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Question # P-Value D-Value Questions Rationales 9 0.98 0.05 Original Question: With a p-value of 0.98, this question was too A triage nurse in a busy emergency department easy. With a d-value of 0.05, the question did not assesses a client who complains of 6/10 abdominal differen
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    Question # P-Value D-Value Questions Rationales 9 0.98 0.05 Original Question: A triage nurse in a busy emergency department assesses a client who complains of 6/10 abdominal pain and states, “I had a temperature of 104.6 o F at home. Which action would the nurse perform first? a.   Inform the client that it may be several hours before being seen by the doctor. b.   Obtain a clean-catch urine for urinalysis culture. c.   Assess the client’s current vital signs. d.   Ask the doctor to order an antipyretic for the client. With a p-value of 0.98, this question was too easy. With a d-value of 0.05, the question did not differentiate between high and low scorers. In fact, only one student got the question wrong. Revised Question: A triage nurse in a busy emergency department assesses a client who complains of 6/10 abdominal pain and states, “I had a temperature of 104.6 o F at home. Which action would the nurse perform first? a.   Assess when patient had last BM   b.   Obtain a clean-catch urine for urinalysis culture.   c.   Assess the client’s current vital signs. d.   Assess patient history of UTIs   This question is asking the student to prioritize care, but in the srcinal version, two choices (a & d) were obviously wrong. Therefore, students were only left with two options, which makes it a 50-50 chance that they will guess the correct answer. To make this question more difficult, I added in two new distractors, which are good actions, but not appropriate for the first action. 10 0.93 0.1 Original Question: After receiving morning report on a medical/surgical unit, which of the following clients should the nurse see FIRST ? a.   A 36 year old man who underwent surgery for multiple fractures in his left leg after an automobile accident who reports coughing up a small amount of blood This question is too easy, as shown by a 0.93 p-value. With a d-value of 0.1, this question does not differentiate between high and low scorers. Three students got this question wrong.  b.   A 56 year old woman newly diagnosed with diabetes mellitus Type II who has a fasting blood sugar of 83mg/dL c.   A 68 year old man with head and neck cancer receiving a continuous 5-flouracil infusion who reports feeling very nauseous d.   A 28 year old woman with sickle cell anemia who reports a pain level of 8 on a scale of 1-10 Revised question: After receiving morning report on a medical/surgical unit, which of the following clients should the nurse see FIRST ? a.   A 36 year old man who underwent surgery for multiple fractures in his left leg after an automobile accident who reports coughing up a small amount of blood b.   A 56 year old woman newly diagnosed with diabetes mellitus Type II who has a fasting blood sugar of 150mg/dL c.   A 68 year old man with head and neck cancer receiving a continuous 5-flouracil infusion who reports feeling nauseated and vomited after breakfast d.   A 28 year old woman with sickle cell anemia who reports a pain level of 8 on a scale of 1-10 This question is asking students to prioritize and determine which patient in a riskier situation. For choices b and c, the situations were obviously not serious. So, to make the question harder and to make sure that students really know the material, I made the distractors more “distracting”. I increased the blood sugar in b to a level which would require attention, but is not an emergency. That patient needs coverage, but not immediately. For choice c, the patient is experiencing expected side effects of chemotherapy, but he probably needs an antiemetic medication. He needs attention, but can wait. Choice d is something that needs relatively quick attention, but not as urgently as a. 15 0.93 0.05 Original Question: The charge nurse of a surgical unit has been notified of an external disaster with multiple casualties. Which client should the charge nurse request to be discharged from the hospital? This question is both too easy (p-value=0.93) and does not differentiate between high and low scorers (d-value=0.05). Three students got it incorrect.  a.   The client scheduled for a repair of an abdominal aortic aneurysm (AAA) in the morning and whose preoperative teaching has not been started b.   The client who had an abdominal hysterectomy two days ago and whose catheter was removed this AM. c.   The client who has a bleeding peptic ulcer and now has a hemoglobin of 7mg/dL and a hematocrit of 22.1% d.   The client who was in a motor vehicle accident and has a 6 on the Glasgow coma scale and intermittent decorticate posturing Revised Question: The charge nurse of a surgical unit has been notified of an external disaster with multiple casualties. Which client should the charge nurse request to be discharged from the hospital? a.   The client who had a repair of an abdominal aortic aneurysm (AAA) that morning and whose postoperative teaching has not been started b.   The client who had an abdominal hysterectomy two days ago and whose catheter was removed this AM. c.   The client who has a bleeding peptic ulcer and now has a hemoglobin of 8.5mg/dL and a hematocrit of 30.1% d.   The client who was in a motor vehicle accident and has a 6 on the Glasgow coma scale and intermittent decorticate posturing This question is asking students to determine which patient is the most stable, but the choice of b is quite obvious. So, to make the choices harder, I made two of the distractors less serious, though still unstable. A & C are still not appropriate for discharge, but it requires students to understand the material to eliminate them as possibilities.  16 0.98 0 Original Question: The client is to undergo surgery for a cataract in the left eye. Which of the following instructions should be included in the teaching plan for the client? a.   Cough and deep breathe every two hours b.   Perform prescribed eye exercises daily c.   Use a saline eye irrigation as needed d.   Take the prescribed stool softener as ordered This question does not differentiate between low and high scores at all and is too easy. Only one student got this wrong. Revised Question: The client is to undergo surgery for a cataract in the left eye. Which of the following instructions should be included in the teaching plan for the client? a.   Cough and deep breathe every two hours b.   Continue taking all home medications c.   Use a saline eye irrigation as needed d.   Avoid bending over for 24 hours after surgery  All of the answers involved pressure post-surgery and all the student needed to do was “play which one is not like the others”. To m ake this question harder and to really make sure that students understood the material, I made the actual answer a bit less obvious (it is common to take stool softeners after lots of surgeries) and to make the distractors a bit harder. For choice b, students may consider cataract surgery to be minor and therefore not require changes in medications. But, in fact, there are some medications that patients need to dc. 19 0.95 0.05 Original Question: The nurse is caring for the following clients. After receiving shift report, which client should the nurse assess first? a.   The client whose scheduled IV antibiotic is one hour late. b.   The client diagnosed with renal colic pain who is scheduled for a lumbar CT scan c.   The client with a total knee replacement who is complaining of a painful, cold foot on the operative extremity This question is too easy (p-value=0.95) and does not differentiate between high and low learners (d-value=0.05). Only two students got this question incorrect.
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