CNOR - Certification Preoperative Patient Assessment Questions and Answers — Questions and Answers
Question 1: A 68-year-old male is scheduled for a total knee arthroplasty. His medical history includes well-controlled hypertension and type 2 diabetes managed with oral medication. He quit smoking 10 years ago and has no other systemic diseases. According to the American Society of Anesthesiologists (ASA) Physical Status Classification System, which classification would be most appropriate for this patient?
- ASA I
- ASA II (Correct answer)
- ASA III
- ASA IV
Correct answer: ASA II
The ASA Physical Status Classification System categorizes patients based on their overall health and the presence of systemic disease. An ASA II classification is for a patient with mild systemic disease. This patient's well-controlled hypertension and type 2 diabetes fall into this category. ASA I is a normal healthy patient. ASA III is a patient with severe systemic disease. ASA IV is a patient with severe systemic disease that is a constant threat to life.
Question 2: During the preoperative assessment for a patient scheduled for a cholecystectomy, the perioperative nurse discovers the patient has been taking a daily herbal supplement containing garlic, ginger, and ginkgo biloba. Which of the following is the most critical action for the nurse to take?
- Document the use of the supplement in the patient's chart.
- Instruct the patient to double the dose on the morning of surgery.
- Inform the anesthesia care provider and surgeon immediately. (Correct answer)
- Advise the patient to discontinue the supplement a week after surgery.
Correct answer: Inform the anesthesia care provider and surgeon immediately.
Herbal supplements such as garlic, ginger, and ginkgo biloba can increase the risk of bleeding by affecting platelet aggregation. It is crucial to inform the anesthesia care provider and surgeon immediately as this may impact the surgical plan and anesthetic management, and may require postponement of the surgery. While documentation is important, immediate communication is the priority for patient safety.
Question 3: Which of the following patient statements during a preoperative assessment would indicate the highest risk for a potential latex allergy?
- "I get a rash from the adhesive on bandages."
- "My lips swell whenever I eat bananas or avocados." (Correct answer)
- "I have a family history of seasonal allergies."
- "I am allergic to penicillin."
Correct answer: "My lips swell whenever I eat bananas or avocados."
There is a known cross-reactivity between latex and certain foods, including bananas, avocados, kiwis, and chestnuts. A patient reporting an allergic reaction to these foods is at a significantly higher risk for a latex allergy. While an allergy to tape adhesive can indicate sensitivity, the food cross-reactivity is a stronger predictor. Seasonal allergies and penicillin allergies are not directly related to latex allergies.
Question 4: A patient arrives in the emergency department unconscious following a severe motor vehicle accident and requires immediate emergency surgery to control internal bleeding. The patient is unidentified, and no family is present. Regarding informed consent for the surgery, what is the appropriate course of action?
- The surgery must be delayed until a family member can be located to provide consent.
- The surgeon can proceed with the surgery under the principle of implied consent in an emergency. (Correct answer)
- A court order must be obtained before the surgery can be performed.
- Two nurses can sign the consent form on behalf of the patient.
Correct answer: The surgeon can proceed with the surgery under the principle of implied consent in an emergency.
In a life-threatening emergency where the patient is unable to consent and no surrogate decision-maker is available, the law typically allows healthcare providers to proceed with necessary treatment under the principle of implied consent. It is assumed that a reasonable person would consent to life-saving treatment. Delaying surgery to find family or obtain a court order could result in the patient's death.
Question 5: The perioperative nurse is reviewing the preoperative laboratory results for a 55-year-old female scheduled for a total abdominal hysterectomy. The nurse notes a serum potassium level of 2.8 mEq/L. What is the nurse's primary concern?
- Increased risk of postoperative infection.
- Potential for intraoperative hypoglycemia.
- Risk of cardiac dysrhythmias under anesthesia. (Correct answer)
- Impaired wound healing.
Correct answer: Risk of cardiac dysrhythmias under anesthesia.
The normal range for serum potassium is typically 3.5 to 5.0 mEq/L. A level of 2.8 mEq/L indicates hypokalemia, which can increase the risk of cardiac irritability and lead to life-threatening dysrhythmias, especially during anesthesia and surgery. This finding must be reported to the anesthesia and surgical teams immediately for correction before the procedure.
Question 6: According to The Joint Commission's Universal Protocol, what is the final step performed in the operating room, just before the initial incision, to confirm the correct patient, procedure, and site?
- Preoperative verification
- Surgical site marking
- Patient identification
- Time-out (Correct answer)
Correct answer: Time-out
The "time-out" is a critical safety check and the final step of the Universal Protocol. It is conducted immediately before the start of the invasive procedure or incision. The entire surgical team actively communicates and confirms the correct patient, correct procedure, and correct surgical site. Preoperative verification and site marking are earlier, essential components of the protocol.
CNOR - Certification Preoperative Patient Assessment Questions and Answers
A 68-year-old male is scheduled for a total knee arthroplasty.
His medical history includes well-controlled hypertension and type 2 diabetes managed with oral medication.
He quit smoking 10 years ago and has no other systemic diseases.
According to the American Society of Anesthesiologists (ASA) Physical Status Classification System, which classification would be most appropriate for this patient?