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NRNP 6560 Midterm Exam Questions With Guaranteed Pass Solutions.
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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 ...

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  • November 12, 2024
  • 67
  • 2024/2025
  • Exam (elaborations)
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NRNP 6560 Midterm Exam Questions
With Guaranteed Pass Solutions.
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)

- 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



Hip/ knee OA:

- weight reduction, cardiovascular exercises

- transcutanous external nerve stimulator

- acetaminophen

- Topical NSAIDS (knee)

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