NRNP 6560 Midterm exam | UPDATED Questions with 100%
Verified Answers
Q1: Surgery risk classes
A: Class 1: benefits outweigh risk, should be done Class 2a: reasonable to perform Class 2b: should be considered
Class 3: rarely appropriate
Q2: General rules for surgery: testing
A: ECG before surgery only if coronary disease, except when low risk surgery Stress test not indicated before surgery
Do not do prophylactic coronary revascularization
Q3: Meds before surgery
A: - Diabetic agents: Use insulin therapy to maintain glycemic goals(iii) Discontinue biguanides, alpha glucosidase
inhibitors, thiazolidinediones, sulfonylureas, and GLP-1 agonists - Do not start aspirin before surgery - Stop Warfarin
5 days before surgery. May be bridged with Lovenox. - Do not stop statin before surgery - Do not start beta-blocker
on day of surgery, but may continue
Q4: Assessment of surgical risk
A: - Unstable cardiac condition (recent MI, active angina, active HF, uncontrolled HTN, severe valvular disease),
concern with CAD, CHF. arrhythmia, CVD - patient stable or unstable? - urgency of the procedure (oncology will be
time sensitive) - risk of procedure - nutritional status - immune competence - determine functional capacity (need to
be more than 4 METS, more than 10 METs makes low risk)
Q5: Low risk surgeries
A: catarcts breast biopsy cystoscopy, vasectomy laporascopic procedures Plastic surgery
Q6: intermediate risk surgeries
A: Head/ neck surgery thyroidectomy Intraperitoneal Prostate Laminectomy Hip/ knee Hysterectomy cholecystectomy
nephrectomy non majot intrathoracic
Q7: High risk surgeries
A: aortic/ cabg transplants spinal reconstruction peripheral vascular surgery
Q8: Lee's revised cardiac risk index
A: 6 points: High risk surgery = 1 CAD = 1 CHF = 1 Cerebrovascular disease = 1 DM 1 on insulin = 1 Creat greater than
2 = 1 1 = low risk 2 = moderate risk 3 = high risk
,Q9: SCIP pre-operative infection measures
A: - Prophylactic antibiotics should be received within 1 h prior to surgical incision - be selected for activity against the
most probable antimicrobial contaminants - be discontinued within 24 h after the surgery end-time
Q10: Postoperative infection reduction methods
A: - pre-op hair removal (clippers) - wash hands - normothermia - maintain euglycemia - urinary catheters are to be
removed within the first two postoperative days
Q11: Osteoarthritis: what, incidence
A: Slow destruction of bones/ joint followed by production of replacement collagen which causes inflammatory changes -
older than 60 - more female after 55 - more black than white women - men and women equal risk between 45 - 55 -
abnormal height or weight (obesity) - repetitive movement - prior trauma (sprains/ dislocations) - diabetic neuropathy
- genetic
Q12: Osteoarthritis findings and diagnostics
A: - Pain in weight bearing joints - stiffness after sitting, gets better when arising - feeling of instability on stairs - fine
motor skills deficit - larger affected joints - Heberden nodules (bony bumps on the finger joint closest to the fingernail)
- Bouchard's nodules (bony bumps on the middle joint of the finger) - limited ROM with crepitus - xr shows narrowing
of joint space (need anteroposterior and lateral knee films bilaterally) - synovial fluid is clear and without WBC
Q13: Osteoarthritis treatment
A: Goal is to relieve symptoms, maintain/ improve function, and avoid drug toxicity Hand OA: - rest/ joint protection, with
splinting - heat/ cold therapy - topical capsaicin - topical NSAID (trolamine salicylate) (especially for older than 75) -
Oral NSAIDS, incl COX2 inhibitors such as celecoxib (Celebrex) (may cause cardiac problems) - tramadol - no
opioids Hip/ knee OA: - weight reduction, cardiovascular exercises - transcutanous external nerve stimulator -
acetaminophen - Topical NSAIDS (knee) - intraarticular corticosteroid injections - surgery (joint replacement)
Q14: Rheumatoid arthritis: what, who
A: chronic, systemic autoimmune disease that causes inflammation of connective tissue, first that of jionts them other
soft tissues (renal, cardiovascular, pulm). TNF-alpha plays a big role - more women than men - unknown cause -
Epstein Barr virus
Q15: Rheumatoid arthritis: Findings and diagnostics
A: - symmetric joint/ muscle pain, worse in the morning then gets better - weakness, fatigue - anorexia, weight loss -
generalized malaise - swollen joints/ boggy feeling of joints with deformity of joints - warm, red skin on affected joints
later: - pleural effusions and pulmonary nodules - inflammation of sclerea (scleritis) - pericarditis, myocarditis -
splenomegaly (Felty's syndrome) - anemia (hypochromic, microcytic) with low ferritin - possibly: positive rheumatoid
factor - XR: joint swelling, later cortical and space thinning - synovial fluid: yellow, thick with elevated WBC up to
100.000
