NRNP 6560 Midterm exam questions with answers

NRNP 6560 Midterm exam questions with |\ |\ |\ |\ |\ |\




answers

Surgery risk classes - CORRECT ANSWERS ✔✔Class 1: benefits
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outweigh risk, should be done |\ |\ |\ |\




Class 2a: reasonable to perform
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Class 2b: should be considered
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Class 3: rarely appropriate
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General rules for surgery: testing - CORRECT ANSWERS ✔✔ECG
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before surgery only if coronary disease, except when low risk
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surgery
Stress test not indicated before surgery
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Do not do prophylactic coronary revascularization
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Meds before surgery - CORRECT ANSWERS ✔✔- Diabetic agents:
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Use insulin therapy to maintain glycemic goals(iii) Discontinue
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biguanides, alpha glucosidase inhibitors, thiazolidinediones,
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sulfonylureas, and GLP-1 agonists |\ |\ |\




- Do not start aspirin before surgery
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- Stop Warfarin 5 days before surgery. May be bridged with
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Lovenox. |\




- Do not stop statin before surgery
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- Do not start beta-blocker on day of surgery, but may continue
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,Assessment of surgical risk - CORRECT ANSWERS ✔✔- Unstable
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cardiac condition (recent MI, active angina, active HF,
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uncontrolled HTN, severe valvular disease), concern with CAD,
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CHF. arrhythmia, CVD
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- patient stable or unstable?
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- urgency of the procedure (oncology will be time sensitive)
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- risk of procedure
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- nutritional status
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- immune competence
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- determine functional capacity (need to be more than 4 METS,
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more than 10 METs makes low risk)
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Low risk surgeries - CORRECT ANSWERS ✔✔catarcts
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breast biopsy |\




cystoscopy, vasectomy |\




laporascopic procedures |\




Plastic surgery |\




intermediate risk surgeries - CORRECT ANSWERS ✔✔Head/ neck
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surgery
thyroidectomy
Intraperitoneal
Prostate
Laminectomy
Hip/ knee
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Hysterectomy

,cholecystectomy
nephrectomy
non majot intrathoracic
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High risk surgeries - CORRECT ANSWERS ✔✔aortic/ cabg
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transplants
spinal reconstruction |\




peripheral vascular surgery |\ |\




Lee's revised cardiac risk index - CORRECT ANSWERS ✔✔6
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points:
High risk surgery = 1
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CAD = 1 |\ |\




CHF = 1 |\ |\




Cerebrovascular disease = 1 |\ |\ |\




DM 1 on insulin = 1
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Creat greater than 2 = 1
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1 = low risk
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2 = moderate risk
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3 = high risk
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SCIP pre-operative infection measures - CORRECT ANSWERS ✔✔-
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Prophylactic antibiotics should be received within 1 h prior to
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surgical incision |\

, - be selected for activity against the most probable antimicrobial
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contaminants |\




- be discontinued within 24 h after the surgery end-time
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Postoperative infection reduction methods - CORRECT ANSWERS|\ |\ |\ |\ |\ |\ |\


✔✔- pre-op hair removal (clippers)
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- wash hands
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- normothermia
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- maintain euglycemia
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- urinary catheters are to be removed within the first two
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postoperative days |\




Osteoarthritis: what, incidence - CORRECT ANSWERS ✔✔Slow |\ |\ |\ |\ |\ |\ |\


destruction of bones/ joint followed by production of replacement
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collagen which causes inflammatory changes
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- older than 60
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- more female after 55
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- more black than white women
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- men and women equal risk between 45 - 55
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- abnormal height or weight (obesity)
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- repetitive movement
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- prior trauma (sprains/ dislocations)
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- diabetic neuropathy
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- genetic
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