Quality Measurement and Assessment

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Quality Measurement and Assessment

This week you continue working on Section 3 of your Course Project, which was introduced in Week 6. Through your work in previous weeks of this course, you have likely gained critical insights into the organization that serves as the focus for your quality improvement plan. Integrating this knowledge of the organization into your plan for addressing a quality improvement issue is essential for successfully facilitating change.

As you deepen your analysis of your selected organization, consider how the information presented in this week’s Learning Resources relates to strategic priorities as well as to the uniquely collaborative and competitive dynamic that binds organizations in health care.

To prepare:

  • Think about the quality improvement issue that you are addressing and the associated plan that you are developing. Consider the following:
    • What is the overall purpose, or aim, of doing this work?
    • What would you hope to achieve for the organization by undertaking this project? What are the objectives of this initiative?
    • What value would this work add to the organization?
    • How would this work improve practice and create outcomes with impact?
  • Review Chapter 7 of the Sadeghi, Barzi, Mikhail, and Shabot course text. Consider how addressing this quality improvement issue would align with the organization’s mission, vision, values, and strategic goals and objectives. How does it relate to regulatory issues, and other matters that are significant for the organization? If you notice a misalignment, use this as an opportunity to refine your focus.
  • With this in mind, continue to hone your development of this Assignment, integrating the concepts addressed here into Section 3.

To complete:

Write a 3- to 5-page paper that includes:

  • An introduction to your quality improvement plan, including the overarching aim of this initiative and an explanation of how it aligns with the mission, vision, values, and strategic goals and objectives of the organization, as well as regulatory issues and other matters that are significant for the organization
  • An overview of the current situation with regard to this quality improvement issue in the organization
  • A description of measures and indicators
  • A presentation on data related to this issue, including:
    • Actual historical and current data and/or a description of the methods that you would use to collect and analyze the data
    • Methods for collecting and analyzing data in the future, including when you would do this
  • A description of realistic, evidence-based targets

Be sure to cite evidence from the literature to justify your selection of the measures and indicators, as well as the performance targets. This section of the Course Project serves as the Portfolio Assignment for this course.

Due by Day 7 of Week 8.

Section 4: Quality Improvement Strategies

Through your work on Section 3 of the Course Project, you have examined the gap between current performance and evidence-based targets and considered how addressing this gap relates to organizational priorities and large-scale aims for quality improvement.

In this section of the Course Project, you begin to think about quality improvement strategies that could help to bridge this gap. As noted in the Sadeghi, Barzi, Mikhail, and Shabot text, this is referred to as performance-driven planning.

Since the publication of the Institute of Medicine’s report “Crossing the Quality Chasm,” a good deal of attention has been paid to the need to examine processes that contribute to outcomes (Ernst, Wooldridge, Conway, Dressman, Weiland, Tucker, and Seid). As the USAID has noted, interventions “will not create the desired outcome to improve the quality of care unless the overall process of care delivery is also improved.” Therefore, attention to process redesign is a central aspect of cultivating strategies for improvement.

To prepare:

  • Refer to the modified Donabedian model (access, structure, process, outcome, and patient experience) presented in Chapter 9 of the Sadeghi, Barzi, Mikhail, and Shabot text.
  • Recall the performance targets that you identified for Section 3 (in Week 6). What does the recommendation that performance-driven planning should “begin with the end in mind” suggest given your established goals?
  • Review the information presented in Chapter 9 of the Sadeghi, Barzi, Mikhail, and Shabot text, and think about how you would assess the organization’s strengths and weaknesses related to the performance gaps you identified in Section 3 (Week 6).
  • Based on the above, start to think of specific evidence-based strategies that could be implemented to close/minimize the performance gaps you have identified. Consider both interventions (what) and processes (how). Focus on strategies that are supported by the latest research and could create systems-level change. These may be tentative for now, but be sure to identify at least one that specifically lends itself to a change in process (i.e., practice, protocol, pathway, activity).

Additional instructions for Section 4 are presented next week. To complete this Assignment, you will create a process map and write a paper describing quality improvement strategies. This Assignment is due by Day 7 of Week 8.

