Page 1 of 71
NRNP 6560 MIDTERM EXAM (WALDEN UNIVERSITY)
LATEST UPDATE 2024\2025 QUESTIONS AND CORRECT
ANSWERS (VERIFIED ANSWERS) | GRADED A+
Surgery risk classes
--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
- --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
,Page 2 of 71
(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
,Page 3 of 71
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
- 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)
, Page 4 of 71
- diabetic neuropathy
- genetic
Osteoarthritis findings and diagnostics - -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 - -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)
NRNP 6560 MIDTERM EXAM (WALDEN UNIVERSITY)
LATEST UPDATE 2024\2025 QUESTIONS AND CORRECT
ANSWERS (VERIFIED ANSWERS) | GRADED A+
Surgery risk classes
--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
- --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
,Page 2 of 71
(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
,Page 3 of 71
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
- 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)
, Page 4 of 71
- diabetic neuropathy
- genetic
Osteoarthritis findings and diagnostics - -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 - -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)
