test question!

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So the question asked, what is the FIRST thing the nurse should do if the dressing on a patient who is one day post op abdominal surgery, is saturated in bright red blood. Answers were between a) alert the physician. B) assess the wound. C) take vitals.

Opions??? My first thought was risk of evisceration...

Please excuse grammar in this post; i'm typing from my phone.:-)

Thanks!!!!

Specializes in Pedi, Geri, Hospice, Corrections.

In real world...vitals is the LAST thing I'd do. Taking the BP isn't going to help your pt who is bleeding out! And NCLEX uses this same thought process!

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I know, right?

I just can't imagine calling the doc and not having any valid information about why you're calling.

I'm a nurse, I have a brain. I've assessed my pt. Maybe it's something I can handle on my own, maybe the doc needs to know right now, or maybe they just need to know sometime today.

Either way-->I'm assessing MY pt, and doing my job of caring for my pt before anything else.

And in the ICU, the Drs expect nothing less...

I've been in the ICU since the beginning of January for my senior preceptorship....maybe I'm just starting to think like an ICU RN :D

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Specializes in Cath Lab/ ICU.
In real world...vitals is the LAST thing I'd do. Taking the BP isn't going to help your pt who is bleeding out! And NCLEX uses this same thought process!

Scary comment. Scarrrrry!

Um, taking the 20 seconds to do VS will help you assess if your pt is just bleeding...OR bleeding out! That's the point!! Vitals are the last thing? Really?

I can see it now. Calling the MD in the middle of the night....

Nurse- My pt is bleeding out!!

MD- how are the VS

Nurse- I don't know

MD-describe the wound

Nurse-lots of blood, I didn't look. I called you first (leaving my sick pt unattended and unassessed...)

MD resident arrives on floor. VS stable.

Nurse looks like a fool.

I just participated in a thread about how Drs don't take nurses seriously. And if we can't even do VS before calling on a BLEEDING pt, then criminey, you don't deserve to be taken seriously...

ETA: to the OP and other nursing students nearing NCLEX...this won't even be remotely like a question on the NCLEX. Not at all. NCLEX questions are so obscure and complex.

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Specializes in Pedi, Geri, Hospice, Corrections.
Scary comment. Scarrrrry!

Um, taking the 20 seconds to do VS will help you assess if your pt is just bleeding...OR bleeding out! That's the point!! Vitals are the last thing? Really?

I can see it now. Calling the MD in the middle of the night....

Nurse- My pt is bleeding out!!

MD- how are the VS

Nurse- I don't know

MD-describe the wound

Nurse-lots of blood, I didn't look. I called you first (leaving my sick pt unattended and unassessed...)

MD resident arrives on floor. VS stable.

Nurse looks like a fool.

I just participated in a thread about how Drs don't take nurses seriously. And if we can't even do VS before calling on a BLEEDING pt, then criminey, you don't deserve to be taken seriously...

ETA: to the OP and other nursing students nearing NCLEX...this won't even be remotely like a question on the NCLEX. Not at all. NCLEX questions are so obscure and complex.

First of all she stated that the amount of blood was 6cm...so taking that into consideration...I'd be reinforcing my dressing FIRST before I took vitals.

If I'm your patient and I'm bleeding out and you come at me with a blood pressure cuff?! Excuse me, no. You don't need a BP to tell if I will be going to into shock...you can SEE THAT. What you better do is apply pressure and hit that call light for help, hollar out the door, or SOMETHING.

Once the patient is STABLE, then I would get a set of vitals BEFORE I called the MD.

I never said I would call the MD without vitals. However, if it was an emergency and I didn't have them all the info they need is "Your patient Ms.B is bleeding out...get here quick."

And for another thing...my NCLEX questions were very straight forward and to the point.

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First of all she stated that the amount of blood was 6cm...so taking that into consideration...I'd be reinforcing my dressing FIRST before I took vitals.

If I'm your patient and I'm bleeding out and you come at me with a blood pressure cuff?! Excuse me, no. You don't need a BP to tell if I will be going to into shock...you can SEE THAT. What you better do is apply pressure and hit that call light for help, hollar out the door, or SOMETHING.

Once the patient is STABLE, then I would get a set of vitals BEFORE I called the MD.

