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What are the six dimensions of quality care according to the Institute of Medicine?
- A. Safe, timely, effective, efficient, equitable, and person-centered
- B. Safe, transparent, effective, efficient, equitable, and person-centered
- C. Safe, timely, effective, low-cost, equitable, and person-centered
- D. Safe, timely, effective, efficient, cutting-edge, and person-centered
Correct Answer: A
Rationale: The correct answer is A: Safe, timely, effective, efficient, equitable, and person-centered. According to the Institute of Medicine, these six dimensions encompass quality care. Safety is essential to avoid harm. Timeliness ensures care is provided promptly. Effectiveness means care should be evidence-based and achieve desired outcomes. Efficiency aims to minimize waste. Equitability ensures fair and non-discriminatory care. Lastly, being person-centered emphasizes individual preferences and needs.
Summary:
Choice B is incorrect because transparency is not included in the six dimensions. Choice C is incorrect as low-cost is not a primary dimension of quality care. Choice D is incorrect as it includes cutting-edge, which is not one of the six dimensions outlined by the Institute of Medicine.
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What is the nurse's priority when caring for a client who just completed a bone marrow aspiration and biopsy?
- A. Teach the client to avoid activity for 24 to 48 hours to prevent infection.
- B. Administer a nonsteroidal anti-inflammatory drug (NSAID) to promote comfort.
- C. Check the pressure dressing frequently for signs of excessive or active bleeding.
- D. Report the laboratory results to the primary health care provider.
Correct Answer: C
Rationale: The correct answer is C: Check the pressure dressing frequently for signs of excessive or active bleeding. After a bone marrow aspiration and biopsy, the priority is to monitor for bleeding, as these procedures can cause bleeding complications. Checking the pressure dressing helps to detect any signs of excessive bleeding early, allowing for prompt intervention. This is crucial to prevent complications such as hematoma or hemorrhage.
Incorrect choices:
A: Teaching the client to avoid activity is important but not the priority immediately post-procedure.
B: Administering NSAIDs may not be appropriate as they can increase the risk of bleeding.
D: Reporting laboratory results is important but not the priority in this immediate post-procedure scenario.
When should autologous hematopoietic stem cell transplantation be used, and what are the common cancers it is used for?
- A. It should be used when high dose therapy is needed to maximize response. Most common cancers it is used for include lymphoma, late relapse of acute lymphoblastic leukemia, neuroblastoma, and Ewing sarcoma.
- B. It should be used any time this approach can provide a meaningful survival benefit over chemotherapy. Most common cancers it is used for include neuroblastoma, responsive brain tumors in young children to avoid/minimize early radiation therapy, and relapsed lymphoma.
- C. It should be used for tumors in which a graft-versus-tumor effect does not occur. Most common cancers include neuroblastoma, lymphoma, selected brain tumors, rhabdomyosarcoma, and Ewing sarcoma with lung metastases.
- D. It should be used to avoid extensive treatment with chemotherapy and to shorten treatment. Most common cancers include neuroblastoma, relapsed Wilms' tumor, and selected brain tumors.
Correct Answer: B
Rationale: The correct answer is B because autologous hematopoietic stem cell transplantation should be used when it can provide a survival benefit over chemotherapy. This approach is particularly beneficial for certain cancers such as neuroblastoma and relapsed lymphoma.
- Choice A is incorrect because the indication for autologous transplantation is not solely based on the need for high-dose therapy, but rather on providing a meaningful survival benefit over chemotherapy. The listed cancers are not the most common ones treated with this approach.
- Choice C is incorrect because the graft-versus-tumor effect is actually desired in some cases of autologous transplantation, and the listed cancers are not the most common ones treated with this approach.
- Choice D is incorrect because the purpose of autologous transplantation is not to avoid extensive chemotherapy but to provide a survival benefit. The listed cancers are not the most common ones treated with this approach.
A nurse reviews the laboratory data for an older patient. The nurse would be most concerned about which finding?
- A. Hematocrit of 35%
- B. Hemoglobin of 11.8 g/dL
- C. Platelet count of 400000/L
- D. White blood cell (WBC) count of 2800/L
Correct Answer: D
Rationale: The correct answer is D: White blood cell (WBC) count of 2800/L. A low WBC count (leukopenia) in an older patient can indicate an impaired immune system, making them vulnerable to infections. This is concerning as older adults have a weakened immune response. A: Hematocrit of 35% is within the normal range. B: Hemoglobin of 11.8 g/dL is slightly low but not a major concern as long as it's not significantly lower. C: Platelet count of 400000/L is within the normal range and not typically a cause for concern.
Plummer Vinson syndrome is not associated with:
- A. angular stomatitis
- B. splenomegaly
- C. clubbing
- D. post cricoid web
Correct Answer: C
Rationale: The correct answer is C: clubbing. Plummer Vinson syndrome is characterized by the triad of dysphagia, iron deficiency anemia, and esophageal webs. Clubbing is not a typical feature of this syndrome. Angular stomatitis (A), splenomegaly (B), and post cricoid web (D) are all associated with Plummer Vinson syndrome. Angular stomatitis is due to iron deficiency anemia, splenomegaly can be present due to chronic anemia, and post cricoid web is a characteristic finding in the esophagus of patients with this syndrome.
The nurse is monitoring a patient receiving a blood product and is concerned that the blood is going to deteriorate before it is complete infused. What is the maximum time that blood can hang during infusion before it begins to deteriorate?
- A. 1 hour
- B. 2 hours
- C. 3 hours
- D. 4 hours
Correct Answer: D
Rationale: The correct answer is D: 4 hours. Blood products typically have a maximum hang time of 4 hours to prevent bacterial contamination and ensure the integrity of the product. Beyond 4 hours, the risk of bacterial growth and contamination increases, leading to potential harm for the patient. Therefore, it is crucial to adhere to this time limit to maintain the safety and effectiveness of the blood product.
Summary:
- A (1 hour), B (2 hours), and C (3 hours) are incorrect because they do not align with the standard maximum hang time for blood products, which is 4 hours. Adhering to this time limit is essential to prevent deterioration and ensure patient safety.