ONLYSTUDENT STORE 2024/2025 ALL THE BEST
NRNP 6560 Midterm Exam With Verified
Answers graded A+
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)
ONLYSTUDENT STORE 1 DO NOT COPY
,ONLYSTUDENT STORE 2024/2025 ALL THE BEST
- 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
ONLYSTUDENT STORE 2 DO NOT COPY
,ONLYSTUDENT STORE 2024/2025 ALL THE BEST
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
ONLYSTUDENT STORE 3 DO NOT COPY
, ONLYSTUDENT STORE 2024/2025 ALL THE BEST
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)
ONLYSTUDENT STORE 4 DO NOT COPY
NRNP 6560 Midterm Exam With Verified
Answers graded A+
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)
ONLYSTUDENT STORE 1 DO NOT COPY
,ONLYSTUDENT STORE 2024/2025 ALL THE BEST
- 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
ONLYSTUDENT STORE 2 DO NOT COPY
,ONLYSTUDENT STORE 2024/2025 ALL THE BEST
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
ONLYSTUDENT STORE 3 DO NOT COPY
, ONLYSTUDENT STORE 2024/2025 ALL THE BEST
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)
ONLYSTUDENT STORE 4 DO NOT COPY
