Test Item Part 2

Statistics for Adult Medical Surgical Nursing Quiz

Eight individuals took this quiz, and out of the eight quiz takers, all persons passed. The quiz was taken a total of nine times, as one person took the test twice, scoring 100% both times. The average score for the quiz was 94%. The average time spent taking the quiz was two minutes and twenty one seconds. Five of the quiz takers scored 100% on the quiz, two people scored 86% and one person scored 71%. All questions in this quiz were weighted equally for scoring purposes.

Question Revisions

The three questions that need to be looked at specifically in this analysis are numbers 3, 6, and 7. Number 3 was chosen because it makes the student read the question, analyze, and critically think to apply the answer. In order to critically think through this question, the student must be able to understand the rationale between anticoagulation, a possible hemorrhage, and the fact that taking aspirin and a nap instead of seeking medical attention immediately would be contraindicated. The question is reverse application because it forces the student to read the question which actually asks the student to pick the incorrect response from the patient.   The current format of the NCLEX-RN examination included alternative format questions, and critical thinking questions that force the student to apply critical thinking skills in order to answer the question (Herrman and Johnson, 2009). The stem of this question could be modified to ask the question in a clearer manner with less opportunity for confusion. Maybe presenting a scenario as I did in the first two questions might help the students put the question into perspective.

You are a medical surgical nurse who is discharging a patient who is newly prescribed Coumadin for a diagnosis of atrial fibrillation. Which statement made by the patient after receiving their discharge teaching would alert you that the discharge teaching has not been effective, and further teaching with this client is necessary?

A.      “If I notice that I have a bruise that is three inches or bigger and continually gets larger, I will seek immediate medical help.”

B.      “I will eat green leafy vegetables in moderation, as they are healthy, but can increase the thickness of my blood, potentially causing a clot.”

C.      “I will keep all scheduled appointments for blood work because it is important to monitor my PT/ INR levels to ensure that my Coumadin dose is therapeutic.”

D.      “If I get a severe headache, worse than any other headache I have ever had in my life, I will take two aspirin, and take a nap, as that should help.”

Number 6 addresses the basic principles of nursing and medication administration, and is based on the five rights of medication administration. I do not think that just because two people answered this question incorrectly that it should be removed or changed, it is clearly asking which of the orders that is listed is complete.

Question number 7 is an application question that asks the student to identify a critical potassium level. Three of the options given are within normal limits. This question should not be changed either, because it addresses laboratory blood values, which are important for the nurse to be able to identify.

 

The following questions were included in the initial quiz, and the percentage answered correctly for each.

You are the RN charge nurse on the medical surgical unit, and you are in charge of delegating assignments for the shift. Which of the following would be the most appropriate to delegate to the LPN/LVN? 100% of quiz takers answered this question correctly

A.      A 25 year old patient who requires IV antibiotic therapy, and needs a PICC line dressing change before administering the antibiotic.

B.      A 72 year old patient who requires Lasix 20mg IV push

C.      A 50 year old patient who is 3 days post op and requires a simple dressing change

D.      A 45 year old patient who is a newly diagnosed diabetic and requires discharge teaching

 

You are caring for a patient who is newly diagnosed with Congestive Heart Failure CHF. Which statement by the patient would indicate that your patient teaching has been a success? 100% of quiz takers answered this question correctly

A.      I will watch my salt intake and ensure that I do not exceed 4g or 4000mg per day in my diet

B.      I will conduct a daily weight, keep a log of my daily weight, and report to my doctor immediately any weight gain of 3 or more pounds in one day

C.      If I feel that I am urinating too frequently, I will not take my diuretic for a few days to help with the frequency of urination, after all, I don’t want to fall getting out of bed so much at night

D.      I will just smoke one half pack of cigarettes per day, as this is healthier than one pack.

Which statement by the client receiving anticoagulation therapy with Coumadin would indicate a need for further teaching? 88% of quiz takers answered this question correctly

E.       If I notice that I have a bruise that is three inches or bigger and continually gets larger, I will seek immediate medical help.

F.       I will eat green leafy vegetables in moderation, as they are healthy, but can increase the thickness of my blood, potentially causing a clot.

G.     I will keep all scheduled appointments for blood work because it is important to monitor my PT/ INR levels to ensure that my Coumadin dose is therapeutic

H.      If I get a severe headache, worse than any other headache I have ever had in my life, I will take two aspirin, and take a nap, as that should help

Which of the following foods should a patient receiving Coumadin therapy be instructed to eat in moderation? 100% of quiz takers answered this question correctly

A.      Spinach and other green leafy vegetables

B.      Corn

C.      Brown Rice

D.      Lean Chicken Breast

 

A client receiving Lopressor 50mg IV should most importantly have which vital signs checked prior to administration? 100% of quiz takers answered this question correctly

A.      Temperature

B.      Respirations

C.      Blood pressure and heart rate    

D.      Pain

Which of the following orders is complete, not requiring nurse clarification? 75% of quiz takers answered this question correctly

A.      Tylenol 650mg PO q4hours PRN for mild pain

B.      Ativan 1mg PO PRN

C.      Ibuprofen 400mg q6hours PRN for moderate pain

D.      Haldol 2mg IM q6hours PRN

Which of the following laboratory values is considered critical? 88% of quiz takers answered this question correctly

A.      Potassium 4.2 mEq/L

B.      Potassium 2.8 mEq/L

C.      Potassium 3.7 mEq/L

D.       Potassium 4.9 mEq/L

 

References

Herrman, J., & Johnson, A. (2009). From beta-blockers to boot camp: preparing students for the NCLEX-RN. Nursing Education Perspectives, 30(6), 384-388.