NRNP 6560 MIDTERM EXAM QUESTIONS AND
CORRECT ANSWERS – LATEST UPDATE
Surgery Risk Classes
- 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
- 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
- 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
- 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
- Catarcts
Breast Biopsy
Cystoscopy, Vasectomy
Laporascopic Procedures
Plastic Surgery
Intermediate Risk Surgeries
- Head/ Neck Surgery
Thyroidectomy
Intraperitoneal
Prostate Laminectomy
Hip/ Knee
Hysterectomy
Cholecystectomy
Nephrectomy
Non Majot Intrathoracic
High Risk Surgeries
- Aortic/ Cabg
Transplants
Spinal Reconstruction Peripheral
Vascular Surgery
Lee's Revised Cardiac Risk Index
- 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
- 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
- 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
- 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
- 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
- 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
Hip/ Knee OA:
- Weight Reduction, Cardiovascular Exercises
- Transcutanous External Nerve Stimulator
- Acetaminophen
- Topical NSAIDS (Knee)
- Intraarticular Corticosteroid Injections
- Surgery (Joint Replacement)
Rheumatoid Arthritis: What, Who
- Chronic, Systemic Autoimmune Disease That Causes Inflammation Of Connective Tissue, First
That Of Jionts Them Other Soft Tissues (Renal, Cardiovascular, Pulm). TNF-Alpha Plays A Big
Role
- More Women Than Men
- Unknown Cause
CORRECT ANSWERS – LATEST UPDATE
Surgery Risk Classes
- 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
- 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
- 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
- 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
- Catarcts
Breast Biopsy
Cystoscopy, Vasectomy
Laporascopic Procedures
Plastic Surgery
Intermediate Risk Surgeries
- Head/ Neck Surgery
Thyroidectomy
Intraperitoneal
Prostate Laminectomy
Hip/ Knee
Hysterectomy
Cholecystectomy
Nephrectomy
Non Majot Intrathoracic
High Risk Surgeries
- Aortic/ Cabg
Transplants
Spinal Reconstruction Peripheral
Vascular Surgery
Lee's Revised Cardiac Risk Index
- 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
- 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
- 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
- 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
- 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
- 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
Hip/ Knee OA:
- Weight Reduction, Cardiovascular Exercises
- Transcutanous External Nerve Stimulator
- Acetaminophen
- Topical NSAIDS (Knee)
- Intraarticular Corticosteroid Injections
- Surgery (Joint Replacement)
Rheumatoid Arthritis: What, Who
- Chronic, Systemic Autoimmune Disease That Causes Inflammation Of Connective Tissue, First
That Of Jionts Them Other Soft Tissues (Renal, Cardiovascular, Pulm). TNF-Alpha Plays A Big
Role
- More Women Than Men
- Unknown Cause
