CAPA Preoperative Evaluation 3 — Questions and Answers
Question 1: A preoperative nurse is assessing a patient's airway. Which finding is MOST predictive of a difficult intubation?
- Mallampati Class I
- Thyromental distance of 7 cm
- Mallampati Class IV with limited neck extension (Correct answer)
- Mouth opening of 4 cm
Correct answer: Mallampati Class IV with limited neck extension
Mallampati Class IV combined with limited neck extension significantly predicts difficult laryngoscopy and intubation.
Question 2: A 45-year-old female patient reports menstrual irregularity and hot flashes. The surgeon orders a pregnancy test. She refuses, stating she cannot be pregnant. What is the nurse's BEST response?
- Document the refusal and proceed without the test
- Explain that facility policy requires the test for patient safety (Correct answer)
- Notify security
- Cancel the surgery immediately
Correct answer: Explain that facility policy requires the test for patient safety
The nurse should explain institutional policy and the safety rationale because pregnancy significantly alters anesthetic risk and medication safety.
Question 3: Which preoperative laboratory test is considered routine for a healthy 25-year-old male scheduled for arthroscopic knee surgery?
- Complete blood count
- Basic metabolic panel
- Coagulation studies
- No routine labs are indicated (Correct answer)
Correct answer: No routine labs are indicated
Evidence-based guidelines indicate that routine preoperative laboratory testing is not indicated for healthy patients undergoing minor procedures.
Question 4: A patient's ECG shows a new left bundle branch block (LBBB) compared to a prior tracing. What is the APPROPRIATE preoperative action?
- Proceed as planned since LBBB is common
- Notify the surgeon and anesthesiologist for cardiology evaluation (Correct answer)
- Administer IV fluids and repeat the ECG
- Document the finding and continue preoperative preparation
Correct answer: Notify the surgeon and anesthesiologist for cardiology evaluation
A new LBBB may indicate acute myocardial injury and requires urgent cardiology evaluation before proceeding with elective surgery.
Question 5: During preoperative history taking, a patient discloses recreational cocaine use within the past 48 hours. Which anesthetic concern is MOST relevant?
- Increased opioid tolerance
- Risk of malignant hyperthermia
- Coronary vasospasm and cardiovascular instability (Correct answer)
- Prolonged neuromuscular blockade
Correct answer: Coronary vasospasm and cardiovascular instability
Recent cocaine use causes coronary vasospasm, tachycardia, and hemodynamic instability, significantly elevating perioperative cardiovascular risk.
Question 6: A patient with obstructive sleep apnea (OSA) presents for ambulatory surgery. Which preoperative factor MOST supports proceeding in an outpatient setting?
- Morbid obesity with BMI of 48
- CPAP-compliant patient with mild OSA and no comorbidities (Correct answer)
- Uncontrolled hypertension requiring IV antihypertensives
- Moderate OSA with planned opioid analgesia
Correct answer: CPAP-compliant patient with mild OSA and no comorbidities
CPAP-compliant patients with mild OSA and no significant comorbidities can safely undergo ambulatory surgery with appropriate monitoring.
Question 7: Which condition is an ABSOLUTE contraindication for ambulatory surgery in most facilities?
- Controlled type 2 diabetes
- Former premature infant less than 60 weeks postconceptual age (Correct answer)
- Mild controlled asthma
- History of deep vein thrombosis on anticoagulation therapy
Correct answer: Former premature infant less than 60 weeks postconceptual age
Former premature infants under 60 weeks postconceptual age are at high risk for postoperative apnea and require inpatient monitoring.
CAPA Preoperative Evaluation 3
A preoperative nurse is assessing a patient's airway.
Which finding is MOST predictive of a difficult intubation?