NRNP 6560 Midterm Exam Latest 2022/2023 Already graded A+

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)

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

- surgery: joint debridement, joint replacement

Gout: what, who