The National Cholesterol Education Program published updated guidelines for cholesterol testing and management, as recommended by its Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults.
According to these guidelines and the recent Adult Treatment Panel (ATP) III Update, the target LDL cholesterol for patients with type 2 diabetes mellitus is:
Correct Answer B:
The National Cholesterol Education Program Adult Treatment Panel III guidelines and the recent update, as well as guidelines previously published by the Canadian Diabetes Association, have established a target LDL cholesterol level of 2.0 mmol/L for patients with diabetes. This target is also applicable for individuals with known coronary artery disease (CAD), symptomatic carotid artery disease, abdominal aortic aneurysm, peripheral vascular disease, and multiple risk factors that confer a 10-year risk for coronary heart disease that is > 20%. An LDL level of 3.5 mmol/L is acceptable for other individuals with only two risk factors for CAD and a 10-year CAD risk < 20%, and 4.0 mmol/L is the upper limit of acceptability for patients with no more than one risk factor for CAD and a 10-year CAD risk < 20%.
Of the following, which is the most common adverse event to complicate hospital course of patients age 65 and over?
Correct Answer D:
An adverse event has been defined as an unintended injury or complication that results in disability at the time of discharge, death, or prolonged hospital stay, and that is caused by healthcare management rather than by the patient’s underlying disease process. The three most common adverse events to occur are surgery, medication, and infection.
Canadian national study of adverse event by Ross Baker and Peter Norton revealed that surgery-related problems (choice D) are the most common type of adverse event, and for hospitalized patients the rate of these events increases with the patient’s age. Surgery-related events are followed by drug-related and fluid-related adverse events.
→ Fluid related events (choice A) and Drug-related events (choice C) come as second most common cause of adverse events after surgery.
→ Wound infections (choice B) come after drug-related and fluid-related events in terms of rate of occurrence.
→ Alcohol withdrawal and delirium tremens (choice E) occur in many patients admitted in hospitals, but these usually are not due to error of health professionals.
You are on the infection control committee for your hospital. The control charts indicate an increase in methicillin resistant Staphylococcus aureus (MRSA) on the surgery unit of the hospital. Based on anecdotal reports the committee has received, there apparently is poor hand hygiene on the surgery on the part of the nurses and surgeons.
When making recommendations for improvements, the use of soap and water would be preferred for hand washing in which one of the following situations?
A key element in improving hand hygiene is the use of an alcohol-based rub instead of washing with soap and water. An alcohol-based hand rub requires less time, is microbiologically more effective and less irritating to skin than traditional hand washing with soap and water. Therefore, alcohol-based hand rubs should replace hand washing as the standard for hand hygiene in health care settings unless the hands are visibly soiled.
According to WHO: "Perform hand washing with soap and water if hands are visibly soiled, or exposure to spore forming organisms is proven or strongly suspected, or after using the restroom. Otherwise, if resources permit, perform hand rubbing with an alcohol-based preparation."
A civic group in your community is concerned about airborne bioterrorism, and requests your advice concerning the use of respirators in the event of an attack.
Which one of the following would be accurate advice?
Correct Answer A:
The increased work of breathing associated with respirator use may adversely affect patients with certain medical problems, including asthma, COPD, coronary artery disease, and anxiety states. Some facial features, such as a beard or large mustache, affect the fit of a respirator. Air-purifying respirators do not protect from hypoxia in confined, oxygen-deficient spaces. Comfort is important for increasing compliance with respirator use, but the respirator should be chosen based on the protection provided rather than on comfort. There is no single filter that will work for all exposures under all conditions.
Various studies have evaluated the use of feeding tubes. Which one of the following is true regarding the use of feeding tubes in patients who are unable to eat and swallow normally due to significant dementia?
Correct Answer E:
Physicians commonly rely on feeding tubes to supply nutrition to severely demented patients who are unable to chew and/or swallow normally. However, various studies have not shown the use of feeding tubes to be effective in healing pressure sores, preventing aspiration pneumonia, preventing malnutrition, providing comfort, improving functional status, or extending life. Furthermore, the associated complications increase the difficulty of caring for demented patients. While hand feeding may not prevent malnutrition or dehydration, it does have the advantage of maintaining patient comfort.
Click to expand