CAPA Preoperative Evaluation 2 — Questions and Answers
Question 1: A patient scheduled for ambulatory surgery reports taking warfarin for atrial fibrillation. Which INR value would most likely require postponement of an elective procedure?
- 1.5
- 2.0
- 2.8
- 3.6 (Correct answer)
Correct answer: 3.6
An INR above 3.5 generally indicates excessive anticoagulation and warrants postponement of elective surgery to reduce bleeding risk.
Question 2: During preoperative screening, a 68-year-old patient mentions he takes sildenafil for pulmonary hypertension. Which medication class is CONTRAINDICATED when combined with sildenafil perioperatively?
- Beta-blockers
- Nitrates (Correct answer)
- ACE inhibitors
- Calcium channel blockers
Correct answer: Nitrates
Combining sildenafil with nitrates causes severe, potentially fatal hypotension due to synergistic vasodilation.
Question 3: A patient has a documented latex allergy. Which preoperative intervention is MOST important in the ambulatory surgical setting?
- Administer prophylactic diphenhydramine
- Schedule the patient as the first case of the day
- Avoid all rubber-containing products and alert the OR team (Correct answer)
- Order preoperative corticosteroids
Correct answer: Avoid all rubber-containing products and alert the OR team
Removing all latex-containing products and notifying the entire perioperative team is the primary intervention to prevent latex anaphylaxis.
Question 4: Which ASA physical status classification would be assigned to a well-controlled insulin-dependent diabetic patient with no end-organ damage scheduled for ambulatory surgery?
- ASA I
- ASA II (Correct answer)
- ASA III
- ASA IV
Correct answer: ASA II
A well-controlled chronic systemic disease without end-organ involvement is classified as ASA II.
Question 5: A patient undergoing preoperative evaluation reports a prior adverse reaction to anesthesia described as 'waking up during surgery.' Which documentation is MOST critical to obtain?
- Prior anesthesia records detailing agents used and dosing (Correct answer)
- Cardiology clearance
- Baseline serum creatinine levels
- Pulmonary function tests
Correct answer: Prior anesthesia records detailing agents used and dosing
Prior anesthesia records are essential to identify agents used and determine if the reaction was awareness under anesthesia, guiding the anesthesia plan.
Question 6: Which preoperative finding in an adult patient would MOST likely result in cancellation of an elective ambulatory procedure?
- Blood pressure 148/88 mmHg
- Blood pressure 185/115 mmHg (Correct answer)
- Heart rate of 88 bpm
- Temperature of 37.2°C
Correct answer: Blood pressure 185/115 mmHg
Severely elevated blood pressure (>180/110 mmHg) increases perioperative cardiovascular risk and typically warrants postponement of elective procedures.
Question 7: When reviewing a patient's medication list preoperatively, which herbal supplement is MOST associated with increased perioperative bleeding risk?
- Valerian root
- Ginkgo biloba (Correct answer)
- Melatonin
- Probiotics
Correct answer: Ginkgo biloba
Ginkgo biloba inhibits platelet-activating factor and has anticoagulant properties that increase bleeding risk perioperatively.
CAPA Preoperative Evaluation 2
A patient scheduled for ambulatory surgery reports taking warfarin for atrial fibrillation.
Which INR value would most likely require postponement of an elective procedure?