NURS 6560 MIDTERM EXAM 2 LATEST VERSIONS
(VERSION A & B) 2025 ACTUAL EXAM 200
QUESTIONS AND CORRECT DETAILED ANSWERS
WITH RATIONALES
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 (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
V
, Cerebrovascular Vdisease V= V1
DM V1 Von Vinsulin V= V1
V
Creat Vgreater Vthan V2 V= V1
1 V= Vlow Vrisk
2 V= Vmoderate Vrisk
3 V= Vhigh Vrisk
SCIP Vpre-operative Vinfection Vmeasures V- VAnswer- V- VProphylactic Vantibiotics Vshould Vbe
Vreceived Vwithin V1 Vh Vprior Vto Vsurgical Vincision
- be Vselected Vfor Vactivity Vagainst Vthe Vmost Vprobable Vantimicrobial Vcontaminants
- be Vdiscontinued Vwithin V24 Vh Vafter Vthe Vsurgery Vend-time
Postoperative Vinfection Vreduction Vmethods V- VAnswer- V- Vpre-op Vhair Vremoval V(clippers)
- wash Vhands
- normothermia
- maintain Veuglycemia
- urinary Vcatheters Vare Vto Vbe Vremoved Vwithin Vthe Vfirst Vtwo Vpostoperative Vdays
Osteoarthritis: Vwhat, Vincidence V- VAnswer- VSlow Vdestruction Vof Vbones/ Vjoint Vfollowed Vby
Vproduction Vof Vreplacement Vcollagen Vwhich Vcauses Vinflammatory Vchanges
- older Vthan V60
- more Vfemale Vafter V55
- more Vblack Vthan Vwhite Vwomen
- men Vand Vwomen Vequal Vrisk Vbetween V45 V- V55
- abnormal Vheight Vor Vweight V(obesity)
- repetitive Vmovement
- prior Vtrauma V(sprains/ Vdislocations)
(VERSION A & B) 2025 ACTUAL EXAM 200
QUESTIONS AND CORRECT DETAILED ANSWERS
WITH RATIONALES
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 (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
V
, Cerebrovascular Vdisease V= V1
DM V1 Von Vinsulin V= V1
V
Creat Vgreater Vthan V2 V= V1
1 V= Vlow Vrisk
2 V= Vmoderate Vrisk
3 V= Vhigh Vrisk
SCIP Vpre-operative Vinfection Vmeasures V- VAnswer- V- VProphylactic Vantibiotics Vshould Vbe
Vreceived Vwithin V1 Vh Vprior Vto Vsurgical Vincision
- be Vselected Vfor Vactivity Vagainst Vthe Vmost Vprobable Vantimicrobial Vcontaminants
- be Vdiscontinued Vwithin V24 Vh Vafter Vthe Vsurgery Vend-time
Postoperative Vinfection Vreduction Vmethods V- VAnswer- V- Vpre-op Vhair Vremoval V(clippers)
- wash Vhands
- normothermia
- maintain Veuglycemia
- urinary Vcatheters Vare Vto Vbe Vremoved Vwithin Vthe Vfirst Vtwo Vpostoperative Vdays
Osteoarthritis: Vwhat, Vincidence V- VAnswer- VSlow Vdestruction Vof Vbones/ Vjoint Vfollowed Vby
Vproduction Vof Vreplacement Vcollagen Vwhich Vcauses Vinflammatory Vchanges
- older Vthan V60
- more Vfemale Vafter V55
- more Vblack Vthan Vwhite Vwomen
- men Vand Vwomen Vequal Vrisk Vbetween V45 V- V55
- abnormal Vheight Vor Vweight V(obesity)
- repetitive Vmovement
- prior Vtrauma V(sprains/ Vdislocations)
