Whole class failed first test....now its a TAKE HOME!

tippytootagon · Feb 10, 2012

I'm a second semester nursing student as well, but I took pharmacology first semester that said.

Question 1. Another way of phrasing the question would be like this: Your patient is taking albuterol for bronchospasm. This means that you have to do ________________ to make sure that the albuterol is working. What fills in that blank?

Question 2. I'm unsure of the answer here. I've definitely eliminated two options, and leaning more towards one of the remaining than the other, but I'm not certain.

Question 3. Some things to think about with regards to answering this question. What is your #1 patient priority? Also, how do you account for your patient's autonomy?

Question 4. You absolutely MUST know what a medication is for before you give it. Imagine giving a patient who currently has low blood pressure a blood pressure medication just because "the doctor ordered it". Even if you give it by the right route, to the right patient, at the right time, at the right dose, if you don't know what the medication is for, you could cause a huge med error.

nurseprnRN, BSN, RN · Feb 10, 2012

think of the answer that requires independent nursing education and action. for example (here's the answer for the first one-- say thank you, because i do not usually do this, and i will probably lose my crusty old bat badge :sniff: ), actions related to giving a med and monitoring its effects, side effects, etc. are related to the medical plan of care.

but the patient education is all nursing.

hmmm, all nursing. i like the sound of that. might help you remember the next time you run into a question that looks ambiguous (or tribiguous:d ).

noahsmama · Feb 10, 2012

I'm a second semester nursing student as well, but I took pharmacology first semester that said.
Question 1. Another way of phrasing the question would be like this: Your patient is taking albuterol for bronchospasm. This means that you have to do ________________ to make sure that the albuterol is working. What fills in that blank?
.

I disagree with this rewording of Question 1. The original question asks what the initial nursing intervention should be. This means that, out of all of the responses that are appropriate interventions, you need to decide which one should be done first. I'm not going to say what I think the correct answer is, I'm only going to say that I think it's fairly obvious, and also that rewording the question the way you did will, in my opinion, give you the wrong answer.

Esme12, ASN, BSN, RN · Feb 10, 2012

1. The client is receiving albuterol (Proventil) for treatment of bronchospasm related to asthma. What is the initial nursing intervention as it relates to this medication?

-Monitor the client for nausea & headache

-Provide the client with age-appropriate education about albuterol.

-Monitor the client's serum drug levels.

-Monitor the client for relief of bronchospasms.

Why are you giving the drug? What is albuterol used for? What would you FIRST want to happen when someone can't breathe.....you want them to breathe. ABC AIRWAY breathing circulation. But there is always time to teach. You really need to refer to your text

2. The client is diagnosed with cancer. The physician has recommended chemotherapy, which would likely save the client's life. The client tells the nurse, "This is punishment from God for sins I have committed; some women at my church say so." What will the best plan of the nurse include? With the client's permission:

-plan to contact the client's minister to discuss the client's perspective about cancer.

-plan to meet with family members to discuss the client's perspective about cancer.

-plan to bring the case before the hospital's board of ethics.

-plan to involve a hospital minister to discuss the client's perspective about cancer.

A pharmacology question...wow. Ok. Which would benefit the patient the most at this point with a strong faith and connection with their church. What would improve the patients compliance with the medical regime. You can only pick one?

3. The African-American client has panic attacks, is suicidal, and is on an inpatient psychiatric unit. The psychiatrist orders Zoloft and Klonopin. The client refuses the drugs; he requests to have herbs & African objects in his room to "remove the curse". What is the priority action by the nurse?

-Allow the request without seeking further information from the client.

-Allow the request after the client signs a release of responsibility to avoid litigation.

-Allow the request after all members of the treatment team agree to it.

-Allow the request as long as the herbs and objects do not pose a safety risk for the client or other clients.

Wow....none of the above. Ok. What would support the client in compliance with traditional medicine treatment? What would support the clients sense of self and well being and ultimate cooperation with the treatment plan.?

4. The nurse was very busy and unfamiliar with a new medication, but administered it anyway. Later the nurse looked up the medication. How does the nurse manager evaluate this behavior?

