NRNP 6566 STUDY GUIDE KEY CONCEPTS
WEEK 1 TO 5 2026 PRACTICE SET MOCK
EXAM REVISION NOTES AND SOLUTIONS
EXPERT GRADE A+
◉ 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)
WEEK 1 TO 5 2026 PRACTICE SET MOCK
EXAM REVISION NOTES AND SOLUTIONS
EXPERT GRADE A+
◉ 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)
