CNOR Preoperative Patient Assessment 2 — Questions and Answers
Question 1: A patient scheduled for elective surgery reports taking warfarin daily. What is the perioperative nurse's priority action?
- Proceed with surgery as scheduled
- Notify the surgeon and anesthesia provider of the anticoagulant use (Correct answer)
- Administer vitamin K immediately
- Cancel the surgery without consulting the surgeon
Correct answer: Notify the surgeon and anesthesia provider of the anticoagulant use
Anticoagulant use must be reported to the surgical team to allow appropriate management and reduce bleeding risk.
Question 2: During preoperative assessment, the nurse notes the patient has a latex allergy. Which action is most appropriate?
- Document the allergy and proceed normally
- Alert the entire surgical team and prepare a latex-free environment (Correct answer)
- Reschedule the surgery for a later date
- Apply a latex allergy wristband only
Correct answer: Alert the entire surgical team and prepare a latex-free environment
A latex allergy requires preparation of a latex-free OR environment and notification of all team members to prevent anaphylaxis.
Question 3: Which preoperative laboratory value would most concern the perioperative nurse in a patient scheduled for a major abdominal procedure?
- Hemoglobin of 13 g/dL
- Platelet count of 45,000/mm³ (Correct answer)
- White blood cell count of 8,000/mm³
- Serum sodium of 138 mEq/L
Correct answer: Platelet count of 45,000/mm³
A platelet count of 45,000/mm³ is critically low and significantly increases the risk of intraoperative hemorrhage.
Question 4: A patient states they last ate solid food 4 hours ago. The surgery is scheduled to begin in 30 minutes. What should the perioperative nurse do?
- Proceed since 4 hours is sufficient fasting time
- Notify the anesthesia provider immediately (Correct answer)
- Give the patient a small sip of water to take medications
- Document and continue preoperative preparations
Correct answer: Notify the anesthesia provider immediately
NPO guidelines typically require 6-8 hours for solids; the anesthesia provider must be notified to determine if surgery should be delayed.
Question 5: When assessing a patient's airway preoperatively, the nurse notes a Mallampati class IV. This finding suggests:
- Easy intubation is anticipated
- Potentially difficult intubation requiring advance planning (Correct answer)
- General anesthesia is contraindicated
- Regional anesthesia will not be effective
Correct answer: Potentially difficult intubation requiring advance planning
Mallampati class IV indicates minimal pharyngeal structures are visible, suggesting a potentially difficult airway for intubation.
Question 6: A patient undergoing preoperative assessment has a history of sleep apnea but does not use their CPAP device. The nurse's priority is to:
- Proceed with surgery since CPAP is optional
- Document the history and inform the anesthesia team (Correct answer)
- Instruct the patient to bring their CPAP to the hospital
- Cancel the procedure immediately
Correct answer: Document the history and inform the anesthesia team
Sleep apnea significantly affects anesthetic management and respiratory monitoring; the anesthesia provider must be informed.
Question 7: Which finding during preoperative skin assessment requires immediate communication to the surgeon before proceeding?
- A well-healed surgical scar near the operative site
- Redness, warmth, and exudate at the planned incision site (Correct answer)
- Dry skin requiring moisturizer
- A small tattoo distant from the operative field
Correct answer: Redness, warmth, and exudate at the planned incision site
Signs of infection at the planned incision site may necessitate postponement to prevent surgical site infection.
CNOR Preoperative Patient Assessment 2
A patient scheduled for elective surgery reports taking warfarin daily.
What is the perioperative nurse's priority action?