, Q16: Felty's syndrome
A: rheumatoid arthritis, splenomegaly, neutropenia
Q17: Rheumatoid arthritis treatment
A: - early treatment better than stepwise - early referral rheumatologist - disease-modifying anti-rheumatic drugs
(DMARDs): - methotrexate ( no alcohol, monitor renal and liver, give with folic acid) - cyclosporine - Gold
preparations (can cause thrombocytopenia) - Hydroxychloroquine: antimalarial drug (may cause visual changes,
monitor) - sulfasalazine, moderate RA - Leflunomide, moderate to severe RA - Etanercept - monitor liver function with
DMARDs - screen for TB (skin test) and Hep B - surgery: joint debridement, joint replacement
Q18: Gout: what, who
A: Inflammatory disorder in response to high uric acid production/ levels in blood and synovial fluid causing
crystallization which causes inflammation (Type A and Mediterranean) - impaired renal function which causes excess
uric acid - foods high in purine, such as dairy, red meat, shellfish, beer
Q19: Gout findings, diagnostics
A: - acute painful joint, often great toe (warm, swollen) - pain at night - flank pain because of renal calculi - fever -
leukocytosis - elevated erythrocyte sedimentation rate - tophi (bump under skin) on ear - limited joint motion -
elevated serum uric acid (greater than 7mg/dl) - urate crystals seen with joint aspiration - xr: joint erosion and renal
stones
Q20: Gout treatment
A: - NSAIDS: naproxen, ondomethacin, sulindac - Colchicine for those who do not tolerate NSAIDS (caution with renal
impairment). Also for prophylaxis - Corticosteroids, if NSAIDS and colchicine not tolerated - 24hr urine for uric acid -
Allopurinol after flare is over (100mg PO daily) - Biological modifiers of disease (BMD): Pegloticase. Not for
asymptomatic. Treat with prophylaxis first. Monitor serum uric acid
Q21: ANA. Tests in rheumatic disease: what, normal level, abnormal with.
A: Antinuclear antibody (ANA). Normal: Titer 1.32 POsitive with: Sjogren's (SS), SLE (lupus),
Q22: C4 Complement. Tests in rheumatic disease: what, normal level, abnormal with.
A: Determines hemolytic activity which speaks to level of inflammatory response Normal: men: 12-72. Women: 13-75
mg/dl Increased with: inflammatory disease Decreased with: RA, lupus, SS
Q23: The radioallergosorbent test (RAST). Tests in rheumatic disease: what, normal level, abnormal with.
A: measures presence/ increase antigen IgE normal: 0.01 - 0.04 mg/dl Increased with allergic reaction
Verified Answers
Q1: Surgery risk classes
A: Class 1: benefits outweigh risk, should be done Class 2a: reasonable to perform Class 2b: should be considered
Class 3: rarely appropriate
Q2: General rules for surgery: testing
A: ECG before surgery only if coronary disease, except when low risk surgery Stress test not indicated before surgery
Do not do prophylactic coronary revascularization
Q3: Meds before surgery
A: - Diabetic agents: Use insulin therapy to maintain glycemic goals(iii) Discontinue biguanides, alpha glucosidase
inhibitors, thiazolidinediones, sulfonylureas, and GLP-1 agonists - Do not start aspirin before surgery - Stop Warfarin
5 days before surgery. May be bridged with Lovenox. - Do not stop statin before surgery - Do not start beta-blocker
on day of surgery, but may continue
Q4: Assessment of surgical risk
A: - Unstable cardiac condition (recent MI, active angina, active HF, uncontrolled HTN, severe valvular disease),
concern with CAD, CHF. arrhythmia, CVD - patient stable or unstable? - urgency of the procedure (oncology will be
time sensitive) - risk of procedure - nutritional status - immune competence - determine functional capacity (need to
be more than 4 METS, more than 10 METs makes low risk)
Q5: Low risk surgeries
A: catarcts breast biopsy cystoscopy, vasectomy laporascopic procedures Plastic surgery
Q6: intermediate risk surgeries
A: Head/ neck surgery thyroidectomy Intraperitoneal Prostate Laminectomy Hip/ knee Hysterectomy cholecystectomy
nephrectomy non majot intrathoracic
Q7: High risk surgeries
A: aortic/ cabg transplants spinal reconstruction peripheral vascular surgery
Q8: Lee's revised cardiac risk index
A: 6 points: High risk surgery = 1 CAD = 1 CHF = 1 Cerebrovascular disease = 1 DM 1 on insulin = 1 Creat greater than
2 = 1 1 = low risk 2 = moderate risk 3 = high risk
,Q9: SCIP pre-operative infection measures
A: - Prophylactic antibiotics should be received within 1 h prior to surgical incision - be selected for activity against the
most probable antimicrobial contaminants - be discontinued within 24 h after the surgery end-time
Q10: Postoperative infection reduction methods
A: - pre-op hair removal (clippers) - wash hands - normothermia - maintain euglycemia - urinary catheters are to be
removed within the first two postoperative days
Q11: Osteoarthritis: what, incidence
