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OR Nurse:
doi: 10.1097/01.ORN.0000434525.49585.8b
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Rotator cuff arthroscopy in the older adult

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INSTRUCTIONS Rotator cuff arthroscopy in the older adult

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Rotator cuff arthroscopy in the older adult

GENERAL PURPOSE: To provide information about rotator cuff surgery in older adult patients. LEARNING OBJECTIVES: After reading this article and taking the test, the learner should be able to: 1. Identify factors affecting pathogenesis and evaluation of rotator cuff tears. 2. Recognize options for and potential consequences of surgical rotator cuff repair.

  1. The structure that enables full range of motion of the shoulder joint is the
    1. scapula.
    2. bicep tendon.
    3. subscapularis joint.
    4. glenohumeral joint.
  2. Which muscle is not part of the rotator cuff?
    1. glenohumeral
    2. supraspinatus
    3. infraspinatus
    4. teres minor
  3. The most important factor in the pathogenesis of rotator cuff tears is
    1. injury.
    2. aging.
    3. disease.
    4. impingement.
  4. Which statement about rotator cuff surgery approaches is true?
    1. Arthroscopic surgery maintains the deltoid muscle.
    2. Arthroscopy is safer but less effective than open surgery.
    3. Open surgery provides better mobilization outcomes.
    4. Open surgery provides better treatment of intraarticular lesions.
  5. Which combination of factors contributes to a higher surgical failure rate?
    1. older age and larger tear size
    2. older age and arthroscopic surgery
    3. larger tear size and arthroscopic surgery
    4. larger tear size and outpatient surgery
  6. Colvin and colleagues found that compared to open surgery, arthroscopy on average required
    1. less surgical time.
    2. more surgical time.
    3. more postanesthesia care unit (PACU) time.
    4. less PACU time.
  7. The imaging test of choice for evaluating rotator cuff pathology is
    1. X-ray.
    2. ultrasound.
    3. computed tomography scan.
    4. magnetic resonance imaging.
  8. A standard indicator of the need for surgical repair is
    1. a tear greater than 1 cm.
    2. a tear greater than 2 cm.
    3. persistent symptoms for 3 to 6 months.
    4. persistent symptoms for 6 to 12 months.
  9. Which statement represents the authors' views about presurgical patient assessment of older adults?
    1. Performing a comprehensive neurological assessment is critical.
    2. A nutrition assessment helps identify patients at risk for postsurgical infection.
    3. The nurse should encourage the family members to help answer interview questions.
    4. Good outcomes are more dependent on the physical assessment than functional or psychosocial assessments.
  10. Because older adult patients have reduced baroreceptor reflexes, anesthesia can cause a sharp
    1. rise in body temperature.
    2. decrease in oxygenation.
    3. drop in BP.
    4. shift in fluid volumes.
  11. An interscalene nerve block
    1. anesthetizes the scalene muscles.
    2. anesthetizes the roots of the brachial plexus.
    3. should never be given with general anesthesia.
    4. is associated with unplanned hospitalizations.
  12. To minimize the risk of nerve block complications,
    1. ultrasound can be used to facilitate accurate injection.
    2. the anesthetic should not include epinephrine.
    3. general anesthesia is given prior to performing the nerve block.
    4. position the patient in supine position with the head turned ipsilaterally.
  13. An acromioplasty is performed to
    1. remove osteophytes.
    2. avoid injury to the deltoid muscle.
    3. facilitate a tendon transfer procedure.
    4. facilitate a shorter period of pain and rehabilitation.
  14. To perform rotator cuff surgery in the lateral position, the arm may be distracted overhead to
    1. 30 degree with a 5 lb (2.3 kg) weight.
    2. 30 degree with a 10 lb (4.6 kg) weight.
    3. 45 degree with a 5 lb (2.3 kg) weight.
    4. 45 degree with a 10 lb (4.6 kg) weight.
  15. Older adult patients are at risk for drug clearance problems because they
    1. have decreased renal and hepatic function.
    2. have decreased cardiac and pulmonary function.
    3. have increased risk for fluid and electrolyte problems.
    4. frequently take multiple medications for multiple comorbidities.
  16. A study by Cho and colleagues found that
    1. NSAIDs provided effective pain relief with minimal adverse reactions.
    2. I.PCA is less likely to cause delirium than epidural PCA.
    3. multimodal approaches to pain management were more effective than I.analgesia alone.
    4. around-the-clock opioid dosing is the best way to control pain after arthroscopic surgery.
  17. What is the average structural failure rate of rotator cuff surgery?
    1. 22%
    2. 28%
    3. 32%
    4. 40%
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