CAPA Preoperative Evaluation 5 — Questions and Answers
Question 1: A patient discloses a family history of death during general anesthesia in a young relative. Which genetic condition should the perianesthesia nurse MOST suspect?
- G6PD deficiency
- Malignant hyperthermia susceptibility (Correct answer)
- Pseudocholinesterase deficiency
- Porphyria
Correct answer: Malignant hyperthermia susceptibility
Unexplained anesthetic deaths in young family members are a classic red flag for malignant hyperthermia susceptibility, an autosomal dominant condition.
Question 2: Which preoperative NPO guideline applies to clear liquids in a healthy adult before elective general anesthesia per ASA guidelines?
- Nothing by mouth after midnight
- 2 hours before anesthesia (Correct answer)
- 4 hours before anesthesia
- 6 hours before anesthesia
Correct answer: 2 hours before anesthesia
ASA guidelines allow clear liquids up to 2 hours before elective procedures in healthy adults to reduce aspiration risk while minimizing patient discomfort.
Question 3: A patient taking SSRIs reports they stopped their medication abruptly three days ago. Which perioperative risk is MOST associated with this history?
- Serotonin syndrome with opioid administration
- Increased MAC requirement for volatile agents
- Prolonged paralysis from neuromuscular blockers
- Withdrawal-induced seizures (Correct answer)
Correct answer: Withdrawal-induced seizures
Abrupt SSRI discontinuation can cause withdrawal syndrome including seizures, dizziness, and paresthesias, increasing perioperative instability.
Question 4: During a preoperative phone screening, a patient states she was told she has 'a heart murmur' but has never had a cardiac workup. She is now scheduled for a colonoscopy under MAC. What is the BEST next step?
- Proceed; colonoscopy is low-risk and doesn't require cardiac evaluation
- Obtain a cardiology clearance before scheduling (Correct answer)
- Ask the patient to bring her medical records on the day of surgery
- Perform an ECG on the day of the procedure
Correct answer: Obtain a cardiology clearance before scheduling
An uncharacterized heart murmur warrants cardiology evaluation to rule out hemodynamically significant valvular disease before elective sedation.
Question 5: A preoperative nurse reviews that a patient takes varenicline (Chantix) for smoking cessation. Which behavioral consideration should be documented related to this medication?
- Risk of bronchospasm intraoperatively
- Neuropsychiatric symptoms including mood changes and suicidal ideation (Correct answer)
- Prolonged sedation postoperatively
- Increased anesthetic requirements
Correct answer: Neuropsychiatric symptoms including mood changes and suicidal ideation
Varenicline carries an FDA warning for neuropsychiatric adverse effects including depression, agitation, and suicidal ideation that must be documented preoperatively.
Question 6: Which preoperative intervention MOST effectively reduces patient anxiety in the ambulatory surgical setting?
- Routine administration of oral midazolam to all patients
- Structured patient education and clear explanation of the surgical process (Correct answer)
- Restricting family presence during preoperative preparation
- Keeping preoperative waiting time to less than 15 minutes
Correct answer: Structured patient education and clear explanation of the surgical process
Evidence consistently shows that structured patient education and procedural explanations are among the most effective non-pharmacological anxiety reduction strategies.
Question 7: A preoperative assessment reveals that a patient has chronic kidney disease with a GFR of 28 mL/min. Which anesthetic consideration is MOST relevant to document?
- Increased risk of malignant hyperthermia
- Altered drug metabolism and prolonged action of renally cleared medications (Correct answer)
- Higher MAC requirements for volatile agents
- Increased risk of latex allergy
Correct answer: Altered drug metabolism and prolonged action of renally cleared medications
Reduced GFR impairs renal clearance of many drugs including muscle relaxants and opioids, prolonging their effects and requiring dose adjustments.
CAPA Preoperative Evaluation 5
A patient discloses a family history of death during general anesthesia in a young relative.
Which genetic condition should the perianesthesia nurse MOST suspect?