NRNP 6540 MIDTERM 2026 COMPREHENSIVE
ASSESSMENT SCRIPT SOLVED QUESTIONS
ANSWERS UPDATED REVIEW SET
◉ General rules for surgery: testing.
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.
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.
,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.
Answer: catarcts
breast biopsy
cystoscopy, vasectomy
laporascopic procedures
Plastic surgery
◉ intermediate risk surgeries.
Answer: Head/ neck surgery
thyroidectomy
Intraperitoneal
,Prostate
Laminectomy
Hip/ knee
Hysterectomy
cholecystectomy
nephrectomy
non majot intrathoracic
◉ High risk surgeries.
Answer: aortic/ cabg
transplants
spinal reconstruction
peripheral vascular surgery
◉ Lee's revised cardiac risk index.
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.
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.
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.
Answer: Slow destruction of bones/ joint followed by production of
replacement collagen which causes inflammatory changes
ASSESSMENT SCRIPT SOLVED QUESTIONS
ANSWERS UPDATED REVIEW SET
◉ General rules for surgery: testing.
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.
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.
,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.
Answer: catarcts
breast biopsy
cystoscopy, vasectomy
laporascopic procedures
Plastic surgery
◉ intermediate risk surgeries.
Answer: Head/ neck surgery
thyroidectomy
Intraperitoneal
,Prostate
Laminectomy
Hip/ knee
Hysterectomy
cholecystectomy
nephrectomy
non majot intrathoracic
◉ High risk surgeries.
Answer: aortic/ cabg
transplants
spinal reconstruction
peripheral vascular surgery
◉ Lee's revised cardiac risk index.
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.
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.
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.
Answer: Slow destruction of bones/ joint followed by production of
replacement collagen which causes inflammatory changes
