NRNP 6560 Midterm exam questions with correct answers .

NRNP 6560 Midterm exam questions with
correct answers
Surgery |risk |classes |- |VERIFIED |ANSWER✔✔-Class |1: |benefits |outweigh |risk, |should |be |done

Class |2a: |reasonable |to |perform

Class |2b: |should |be |considered

Class |3: |rarely |appropriate



General |rules |for |surgery: |testing |- |VERIFIED |ANSWER✔✔-ECG |before |surgery |only |if |coronary
|disease, |except |when |low |risk |surgery



Stress |test |not |indicated |before |surgery

Do |not |do |prophylactic |coronary |revascularization



Meds |before |surgery |- |VERIFIED |ANSWER✔✔-- |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



Assessment |of |surgical |risk |- |VERIFIED |ANSWER✔✔-- |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)

,Low |risk |surgeries |- |VERIFIED |ANSWER✔✔-catarcts

breast |biopsy

cystoscopy, |vasectomy

laporascopic |procedures

Plastic |surgery



intermediate |risk |surgeries |- |VERIFIED |ANSWER✔✔-Head/ |neck |surgery

thyroidectomy

Intraperitoneal

Prostate

Laminectomy

Hip/ |knee

Hysterectomy

cholecystectomy

nephrectomy

non |majot |intrathoracic



High |risk |surgeries |- |VERIFIED |ANSWER✔✔-aortic/ |cabg

transplants

spinal |reconstruction

peripheral |vascular |surgery



Lee's |revised |cardiac |risk |index |- |VERIFIED |ANSWER✔✔-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



SCIP |pre-operative |infection |measures |- |VERIFIED |ANSWER✔✔-- |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



Postoperative |infection |reduction |methods |- |VERIFIED |ANSWER✔✔-- |pre-op |hair |removal |(clippers)

- |wash |hands

- |normothermia

- |maintain |euglycemia

- |urinary |catheters |are |to |be |removed |within |the |first |two |postoperative |days



Osteoarthritis: |what, |incidence |- |VERIFIED |ANSWER✔✔-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



Osteoarthritis |findings |and |diagnostics |- |VERIFIED |ANSWER✔✔-- |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



Osteoarthritis |treatment |- |VERIFIED |ANSWER✔✔-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