NRNP 6560 Midterm Exam Actual Exam 2026/2027 – Complete Exam-Style
Questions with Detailed Rationales | 100% Verified | Pass Guaranteed – A+
Graded
Section A: Preoperative & Postoperative Care Management (15
Questions)
Q1: A 68-year-old male is scheduled for elective total knee arthroplasty. His surgeon
explains that the benefits of the procedure clearly outweigh the risks based on current
evidence. According to surgery risk classification, this recommendation is:
A. Class 2a (reasonable to perform)
B. Class 2b (should be considered)
C. Class 1 (benefits outweigh risk, should be done) [CORRECT]
D. Class 3 (risks outweigh benefits)
Correct Answer: C
Rationale: Class 1 indicates strong evidence that benefits outweigh risks and the
procedure should be performed. Class 2a/2b represent weaker recommendations, and
Class 3 indicates the procedure should not be performed.
,Q2: During preoperative evaluation of a 72-year-old female scheduled for abdominal
surgery, which finding is the strongest predictor of increased postoperative morbidity
and mortality?
A. Mild anxiety about surgery
B. History of well-controlled hypertension
C. Hemoglobin 8.2 g/dL [CORRECT]
D. Remote history of appendectomy
Correct Answer: C
Rationale: Low hemoglobin is a recognized predictor of poor postoperative outcomes
including increased morbidity and mortality. Options A, B, and D do not carry the same
prognostic significance for perioperative risk.
Q3: A 65-year-old patient on chronic warfarin therapy for atrial fibrillation is scheduled
for elective colon resection in one week. The AGACNP's preoperative medication
management plan should include:
A. Continue warfarin through the morning of surgery
,B. Stop warfarin 5 days before surgery and bridge with Lovenox if indicated [CORRECT]
C. Stop warfarin 2 days before surgery and start aspirin
D. Switch warfarin to aspirin 5 days before surgery
Correct Answer: B
Rationale: Warfarin should be stopped approximately 5 days preoperatively to allow INR
normalization, with bridging anticoagulation (e.g., Lovenox) based on thromboembolic
risk. Aspirin should not be started preoperatively for this indication.
Q4: Which medication should generally be taken on the morning of surgery with a sip of
water?
A. Warfarin
B. Furosemide
C. Beta-blockers [CORRECT]
D. Metformin
Correct Answer: C
, Rationale: Beta-blockers should typically be continued perioperatively to avoid rebound
hypertension and tachycardia. Warfarin is stopped preoperatively, diuretics may be held,
and metformin is typically held on the day of surgery due to renal function concerns.
Q5: A 58-year-old patient with poorly controlled diabetes, chronic smoking, and
malnutrition is scheduled for open reduction internal fixation of a femur fracture. Which
factor most significantly increases this patient's risk for poor wound healing?
A. Age 58
B. Diabetes and smoking [CORRECT]
C. Type of anesthesia planned
D. Male gender
Correct Answer: B
Rationale: Diabetes and smoking are major modifiable risk factors for impaired wound
healing due to microvascular disease and tissue hypoxia. Age 58 is not advanced age,
and gender is not a primary risk factor.
Questions with Detailed Rationales | 100% Verified | Pass Guaranteed – A+
Graded
Section A: Preoperative & Postoperative Care Management (15
Questions)
Q1: A 68-year-old male is scheduled for elective total knee arthroplasty. His surgeon
explains that the benefits of the procedure clearly outweigh the risks based on current
evidence. According to surgery risk classification, this recommendation is:
A. Class 2a (reasonable to perform)
B. Class 2b (should be considered)
C. Class 1 (benefits outweigh risk, should be done) [CORRECT]
D. Class 3 (risks outweigh benefits)
Correct Answer: C
Rationale: Class 1 indicates strong evidence that benefits outweigh risks and the
procedure should be performed. Class 2a/2b represent weaker recommendations, and
Class 3 indicates the procedure should not be performed.
,Q2: During preoperative evaluation of a 72-year-old female scheduled for abdominal
surgery, which finding is the strongest predictor of increased postoperative morbidity
and mortality?
A. Mild anxiety about surgery
B. History of well-controlled hypertension
C. Hemoglobin 8.2 g/dL [CORRECT]
D. Remote history of appendectomy
Correct Answer: C
Rationale: Low hemoglobin is a recognized predictor of poor postoperative outcomes
including increased morbidity and mortality. Options A, B, and D do not carry the same
prognostic significance for perioperative risk.
Q3: A 65-year-old patient on chronic warfarin therapy for atrial fibrillation is scheduled
for elective colon resection in one week. The AGACNP's preoperative medication
management plan should include:
A. Continue warfarin through the morning of surgery
,B. Stop warfarin 5 days before surgery and bridge with Lovenox if indicated [CORRECT]
C. Stop warfarin 2 days before surgery and start aspirin
D. Switch warfarin to aspirin 5 days before surgery
Correct Answer: B
Rationale: Warfarin should be stopped approximately 5 days preoperatively to allow INR
normalization, with bridging anticoagulation (e.g., Lovenox) based on thromboembolic
risk. Aspirin should not be started preoperatively for this indication.
Q4: Which medication should generally be taken on the morning of surgery with a sip of
water?
A. Warfarin
B. Furosemide
C. Beta-blockers [CORRECT]
D. Metformin
Correct Answer: C
, Rationale: Beta-blockers should typically be continued perioperatively to avoid rebound
hypertension and tachycardia. Warfarin is stopped preoperatively, diuretics may be held,
and metformin is typically held on the day of surgery due to renal function concerns.
Q5: A 58-year-old patient with poorly controlled diabetes, chronic smoking, and
malnutrition is scheduled for open reduction internal fixation of a femur fracture. Which
factor most significantly increases this patient's risk for poor wound healing?
A. Age 58
B. Diabetes and smoking [CORRECT]
C. Type of anesthesia planned
D. Male gender
Correct Answer: B
Rationale: Diabetes and smoking are major modifiable risk factors for impaired wound
healing due to microvascular disease and tissue hypoxia. Age 58 is not advanced age,
and gender is not a primary risk factor.