PART 2 OF THIS ASSIGNMENT:

Respond to at least two of your colleagues on two different days using one or more of the following approaches:

  • Ask a probing question, substantiated with additional background information or research.
  • Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.
  • Validate an idea with your own experience and additional resources.
Submission and Grading Information
Grading Criteria

Compare the findings of the Regulatory Decision Pathway  to what actually happened at the unit in your organization. Was the event deemed: bad intent, reckless, at risk, or human error? According to the pathway, do you now think it was the correct action?

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This Discussion examines the opportunities of managers in working with groups to promote change that facilitates the delivery of safe, high–quality care.

To Prepare

  • Review the information on just culture presented in the Learning Resources.
  • For this discussion, you will use the Regulatory Decision Pathway found in Russell, K. A. & Radtke, B. K. (2014).
  • Examine an adverse event at the unit level in your organization or one with which you are familiar and apply the Regulatory Decision Pathway.
  • Compare the findings of the Regulatory Decision Pathway  to what actually happened at the unit in your organization. Was the event deemed: bad intent, reckless, at risk, or human error? According to the pathway, do you now think it was the correct action?
  • Think about how a nurse leader–manager may use just culture as a framework to create or maintain a focus on accountability and outcomes throughout a group. What actions could be taken if a systems–related error was made or if an error resulted from risky behavior?
  • How might role conflict and/or ambiguity have contributed to the situation?

Post a description of an adverse event in your organization and your analysis of the issue using the Regulatory Decision Pathway. Explain how role conflict or ambiguity might have influenced this situation. Apply the principles of just culture as you explain how you, as the group’s manager, would handle the situation.

http://sidneydekker.com/wp-content/uploads/2013/01/JustCultureCritique.pdf

http://www.outcome-eng.com/wp-content/uploads/2012/01/manage-risk.pdf

**************Below is a paper to use as reference!!!!!!!!!

PLEASE USE THIS AS A REFERENCE ONLY.

 

Adverse Event

Adverse events are a part of the healthcare environment and how an event is dealt with can affect patient safety.  The regulatory pathway and just culture are a means of improving the quality of care and safety culture (Russell & Radtke, 2014).  Health care employees need to trust in their organization that an adverse event can be reported so that the organization and employee can learn from the event, and that it is not just a means to place blame.

An adverse event that took place in the cardiac catheterization lab was a procedure was done on the wrong patient.  A patient that was to have a pacemaker instead ended up having a diagnostic catheterization.  This event involved a patient identification issue by the nurse.  The hospital’s patient identification policy and time out policy were not adhered to by the nurse and then the catheterization team.   The incident was reported to the state, and there were several event meetings with the nurse and physician.  As a result of the investigation, all staff in the catheterization lab were re-educated to the patient identification and time out policy.  All staff had to sign an individual affidavit that they understood the policy.  The nurse was given a written warning.  This event would not have happened if the nurse and catheterization team had adhered to policy.

Regulatory Decision Pathway

Using the regulatory decision pathway, the nurse did not intend to harm the patient deliberately.  The nurse asked the patient if she was Ms. X and the patient said yes.  The identification policy is to check the patient’s identification band for name and medical record number against a second identifier.  This was not done.  There were no significant circumstances involving the system that led to the error.  The nurse did not conceal the error or falsify the record.  The nurse did not disregard or consciously take a substantial risk.  She thought she had the correct patient.  There were no similar or serious errors by this nurse.  A reasonably prudent nurse would not have done the same in similar circumstances as the patient identification policy would have been adhered to.  According to the regulatory decision pathway, this was at-risk behavior by the nurse (Russell & Radtke, 2014).

The catheterization team which included the physician, nurse, physician assistant, and technician contributed to this adverse event.  The team did not follow the time out process policy where everything stops, and patient identification is reconfirmed with other parameters.  Again, following the regulatory decision pathway, the catheterization team demonstrated at-risk behavior.  At-risk behavior involves unsafe practice and carelessness which is shown by the nurse and catheterization team not adhering to policy (Russell & Radtke, 2014).

Role Conflict

The cardiac catheterization lab is very fast-paced, and the nurses can feel the stress of the workload.  The procedure area and recovery room was very busy and crowded that day.  Role conflict could have contributed to the situation as there is constant pressure to keep moving.  Role conflict could have contributed in the time-out process not taking place in the procedure room.  Nurses have to initiate the time out process when the physician arrives, and some physicians are not very cooperative in the process.  Since the adverse event, patient identification and the time out policy are strictly adhered to.

