NRNP 6560 Midterm exam questions with |\ |\ |\ |\ |\ |\
answers
Surgery risk classes - CORRECT ANSWERS ✔✔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 - CORRECT ANSWERS ✔✔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 - CORRECT ANSWERS ✔✔- 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 - CORRECT ANSWERS ✔✔- 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 - CORRECT ANSWERS ✔✔catarcts
|\ |\ |\ |\ |\ |\
breast biopsy |\
cystoscopy, vasectomy |\
laporascopic procedures |\
Plastic surgery |\
intermediate risk surgeries - CORRECT ANSWERS ✔✔Head/ neck
|\ |\ |\ |\ |\ |\ |\ |\
surgery
thyroidectomy
Intraperitoneal
Prostate
Laminectomy
Hip/ knee
|\
Hysterectomy
,cholecystectomy
nephrectomy
non majot intrathoracic
|\ |\
High risk surgeries - CORRECT ANSWERS ✔✔aortic/ cabg
|\ |\ |\ |\ |\ |\ |\
transplants
spinal reconstruction |\
peripheral vascular surgery |\ |\
Lee's revised cardiac risk index - CORRECT ANSWERS ✔✔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 - CORRECT ANSWERS ✔✔-
|\ |\ |\ |\ |\ |\ |\ |\
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 - CORRECT ANSWERS|\ |\ |\ |\ |\ |\ |\
✔✔- 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 - CORRECT ANSWERS ✔✔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
|\
answers
Surgery risk classes - CORRECT ANSWERS ✔✔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 - CORRECT ANSWERS ✔✔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 - CORRECT ANSWERS ✔✔- 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 - CORRECT ANSWERS ✔✔- 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 - CORRECT ANSWERS ✔✔catarcts
|\ |\ |\ |\ |\ |\
breast biopsy |\
cystoscopy, vasectomy |\
laporascopic procedures |\
Plastic surgery |\
intermediate risk surgeries - CORRECT ANSWERS ✔✔Head/ neck
|\ |\ |\ |\ |\ |\ |\ |\
surgery
thyroidectomy
Intraperitoneal
Prostate
Laminectomy
Hip/ knee
|\
Hysterectomy
,cholecystectomy
nephrectomy
non majot intrathoracic
|\ |\
High risk surgeries - CORRECT ANSWERS ✔✔aortic/ cabg
|\ |\ |\ |\ |\ |\ |\
transplants
spinal reconstruction |\
peripheral vascular surgery |\ |\
Lee's revised cardiac risk index - CORRECT ANSWERS ✔✔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 - CORRECT ANSWERS ✔✔-
|\ |\ |\ |\ |\ |\ |\ |\
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 - CORRECT ANSWERS|\ |\ |\ |\ |\ |\ |\
✔✔- 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 - CORRECT ANSWERS ✔✔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
|\
