NRNP 6560 MIDTERM EXAM QUESTIONS WITH
CERTIFIED SOLUTIONS.
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
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
- 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)
- 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
CERTIFIED SOLUTIONS.
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
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
- 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)
- 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
