NRNP 6540 MIDTERM EXAM STUDY GUIDE
QUESTIONS AND SOLUTIONS 100 PERCENT
CORRECT VERIFIED ANSWERS
●● 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
QUESTIONS AND SOLUTIONS 100 PERCENT
CORRECT VERIFIED ANSWERS
●● 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
