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