I never said I would call the MD without vitals. However, if it was an emergency and I didn't have them all the info they need is "Your patient Ms.B is bleeding out...get here quick."

And for another thing...my NCLEX questions were very straight forward and to the point.

Someone else said the amount of blood for a test question was 6cm (in post 33, someone other than the OP said they had a question that specified 6 cm of blood on bandage).

The OP said this was the question:

So the question asked, what is the FIRST thing the nurse should do if the dressing on a patient who is one day post op abdominal surgery, is saturated in bright red blood. Answers were between a) alert the physician. B) assess the wound. C) take vitals.

It says the bandage is saturated in bright red blood....no mention of a number.

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Specializes in Emergency Dept. Trauma. Pediatrics.

Here is everything that was said on the paper I was talking about in the particular section that was similar to this question. I am retyping it as is. (sorry for any typos)

Again to clarify, we were told to use this sheet for NCLEX not necessarily nursing school exams.

EXAMPLES OF PRIORITY QUESTIONS

Let's look at some examples to make these points come to light. This first question is an example of a priority intervention question.

+NCLEX practice question

A client has returned from a routine colonoscopy. The client is complaining of a small amount of abdominal discomfort. The client has informed the nurse that he has passed a drop of blood. Which action takes priority.

1. Taking the vital signs

2. Instructing the client to remain in the bed

3. Calling the physician

4. Administering pain medication

You need to read this information slowly and with an open mind! This type of thinking is a MUST if you want to pass NCLEX

First let me ask you something. Based on this information are you worried or not about this client? You'd better be worried to death because this is NCLEX we are taking.

A question will not be a question on NCLEX unless their is something wrong with the client--something you should be worried about.

Now don't panic, but the answer is #3. Okay, go ahead and have a panic attack and then read on. I've already told you this kind of thinking does not occur overnight.

When you read the data, what is the worst thing(s) that could happen with this client? You may be saying "I don't know, doesn't seem like much of a problem to me. He is just having a little discomfort and a drop of blood never hurt anyone."

NCLEX DEADLY DISTRACTER

You just fell into the NCLEX trap. This kind of thinking is exactly what the NCLEX people fear you will have when you become a nurse. In the NCLEX people's eyes, with that attitude, you just brushed off client symptoms and complaints. This is a no-no! You are a brand new nurse who must view everything as a problem. You can't go wrong thinking like this. Even if it's not a problem, in the end you still offset a potential problem. Be overly cautious.

You'd better ASSUME THE WORST to keep yourself and your client out of trouble when answering NCLEX questions. When you assume the worst, you are forced to at least rule out the life-threatening situations first.

Here's the Deal: Assume all test question scenarios are set up to trick you into thinking nothing is going on with the client that can't wait a little while.

CLINICAL ALERT!You may think you are overreacting thinking like this. It's better to overreact and possibly save somebody's life then to under-react and miss something big. Again, I want you to be overly cautions. We are trying to keep people alive.

- Let me re-emphasize that the questions will be worded to make you think "this situations is no big deal. I'll just sit back and watch the client for a while."

The NCLEX Lady thinks you are going to brush off little subtle hints. Now that you have been forewarned, are you? No! You are going to pretend, with each question, something horrible is happening to the client! Hey, I don't have to go to nursing school to know something is wrong when I see a large amount of bright red blood coming from a client! In the end if I did overreact, and nothing major is going on with my client, I still did the right thing.

-Now let's get back to figuring out what is the worst thing that could happen in this scenario. Based on the data (small amount of discomfort and a drop of blood post-colonoscopy). The worst thing that could occur is hemorrhage or perforation of the intestine due to the procedure.

CLINICAL ALERT Just because you only see one drop of blood doesn't mean there's not a lot of blood concealed inside the peritoneum.

But I'm not a doctor!

Now I know what you're saying. Nurses are not supposed to diagnose. But you do not need to understand the why of the medical situations in order to pass NCLEX.

UNDERSTANDING THE WHY: You have vast nursing knowledge, so use it.

-You aren't going to call the doctor and say, "We have a perforation here, and I've notified the surgical team." You are just using your knowledge to help you make the right decisions for your clients and to pass NCLEX.

-Even if you don't think about perforation of hemorrhage you still should have at least known the following.

