NRNP 6560 MIDTERM EXAM
LATEST 2023-2024 (190+ REAL
EXAM QUESTIONS AND ANSWERS
NRNP6560 MIDTERM EXAM /
NRNP 6560 WEEK 6 MIDTERM
EXAM WALDEN UNIVERSITY –
EXPERT FEEDBACK
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,Surgery risk classes
– 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
- 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
- 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 - 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
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,- 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
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, 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
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