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

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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!

"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??"

this is not a pharmacology or oncology question. it's a question of spiritual distress, which see. if you look at it that way, the answer is clear-- speak to the patient's own clergy (with her permission). the nurse will do this action because it is the patient's spiritual distress that needs addressing. the "church ladies" may be wrong, or have another agenda, whatever... the pastor is the authority to be consulted here, and so that is the straight-away answer.

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!

I respectfully disagree with you.

All of our questions are usually based on Maslow. There is a clear Maslow pattern in all of the NCLEX questions I've see here as well.

The psych patient - from those answers it seems the best course of action is to allow as long as the patient signs a waiver. Obviously it's not reality.

edit: Treatment team is the better answer but when I've had questions like this it was educate pt talk to provider.

Noahsmama- Our initial test was graded (I made a 64) but since our instructor allowed us to retest, we were not allowed to see the actual test, only the grades. We have to turn the 2nd test in Monday, and should get our grades and test back Wed. of this upcoming week and I will let you guys know how it turns out!

VickyRN-I completely agree with you. I feel these questions are not evaluating our knowledge accurately. Soon as I completed the test (following an acute panic attack I'm sure lol), I spoke with several classmates about the content of the test and the feeling was mutual. I felt more than apt to take the test the morning of but after taking it I wasn't so sure I studied correctly and I wasn't sure where my disconnect was. I really feel like the time and effort I dedicated the previous week studying, reading, and reviewing material was not accurately reflected by my test grade.

ALL OF YOU , Thanks so much for the helpful words of advice! I can't explain how much I appreciate each and every response. I'm really torn as to what to put for my 2nd set of answers. I will definitely let you all know what the "correct" answers are possibly this Wed. depending if my instructor has given us the test back. ("usually" she is a pretty fast grader!)

Instinctively for me:

1. d

If your patient can't breathe then they might die and then you won't have a patient anymore. Make sure the patient is breathing comfortably and THEN teaching would be appropriate. A person who is having difficulty breathing isn't going to listen to your spiel about proper use of an inhaler.

2. d

This is a spiritual/psycho-social question and the other three options seem like borderline HIPPA violations to me.

3. d

This is another spiritual/psycho-social/cultural sensitivity type question that also includes safety. The last answer mentions safety and you are also providing culturally competent care at the same time.

4. b

Don't administer a medication you are not familiar. Period. End of story. Never do this. It will always be wrong. It will always be an error, and it will always be your ass! The nursing manager might go down too but you will definitely be held responsible.

Your priorities as a nurse will follow Maslow's Hierarchy of Needs (ABCs, Safety, etc), but not every question is going to address the patient's physiologic state.

hey everyone! sorry for such a late reply but i just got my 2nd test (take home) grade back. i made an 85, not as good as i had hoped for but better than last. the test were not passed back out in class for the class to discuss as a whole (how we usually do it so we can express our concerns together) but rather we had to make an appointment with the teacher for a one on one review of the test. my appointment was wednesday so that's why it took so long to get back to you all. the teacher handed me the 2nd take home test along with her answer sheet and said "go for it". when i asked for explanations of the ones i had trouble with, i was given a brief explanation of "her" reasoning. here are the questions i posted earlier and "correct" answers(in bold):

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.

once again, thanks for everyone's help & guidance!!

Specializes in Medical Surgical Orthopedic.

Yay! I made a 50% :)

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
"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??"

this is not a pharmacology or oncology question. it's a question of spiritual distress, which see. if you look at it that way, the answer is clear-- speak to the patient's own clergy (with her permission). the nurse will do this action because it is the patient's spiritual distress that needs addressing. the "church ladies" may be wrong, or have another agenda, whatever... the pastor is the authority to be consulted here, and so that is the straight-away answer.

this was a pharmacology take home test and i guess i just thought there would be more questions about meds themselves that's all....like look for bronchospasm and the albuterol question, and i did suggest (without answering the question) what would best engage the patient with compliance is to engage their church and the patients own pastor and not to listen to the churches old bitties....;)

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

Good for you......can you see how I tried to lead you tot hat conclusion?

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

In accordance with Maslow's hierarchy of needs, Airway is important and if the patient is still having bronchospasm OR the spasms have worsened further and have further comprised the patients airway.

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?

I would have to say I would think a more cause and effect definitive drug question for a pharmacology would seem more appropriate, but after all the mentally prepared patient is a healthier patient. So the patients minister would be the first choice to talk with the patient thereby increasing compliance with the care regime.

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....technically, 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.?

Again, engaging the patient and their belief/culture will foster trust and compliance with treatment regime.

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.

Congratulations!

i am reassured to know that even though i am old, tough, and use comic sans, i can still get an a in nursing school.:thankya:

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
i am reassured to know that even though i am old, tough, and use comic sans, i can still get an a in nursing school.:thankya:

you saw that too...:rolleyes:....i thought really????

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.

*4

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.

*1

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

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.

*3...or *2 tricky tricky

This is my take on these questions. They may or may not be correct.

This test really blew my mind! After reviewing the 2nd test (take home) everything made sense. I was like wow, I really read into the questions too much. I was under the assumption that pharmacology would be memorizing drugs, actions, interactions, etc. but apparently our instructor thinks otherwise. She is very young, just finished her masters, all the while trying to teach a pharmacology class while working a second job. Our previous instructor, up and quit, leaving our school empty handed over Christmas break. Our new instructor took the job a week before our classes began and has been reading the text book that was selected by previous instructor & teaching by it, which she hates (I've heard this from numerous instructors & students). So all in all, hopefully I'll make it through this semester!! Thanks again for everyone's support!!

P.S. GrnTea: this just goes to show that even though nursing is continuously progressing as a whole, that at the core of it all nursing today is still "nursing"!

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