1. You're taking the NCLEX

2. There's a problem.

3. There are symptoms in this scenario.

4. Can you fix the problem with the options you have been given?

5. No, you can't.

Let's go back to some of the guidelines we have reviewed with these two complications in mind.

1. If the problem is hemorrhage or perforation, which answer will attack/fix the problem? Now hold that thought. Let's look at the answers individually.

-Answer 1: Taking the vital signs. In your nursing student brain you are saying things like assessment is the first phase of the nursing process, or you have to take the vital signs before you call the doctor (I know you are thinking this because the first thing the doctor is going to ask is "what are the vitals?")

-But I want to ask you something: Tell me how taking the vital signs FIXES hemorrhaging or perforation? It doesn't.

2. Go back to another one of my guidelines: Once I pick my answer I'm COMMITTED to it. That's it. You can't do anything else.

KILLER ANSWER You are telling the NCLEX people (to be said very humbly): "NCLEX Lady, I promise, when I have a client who is hemorrhaging or has a perforation I will, without a doubt, take their vital signs over and over and over. This is the ONE thing I will do. I'm COMMITTED to this. I will take them over and over and watch the blood pressure go down, down, down.....to zero.

-No! I am not saying that taking the vital signs is inappropriate, but the question did not ask you for which data the doctor was going to ask you for first. The question asked which intervention takes priority. In other words, what MUST be done (out of the four options I have been given) to keep this client alive? Select an answer that is the closest to fixing the problem and keeping the client alive.

MARLENE'S RULE This is the way you should think about all NCLEX questions. If you do not tell the NCLEX people anything else in this scenario, you had better let them know you know how important it is to notify the physician.

DON'T LEAVE THEM WONDERING When you click answer choice #1 and move to the next question, you leave the NCLEX lady wondering, "Was the student going to check the vital signs and than call the physician, or did the student think that was all that was needed?" The answer did not say "Check the vital signs and then call the physician." You wish it had said that, didn't you?!

BUT MARLENE! Now I know what you are battling with. The first thing the doctor is going to ask me when I call is "what are the vital signs?"

-Never leave the NCLEX lady wondering if you were going to take action to save the client's life.

-Real world nursing: Yes, in the real world you would immediately check the vitals signs and then call the doctor. But once again, this is a PRIORITY question, and the word "priority" changes everything.

-NCLEX nursing: The word "priority" in this question means "If I can only do ONE thing, what is the ONE thing I should do to keep this client alive?" Even if you do not know the vital signs when you call the doctor, you still did the right thing as far as NCLEX is concerned. You know to hurry and notify the physician of this problem, as calling the physician is the only one (out of the four options) that can fix the problem.

Get real!! if the arm were bleeding profusely from a laceration, you would say "Uh-Oh, the client is hemorrhaging: I need to apply pressure!" Because in this situation the problem is hemorrhage and the appropriate intervention to attack/fix the problem is to hold pressure. However, in my sample test question, applying pressure and fixing the perforation are not options! Besides, how are you going to hold pressure on a bleeding intestine.

+++++++ (side note)I am leaving out why answer 2 and 4 are not the answers because I am tired of typing and it should be obvious+++++++++

MARLENE'S RULE If there is something you can do to fix the problem, do this first and then notify the physician.

-In this situation, there was no option you could do right then that fixed the problem. The only person who can fix the problem is the Doctor.

-Yes there are things that could be done, but they won't help the client. These things delay treatment.

-If we assume the worst about this situation, the client goes back to surgery and the doctor rushes to get there. Real world nursing: Okay, here we go. You call the physician. The first thing she asks is, "What are the client's vitals?" you say "I don't know but you'd better hurry up and get here." Now the doctor is mad because you didn't relay the vitals. That's okay. This type of thinking is for a specific test! NCLEX does not care if the doctor is mad. In the real world, you would quickly take the vitals and call the doctor. But, NCLEX isn't like the real world. Sorry. hey, aren't you glad you read this prior to taking your test!

MAKE THE NCLEX LADY VERY HAPPY Now that you select this answer, the NCLEX people can breathe a sigh of relief. Even if it comes to pass that neither problem is occurring, you still acted correctly while preventing harm to the client. Yes, the doctor could get mad because you called her about a drop of client blood, but who cares! You're trying to pass a test in which the major focus is keeping people alive. So you are going to overreact at times. This is much safer than under-reacting or using your 2 weeks of vast nursing knowledge and judgment to just sit back and watch the client for a while.

