HOSMERIT
NRNP 6560 MIDTERM EXAM | QUESTIONS &
ANSWERS (VERIFIED) | LATEST UPDATE | GRADED
A+
Surgery risk classes
Correct 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
Correct 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
Correct 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
Correct 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
Correct Answer: catarcts
breast biopsy
cystoscopy, vasectomy
laporascopic procedures
Plastic surgery
intermediate risk surgeries
Correct Answer: Head/ neck surgery
thyroidectomy
,Intraperitoneal
Prostate
Laminectomy
Hip/ knee
Hysterectomy
cholecystectomy
nephrectomy
non majot intrathoracic
High risk surgeries
Correct Answer: aortic/ cabg
transplants
spinal reconstruction
peripheral vascular surgery
Lee's revised cardiac risk index
Correct 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
Correct 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
Correct 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
Correct 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
NRNP 6560 MIDTERM EXAM | QUESTIONS &
ANSWERS (VERIFIED) | LATEST UPDATE | GRADED
A+
Surgery risk classes
Correct 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
Correct 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
Correct 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
Correct 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
Correct Answer: catarcts
breast biopsy
cystoscopy, vasectomy
laporascopic procedures
Plastic surgery
intermediate risk surgeries
Correct Answer: Head/ neck surgery
thyroidectomy
,Intraperitoneal
Prostate
Laminectomy
Hip/ knee
Hysterectomy
cholecystectomy
nephrectomy
non majot intrathoracic
High risk surgeries
Correct Answer: aortic/ cabg
transplants
spinal reconstruction
peripheral vascular surgery
Lee's revised cardiac risk index
Correct 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
Correct 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
Correct 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
Correct 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
