NRNP 6560 Midterm Exam
Latest Multiple Versions
Verified Questions and Answers (100 in Each Version)
Complete and best documents for exam Preparation
Secure HIGHSCORE
,NRNP 6560 Midterm exam
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)
Latest Multiple Versions
Verified Questions and Answers (100 in Each Version)
Complete and best documents for exam Preparation
Secure HIGHSCORE
,NRNP 6560 Midterm exam
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)
