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

Nursing Students Student Assist

Published

To begin, I'm new to this site! Every time I google questions related to my nursing studies AllNurses.com seems to always pop up so I figured I would give it a try. I'm currently in my 2nd semester and enrolled in Med-Surg and Pharmacology. The nursing program I'm in is all messed up right now as one of the instructors were forced to resign due to the complaints from former and current students. In addition, the school was scrambling to find a teacher at last minute and the one they found is only 25 years old. She is not only trying to instruct us but also refresh herself. We recently took out first pharmacology test which was 12 chapters long from the Pearson Pharmacology for Nurses: A Pathophysiologic Approach 3rd Edition. Unfortunately, the highest grade was a 65, so the instructor gave us the exact test back to take home for the weekend and redo using any materials and she is going to average the previous test and the take home for a final grade. Okay, my dilemma: this test seems way harder now as a take home test than it did when I took it in class even though it's the same exact test. The questions which were supposed to be strictly from chapters 1-12 are not by any means. Many questions are critical thinking questions and only being in our 2nd semester the majority of my classmates have not developed strong critical thinking skills. I've found almost all of them except 4 (out of 75). I'm not asking for answers but I would like someone to guide me in the correct direction as to how to answer these questions.

(One answer per question)

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.

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.

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.

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.

Like I said earlier, I'm not looking for anyone to give me the answers but I would like help in understanding how to answer these questions. I have a general idea of what the answers should be but I can't find anything in my books about how to address these situations. And I'm scared to answer them the same way I did on the initial test because apparently I didn't get them correct if I failed it the first time. I'm scared I'm either reading into the questions TOO much or NOT enough. HELP ME PLEASE!

Specializes in pediatrics, public health.

So Dowdy, was your initial test graded, and do you know if your original responses were graded correct or incorrect?

I'd be very interested in hearing what your pharm prof and/or book considers to be the "correct" response. Please come back and let us know once you find out!

As for whether or not your prof wants the NCLEX answer or "real world" answer, in my experience my profs always wanted the NCLEX answer and I'm guessing your prof probably does too -- but the best way to find this out is to ask her.

Good luck!

Now you have me curious, please let us know what the answers were when you get them! Just my opinion but I would totally go with monitor for relief of spasms and not teaching as my FIRST intervention related to the medication. I am first year and have not had pharm, but as our instructors keep telling us nclex is often about order and critical thinking. I am curious though, how do you contact the patients minister without violating hippa? Is this assuming we are getting the patients okay and participation is that what "plan to" is about? That questioning in my head made me wonder of the hospital minister was the right one instead of her own.? Responses? I am not by any means an expert so for me the discussion of these questions helps me learn and understand.~ CS

Specializes in pediatrics, public health.
I am curious though, how do you contact the patients minister without violating hippa? Is this assuming we are getting the patients okay and participation is that what "plan to" is about? That questioning in my head made me wonder of the hospital minister was the right one instead of her own.? Responses?

Yes, you would have to get the patient's permission before contacting their minister in order to avoid violating HIPAA. That also made me wonder which answer to the question is considered correct, but I still lean towards choosing the answer about contacting the patient's own minister (and assuming that I've asked for permission and the pt has said yes). Seems to me that if you want to contact the pt's minister you're going to have to ask them anyway, since how else would you know who their minister is? (unless that's in the admissions paperwork -- at the hospital where I used to work, it was not)

quote from esme12

[color=#333333]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.

[color=#333333]

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.

this disparity between real world and nclex world is what makes me think i will be woefully unprepared when i graduate. it's frustrating when your hear that nclex world is not real world knowing that schools teach you to pass the nclex to keep their pass rates high. i want to be an excellent "real world" nurse and, of course, i have to pass nclex. i wish my education wasn't an either/or situation :banghead:.

Specializes in Gerontological, cardiac, med-surg, peds.

In my not so humble opinion, these questions are horrible. The fact that the best grade in the entire class was 65% ought to be a wakeup call for your instructor. These test items are so ambiguously worded that they are not accurately assessing or measuring the knowledge of the students taking the test!

Specializes in MedSurg, OR, Cardiac step down.

We had to learn how to critical think as soon as we hit the door, like the 1st day......and there wasn't a class for it.

Specializes in Medical Surgical Orthopedic.

My best guesses:

"Monitor the client for relief of bronchospasms" is what I'd choose for the first answer since the client is already (presumably) receiving the treatment.

