NURS 5354 FINAL EXAM WITH
QUESTIONS AND ANSWERS
What are the pre-op screening domains for adults older than 65 having elective surgery? -
ANSWER✔✔✨---Goal setting-overall health goals, patient's understanding of surgery
Function and social support-Can you dress and bathe yourself? Get out of bed/chair by yourself? Do you
have a family member/friend for support?
Nutrition-nutritional assessment
Mobility-High risk for falls if gait speed is less than 0.8 m/s and Get up and Go test is greater than 15 s.
Cognition-Mini-Cog test. Impaired cognition increases risk for post-op delirium
Mental health-depression?
Medication review-Avoid high risk meds (anticholinergics)
Medical conditions-Cardiac, Pulmonary, OSA?
Shared decision making
Should cardiac testing be done for all pre-operative patients? - ANSWER✔✔✨---No. Supplemental
cardiac testing (ECG, LV function, ECHO, etc.) is only useful for patients with heart disease, dyspnea,
and/or valvular stenosis/regurgitation
When should anticoagulants NOT be held? - ANSWER✔✔✨---For cutaneous surgery, dental
extractions, minor oral procedures or cataract surgery.
When can elective surgery occur in patients who have received a coronary stent? - ANSWER✔✔✨---
Not before 30 days after a bare metal stent and not before 365 days after a drug-eluting stent.
What are major patient related risk factors for pulmonary complications after surgery? -
ANSWER✔✔✨---Age, COPD, ASA class II or greater, heart failure, ADL deficit, low albumin
, What are major procedure related risk factors for pulmonary complications after surgery? -
ANSWER✔✔✨---Emergency surgery, prolonged surgery (>3 hours), AAA repair, neurosurgery,
thoracic surgery, abdominal, head/neck or vascular surgery and general anesthesia.
Is a routine chest xray needed pre-operatively? - ANSWER✔✔✨---No. Only recommnded for known
cardiac or pulmonary disease in patients undergoing thoracic, upper abdominal or AAA surgery.
Is the accurate estimation of GFR important pre-operatively? - ANSWER✔✔✨---Yes. renal and
glomerular blood flow and muscle mass decreases with age so serum creatinine may appear normal
even when kidney function is not. Calculate the GFR.
What are the pre-op risk factors for delirium? - ANSWER✔✔✨---Age old than 65
Cognitive impairment
Limited physical function
History of alcohol abuse
Abnormal serum sodium, potassium or glucose
Intrathoracic surgery or abdominal aneurysm surgery
What is the most important intra operative risk factor for delirium? - ANSWER✔✔✨---Blood loss.
How can patients avoid iatrogenic complications after surgery? - ANSWER✔✔✨---OOB, avoid
restraints, PT/OT, remove foley, stop IV fluids, lift restrictions on diet, review medications daily.
How would postoperative hypertension be managed? - ANSWER✔✔✨---Look for non-cardiac
causes-pain or urinary retention.
Assess vol. status, review fluid administration and note if antihypertensives were omitted
Consider parenteral antihypertensives while NPO
Topical nitroglycerin if patient is unable to take oral meds.
QUESTIONS AND ANSWERS
What are the pre-op screening domains for adults older than 65 having elective surgery? -
ANSWER✔✔✨---Goal setting-overall health goals, patient's understanding of surgery
Function and social support-Can you dress and bathe yourself? Get out of bed/chair by yourself? Do you
have a family member/friend for support?
Nutrition-nutritional assessment
Mobility-High risk for falls if gait speed is less than 0.8 m/s and Get up and Go test is greater than 15 s.
Cognition-Mini-Cog test. Impaired cognition increases risk for post-op delirium
Mental health-depression?
Medication review-Avoid high risk meds (anticholinergics)
Medical conditions-Cardiac, Pulmonary, OSA?
Shared decision making
Should cardiac testing be done for all pre-operative patients? - ANSWER✔✔✨---No. Supplemental
cardiac testing (ECG, LV function, ECHO, etc.) is only useful for patients with heart disease, dyspnea,
and/or valvular stenosis/regurgitation
When should anticoagulants NOT be held? - ANSWER✔✔✨---For cutaneous surgery, dental
extractions, minor oral procedures or cataract surgery.
When can elective surgery occur in patients who have received a coronary stent? - ANSWER✔✔✨---
Not before 30 days after a bare metal stent and not before 365 days after a drug-eluting stent.
What are major patient related risk factors for pulmonary complications after surgery? -
ANSWER✔✔✨---Age, COPD, ASA class II or greater, heart failure, ADL deficit, low albumin
, What are major procedure related risk factors for pulmonary complications after surgery? -
ANSWER✔✔✨---Emergency surgery, prolonged surgery (>3 hours), AAA repair, neurosurgery,
thoracic surgery, abdominal, head/neck or vascular surgery and general anesthesia.
Is a routine chest xray needed pre-operatively? - ANSWER✔✔✨---No. Only recommnded for known
cardiac or pulmonary disease in patients undergoing thoracic, upper abdominal or AAA surgery.
Is the accurate estimation of GFR important pre-operatively? - ANSWER✔✔✨---Yes. renal and
glomerular blood flow and muscle mass decreases with age so serum creatinine may appear normal
even when kidney function is not. Calculate the GFR.
What are the pre-op risk factors for delirium? - ANSWER✔✔✨---Age old than 65
Cognitive impairment
Limited physical function
History of alcohol abuse
Abnormal serum sodium, potassium or glucose
Intrathoracic surgery or abdominal aneurysm surgery
What is the most important intra operative risk factor for delirium? - ANSWER✔✔✨---Blood loss.
How can patients avoid iatrogenic complications after surgery? - ANSWER✔✔✨---OOB, avoid
restraints, PT/OT, remove foley, stop IV fluids, lift restrictions on diet, review medications daily.
How would postoperative hypertension be managed? - ANSWER✔✔✨---Look for non-cardiac
causes-pain or urinary retention.
Assess vol. status, review fluid administration and note if antihypertensives were omitted
Consider parenteral antihypertensives while NPO
Topical nitroglycerin if patient is unable to take oral meds.