REFRESH YOUR KNOWLEDGE Even if you don't consider hemorrhage or perforation, you still should follow this principle: When a client goes for a procedure and they come back with symptoms or complaints they were not having before the procedure, you have to assume the worst!

CLINICAL ALERT Procedure + Symptoms = Something bad!

Be Proactive: Ask for help. Let the doctor tell you to just watch the client. It's not your place to make these kinds of judgment calls.

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First of all she stated that the amount of blood was 6cm...so taking that into consideration...I'd be reinforcing my dressing FIRST before I took vitals.

If I'm your patient and I'm bleeding out and you come at me with a blood pressure cuff?! Excuse me, no. You don't need a BP to tell if I will be going to into shock...you can SEE THAT. What you better do is apply pressure and hit that call light for help, hollar out the door, or SOMETHING.

Once the patient is STABLE, then I would get a set of vitals BEFORE I called the MD.

I never said I would call the MD without vitals. However, if it was an emergency and I didn't have them all the info they need is "Your patient Ms.B is bleeding out...get here quick."

And for another thing...my NCLEX questions were very straight forward and to the point.

I can't tell that you're going into shock by looking at you unless you're past the point of compensation.

The scenario you describe isn't relevant to the one presented in the question asked by the original poster, you're inserting or assuming information not provided in the original information. What you would do in the 'real world' or when presented with X, Y and Z is blah blah blah isn't relevent.

The original question posed very straight forward:

One day post op, abdominal dressing is saturated. What do you do first?

In real world...vitals is the LAST thing I'd do. Taking the BP isn't going to help your pt who is bleeding out! And NCLEX uses this same thought process!

The NCLEX expects you to answer the question exactly as it's written. The patient isn't "bleeding out" unless they (NCLEX) tells you are.

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Here is everything that was said on the paper I was talking about in the particular section that was similar to this question. I am retyping it as is. (sorry for any typos)

Again to clarify, we were told to use this sheet for NCLEX not necessarily nursing school exams.

Sorry, but I have to disagree with your instructor's approach.

It contradicts things I learned in school and is an approach to the NCLEX that I was specifically taught to avoid, that is reading information into the questions.

A question will not be a question on NCLEX unless their is something wrong with the client--something you should be worried about
Unless there has been a massive change in the NCLEX this simply isn't true.
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Between what I see done at the hospital and what were taught at school; oh yeah, and throw in NCLEX, too; I'm simply amazed when we (nursing students) can decipher a correct answer. :uhoh3:

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Specializes in Emergency Dept. Trauma. Pediatrics.
Sorry, but I have to disagree with your instructor's approach.

It contradicts things I learned in school and is an approach to the NCLEX that I was specifically taught to avoid, that is reading information into the questions.

Unless there has been a massive change in the NCLEX this simply isn't true.

Actually their was a change to NCLEX in April I think it was.

Regardless though, this wasn't my instructor's approach. The lady that put this out there used to be involved with NCLEX and now tutors students preparing to take NCLEX. My instructor got the paper from her and gave it to me, said it was really good and very true regarding NCLEX. I am simply passing on the information I was given regarding NCLEX from someone that knows a lot about it. People don't have to take it.

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thanks for the effort to put the info out there for me. I appreciate it!!

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I know, right?

I just can't imagine calling the doc and not having any valid information about why you're calling.

I'm a nurse, I have a brain. I've assessed my pt. Maybe it's something I can handle on my own, maybe the doc needs to know right now, or maybe they just need to know sometime today.

Either way-->I'm assessing MY pt, and doing my job of caring for my pt before anything else.

And in the ICU, the Drs expect nothing less...

Now let me clarify before CuriousMe takes anything else the wrong way. I never said I WOULD NOT assess my patient or have any info for the doctor when I called. I said multiple times I'd have someone get my vitals, I'd check out the patient and dressing and have someone else page the MD. That way I have all my info about what I need to tell them, and I've assessed my patient. I did however say that depending on how they word the question(a test question), vitals may or may not be correct. Some practice NCLEX questions(since everyone swears to practice them non-stop), will have a rationale that vitals will not fix a problem and/or delay treatment. What's the problem? Of course I'd get vitals and an assessment before speaking with someone.

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