CAA CAA Perioperative Patient Care & Assessment 1 — Questions and Answers
Question 1: During the preoperative assessment, which ASA Physical Status classification applies to a patient with well-controlled hypertension and type 2 diabetes with no systemic complications?
- ASA I
- ASA II (Correct answer)
- ASA III
- ASA IV
Correct answer: ASA II
ASA II applies to patients with mild systemic disease that is well-controlled and causes no functional limitations.
Question 2: A patient scheduled for elective surgery reports taking warfarin daily. What is the most appropriate initial action for the anesthesia team?
- Proceed with surgery as scheduled
- Check the patient's INR and notify the surgical team (Correct answer)
- Cancel the surgery immediately
- Administer vitamin K preoperatively without consulting the surgeon
Correct answer: Check the patient's INR and notify the surgical team
Checking the INR determines the degree of anticoagulation, which guides bridging therapy decisions made collaboratively with the surgeon.
Question 3: Which preoperative fasting guideline (NPO) is recommended by the ASA for clear liquids in adult patients undergoing elective surgery?
- 2 hours (Correct answer)
- 4 hours
- 6 hours
- 8 hours
Correct answer: 2 hours
ASA guidelines permit clear liquids up to 2 hours before elective procedures to reduce pulmonary aspiration risk while minimizing patient discomfort.
Question 4: When positioning a patient in the lithotomy position, which complication is the anesthesia assistant most vigilant about during prolonged procedures?
- Brachial plexus stretch injury
- Compartment syndrome of the lower extremities (Correct answer)
- Pressure ulcers on the occiput
- Ulnar nerve compression at the wrist
Correct answer: Compartment syndrome of the lower extremities
Elevated legs with restricted perfusion during prolonged lithotomy can cause lower extremity compartment syndrome, a limb-threatening emergency.
Question 5: A 68-year-old patient with known GERD is scheduled for a laparoscopic cholecystectomy. Which preoperative medication is commonly given to reduce aspiration risk?
- Ondansetron
- Metoclopramide and sodium citrate (Correct answer)
- Dexamethasone
- Lorazepam
Correct answer: Metoclopramide and sodium citrate
Metoclopramide accelerates gastric emptying and increases lower esophageal sphincter tone, while sodium citrate neutralizes gastric acid to reduce aspiration injury risk.
Question 6: Which finding on a preoperative airway assessment would most strongly predict a difficult laryngoscopy?
- Mallampati class I oropharynx
- Thyromental distance greater than 6 cm
- Mouth opening greater than 3 cm
- Interincisor gap less than 3 cm with limited neck extension (Correct answer)
Correct answer: Interincisor gap less than 3 cm with limited neck extension
Reduced mouth opening combined with limited neck extension severely restricts laryngoscope blade placement and laryngeal axis alignment, predicting difficult direct laryngoscopy.
Question 7: In the PACU, a patient becomes increasingly agitated and is not responding to verbal commands 30 minutes after a sevoflurane-based general anesthetic. What should be ruled out first?
- Residual neuromuscular blockade
- Emergence delirium or hypoxia (Correct answer)
- Opioid overdose causing sedation
- Malignant hyperthermia
Correct answer: Emergence delirium or hypoxia
Hypoxia is the most life-threatening immediately reversible cause of postoperative agitation and must be excluded before attributing symptoms to emergence delirium.
CAA CAA Perioperative Patient Care & Assessment 1
During the preoperative assessment, which ASA Physical Status classification applies to a patient with well-controlled hypertension and type 2 diabetes with no systemic complications?