Test question, just wanted your thoughts

FireStarterRN, BSN, RN · Apr 30, 2009

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

:lol2: :lol2: :lol2:

Just about. The question is totally lacking in useful information.

FireStarterRN, BSN, RN · Apr 30, 2009

I think, what the questioner is looking for in a round about way, is whether the test taker knows that tylenol reduces fever and pain at the same time. Take it from me, I'm a good tester.

NamasteNurse, BSN, RN · Apr 30, 2009

pt admitted to unit with 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'm surprised at this, since no infection was confirmed with lab tests. i thought we were holding antibiotics until infection is confirmed? you can have fever, pain and cough with a viral infection as well and an antibiotic is only called for with bacterial infection. no?

FireStarterRN, BSN, RN · Apr 30, 2009

This question epitomizes the ridiculous nursing test to the max. What a stupid question. You can't diagnose an infection based on a temp, cough, and pain. In the ER they would give the tylenol, then wait for results of the bloodwork, x-ray, maybe blood cultures before any abx given. They don't specify even what type of unit the pt has been admitted to.

Dumb question.

Daytonite, BSN, RN · Apr 30, 2009

pt admitted to unit with 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'm surprised at this, since no infection was confirmed with lab tests. i thought we were holding antibiotics until infection is confirmed? you can have fever, pain and cough with a viral infection as well and an antibiotic is only called for with bacterial infection. no?
we work in a collaborative role with the doctor. confirming lab tests was not an issue for this question. we have to be aware of physician diagnosis and treatment of medical conditions when problem solving. it is the doctor's prerogative as the physician to assess and order antibiotics for the signs and symptoms of a viral or bacterial infection. they are licensed to do that. it is the nurse's job to follow doctor's orders.

classicdame, MSN, EdD · Apr 30, 2009

NCLEX will want you to consider pain a psychosocial issue. You address the CAUSE not the symptom. At least, that is the first thing you address. You will address the pain also most of the time.

lynette.johnson · Apr 30, 2009

My 1st thought was tx the pain, but then I remembered learning that pain (although very real and distressing) is a psych issue which is always secondary to the tx of the primary medical problem. In this case the infx as evidenced by: Temp., pain and cough. Am I completely off base? Just a thought!!!

lynette.johnson · May 1, 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....

Why would you "only give codeine if the cough was bad"? It's a narcotic which could cause further respiratory depression. Am I overthinking?

Lucky0220 · May 1, 2009

Classicdame, I have to disagree, I just graduated and passed NCLEX; we were consistently told that pain in now considered the 5th vital sign. It can cause HBP and other physical symptoms, so it would not be considered just a psychosocial issue. But I still contend that Tylenol would be the answer. A fever over 100.4 is supposed to at least catch our attention, so 101.8 would certainly need an antipyretic. Isn't Tylenol usually the drug of choice for a fever? Usually with standing orders? And also, codeine by itself is almost never given alone for pain. It is usually mixed with an analgesic of some sort..isn't it?

Guest321574 · May 1, 2009

I chose abx too, because with those "what do you do first" questions, all of the orders are correct, you literally just have to pick which one should be done first, and not read too much into the question (i.e. c+s not done yet, no order given for abx, etc.)

nerdtonurse?, BSN, RN · May 2, 2009

Lynette --

You're right, codeine can cause respiratory depression, like any narcotic. However, when I've seen codeine used for cough in the "real world" we do it if a) the pt has a dry non productive cough (no goop that needs to be expectorated) and b) the cough is preventing the pt from sleeping, eating, or is causing vomiting. If you're coughing, but you're getting green goop out of your lungs, I want you to cough.

What would I call for/give in the real world?

1) assess lung sounds and overall pt status. I've already had one "near syncopy and headache" admission that turned out to be meningitis.

2) Give tylenol. This is for fever, not pain. If your neck hurts and feels stiff, I want you able to tell me, not stoned on demerol like the patient I had with "oops! they have meningitis"

3) get a CBC, CMP and C&S and get it to the lab. You can always have an asthmatic who's coughing from pollen, but has a fever from appendicitis....

4) give something like Levaquin until we get the C&S back.

5) with what's going on now (and general hysteria), if you come in with flu like syptoms, you're going to be on contact and droplet precautions. The rapid flu comes back positive for Flu A, I'm going to be on the doc, yelling "we may have HOGS!"

buttercup99 · May 3, 2009

I just think this is such a ridiculous question. If it is what Daytonite said, they should have said "These 4 drugs have been ordered by the doctor, which would you give first?" or some such thing. Anyhow, if we are to assume that Tylenol and ABs have been ordered, then what a stupid question: you would give them both at the same time. Unless of course, the C & S hadn't been done yet but again, they haven't specified this. There are about 100 ways to get to an answer and they all include making assumptions such as what stage of assessment the nurse/doctor is up to, whether the doctor has seen them, what the PROTOCOL of the hospital is! They should make the question very clear - have these drugs been prescribed or is the nurse approaching the doctor to get a quick order? If they have been ordered, you would probably give the ABs and tylenol together and leave the codeine and antihistamine (?!) until further assessment has been completed and the effects of the tylenol and ABs have been evaluated.

UNCLEAR QUESTION! :down: :down: :down:

They should ask you to explain your reasoning and mark you on that. At least for a couple of questions out of the MCQ. Nursing is not an exact science. It's a combination of many factors and how you deal with that is the important thing. Sheesh!