NRNP 6560 MIDTERM EXAM
QUESTIONS AND ANSWERS GRADED A+
2025/2026
Surgery risk classes - ANS 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 - ANS 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 - ANS - 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 - ANS - Unstable cardiac condition (recent MI, active angina,
active HF, uncontrolled HTN, severe valvular disease), concern with CAD, CHF. arrhythmia, CVD
1 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED.
,- 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 - ANS catarcts
breast biopsy
cystoscopy, vasectomy
laporascopic procedures
Plastic surgery
intermediate risk surgeries - ANS Head/ neck surgery
thyroidectomy
Intraperitoneal
Prostate
Laminectomy
Hip/ knee
Hysterectomy
cholecystectomy
nephrectomy
non majot intrathoracic
High risk surgeries - ANS aortic/ cabg
transplants
spinal reconstruction
peripheral vascular surgery
2 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED.
,Lee's revised cardiac risk index - ANS 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 - ANS - 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 - ANS - 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 - ANS Slow destruction of bones/ joint followed by production
of replacement collagen which causes inflammatory changes
- older than 60
- more female after 55
3 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED.
, - 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 - ANS - 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 - ANS 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)
4 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED.
QUESTIONS AND ANSWERS GRADED A+
2025/2026
Surgery risk classes - ANS 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 - ANS 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 - ANS - 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 - ANS - Unstable cardiac condition (recent MI, active angina,
active HF, uncontrolled HTN, severe valvular disease), concern with CAD, CHF. arrhythmia, CVD
1 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED.
,- 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 - ANS catarcts
breast biopsy
cystoscopy, vasectomy
laporascopic procedures
Plastic surgery
intermediate risk surgeries - ANS Head/ neck surgery
thyroidectomy
Intraperitoneal
Prostate
Laminectomy
Hip/ knee
Hysterectomy
cholecystectomy
nephrectomy
non majot intrathoracic
High risk surgeries - ANS aortic/ cabg
transplants
spinal reconstruction
peripheral vascular surgery
2 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED.
,Lee's revised cardiac risk index - ANS 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 - ANS - 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 - ANS - 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 - ANS Slow destruction of bones/ joint followed by production
of replacement collagen which causes inflammatory changes
- older than 60
- more female after 55
3 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED.
, - 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 - ANS - 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 - ANS 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)
4 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED.