Just Culture

Quality improvement and work environment improvement are a part of just culture (Lockhart, 2015).  Just culture is safety issues, improving processes, and not about punishing individuals (Pepe & Cataldo, 2011).  As the group’s manager using the principles of culture, I would have done firm counseling stressing the significance of the incident, but as this was the nurse’s  first risky behavior, I would not have done a formal written warning with the threat of being fired if it happens again.   Doing a staff meeting and re-educating the policies was appropriate.  Patient identification and the time out process are now part of the cardiac catheterization lab’s monthly quality assurance surveys.  All new employees are well educated in the two policies and must sign an attestation that they understand by the end of orientation.  This adverse event led to improved processes in the cardiac catheterization lab which is the goal of just culture (Pepe & Cataldo, 2011).

References

Lockhart, L. (2015).  Does your organization have a just culture?  Retrieved from http://www.NursingMadeIncrediblyEasy.com doi-10.1097/01.NME.0000457286.16594.92

Pepe, J., & Cataldo, P. J. (2011).  Manage risk, build a just culture.  Health Progress.  Retrieved from http://www.outcome-eng.com/wp-content/uploads/2012/01/manage-risk.pdf

Russell, K. A. & Radtke, B. K. (2014).  An evidence-based tool for regulatory decision-making: regulatory decision pathway.  Journal of Nursing Regulation, 5(2), 5-9. https://class.waldenu.edu/bbcswebdav/institution/USW1/201810_27/MS_NURS/NURS_6201/readings/USW1_NURS_6201_Russell.pdf

The Dual Nature of Informatics

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The Dual Nature of Informatics

 

Informatics can be used for improving health outcomes not only for individual patients, but also for whole groups of patients with similar conditions. This is often referred to as the dual nature of informatics. Technologies, such as electronic health records (EHRs) and clinical decision support (CDS) systems, can provide insights and guidance for health care professionals at the point of care. In addition, data warehousing and mining allow health care organizations to use the vast amount of information stored in EHRs to make predictions and diagnoses for other patients with similar conditions.

 

In this Discussion, you examine the dual nature of informatics. First, you review a scenario and consider the patient information to be collected and recorded at the point of care. Then, you decide how this information could be aggregated for population health and future use.

 

Consider the following scenario:

 

Mrs. Jones has come into your office stating that she has been experiencing frequent dizzy spells. She also reports that she has been unable to eat anything substantial over the last few days due to extreme nausea. The last time Mrs. Jones was in your office, the physician had suggested she start walking around the block or bicycling around the neighborhood to get her activity level up. Mrs. Jones admits that she did very little of that after a “ flip-flop” feeling of her heart scared her. You know that her symptoms could be a result of many conditions. Following the prompts on your informatics system, you begin to gather more specific information about Mrs. Jones’ symptoms and health history.

 

To prepare:

 

  • Based on the scenario, what information would you want to immediately gather about Mrs. Jones?
  • With that in mind, compile a list of patient questions you would like an EHR documentation screen to have.
  • How might the information derived from these questions help you provide high-quality care to Mrs. Jones?
  • Once this information is collected, what alerts might be critical to the evaluation of Mrs. Jones?
  • Review this week’s media presentation, Dual Nature of Informatics Systems, and reflect on the movement towards more transparent data and meaningful use. How might the data entered about an individual patient help to build preventative care and treatment for whole populations?
  • Refer back to your list of patient questions. Of these questions, which would generate data that could be aggregated for use with a larger group of patients? (Note: When developing your questions, consider the whole patient.)

 

Post on Tuesday 06/06/2016 a minimum of 550 words in APA format with 4 references

 

1) A description of the ideal EHR documentation screen that you would like to have at the point of care for all patients and why.

 

2) Explain how information gathered at the point of care with an individual patient can be aggregated to help provide high quality care to a larger population of patients.

