test question!

[BA_anthropology]

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!!!!

[CCL RN, RN]

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.

What's funny is that if you timed us all, we would probably all do all of the tasks in the same amount of time. All would get done...

[JenniBeth]

What's funny is that if you timed us all, we would probably all do all of the tasks in the same amount of time. All would get done...

Agreed.

[CrazierThanYou]

It's one thing if the patient who had abdominal surgery said that she felt a "pop" and something "give way" when she reached over to retrieve something off her bed table. It's different when you get a question about 6cm of red blood on a dressing. One is an emergency and the other isn't an emergency unless you have some other indications that the patient is hemorrhaging. I say, take a BP and pulse and you'll have a better idea. If the patient feels the pop and giving way, the surgeon needs to prep for emergency surgery.

We had that question too. The answer choices for what would you do included:

A: Cover the wound with a moist dressing.

B: Pull the ends of the wound together and tape it.

C: Put the patient in Fowler's position and tell her not to touch it

D: Call the physician.

What do YOU GUYS think the answer should be?

[kgh31386, BSN, MSN, RN]

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.

I took the thing, 75 questions in under an hour. Not one question was more complex than a nursing school test question. Even the SATA were straight forward...what I said, and what CCL RN said are both subjective though. But my test wasn't complex, not to say that someone else's isn't.

[kgh31386, BSN, MSN, RN]

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.

That's because that's from the Hurst review...so yeah it might not agree with what was taught in school. Which is also why I say that calling the doctor is a more popular answer with some of the most popular reviews, Kaplan, Saunders, Hurst, etc.

[kgh31386, BSN, MSN, RN]

My question to CuriousMe, would you ever intervene before assessing? What if you find your patients guts hanging out because their wound split open, would you get their vitals first still?

[CCL RN, RN]

I took the thing, 75 questions in under an hour. Not one question was more complex than a nursing school test question. Even the SATA were straight forward...what I said, and what CCL RN said are both subjective though. But my test wasn't complex, not to say that someone else's isn't.

Mine was a complex, obscure nightmare!! The questions were ridiculous! Also, 75 questions, 45 mins...

[julyemrn]

It's more than just the basics though. That's why I said it depends on how it's worded. Once you start doing NCLEX review questions and you run into questions like this..someone has a bloody dressing(a few HURST questions were about this exact scenario), vital signs may not be the first thing you do. I've been through the NCLEX review and already taken the thing. Most questions will give you a scenario that's vague like a bloody dressing and give you the answer of "take vitals, call the doc, re-assess, etc." Taking vitals will not fix the problem, it delays treatment(even if it's just a few moments)...never delay treatment in the eyes of the NCLEX people. Even if it takes just a few moments, in the NCLEX people's eyes...you're saying that you want your patient to bleed just a little bit longer so you can tell the doctor your vitals. Like others said, pretend you can only pick ONE thing and go home. You learn in school that the answer is most likely not to call the doctor, in NCLEX review stuff, that answer is correct much more often. The NCLEX people don't care if the doctor gets mad, they only care about YOU and what you do to fix the patient..you can't say on the NCLEX or a nursing school test "what if the doctor gets mad at me"

... i remember what our clinical instructors always tell us while doing our clinicals ... "a delay in service means a failure in service" ...

[NCRNMDM, ASN, RN]

I would get a set of vitals first, and assess the overall appearance of the patient. Do they look like they're hypotensive or about to go into shock? Do they look like they're about to code? While the vitals were taking, and after I had done a quick visual assessment, I would ensure that I had adequate IV access in case I had to do a volume resuscitation or give blood products, etc. Finally, after I had some vitals, and had asked the patient some basic questions, about pain, etc, I would call the physician and inform them of the situation.