-this was acceptable as long as the nurse looked up the action & side effects of the drug later

-An error did occur because the nurse could have administered the medication via the incorrect route.

-An error could have occurred because the nurse was unfamiliar with the medication

-The nurse manager was partially at fault because the nursing unit was understaffed & the nurse was too busy.

A nurse should know what meds she is giving before she gives them to prevent any errors. A nurse should not give medicine unfamiliar without looking them up...a busy unit will not absolve you from litigation if an error is made.

Without having your text books I maybe way off and I would hate to miss lead you. I wish you the best.

tippytootagon · Feb 10, 2012

I disagree. If you're giving albuterol, your primary concern is your patient's airway and breathing, and education would be secondary (I'm assuming that's why you're disagreeing with my rewording). If your patient is sitting there wheezing, you're not going to sit there and educate them about albuterol - you're going to give them the medication, and make sure that they can breathe first!

Assessment is the first and most important step of the nursing process, and in this case, we must assess our patient's breathing.

ETA: this is in response to noahsmama and grntea

noahsmama · Feb 10, 2012

I disagree with this. If you're giving albuterol, your primary concern is your patient's airway and breathing, and education would be secondary (I'm assuming that's why you're disagreeing with my rewording). If your patient is sitting there wheezing, you're not going to sit there and educate them about albuterol - you're going to give them the medication, and make sure that they can breathe first!

Tippy, in the REAL world you might be right. But this is an NCLEX style question, in an NCLEX hospital, which is NOT the real world. In the NCLEX universe, there is always time for patient education.

I'd bet my next paycheck that the "correct" answer to this question is patient education first. And although you might be able to argue with your pharmacology prof about this, you don't get to argue with the NCLEX test -- they decide which answer is the "best" answer.

Also, educating about albuterol doesn't really take that long -- even in the real world, I could be explaining to the patient and/or the patient's parents what albuterol does and what the potential side effects are in the time it takes me to set up the nebulizer or shake the canister and attach it to the spacer (depending on how I'm giving the albuterol). So, even in the real world I think one could do education before or simultaneously with administering the medication.

Esme12, ASN, BSN, RN · Feb 10, 2012

See this is the craziness I speak of.......a new grad comes out of school and has a patient in acute respiratory distress and we, the experienced nurses, think they are crazy for "teaching" the patient in a time of crisis and blame the student and not the teachings. Something needs to be fixed in the schools.

noahsmama · Feb 10, 2012

See this is the craziness I speak of.......a new grad comes out of school and has a patient in acute respiratory distress and we, the experienced nurses, think they are crazy for "teaching" the patient in a time of crisis and blame the student and not the teachings. Something needs to be fixed in the schools.

I understand what you're saying Esme, but as a relatively recent (2008) grad myself, I'm happy to report that even in nursing school, they differentiated for us, at least to some extent, what one does in the real world vs. what one does in the NCLEX universe. So even as a new grad, I knew that if I had to choose between helping my patient breathe, or educating them, that I would help them to breathe first, and educate later!

garnetgirl29, BSN, RN · Feb 10, 2012

I am also a 2nd semester LPN student an am currently in pharmacology. This would be my take:

1. The pt is receiving albuterol to treat bronchospasms, so I would assess my pt for relief of bronchospasms & airway patency.

2. We have had questions like this and our instructors tell us it's always appropriate to contact the pt's pastor (or other religious leader) if the patient wishes. Since this pt is in conflict about her illness and her treatment, I would contact her minister and ask for counsel for her. Since this pt is clearly concerned about comments from other church members,I would feel that contacting her minister would serve her needs better than the hospital clergy.

3. We watched a video in lecture about accommodating cultural beliefs and they showed us a clip from Grey's Anatomy where they allowed the family to call in a special religious leader and performed a ritual in the room before the pt could have surgery. We were taught to always accommodate cultural and religious practices, unless they pose a safety hazard, so I would choose the last option. The pt always has the right to refuse treatment, and this pt clearly would never comply with any treatment if his wishes were not granted. So, by allowing this, you are building a relationship with this client and are more likely to get him to comply with his treatment.

