Question 1: Which of the following is the most common factor leading to serious adverse events in the hospital setting?
Lack of Knowledge
FAilure to follow clinical guidelines
Explanation: D: The most common factor leading to serious adverse events in the hospital setting is communication problems. The Joint Commission studied serious adverse events in hospitals and concluded that communication problems contributed to almost 75% of them. Team resource management is the general name given to a number of techniques that can be used to enhance communication between and among groups of health care professionals. The key principle in safeguarding patients is to recognize that no one should be hesitant to raise concerns when an unsafe situation is observed.
Reference: ©2012 Wolters Kluwer Health Lippincott Williams & Wilkins. All rights reserved.
Question 2: Pulmonary airway resistance will increase with which of the following?
Increased airway diameter
Increased alveolar pCO2
Decreased airflow velocity
Explanation: The answer is B, through parasympathetic stimulation. Parasympathetic stimulation causes airway constriction, which will increase airway resistance. Sympathetic stimulation (A) causes relaxation of the smooth muscles of the airway causing dilatation, which decreases airway resistance. As the diameter of a tube increases (C), resistance will decrease, not increase. Alveolar pCO2 affects airway resistance as follows: decreased pCO2 causes bronchoconstriction via a direct effect on the smooth muscles of the airway which will help keep the ventilation/perfusion ratio near baseline and help equilibrate ventilation across the lung fields. The opposite is also true, and so an increased pCO2 (D) will cause bronchodilation and decrease, not increase, airway resistance. A decrease in velocity (E) reduces turbulence, and a less turbulent system is one with a lower resistance.
Reference: Boulpaep, Emile L.; Boron, Walter F. (2003). Medical physiology: a cellular and molecular approach. Philadelphia: Saunders.