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NURS 5354 FINAL EXAM QUESTIONS WITH
VERIFIED ANSWERS|ALREADY GRADED
A+|LATEST UPDATE 2025
What is medical futility? - ANSWER-The proposed therapy will not improve the patient's medical condition.
What is qualitative futility? - ANSWER-A situation in which the quality of benefit an intervention will produce is poor.
What is physiologic futility? - ANSWER-When the proposed intervention cannot physiologically achieve the desired effect.
What is quantitative futility? - ANSWER-The intervention that has a very small chance of benefiting the patient ("less than 1% chance of survival")
What is decisional competence and who is it determined by? - ANSWER-The ability of an individual to participate in legal proceedings which is a legal designation made by the court of law.
What is decisional capacity and who is it determined by? - ANSWER-An individual is or is not capable of making a medical decision within a given situation and is determined by the physician of other clinician.
What is the difference between euthanasia vs. physician-assisted suicide? - ANSWER-Euthanasia-the act of intentionally ending a life to relieve suffering Ex: a lethal injection administered by a doctor.
Physician-assisted suicide-the act of helping another person to kill themselves Ex: providing patient with high dose sedative and patient administers it.
What behaviors can enhance patient (family) dignity? - ANSWER-Do not rush conversation, with the patient and/or family, sitting down and make eye contact.
What is spirometry? - ANSWER-A method of assessing lung function by measuring volume of air that the patient can expel from the lungs after maximal inspiration.
What is FVC? - ANSWER-Forced vital capacity-the total volume of air that the patient can forcibly exhale in one breath.
What is FEV1? - ANSWER-Forced expiratory volume in 1 second-the volume of air that the patient is able to exhale in the first second of forced expiration.
What is FEV1/FVC? - ANSWER-the ratio of FEV1 to FVC expressed as a fraction
What is the normal FEV1/FVC ratio? - ANSWER-Between 0.7-0.8.
0.65-0.70 for older adults
What spirometry indices indicate obstructive disease? - ANSWER-FEV1 less than 80%
FVC reduced or normal
FEV1/FVC less than 0.
What is the spirometric criterion required for a diagnosis of COPD? - ANSWER- FEV1/FVC ratio below 0.7 after bronchodilator.
Why is bronchodilator reversibility testing done? - ANSWER-To determine whether fixed airway narrowing is present and help providers distinguish between COPD and asthma diagnosis.
If there is a significant change in FEV1 post bronchodilator, what is this associated with? - ANSWER-Increases in the FEV1 greater than 12% AND 200 ml is associated with a diagnosis of asthma. Post-bronchodilator results in patients with COPD should still have a FEV1/FVC ration less than 0.7.
For accurate results, the patient should do what before bronchodilator reversibility testing? - ANSWER-Be clinically stable and free from any respiratory infection, hold SABAs 4-6 hours before testing and hold LABAs 24 hours before testing.
What is the procedure for bronchodilator reversibility testing? - ANSWER-1. Conduct spirometry before administrating a bronchodilator
- Administer a bronchodilator (albuterol or ipratropium) and wait 15 min
- Repeat spirometry post-bronchodilator.
What is the criteria for COPD severity? - ANSWER-Mild: FEV1 greater than or equal to 80%
Moderate: FEV1 50-80%
Severe: FEV1 30-50%
Very Severe: Less than 30%
Eye surgery within 1 week is a relative contraindication to spirometry due to...? - ANSWER-Increased intraocular pressure while performing spirometry.
What are some possible side effects to spirometry testing? - ANSWER- Lightheadedness/dizziness, syncope (vasovagal response), bronchospasm, urinary incontinence.
What patient populations should avoid spirometry testing? - ANSWER-Patients who have recently had an MI or CVA.
What is a single suture strand called? - ANSWER-Monofilament; more resistant to harboring microorganisms.
How do you determine the diameter of a suture? - ANSWER-The smaller the number, the larger the strand.
Ex: a 2-0 is larger than 5-0 suture.
What size suture would you use for the face? - ANSWER- 5 - 0 or 6- 0
What size suture would you use for the scalp? - ANSWER- 4 - 0
What size suture would you use for the upper body? - ANSWER- 4 - 0
What size suture would you use for the hand? - ANSWER- 4 - 0 or 5- 0
What size suture would you use for the lower body? - ANSWER- 4 - 0
What size suture would you use over a joint? - ANSWER- 4 - 0
What are non-absorbable sutures? - ANSWER-Two types: Natural-Surgical silk
Synthetic-Nylon (Ethilon) or Polyprolene (Prolene)
How far apart should two sutures be from one another? - ANSWER-No closer than 2 mm in a fine plastic closure. The distance between sutures should equal half the total distance across the incision.
