Test Question

[trishybobishyp]

I saw this question posted in 2008 and there were so many conflicting answers. It is difficult for students to make out the correct answer from all the different thoughts. Here is the real answer and the rational. Remember, what NCLEX says is correct (and they decide if you work as a nurse or not) is not always what actually happens in the "real" world.

A Patient who was admitted to the hospital with pneumococcal pneumonia has a temperature of 101.6° F with a frequent cough and is complaining of chest pain rated 7 on a 10-point scale with deep inspiration. Which of these ordered medications should the nurse give first? [TABLE=class: MsoNormalTable]

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[TD] a.[/TD]

[TD=width: 540, bgcolor: transparent] Azithromycin (Zithromax)[/TD]

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[TD=width: 24, bgcolor: transparent] b.[/TD]

[TD=width: 540, bgcolor: transparent] Acetaminophen (Tylenol)[/TD]

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[TD=width: 24, bgcolor: transparent] c.[/TD]

[TD=width: 540, bgcolor: transparent] Guaifenesin (Robitussin)[/TD]

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[TD=width: 24, bgcolor: transparent] d.[/TD]

[TD=width: 540, bgcolor: transparent] Codeine phosphate (Codeine)

In the NCLEX world: The answer is d. Codeine.

Why? The nurses priority list is ABCDP; Airway, Breathing, Circulation, Deficit, Pain. So according to this the pain is not the priority but because her pain is causing BREATHING issues and she cannot Clear her AIRWAY effectively with 7/10 pain, d. is the correct answer. The codeine is not a "cough" syrup but because of the Cholinergic effects, it acts on the PNS and will help suppress the cough anyways.

In the real world, a. Zithromax is correct.

The ABX takes longer to be effective and the MD will want it started first. In reality the two would probably be given within seconds of one another and it doesn't make much difference but for the NCLEX, the answer is not the ABX.

Hope this helps. [/TD]

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[Lev, MSN, RN, NP]

In the real world, Tylenol would be given first, because that is what's readily available on the floor, and when the antibiotic comes up it would be given then. The cough medicine would only be given if the patient requests it or if they are chest pain from coughing so much or if they are having really thick secretions. For thick secretions, the first thing I would offer is plain old H2O.

[psu_213, BSN, RN]

[TABLE=class: MsoNormalTable]

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[TD=width: 24, bgcolor: transparent][/TD]

[TD=width: 540, bgcolor: transparent]

In the real world, a. Zithromax is correct.

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According to whom? In the ER, until the presence of PNA is confirmed (via chest X-ray), the pt is going to be made comfortable. This includes control of pain and reduction of the cough--both of which will be done with codeine. On the floor, the patient will have already had their dose of ABX in the the ER. If their cough/pain is still an issue, give the codeine. Sure it can be debated, but in the "real world," giving the ABX is not the no-brainer answer you suggest.

[Kandy83]

According to whom? In the ER, until the presence of PNA is confirmed (via chest X-ray), the pt is going to be made comfortable. This includes control of pain and reduction of the cough--both of which will be done with codeine. On the floor, the patient will have already had their dose of ABX in the the ER. If their cough/pain is still an issue, give the codeine. Sure it can be debated, but in the "real world," giving the ABX is not the no-brainer answer you suggest.

Well I don't know about the real world. But I just had this exact test question and zithromax was the correct answer. It was even in my Med-surg book. It said that using and ABX will take longer that is why you give it first then give the codeine immediately after.

[nurseprnRN, BSN, RN]

Probably not an NCLEX question that would be retained in a future edition of the test bank. Likely in there to see how many people got it right/wrong, and how many of the wrong ones chose the same answer, and how those people did overall on the exam. They look at all those stats when evaluating questions for use.

[suzw]

I'm only second quarter and haven't worked in a hospital yet, only LTC, but I had the same thoughts- the chest pain, cough and fever are all being caused by the pneumonia, and since it takes awhile to work (and pneumonia can be very dangerous), it should be given first. But in the big scheme of things, why does it matter? Shouldn't you just give whatever med arrives first? Does it really take hours to give each medication? I doubt it. Why not give whichever med arrives first, if they don't arrive together? And if they can all be given within the same hour (and more likely minutes or even seconds) why is this question even on ANY test? It should read "if you could only give ONE of these, which would it be?" But of course that's not really realistic either.

But then again, I'm only second quarter, so what do I know.

[suzw]

oops, I meant Zithromax should be given first. Not "it". :-)