 

Required Resources

 

Readings

 

  • Saba, V. K., & McCormick, K. A. (2015). Essentials of nursing informatics (6th ed.). New York, NY: McGraw-Hill.
    • Chapter 1, “Historical Perspectives of Nursing Informatics”In this chapter, the authors explain the transition from paper-based records to electronic records. The chapter provides an overview of the historical events that contributed to the rise of electronic health records.
  • Liaw, S.-T., & Boyle, D. I. R. (2010). Primary care informatics and integrated care. Studies in Health Technology and Informatics, 151, 255–268.
    Retrieved from the Walden University databases.This article discusses how the health care field can be reformed by increasing access to information across organizations and professionals. The authors of the article justify the need for this reform and provide guidance on how it can be achieved.
  • Mitchell, J. K. (2011). Nursing informatics 101: Using technology to improve patient care. ONS Connect, 26(4), 8–12.
    Retrieved from the Walden Library databases.The emergence of nursing informatics in health care is the main topic of this article. New trends in informatics are discussed, as well as the certification process, nurse education, and the implementation of new systems to support patient care.
  • Morath, J. (2011). Nurses create a culture of patient safety: It takes more than projects. Online Journal of Issues in Nursing, 16(3).
    Retrieved from the Walden Library databases.The author of this article emphasizes the need for nurses to develop skills for improving care and embracing new health care innovations. The author also describes the connection between individual nursing practice and the system-wide success of informatics.
  • Reiner, B. I. (2011). Improving healthcare delivery through patient informatics and quality centric data. Journal of Digital Imaging, 24(2), 177–178.
    Retrieved from the Walden Library databases.In this article, the author analyzes the impact of the movement towards digitized medical data on patient care. The author discusses how this movement places more responsibility and empowerment on the patient.

    Media

  • Laureate Education, Inc. (Executive Producer). (2012b). Dual nature of informatics systems. Baltimore: Author.Note: The approximate length of this media piece is 7 minutes.

    In this week’s media presentation, Gail Latimer, Dr. Patricia Button, and Dr. Roy Simpson discuss one of the most important aspects of informatics: the collection and aggregation of health information. The electronic health record (EHR) is discussed, as well as the nurse’s roles in working with EHR systems.

     

     

     

1. A 40-year-old woman who experiences severe seasonal allergies has been referred by her family physician to an allergist for weekly allergy injections. The woman is confused as to why repeated exposure to substances that set off her allergies would ultimately benefit her. Which of the following phenomena best captures the rationale for allergy desensitization therapy? (Points : 0.4)

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     1. A 40-year-old woman who experiences severe seasonal allergies has been referred by her family physician to an allergist for weekly allergy injections. The woman is confused as to why repeated exposure to substances that set off her allergies would ultimately benefit her. Which of the following phenomena best captures the rationale for allergy desensitization therapy? (Points : 0.4)

Repeated exposure to offending allergens binds the basophils and mast cells that mediate the allergic response.
Exposure to allergens in large, regular quantities overwhelms the IgE antibodies that mediate the allergic response.
Repeated exposure stimulates adrenal production of epinephrine, mitigating the allergic response.
Injections of allergens simulate production of IgG, which blocks antigens from combining with IgE.

 

Question 2.2. A 24-year-old woman presents with fever and painful, swollen cervical lymph nodes. Her blood work indicates neutrophilia with a shift to the left. She most likely has: (Points : 0.4)

A mild parasitic infection
A severe bacterial infection
A mild viral infection
A severe fungal infection

 

Question 3.3. A 60-year-old male patient with an acute viral infection is receiving interferon therapy. The nurse practitioner is teaching the family of the patient about the diverse actions of the treatment and the ways that it differs from other anti-infective therapies. Which of the following teaching points should the nurse practitioner exclude? (Points : 0.4)

“Interferon can help your father’s unaffected cells adjacent to his infected cells produce antiviral proteins that limit the spread of the infection.”
“Interferon can help limit the replication of the virus that’s affecting your father.”
“Interferon helps your father’s body recognize infected cells more effectively.”
“Interferon can bolster your father’s immune system by stimulating natural killer cells that attack viruses.”

 

Question 4.4. As part of his diagnostic workup, a 77-year-old man’s nurse practitioner has ordered blood work that includes ferritin levels. The man is very interested in the details of his health care and is unfamiliar with ferritin and its role. He asks his nurse practitioner to explain the significance of it and the rationale for testing it. Which of the following explanations by the nurse practitioner is most accurate? (Points : 0.4)

“Ferritin is the activated and usable form of iron that your red blood cells can use to transport oxygen.”

