN · Apr 30, 2009

I would choose the pain med. Tylenol is not strong enough to touch pain that is 7/10. A fever of 101.8 does not necessarily suggest bacterial infection so ATBs would be jumping the gun especially when ATBs are already overused and resistance is growing. Also, that fever is not high enough to make antipyretics a priority. The antihistamine answer is wrong for obvious reasons. If you have a patient with pain 7/10, you had better do something about it as a nurse. Get the order and give the med ASAP.