Nokea
Appropriate statements regarding markers of outcome after major surgery in England in 2014 include:
- A. Data about each hospital's complication rates after surgery are readily available.
- B. Data about each hospital's 30-day mortality after surgery are readily available.
- C. For most procedures, 90-day mortality rate are similar to 30-day mortality rates.
- D. National Hospital Episode Statistics (HES) data are useful for monitoring the performance of units.
Correct Answer: B
Rationale: In 2014 England, surgical outcome transparency increased. Complication rates weren't universally published per hospital, varying by procedure and trust. However, 30-day mortality data were widely available, notably via NHS initiatives and specialty audits (e.g., National Joint Registry), reflecting short-term success. Ninety-day mortality often exceeds 30-day rates (e.g., in vascular surgery), capturing delayed deaths, so they're not typically similar. HES data, capturing inpatient episodes, help monitor trends and performance, though coding accuracy limits granularity. Weekend admission mortality was higher, per studies like 2015 BMJ, due to staffing and care differences. The availability of 30-day mortality data was a key quality metric, driving accountability and improvement in surgical care.
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Which is not an AIDS defining illness?
- A. oesophageal candidiasis
- B. Herpes Zoster
- C. CD4 count <200 cells/microL
- D. Pulmonary TB
Correct Answer: B
Rationale: Herpes zoster's no AIDS marker just shingles, common even sans HIV collapse. Oesophageal thrush, PCP, TB scream opportunists; CD4's a lab line, not illness. Nurses flag true definers chronic crash signs not this skin flare anyone catches.
A nurse is caring for a client who has heart failure and a prescription for digoxin 125 mcg PO daily. Available is digoxin PO 0.25 mg/tablet. How many tablets should the nurse administer per dose?
- A. 0.25
- B. 0.5
- C. 1
- D. 1.5
Correct Answer: B
Rationale: Digoxin math: 125 mcg ordered, 0.25 mg (250 mcg) per tablet 125 ÷ 250 = 0.5 tablets, a precise dose nurses calc to boost heart failure's pump, avoiding toxicity's narrow edge. Wrong cuts (0.25, 1, 1.5) miss the mark. Accuracy here rules, a daily win in this med game.
A patient has been assigned the nursing diagnosis of imbalanced nutrition: less than body requirements related to painful oral ulcers. Which nursing action will be most effective in improving oral intake?
- A. Offer the patient frequent small snacks between meals.
- B. Assist the patient to choose favorite foods from the menu.
- C. Provide teaching about the importance of nutritional intake.
- D. Apply prescribed anesthetic gel to oral lesions before meals.
Correct Answer: D
Rationale: Painful oral ulcers from cancer or chemo kill appetite anesthetic gel (e.g., lidocaine) numbs them pre-meal, making eating bearable. Snacks and favorites tempt but don't dull pain. Teaching informs, not fixes. Nurses in oncology prioritize this pain relief drives intake, tackling the root of this nutrition nosedive.
A nurse who works in an oncology clinic is assessing a patient who has arrived for a 2-month follow-up appointment following chemotherapy. The nurse notes that the patient's skin appears yellow. Which blood tests should be done to further explore this clinical sign?
- A. Liver function tests (LFTs)
- B. Complete blood count (CBC)
- C. Platelet count
- D. Blood urea nitrogen and creatinine
Correct Answer: A
Rationale: Yellow skin signals jaundice, often tied to liver dysfunction, a frequent issue post-chemotherapy due to metastatic spread or drug toxicity. Liver function tests (LFTs) like ALT, AST, and bilirubin directly assess liver health, pinpointing if metastases or chemo agents (e.g., hepatotoxic drugs like methotrexate) are at play. A CBC might show anemia or infection but doesn't target liver issues. Platelet count could hint at clotting problems, possibly liver-related, but it's too narrow. Blood urea nitrogen and creatinine check kidney function, not liver, despite both organs handling chemo clearance. Since the liver's a common metastatic site especially from cancers like breast or lung LFTs are the go-to here, guiding the nurse to catch complications early and adjust care, critical in oncology follow-ups.
The nurse is preparing an adolescent diagnosed with leukemia for a lumbar puncture. The nurse determines that the child understands the reason for the procedure when the child states that the procedure is done to:
- A. Make sure I don't have meningitis along with my cancer.
- B. Relieve some of the pressure on my brain.
- C. Remove the blood cancer cells so I don't have to have surgery.
- D. Check to see if the cancer has spread through my spinal cord and brain.
Correct Answer: D
Rationale: A lumbar puncture (LP) in leukemia is performed to collect cerebrospinal fluid (CSF) to check for central nervous system (CNS) involvement cancer cells spreading to the spinal cord and brain a critical staging step that influences treatment, like intrathecal chemotherapy. The adolescent's statement about checking for spread reflects accurate understanding, essential for informed consent and reducing anxiety through clarity. Ruling out meningitis is a possible LP use, but in leukemia, CNS metastasis is the primary concern unless symptoms suggest infection. Relieving brain pressure applies to conditions like hydrocephalus, not leukemia's typical presentation. Removing cancer cells via LP isn't a treatment; it's diagnostic. The nurse's confirmation of this understanding ensures the child is prepared, aligning with pediatric oncology's emphasis on patient education and procedural readiness.