“Ferritin is a stored form of iron that indirectly shows me whether you would benefit from iron pills.”
“Ferritin is a protein-iron complex that allows your red blood cells to make use of the iron that you consume in your diet.”
“Ferritin is the form of iron that is transported in your blood plasma to the red blood cells that need it.”

 

Question 5.5. A 16-year-old female has been brought to her primary care nurse practitioner by her mother due to the girl’s persistent sore throat and malaise. Which of the following facts revealed in the girl’s history and examination would lead the nurse practitioner to rule out infectious mononucleosis? (Points : 0.4)

The girl has a temperature of 38.1°C (100.6°F) and has enlarged lymph nodes.
Her liver and spleen are both enlarged.
Blood work reveals an increased white blood cell count.
Chest auscultation reveals crackles in her lower lung fields bilaterally.

 

Question 6.6. Which of the following patients is most likely to benefit from transplantation of thymic tissue or major histocompatibility complex (MHC)-compatible bone marrow? (Points : 0.4)

A 12-year-old girl with a history of epilepsy and low IgG levels secondary to phenytoin use
A 7-year-old boy whose blood work indicates decreased IgA and IgG with increased IgM
A 6-year-old boy whose pre-B cells are incapable of translation to normal B cells
A 9-year-old girl who has a diagnosis of IgA deficiency

 

Question 7.7. A 14-year-old boy has been diagnosed with infectious mononucleosis. Which of the following pathophysiological phenomena is most responsible for his symptoms? (Points : 0.4)

The Epstein-Barr virus (EBV) is lysing many of the boy’s neutrophils.
Viruses are killing some of his B cells and becoming incorporated into the genomes of others.
The EBV inhibits the maturation of white cells within his peripheral lymph nodes.
The virus responsible for mononucleosis inhibits the maturation of myeloblasts into promyelocytes.

 

Question 8.8. A 23-year-old man has received a recent diagnosis of appendicitis following 24 hours of acute abdominal pain. The nurse practitioner providing care for the man is explaining that while it is unpleasant, the inflammation of his appendix is playing a role in his body’s fight against the underlying infectious process. Which of the following teaching points should the nurse practitioner eliminate from his teaching for the patient? (Points : 0.4)

“Inflammation can help to remove the body tissue cells that have been damaged by infection.”
“Inflammation will start your body on the path to growing new, healthy tissue at the site of infection.
“Inflammation helps your body to produce the right antibodies to fight the infection.”
“Inflammation ultimately aids in eliminating the initial cause of the cell injury in your appendix.”

 

Question 9.9. A 71-year-old male patient with a history of myocardial infarction and peripheral vascular disease has been advised by his nurse practitioner to begin taking 81 mg aspirin once daily. Which of the following statements best captures an aspect of the underlying rationale for the nurse practitioner’s suggestion? (Points : 0.4)

Platelet aggregation can be precluded through inhibition of prostaglandin production by aspirin.
Aspirin helps to inhibit adenosine disphosphate (ADP) action and minimizes platelet plug formation.
Aspirin can reduce unwanted platelet adhesion by inhibiting thromboxane A2 (TXA2) synthesis.
Aspirin inhibits the conversion of fibrinogen into fibrin and consequent platelet plug formation.

 

Question 10.10. A nurse practitioner is explaining to a 40-year-old male patient the damage that Mycobacterium tuberculosis could do to lung tissue. Which of the following phenomena would underlie the nurse practitioner’s explanation? (Points : 0.4)

Tissue destruction results from neutrophil deactivation.
Nonspecific macrophage activity leads to pulmonary tissue destruction and resulting hemoptysis.
Macrophages are unable to digest the bacteria, resulting in immune granulomas.
Neutrophils are ineffective against the Mycobacterium tuberculosis antigens.

 

Question 11.11. A 2-year-old girl has had repeated ear and upper respiratory tract infections since she was born. A pediatrician has determined a diagnosis of transient hypogammaglobulinemia of infancy. What is the physiological origin of the child’s recurrent infections? (Points : 0.4)

Antibody production by plasma cells is compromised because of impaired communication between B and T cells.
The child had a congenital absence of immunoglobulin G (IgG) antibodies and her body is only slowly beginning to produce them independently.
The child was born with immunoglobulin A (IgA) and immunoglobulin (IgM) antibodies, suggesting intrauterine infection.
The child lacks the antigen presenting cells integral to normal B-cell antibody production.