For the second question, I would ask the client if he'd like to meet with a hospital minister. This would help support the client spiritually, but in a more neutral way. The client is already in contact with his own church and congregation, judging by the statements he's made- and it's not helping.

For the third question... Herbs can be ingested and are technically drugs. For this reason, I would seek approval from the treatment team since it's out of my scope of practice to approve medications independently. If only objects were requested, I would allow them as long as a safety threat didn't exist.

For the forth, I choose "An error could have occurred because the nurse was unfamiliar with the medication." The other answers just don't make any sense.

Okay, it's been awhile since I did the old NCLEX questions, so let me give this a try for old time's sake:

**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.

For this question, the key is *initial*. I would take that to mean, before the medicine is administered, what would you do? Note that the question does not explicitly state that the patient is experiencing a bronchospasm at this moment, and a trick of answering NCLEX questions is to not "think into them too much," aka not think about what "might" be happening beyond what the question explicitly says. Finally, an important part of medication administration for all drugs (except in emergencies) is to do a certain thing... that certain thing is what I believe the answer is.

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.

Ah, this type of question. I remember them so fondly :clown: This is tricky, and I'm not entirely sure of the answer myself, so I will just offer some basic NCLEX tips related to it: always remember to talk to the patient about what the patient is feeling, because only the person experiencing the emotion really knows what they feel. Also, always directly involve the patient in their own care and treatment discussions, never "go around" them and talk to someone else about what the patient should be doing or feeling.

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.

Hmm, okay. Let me put it this way: unless the patient is deemed mentally incompetent by a court of law and has a proxy appointed (or the patient is clearly intoxicated and is temporarily unable to make sound decisions), patients have a right to refuse any and all treatments. Patients also have the right to use alternative medicines if they wish to, and cultural respect is extremely important. However, in psychiatric units, some objects are restricted due to the possibility that a patient could use them to commit suicide (long cords, sharp objects, etc.). Knowing this, what would be the nurse's best choice?

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.

Remember, nurses are responsible for their actions and must always be prepared and knowledgeable about what they're doing. What is the definition of a medication error?

I did not intend to directly give you the answers so I hope I did not, but I hope I gave you food for thought into the NCLEX world :o

Specializes in pediatrics, public health.
quote from esme12

[color=#333333]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.

this disparity between real world and nclex world is what makes me think i will be woefully unprepared when i graduate. it's frustrating when your hear that nclex world is not real world knowing that schools teach you to pass the nclex to keep their pass rates high. i want to be an excellent "real world" nurse and, of course, i have to pass nclex. i wish my education wasn't an either/or situation :banghead:.

imo, your clinical rotations do give you at least some idea of how nursing is done in the "real" world. not quite, because in nursing school you generally never have a full patient load, but at least you're getting exposure to how nursing is done in the real world -- so, pay close attention to what the nurses are doing during your clinicals and you'll at least have the beginnings of a clue :rolleyes:

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.I AGREE, assessment is always first, learned that from Kaplan.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. i Agree3. 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. I AGREE TOO 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)
I AGREE TOO. Weird question, NCLEX will not have "could have" questions like this, I do not think. I believe your professoe is trying to get you to think NCLEX style questioning. In school, I purchased a great book explining how to break down this type of questioning- what are they really asking and what do they want. I think it was from medscape. Ill figure out name and let you know. That book, and then Kaplan after I graduated, helped immensely! I passed with 75 questions and was out of test by 90 minutes.

My book was from meds publishing, I remember it was expensive. You can search for other books that help learn how to answer nclex style questions. My advice is to learn the steps now, because it only gets more confusing in school - where one would think they should teach how to take the test?

Specializes in nursing education.
In my not so humble opinion, these questions are horrible. The fact that the best grade in the entire class was 65% ought to be a wakeup call for your instructor. These test items are so ambiguously worded that they are not accurately assessing or measuring the knowledge of the students taking the test!

Yeah, I thought pharmacology was mechanism of action, onset, duration, and whether the meds are metabolized in the liver and excreted by the kidney. I don't think clients' belief systems came up once in our undergrad class, except as a general "right to refusal, provide education, and document" asterisk.

The types of situations described in the questions DO come up every day where I work, but I don't think the pharm class is the right place to discuss African artifacts. There are other classes where clients' belief systems can and should be addressed. Ethics, nursing theory, and clinical are all great fora for that.

+ Add a Comment