When should sutures be removed from the face? - ANSWER- 4 - 5 days
When should sutures be removed from the scalp? - ANSWER- 10 - 14 days
When should sutures be removed from the upper body? - ANSWER- 7 - 10 days
When should sutures be removed from the hand? - ANSWER- 7 - 10 days
When should sutures be removed from the lower body? - ANSWER- 10 - 14 days
When should sutures be removed over joints? - ANSWER- 14 - 21 days
Consult/referral should be done for...? - ANSWER-Deep wounds of the hand or foot, lacerations of the eyelid/lip/ear, lacerations involving tendon, nerves, arteries, bones or joints, penetrating wounds of unknown depth, severe crush injuries, severely contaminated wounds requiring drainage, wounds for which the patient or clinical is strongly concerned about cosmetic outcome. and galea
What are other methods of wound repair/closure? - ANSWER-Tape, adhesives or staples
What needs to be documented/coded when suturing? - ANSWER-Lesion location, lesion size, benign/malignant (discuss path report), and closure.
What needs to be documented for wound repair? - ANSWER-laceration length and location, any neurovascular damage distal to the injury, laceration clean or
With hand injuries, what should always be documented? - ANSWER-Hand dominance and occupation.
What are the goals of laceration/incision repair? - ANSWER-Achieve hemostasis, prevent infection, preserve function, preserve cosmetic appearance, minimize discomfort.
What is primary closure/intention? - ANSWER-Direct approximation of the wound edges by suture, tape, adhesives, etc.
What is secondary closure/intention? - ANSWER-Wound is left open to heal by the formation of granulation tissue and contraction.
What is delayed primary closure or tertiary intention? - ANSWER-Wound is left open and would benefit from closure in a few days. Irrigation, packings and/or may be done while wound is left open and then by the 3rd day, definitive closure occurs.
What is the main reason not to use primary closure? - ANSWER-Infection.
What is the equipment needed for wound closure? - ANSWER-Forceps, anesthetic, needle holder, suture.
What are the two types of forceps? - ANSWER-Locking-Ex: needle holder, hemostat and Kelly clamps. These are typically used for suturing, hemostasis and extraction.
Non-locking-Ex: DeBakey or Cooley. These are typically used for grasping/handling delicate tissue.
What type of forcep is used for the skin? - ANSWER-The Adson forceps (non- locking forcep)
What hand are forceps held in? - ANSWER-The non-dominant hand. They are typically help between the thumb and the first finger. Imagine holding a pencil or pen.
What type of anesthetic should be used for the ear? - ANSWER-1% or 2% plain lidocaine
What type of anesthetic should be used for the neck, chest, back or abdomen? - ANSWER-1% lidocaine with epinephrine
What type of anesthetic should be used for the extremity? - ANSWER-1% or 2% lidocaine with epinephrine
What type of anesthetic should be used for hands and feet? - ANSWER-1% plain lidocaine or consider regional block with bupivacaine
What type of anesthetic should be used for nail beds? - ANSWER-2% plain lidocaine or consider regional block with bupivacaine
What should be used prior to a digital block - ANSWER-EMLA cream.
What needle gauge is used for joint injections? - ANSWER- 18 - 20 gauge (14- 18 gauge for the shoulder)
What is the landmark for lateral elbow joint aspiration? - ANSWER-Anconeus triangle
What are the contraindications for joint aspiration/injection? - ANSWER-cellulitis, dermatitis, skin infection, osteomyelitis, blood clot, joint prosthesis, suspected bacteremia if septic arthritis not suspected.
What approach is most used in knee joint aspiration? - ANSWER-Lateral (at 45 degree angle)
What approach is most common in shoulder joint aspiration? - ANSWER-Posterior (below the acromion process)
What is the most mobile joint in the body? - ANSWER-The shoulder
Mobility-High risk for falls if gait speed is less than 0.8 m/s and Get up and Go test is greater than 15 s.
Cognition-Mini-Cog test. Impaired cognition increases risk for post-op delirium
Mental health-depression?
Medication review-Avoid high risk meds (anticholinergics)
Medical conditions-Cardiac, Pulmonary, OSA?
Shared decision making
Should cardiac testing be done for all pre-operative patients? - ANSWER-No. Supplemental cardiac testing (ECG, LV function, ECHO, etc.) is only useful for patients with heart disease, dyspnea, and/or valvular stenosis/regurgitation
When should anticoagulants NOT be held? - ANSWER-For cutaneous surgery, dental extractions, minor oral procedures or cataract surgery.
When can elective surgery occur in patients who have received a coronary stent?
- ANSWER-Not before 30 days after a bare metal stent and not before 365 days after a drug-eluting stent.
What are major patient related risk factors for pulmonary complications after surgery? - ANSWER-Age, COPD, ASA class II or greater, heart failure, ADL deficit, low albumin
What are major procedure related risk factors for pulmonary complications after surgery? - ANSWER-Emergency surgery, prolonged surgery (>3 hours), AAA repair, neurosurgery, thoracic surgery, abdominal, head/neck or vascular surgery and general anesthesia.
Is a routine chest xray needed pre-operatively? - ANSWER-No. Only recommnded for known cardiac or pulmonary disease in patients undergoing thoracic, upper abdominal or AAA surgery.
Is the accurate estimation of GFR important pre-operatively? - ANSWER-Yes. renal and glomerular blood flow and muscle mass decreases with age so serum creatinine may appear normal even when kidney function is not. Calculate the GFR.
What are the pre-op risk factors for delirium? - ANSWER-Age old than 65
Cognitive impairment
Limited physical function