 

Question 12.12. A nurse practitioner is teaching her colleagues about the role of cytokines in a variety of pathologies. Which of the following teaching points best captures an aspect of the functions and nature of cytokines? (Points : 0.4)

“A particular cytokine can have varied effects on different systems, a fact that limits their therapeutic use.”
“Cytokine production is constant over time, but effects are noted when serum levels cross a particular threshold.”
“Most cytokines are produced by granular leukocytes, and different cells are capable of producing the same cytokine.”
* “Cytokine actions are self-limiting in that activation of one precludes activation of other cytokines with similar actions.”

 

Question 13.13. A child has been diagnosed with thalassemia. Which of the following other health problems is the child at risk for? (Points : 0.4)

Hypocoagulation
Iron and ferritin deficiencies
Splenomegaly and hepatomegaly
Neutropenia

 

Question 14.14. A 44-year-old female patient presents to the emergency department with abnormal bleeding and abdominal pain that is later attributed to gallbladder disease. Which of the following diagnoses would the medical team be most justified in suspecting as a cause of the patient’s bleeding? (Points : 0.4)

Calcium deficiency
Vitamin K deficiency
Hemophilia B
Idiopathic ITP

 

Question 15.15. A 22-year-old female who adheres to a vegan diet has been diagnosed with iron-deficiency anemia. Which of the following components of her diagnostic blood work would be most likely to necessitate further investigation? (Points : 0.4)

Decreased mean corpuscular volume (MCV)
Decreased hemoglobin and hematocrit
Microcytic, hypochromic red cells
Decreased erythropoietin levels

 

Question 16.16. A 66-year-old female patient has presented to the emergency department because of several months of intermittently bloody stools that has recently become worse. The woman has since been diagnosed with a gastrointestinal bleed secondary to overuse of nonsteroidal anti-inflammatory drugs that she takes for her arthritis. The health care team would realize that which of the following situations is most likely? (Points : 0.4)

The woman has depleted blood volume due to her ongoing blood loss.
She will have iron-deficiency anemia due to depletion of iron stores.
The patient will be at risk for cardiovascular collapse or shock.
She will have delayed reticulocyte release.

 

Question 17.17. A nurse practitioner student is familiarizing herself with the overnight admissions to an acute medical unit of a university hospital. Which of the following patients would the student recognize as being least likely to have a diagnosis of antiphospholipid syndrome in his or her medical history?(Points : 0.4)

A 66-year-old obese male with left-sided hemiplegia secondary to a cerebrovascular accident
A 90-year-old female resident of a long-term care facility who has been experiencing transient ischemic attacks
A 30-year-old female with a diagnosis of left leg DVT and a pulmonary embolism
A 21-year-old male with a diagnosis of cellulitis and suspected endocarditis secondary to intravenous drug use

 

Question 18.18. A patient has been admitted to an inpatient medical unit of a hospital with an acute viral infection. The health care team providing care for the patient would recognize which of the following statements as an accurate description of the role of viruses in human infections? (Points : 0.4)

Viruses have limited or absent genetic material of their own.
Some viruses are capable of transforming normal host cells into malignant cells.
Viruses are often implicated in cases of transmissible neurodegenerative disease.
Viruses require stimulation after a latent period before they are able to produce symptoms.

 

Question 19.19. A 30-year-old man has spent 5 hours on a cross-country flight seated next to a passenger who has been sneezing and coughing, and the man has been inhaling viral particles periodically. Which of the following situations would most likely result in the stimulation of the man’s T lymphocytes and adaptive immune system? (Points : 0.4)

Presentation of a foreign antigen by a familiar immunoglobulin
Recognition of a foreign MHC molecule
Recognition of a foreign peptide bound to a self MHC molecule
Cytokine stimulation of a T lymphocyte with macrophage or dendritic cell mediation

 

Question 20.20. A 60-year-old woman is suspected of having non-Hodgkin lymphoma (NHL). Which of the following aspects of her condition would help to rule out Hodgkin lymphoma? (Points : 0.4)

Her neoplasm originates in secondary lymphoid structures.
The lymph nodes involved are located in a large number of locations in the lymphatic system.
The presence of Reed-Sternberg cells has been confirmed.
The woman complains of recent debilitating fatigue.