A: Slow destruction of bones/ joint followed by production of replacement collagen which causes inflammatory changes -
older than 60 - more female after 55 - more black than white women - men and women equal risk between 45 - 55 -
abnormal height or weight (obesity) - repetitive movement - prior trauma (sprains/ dislocations) - diabetic neuropathy
- genetic
Q12: Osteoarthritis findings and diagnostics
A: - Pain in weight bearing joints - stiffness after sitting, gets better when arising - feeling of instability on stairs - fine
motor skills deficit - larger affected joints - Heberden nodules (bony bumps on the finger joint closest to the fingernail)
- Bouchard's nodules (bony bumps on the middle joint of the finger) - limited ROM with crepitus - xr shows narrowing
of joint space (need anteroposterior and lateral knee films bilaterally) - synovial fluid is clear and without WBC
Q13: Osteoarthritis treatment
A: Goal is to relieve symptoms, maintain/ improve function, and avoid drug toxicity Hand OA: - rest/ joint protection, with
splinting - heat/ cold therapy - topical capsaicin - topical NSAID (trolamine salicylate) (especially for older than 75) -
Oral NSAIDS, incl COX2 inhibitors such as celecoxib (Celebrex) (may cause cardiac problems) - tramadol - no
opioids Hip/ knee OA: - weight reduction, cardiovascular exercises - transcutanous external nerve stimulator -
acetaminophen - Topical NSAIDS (knee) - intraarticular corticosteroid injections - surgery (joint replacement)
Q14: Rheumatoid arthritis: what, who
A: chronic, systemic autoimmune disease that causes inflammation of connective tissue, first that of jionts them other
soft tissues (renal, cardiovascular, pulm). TNF-alpha plays a big role - more women than men - unknown cause -
Epstein Barr virus
Q15: Rheumatoid arthritis: Findings and diagnostics
A: - symmetric joint/ muscle pain, worse in the morning then gets better - weakness, fatigue - anorexia, weight loss -
generalized malaise - swollen joints/ boggy feeling of joints with deformity of joints - warm, red skin on affected joints
later: - pleural effusions and pulmonary nodules - inflammation of sclerea (scleritis) - pericarditis, myocarditis -
splenomegaly (Felty's syndrome) - anemia (hypochromic, microcytic) with low ferritin - possibly: positive rheumatoid
factor - XR: joint swelling, later cortical and space thinning - synovial fluid: yellow, thick with elevated WBC up to
100.000
, Q16: Felty's syndrome
A: rheumatoid arthritis, splenomegaly, neutropenia
Q17: Rheumatoid arthritis treatment
A: - early treatment better than stepwise - early referral rheumatologist - disease-modifying anti-rheumatic drugs
(DMARDs): - methotrexate ( no alcohol, monitor renal and liver, give with folic acid) - cyclosporine - Gold
preparations (can cause thrombocytopenia) - Hydroxychloroquine: antimalarial drug (may cause visual changes,
monitor) - sulfasalazine, moderate RA - Leflunomide, moderate to severe RA - Etanercept - monitor liver function with
DMARDs - screen for TB (skin test) and Hep B - surgery: joint debridement, joint replacement
Q18: Gout: what, who
A: Inflammatory disorder in response to high uric acid production/ levels in blood and synovial fluid causing
crystallization which causes inflammation (Type A and Mediterranean) - impaired renal function which causes excess
uric acid - foods high in purine, such as dairy, red meat, shellfish, beer
Q19: Gout findings, diagnostics
A: - acute painful joint, often great toe (warm, swollen) - pain at night - flank pain because of renal calculi - fever -
leukocytosis - elevated erythrocyte sedimentation rate - tophi (bump under skin) on ear - limited joint motion -
elevated serum uric acid (greater than 7mg/dl) - urate crystals seen with joint aspiration - xr: joint erosion and renal
stones
Q20: Gout treatment
A: - NSAIDS: naproxen, ondomethacin, sulindac - Colchicine for those who do not tolerate NSAIDS (caution with renal
impairment). Also for prophylaxis - Corticosteroids, if NSAIDS and colchicine not tolerated - 24hr urine for uric acid -
Allopurinol after flare is over (100mg PO daily) - Biological modifiers of disease (BMD): Pegloticase. Not for
asymptomatic. Treat with prophylaxis first. Monitor serum uric acid
Q21: ANA. Tests in rheumatic disease: what, normal level, abnormal with.
A: Antinuclear antibody (ANA). Normal: Titer 1.32 POsitive with: Sjogren's (SS), SLE (lupus),
Q22: C4 Complement. Tests in rheumatic disease: what, normal level, abnormal with.
A: Determines hemolytic activity which speaks to level of inflammatory response Normal: men: 12-72. Women: 13-75
mg/dl Increased with: inflammatory disease Decreased with: RA, lupus, SS
Q23: The radioallergosorbent test (RAST). Tests in rheumatic disease: what, normal level, abnormal with.
A: measures presence/ increase antigen IgE normal: 0.01 - 0.04 mg/dl Increased with allergic reaction
