NRNP 6560 MIDTERM EXAM

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NRNP 6560 MIDTERM EXAM

LATEST 2022-2024 (196 REAL

EXAM QUESTIONS AND ANSWERS

) WALDEN UNIVERSITY /

NRNP6560 MIDTERM EXAM /

NRNP 6560 WEEK 6 MIDTERM

EXAM WALDEN UNIVERSITY

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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
• immune competence 2 / 4

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• 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

• = low risk
• = moderate risk 3 / 4

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• = 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

Osteoarthritis findings and diagnostics - ANSWER- - Pain in weight bearing joints

• stiffness after sitting, gets better when arising
• feeling of instability on stairs
• fine motor skills deficit
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