4. I would never give a medication I am not familiar with. The #1 act of a nurse is to assess, assess, assess. How do I know for sure that this medication, dose , route is appropriate for my pt if I don't know what this med is or what it does? In clinical last week, I was following an RN who actually said, "I don't know" when the pt asked her what this pill was. I do not what to be 'that' nurse. Dr's make mistakes. Pharmacies make mistakes. We are the last on the list to to correct medication errors before they are administered to the pt. A hospital in my area is currently under investigation because of a medication error a nurse made. She lost her license and the hospital is now at risk for losing funding from medicaid. (this nurse pulled meds for two pt's at the same time and switched them -potassium and insulin, thankfully, the pt's are ok)

LoveMyBugs, BSN, CNA, RN · Feb 11, 2012

OP what did you orignally answer, pherhaps knowing what you answered would help in guiding you to the right answers here.

Others who have responded gave really good answers.

When thinking of answering NCLEX style questions , always think patient safety first, which means your ABC - airway, breathing, circulation.

Once your patient is safe and breathing the next you would think of is Maslows hierarchy of needs, again patient safety and immediate needs must be met before the patient can learn, so your patient getting albuterol, do you really think they are going to be able to learn anything you are teaching them if they are struggling to breathe?

Dowdy90 · Feb 11, 2012

Thank all of you for your responses! I appreciate every single one of them. From reading through the responses I once again realize how easy it is to read a question differently than the person sitting beside you. My biggest problem is determining whether my teacher wants the "NCLEX answer" or "real world answer" because I've learned quickly there is a BIG difference in the two. Our teacher is fresh out of school herself, with only 2-3 years experience, and so we're all trying to adjust and get a feel for her testing in the sense if she's looking for how we would respond in the real world or how we would answer on the NCLEX.

For 1 question, I answered with "provide the client with age-appropriate education." My reason being that the question does not state if the client is currently experiencing bronchospasms or if the client is simply being prescribed the albuterol for future attacks. The questions does state what is the initial nursing intervention as it relates to this "medication". This lead me to answer with "provide the education" because by reading my book it says you should ALWAYS teach clients about medications before administering the medications. However, you can also read the question as if the client has already received the medication and what should you do now?

For question 2, I answered with "plan to involve a hospital minister to discuss the client's perspective about cancer" on the initial test. Looking through my pharmacology book, there was NOTHING that even closely addressed this situation. I had no basis for my answer besides the fact I wasn't sure if you were, "by hospital protocol", allowed to contact a client's minister. Looking at the responses for this question, I realize I was completely disregarding what would make the CLIENT more comfortable. In this case, with the answers to choose from, contacting the clients minister would probably benefit the client the most.

For question 3, I answered with, "allow the request as long as the herbs and objects do not pose a safety risk for the client or other clients" on the initial test. I answered with this because I've always read that as a nurse, you are supposed to make the client as comfortable as possible and be culturally sensitive to one's beliefs. However, I didn't know if I first needed needed to get the approval of the treatment team members or if I needed the patient to sign a form of some kind stating that he refused meds? I feel like I really read into this question too much and should just stick with my initial answer.

For question 4, I answered with "an error could have occurred because the nurse was unfamiliar with the medication" on the initial test. However, some of my classmates made a valid point by saying that an error did occur (answer 2) because the nurse was unfamiliar with the medicine which neglects the patient's right to education on the medication they are receiving, but I'm not so sure I agree with answer 2 because it says, "an error occurred because the nurse COULD have administered the medication via the incorrect route". Yea, she could have but it doesn't say she made any errors. So that's why I went with answer 3. Plus, my teacher is always preaching, "You cannot add any information to a question or assume when you are looking for an answer. You can only use what you are given."

And far as everyone saying, "read your material", I promise I have read it frontwards, backwards, and sideways. Our instructor has even said that this is the worst pharmacology book she has ever seen, but due to the fact she took the teaching job last minute, the book had already been assigned. So on that note, if anyone knows a book that would be helpful please feel free to elaborate!