After reading the questions below identify the problems with the following questions based on the readings and lecture from this week. (Oerman & Gaberson Chpt 3, 5
Appendix A
Billings & Halstead Chpt 24 (OLD text) Chpt: 25 ( NEW text)
I.) What problems can you find in the following multiple-choice item? Find all of them and rewrite the item.
1. Morphine:
a. Is used for mild pain.
b. Can be used for patients with asthma
c. Is given only by injection
d. Is used for severe pain
II.) Does the following item need revision? Why or why not?
You are caring for an elderly woman who lives alone but has frequent visits from her neighbor. She has shortness of breath and severe back pain from a fall last year. Your patient was told recently that she has COPD, which is:
a. caused only by smoking.
b. the 2nd leading cause of death in the United States
c. developed progressively.
d. can be reversed if treated promptly.
III.) Revise the following item and provide a rationale for each revision:
Cleft palates are repaired at what age?
a. At birth
b. At 1 to 2 months
c. At 2 to 3 months
d. At 2 to 3 years
IV.) What is wrong with this item?
The normal range for potassium in adults is:
a. 2.5 – 4.5 mEq/L.
b. 0.5 – 3.5 mEq/L.
c. 3.5 – 5.2 mEq/L.
d. 1.5 – 4.5 mEq/L.
Find the problems in how these items are written and correct them:
V) . Your patient has recently lost weight and reports that she is constantly thirsty. Which of the following data suggest that the problem is dehydration?
a. Loss of weight
b. Increased blood pressure
c. Decreased urine specific gravity
d. Normal temperature
VI) . Your patient has had GI surgery. Prior to discharge teaching you need to assess:
a. How much lifting is done at work
b. If the patient can take breaks at work
c. If the patient has a stressful job
d. If the patient eats high protein and low fat foods
VII.) Your patient is ordered 60 mg of Roxanol™ (morphine sulfate 20 mg/mL) every 4 hours for severe pain. Which of the following actions should be taken?
a. Dilute in 500cc normal saline
b. Give the morphine as ordered
c. Call the physician about the dose
d. None of the above
VIII.) A client experiences an episode of pulmonary edema because the nurse forgot to administer the morning dose of furosemide (Lasix). The patient calls the nurse to tell her he cannot breath and feels like he is drowning. Which legal element can the nurse be charged with?
Is there excess verbiage in here or not?
Could this be answered without that extra content?
What is your rationale for keeping or removing it?
IX.) A 70 year-old female (ER weight: 80 kg) presents with to the ER with progressively worsening SOB and DOE for 24 hours. She reports no dizziness. Physical exam reveals bilateral crackles and 3+ bilateral peripheral edema. The patient was seen by her cardiologist two days ago for her regular checkup (office weight: 70 kg). Current medications include furosemide 40 mg PO daily (no recent changes), lisinopril 20 mg daily (no recent changes), digoxin 0.125 mg PO daily (no recent changes), and metoprolol XL 50 mg PO daily (increased from 25mg by cardiologist at last visit two days ago). ER vitals include: BP 140/94 mm Hg, HR 84 bpm, RR 20, and temp 98.6 F. Labs include: Na 138 mEq/L, K 4.4 mEq/L, Cl 101 mEq/L, CO2 24 mEq/L, BUN 12 mg/dL, SCr 1.1 mg/dL, BS 119 mg/dL, and serum digoxin 1.2 ng/mL. Her last echocardiogram was two months ago (EF=38%). Which of the following is the BEST approach to manage this patient’s chief complaint?
a) Decrease lisinopril to 10 mg PO daily
b) Increase furosemide to 80 mg PO daily
c) Decrease metoprolol XL to 25 mg PO daily
d) Increase digoxin to 0.25 mg PO daily
Does this past question have excess verbiage?
If so what would you suggest taking out vs. leaving in? Explain your rationale.
