CNOR Preoperative Patient Assessment 3 — Questions and Answers
Question 1: A patient's preoperative ECG shows new ST-segment changes that were not present 6 months ago. The perioperative nurse should:
- Proceed with surgery as the changes are minor
- Notify the anesthesia provider and surgeon before proceeding (Correct answer)
- Administer aspirin and continue preparations
- Repeat the ECG in one hour before notifying anyone
Correct answer: Notify the anesthesia provider and surgeon before proceeding
New ECG changes may indicate acute cardiac pathology and must be reported immediately to determine surgical safety.
Question 2: When documenting informed consent during the preoperative phase, the perioperative nurse's role is to:
- Obtain the patient's signature on the consent form
- Witness the patient's signature after confirming the surgeon explained the procedure (Correct answer)
- Explain the surgical procedure, risks, and alternatives to the patient
- Determine if the patient has decision-making capacity
Correct answer: Witness the patient's signature after confirming the surgeon explained the procedure
The nurse's role in informed consent is to witness the signature after verifying that the surgeon has provided the explanation; obtaining consent is the surgeon's responsibility.
Question 3: A 68-year-old patient reports occasional confusion and memory lapses. Which preoperative assessment tool is most appropriate to screen for cognitive baseline?
- Glasgow Coma Scale
- Mini-Mental State Examination (MMSE) (Correct answer)
- AUDIT-C questionnaire
- Braden Scale
Correct answer: Mini-Mental State Examination (MMSE)
The MMSE is a validated tool for assessing cognitive function and establishing a baseline to monitor for postoperative delirium.
Question 4: During preoperative assessment, a patient discloses recreational marijuana use. What is the most important implication for anesthesia?
- It has no anesthetic implications
- It may alter anesthetic requirements and interact with sedatives (Correct answer)
- The surgery must be cancelled
- The patient requires a urine drug screen before consent
Correct answer: It may alter anesthetic requirements and interact with sedatives
Marijuana use can affect anesthetic depth requirements, cause drug interactions, and increase airway reactivity.
Question 5: Which preoperative finding in a diabetic patient scheduled for morning surgery requires the most immediate follow-up?
- Blood glucose of 145 mg/dL
- Blood glucose of 320 mg/dL (Correct answer)
- HbA1c of 7.2%
- Blood glucose of 110 mg/dL
Correct answer: Blood glucose of 320 mg/dL
A blood glucose of 320 mg/dL indicates poor glycemic control and increases risks for infection, poor wound healing, and hyperosmolar crisis.
Question 6: A patient is scheduled for surgery under regional anesthesia. Which preoperative assessment finding would most likely change the anesthetic plan?
- Mild hypertension controlled with medication
- Anticoagulant therapy with recent therapeutic INR of 2.8 (Correct answer)
- A history of general anesthesia with no complications
- BMI of 27
Correct answer: Anticoagulant therapy with recent therapeutic INR of 2.8
Therapeutic anticoagulation significantly increases the risk of spinal hematoma with neuraxial anesthesia.
Question 7: When reviewing a patient's medication list preoperatively, which herbal supplement is most important to report to the anesthesia team due to risk of prolonged bleeding?
- Echinacea
- Ginkgo biloba (Correct answer)
- Melatonin
- Probiotics
Correct answer: Ginkgo biloba
Ginkgo biloba inhibits platelet-activating factor and can significantly increase bleeding risk perioperatively.
CNOR Preoperative Patient Assessment 3
A patient's preoperative ECG shows new ST-segment changes that were not present 6 months ago.
The perioperative nurse should: