NRNP 6560 Midterm exam Questions And Answers.

NRNP 6560 Midterm exam Questions
And Answers

Surgery risk classes - (correct answer) -Class 1: benefits outweigh risk, should be done
jl jl jl jl jl jl jl jl jl jl jl jl jl



Class 2a: reasonable to performjl jl jl jl



Class 2b: should be considered jl jl jl jl



Class 3: rarely appropriate jl jl jl




General rules for surgery: testing - (correct answer) -ECG before surgery only if coronary
jl jl jl jl jl jl jl jl jl jl jl jl jl



disease, except when low risk surgery
jl jl jl jl jl jl



Stress test not indicated before surgery jl jl jl jl jl



Do not do prophylactic coronary revascularization
jl jl jl jl jl




Meds before surgery - (correct answer) -- Diabetic agents: Use insulin therapy to maintain
jl jl jl jl jl jl jl jl jl jl jl jl jl



glycemic goals(iii) Discontinue biguanides, alpha glucosidase inhibitors,
jl jl jl jl jl jl jl



thiazolidinediones, sulfonylureas, and GLP-1 agonists
jl jl jl jl jl



- Do not start aspirin before surgery
jl jl jl jl jl jl



- Stop Warfarin 5 days before surgery. May be bridged with Lovenox.
jl jl jl jl jl jl jl jl jl jl jl jl



- Do not stop statin before surgery
jl jl jl jl jl jl



- Do not start beta-blocker on day of surgery, but may continue
jl jl jl jl jl jl jl jl jl jl jl




Assessment of surgical risk - (correct answer) -- Unstable cardiac condition (recent MI, jl jl jl jl jl jl jl jl jl jl jl jl



active angina, active HF, uncontrolled HTN, severe valvular disease), concern with CAD,
jl jl jl jl jl jl jl jl jl jl jl jl



CHF. arrhythmia, CVD
jl jl jl



- patient stable or unstable?
jl jl jl jl



- urgency of the procedure (oncology will be time sensitive)
jl jl jl jl jl jl jl jl jl



- risk of procedure
jl jl jl



- nutritional status
jl jl jl



- immune competence
jl jl



- determine functional capacity (need to be more than 4 METS, more than 10 METs makes
jl jl jl jl jl jl jl jl jl jl jl jl jl jl jl



low risk)
jl jl




Low risk surgeries - (correct answer) -catarcts
jl jl jl jl jl jl



breast biopsy jl



cystoscopy, vasectomy jl



laporascopic procedures jl



Plastic surgery jl




intermediate risk surgeries - (correct answer) -Head/ neck surgery jl jl jl jl jl jl jl jl



thyroidectomy
Intraperitoneal

,Prostate
Laminectomy
Hip/ knee jl



Hysterectomy
cholecystectomy
nephrectomy
non majot intrathoracic jl jl




High risk surgeries - (correct answer) -aortic/ cabg
jl jl jl jl jl jl jl



transplants
spinal reconstruction jl



peripheral vascular surgery jl jl




Lee's revised cardiac risk index - (correct answer) -6 points:
jl jl jl jl jl jl jl jl jl



High risk surgery = 1 jl jl jl jl



CAD = 1 jl jl



CHF = 1 jl jl



Cerebrovascular disease = 1 jl jl jl



DM 1 on insulin = 1 jl jl jl jl jl



Creat greater than 2 = 1 jl jl jl jl jl




1 = low risk
jl jl jl



2 = moderate risk
jl jl jl



3 = high risk
jl jl jl




SCIP pre-operative infection measures - (correct answer) -- Prophylactic antibiotics should
jl jl jl jl jl jl jl jl jl jl



be received within 1 h prior to surgical incision
jl jl jl jl jl jl jl jl jl



- be selected for activity against the most probable antimicrobial contaminants
jl jl jl jl jl jl jl jl jl jl jl



- be discontinued within 24 h after the surgery end-time
jl jl jl jl jl jl jl jl jl




Postoperative infection reduction methods - (correct answer) -- pre-op hair removal jl jl jl jl jl jl jl jl jl jl



(clippers)
jl



- wash hands
jl jl



- normothermia
jl



- maintain euglycemia
jl jl



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




Osteoarthritis: what, incidence - (correct answer) -Slow destruction of bones/ joint followed jl jl jl jl jl jl jl jl jl jl jl



by production of replacement collagen which causes inflammatory changes
jl jl jl jl jl jl jl jl jl




- older than 60
jl jl jl



- more female after 55
jl jl jl jl



- more black than white women
jl jl jl jl jl



- men and women equal risk between 45 - 55
jl jl jl jl jl jl jl jl jl



- abnormal height or weight (obesity)
jl jl jl jl jl



- repetitive movement
jl jl

,- prior trauma (sprains/ dislocations)
jl jl jl jl



- diabetic neuropathy
jl jl



- genetic
jl




Osteoarthritis findings and diagnostics - (correct answer) -- Pain in weight bearing joints jl jl jl jl jl jl jl jl jl jl jl jl



- stiffness after sitting, gets better when arising
jl jl jl jl jl jl jl



- feeling of instability on stairs
jl jl jl jl jl



- fine motor skills deficit
jl jl jl jl



- larger affected joints
jl jl jl



- Heberden nodules (bony bumps on the finger joint closest to the fingernail)
jl jl jl jl jl jl jl jl jl jl jl jl



