NRNP 6540 Midterm Test Bank | Complete
Questions & Answers for Exam Success
Graded A+ 100% Pass Guaranteed (2026)
• 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
- 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)
- tramadol
- no opioids
Questions & Answers for Exam Success
Graded A+ 100% Pass Guaranteed (2026)
• 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
- 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)
- tramadol
- no opioids
