NRNP 6560 MIDTERM EXAM QUESTIONS AND
VERIFIED ANSWERS
Surgery Risk Classes
Correct 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
Correct 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
Correct 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
Correct 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
Correct Answer- Catarcts
Breast Biopsy
Cystoscopy, Vasectomy
Laporascopic Procedures
Plastic Surgery
,Intermediate Risk Surgeries
Correct Answer- Head/ Neck Surgery
Thyroidectomy
Intraperitoneal
Prostate
Laminectomy
Hip/ Knee
Hysterectomy
Cholecystectomy
Nephrectomy
Non Majot Intrathoracic
High Risk Surgeries
Correct Answer- Aortic/ Cabg
Transplants
Spinal Reconstruction
Peripheral Vascular Surgery
Lee's Revised Cardiac Risk Index
Correct 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
Correct 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
Correct 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
,Correct 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
Correct 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
Correct 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
- Acetaminophen
- Topical Nsaids (Knee)
, - Intraarticular Corticosteroid Injections
- Surgery (Joint Replacement)
Rheumatoid Arthritis: What, Who
Correct Answer- 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
Rheumatoid Arthritis: Findings And Diagnostics
Correct Answer- - 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
Felty's Syndrome
Correct Answer- Rheumatoid Arthritis, Splenomegaly, Neutropenia
Rheumatoid Arthritis Treatment
Correct Answer- - 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
VERIFIED ANSWERS
Surgery Risk Classes
Correct 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
Correct 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
Correct 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
Correct 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
Correct Answer- Catarcts
Breast Biopsy
Cystoscopy, Vasectomy
Laporascopic Procedures
Plastic Surgery
,Intermediate Risk Surgeries
Correct Answer- Head/ Neck Surgery
Thyroidectomy
Intraperitoneal
Prostate
Laminectomy
Hip/ Knee
Hysterectomy
Cholecystectomy
Nephrectomy
Non Majot Intrathoracic
High Risk Surgeries
Correct Answer- Aortic/ Cabg
Transplants
Spinal Reconstruction
Peripheral Vascular Surgery
Lee's Revised Cardiac Risk Index
Correct 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
Correct 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
Correct 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
,Correct 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
Correct 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
Correct 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
- Acetaminophen
- Topical Nsaids (Knee)
, - Intraarticular Corticosteroid Injections
- Surgery (Joint Replacement)
Rheumatoid Arthritis: What, Who
Correct Answer- 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
Rheumatoid Arthritis: Findings And Diagnostics
Correct Answer- - 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
Felty's Syndrome
Correct Answer- Rheumatoid Arthritis, Splenomegaly, Neutropenia
Rheumatoid Arthritis Treatment
Correct Answer- - 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