 

Question 21.21. Following a course of measles, a 5-year-old girl developed scattered bruising over numerous body surfaces and was diagnosed with immune thrombocytopenic purpura (ITP). As part of her diagnostic workup, blood work was performed. Which of the following results is most likely to be considered unexpected by the health care team? (Points : 0.4)

Increased thrombopoietin levels
Decreased platelet count
Normal vitamin K levels
Normal leukocyte levels

 

Question 22.22. Sputum samples from a patient with pneumonia contain an infective agent that has a peptidoglycan cell wall, expresses endotoxins, replicates readily in broth and on agar, grows in clusters, has pili, and does not stain when exposed to crystal violet. This pneumonia is most likely: (Points : 0.4)

Chlamydial
Viral
Mycoplasmal
Bacterial

 

Question 23.23. The blood work of a 44-year-old male patient with a diagnosis of liver disease secondary to alcohol abuse indicates low levels of albumin. Which of the following phenomena would a clinician be most justified in anticipating? (Points : 0.4)

* Impaired immune function
Acid-base imbalances
Impaired thermoregulation
Fluid imbalances

 

Question 24.24. A 29-year-old construction worker got a sliver under his fingernail four days ago. The affected finger is now reddened, painful, swollen, and warm to the touch. Which of the following hematological processes is most likely occurring in response to the infection? (Points : 0.4)

Proliferation of immature neutrophils
High circulatory levels of myeloblasts
Increased segmented neutrophil production

Phagocytosis by myelocytes

 

Question 25.25. A patient presented to the emergency department of the hospital with a swollen, reddened, painful leg wound and has been diagnosed with methicillin-resistant Staphylococcus aureus cellulitis. The patient’s nurse practitioner has ordered a complete blood count and white cell differential. Which of the following blood components would the nurse practitioner most likely anticipate to be elevated? (Points : 0.4)

Basophils
Eosinophils
Platelets
Neutrophils

 

 

 

Question 1.1. A couple who are expecting their first child have been advised by friends to consider harvesting umbilical cord blood in order to have a future source of stem cells. The couple have approached their nurse practitioner with this request and are seeking clarification of exactly why stem cells are valuable and what they might expect to gain from harvesting them. How can the nurse practitioner best respond to the couple’s inquiry? (Points : 0.4)

“Stem cells can help correct autoimmune diseases and some congenital defects.”
“Stem cells can be used to regenerate damaged organs should the need ever arise.”
“Stem cells can be used as a source of reserve cells for the entire blood production system.”
“Stem cells can help treat some cancers and anemias, but they must come from your child himself or herself.”

 

Question 2.2. A 2-year-old girl has had repeated ear and upper respiratory tract infections since she was born. A pediatrician has determined a diagnosis of transient hypogammaglobulinemia of infancy. What is the physiological origin of the child’s recurrent infections? (Points : 0.4)

Antibody production by plasma cells is compromised because of impaired communication between B and T cells.
The child had a congenital absence of immunoglobulin G (IgG) antibodies and her body is only slowly beginning to produce them independently.
The child was born with immunoglobulin A (IgA) and immunoglobulin (IgM) antibodies, suggesting intrauterine infection.
The child lacks the antigen presenting cells integral to normal B-cell antibody production.

 

Question 3.3. A 40-year-old woman who experiences severe seasonal allergies has been referred by her family physician to an allergist for weekly allergy injections. The woman is confused as to why repeated exposure to substances that set off her allergies would ultimately benefit her. Which of the following phenomena best captures the rationale for allergy desensitization therapy? (Points : 0.4)

Repeated exposure to offending allergens binds the basophils and mast cells that mediate the allergic response.
Exposure to allergens in large, regular quantities overwhelms the IgE antibodies that mediate the allergic response.
Repeated exposure stimulates adrenal production of epinephrine, mitigating the allergic response.
Injections of allergens simulate production of IgG, which blocks antigens from combining with IgE.