- Bouchard's nodules (bony bumps on the middle joint of the finger)
jl jl jl jl jl jl jl jl jl jl jl



- limited ROM with crepitus
jl jl jl jl




- xr shows narrowing of joint space (need anteroposterior and lateral knee films bilaterally)
jl jl jl jl jl jl jl jl jl jl jl jl jl



- synovial fluid is clear and without WBC
jl jl jl jl jl jl jl




Osteoarthritis treatment - (correct answer) -Goal is to relieve symptoms, maintain/ improve jl jl jl jl jl jl jl jl jl jl jl



function, and avoid drug toxicity
jl jl jl jl jl




Hand OA: jl



- rest/ joint protection, with splinting
jl jl jl jl jl



- heat/ cold therapy
jl jl jl



- topical capsaicin
jl jl



- topical NSAID (trolamine salicylate) (especially for older than 75)
jl jl jl jl jl jl jl jl jl



- Oral NSAIDS, incl COX2 inhibitors such as celecoxib (Celebrex) (may cause cardiac
jl jl jl jl jl jl jl jl jl jl jl jl



problems)
jl



- tramadol
jl



- no opioids
jl jl




Hip/ knee OA: jl jl



- weight reduction, cardiovascular exercises
jl jl jl jl



- transcutanous external nerve stimulator
jl jl jl jl



- acetaminophen
jl



- Topical NSAIDS (knee)
jl jl jl



- intraarticular corticosteroid injections
jl jl jl



- surgery (joint replacement)
jl jl jl




Rheumatoid arthritis: what, who - (correct answer) -chronic, systemic autoimmune disease jl jl jl jl jl jl jl jl jl jl



that causes inflammation of connective tissue, first that of jionts them other soft tissues
jl jl jl jl jl jl jl jl jl jl jl jl jl jl



(renal, cardiovascular, pulm). TNF-alpha plays a big role
jl jl jl jl jl jl jl jl




- more women than men
jl jl jl jl



- unknown cause
jl jl jl



- Epstein Barr virus
jl jl jl

, Rheumatoid arthritis: Findings and diagnostics - (correct answer) -- symmetric joint/ jl jl jl jl jl jl jl jl jl jl



muscle pain, worse in the morning then gets better
jl jl jl jl jl jl jl jl jl



- weakness, fatigue
jl jl



- anorexia, weight loss
jl jl jl



- generalized malaise
jl jl



- swollen joints/ boggy feeling of joints with deformity of joints
jl jl jl jl jl jl jl jl jl jl



- warm, red skin on affected joints
jl jl jl jl jl jl



later:
- pleural effusions and pulmonary nodules
jl jl jl jl jl



- inflammation of sclerea (scleritis)
jl jl jl jl



- pericarditis, myocarditis
jl jl



- splenomegaly (Felty's syndrome)
jl jl jl




- anemia (hypochromic, microcytic) with low ferritin
jl jl jl jl jl jl



- possibly: positive rheumatoid factor
jl jl jl jl



- XR: joint swelling, later cortical and space thinning
jl jl jl jl jl jl jl jl



- synovial fluid: yellow, thick with elevated WBC up to 100.000
jl jl jl jl jl jl jl jl jl jl




Felty's syndrome - (correct answer) -rheumatoid arthritis, splenomegaly, neutropenia
jl jl jl jl jl jl jl jl




Rheumatoid arthritis treatment - (correct answer) -- early treatment better than stepwise jl jl jl jl jl jl jl jl jl jl jl



- early referral rheumatologist
jl jl jl



- disease-modifying anti-rheumatic drugs (DMARDs):
jl jl jl jl jl



- methotrexate ( no alcohol, monitor renal and liver, give with folic acid)
jl jl jl jl jl jl jl jl jl jl jl jl



- cyclosporine
jl



- Gold preparations (can cause thrombocytopenia)
jl jl jl jl jl



- Hydroxychloroquine: antimalarial drug (may cause visual changes, monitor)
jl jl jl jl jl jl jl jl



- sulfasalazine, moderate RA
jl jl jl



- Leflunomide, moderate to severe RA
jl jl jl jl jl



- Etanercept
jl



- monitor liver function with DMARDs
jl jl jl jl jl



- screen for TB (skin test) and Hep B
jl jl jl jl jl jl jl jl



- surgery: joint debridement, joint replacement
jl jl jl jl jl




Gout: what, who - (correct answer) -Inflammatory disorder in response to high uric acid
jl jl jl jl jl jl jl jl jl jl jl jl jl



production/ levels in blood and synovial fluid causing crystallization which causes
jl jl jl jl jl jl jl jl jl jl jl



inflammation (Type A and Mediterranean)
jl jl jl jl jl




- impaired renal function which causes excess uric acid
jl jl jl jl jl jl jl jl jl



- foods high in purine, such as dairy, red meat, shellfish, beer
jl jl jl jl jl jl jl jl jl jl jl




Gout findings, diagnostics - (correct answer) -- acute painful joint, often great toe (warm,
jl jl jl jl jl jl jl jl jl jl jl jl jl



swollen)
jl



- pain at night
jl jl jl



- flank pain because of renal calculi
jl jl jl jl jl jl



- fever
jl