Midterm Exam: NRNP 6566/ NRNP6566 Advanced Care of
Adults in Acute Settings I | Questions and Verified Answers|
Latest 2025/ 2026 Update- Walden
Surgery risk classes
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
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
- 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
- Unstable cardiac condition (recent MI, active angina, active HF, uncontrolled HTN, severe
valvular disease), concern with CAD, CHF. arrhythmia, CVD
, Midterm Exam: NRNP 6566/ NRNP6566 Advanced Care of
Adults in Acute Settings I | Questions and Verified Answers|
Latest 2025/ 2026 Update- Walden
- 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
catarcts
breast biopsy
cystoscopy, vasectomy
laporascopic procedures
Plastic surgery
intermediate risk surgeries
Head/ neck surgery
thyroidectomy
Intraperitoneal
Prostate
Laminectomy
Hip/ knee
Hysterectomy
cholecystectomy
, Midterm Exam: NRNP 6566/ NRNP6566 Advanced Care of
Adults in Acute Settings I | Questions and Verified Answers|
Latest 2025/ 2026 Update- Walden
nephrectomy
non majot intrathoracic
High risk surgeries
aortic/ cabg
transplants
spinal reconstruction
peripheral vascular surgery
Lee's revised cardiac risk index
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
, Midterm Exam: NRNP 6566/ NRNP6566 Advanced Care of
Adults in Acute Settings I | Questions and Verified Answers|
Latest 2025/ 2026 Update- Walden
- 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
- 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
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
Adults in Acute Settings I | Questions and Verified Answers|
Latest 2025/ 2026 Update- Walden
Surgery risk classes
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
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
- 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
- Unstable cardiac condition (recent MI, active angina, active HF, uncontrolled HTN, severe
valvular disease), concern with CAD, CHF. arrhythmia, CVD
, Midterm Exam: NRNP 6566/ NRNP6566 Advanced Care of
Adults in Acute Settings I | Questions and Verified Answers|
Latest 2025/ 2026 Update- Walden
- 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
catarcts
breast biopsy
cystoscopy, vasectomy
laporascopic procedures
Plastic surgery
intermediate risk surgeries
Head/ neck surgery
thyroidectomy
Intraperitoneal
Prostate
Laminectomy
Hip/ knee
Hysterectomy
cholecystectomy
, Midterm Exam: NRNP 6566/ NRNP6566 Advanced Care of
Adults in Acute Settings I | Questions and Verified Answers|
Latest 2025/ 2026 Update- Walden
nephrectomy
non majot intrathoracic
High risk surgeries
aortic/ cabg
transplants
spinal reconstruction
peripheral vascular surgery
Lee's revised cardiac risk index
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
, Midterm Exam: NRNP 6566/ NRNP6566 Advanced Care of
Adults in Acute Settings I | Questions and Verified Answers|
Latest 2025/ 2026 Update- Walden
- 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
- 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
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
