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Adult II goes into a bit more detail about diseases.  Instead of learning just about heart failure like we did in Adult I, we learn about pericarditis, endocarditis, cardiomyopathy, tamponade, etc.  It’s a lot of information and the tests truly require you to put information together and make an educated guess on what the answer may be.  For the first time in a long time, the majority of students in the class took the entire 90 minute test period (most people leave after 45 minutes or so).  You really have to scrape your brain to answer questions correctly.

Not impossible at all.  Totally doable.  But you do have to start considering test taking strategies AND you have to start thinking outside the box (gotta use your judgement to answer questions).  I think they are trying to prepare us for NCLEX as much as they can (although from the practice NCLEX tests I’ve seen, our tests in school are way harder).

An Example:

A client is diagnosed with pericarditis.  What assessment finding would alert the nurse the client may be experiencing cardiac tamponade?

  1. A loud S3
  2. Flat jugular veins
  3. An increase in blood pressure
  4. Carotid pulse diminishes upon inspiration

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I had never seen #4 before.  Had no idea about it.  I thought #1-3 were wrong but I started to doubt myself.  I worked through the logic:  tamponade causes muffled heart sounds (therefore there would be no loud S3), decreased blood pressure (because pressure on the heart makes it difficult to pump efficiently) and bulging jugular veins (d/t pressure building up).  So even though I had no idea if #4 was right, I picked that answer because by deductive logic it was the only one left.  I used what knowledge I had to answer the question but I didn’t necessarily know the answer.

Later in test review, I found out this question is an example of a “critical thinking” question.  Also, over 75% of the class missed this question.  #4 made sense later when the teacher explained it:  when we inhale, the diaphragm creates added pressure against a heart already experiencing pressure, therefore for a brief moment the blood pulsing through our carotid slows (therefore the pulse is diminished when you palpate).

It’s actually kinda cool to start to realize how your body’s actions and what you see a patient present with (symptom wise) makes absolute sense when you can grasp the underlying physiology.  I’m getting smarter!

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