CNOR Preoperative Patient Assessment 4 — Questions and Answers
Question 1: A patient who is a Jehovah's Witness is scheduled for a procedure with anticipated blood loss. The preoperative nurse's priority is to:
- Arrange for blood products to be available without informing the patient
- Document the patient's wishes regarding blood transfusion and notify the surgical team (Correct answer)
- Refuse to participate in the procedure
- Administer iron supplements without consent
Correct answer: Document the patient's wishes regarding blood transfusion and notify the surgical team
Respecting patient autonomy requires documenting refusal of blood products and communicating this to all team members to plan accordingly.
Question 2: During preoperative assessment, the nurse identifies that the patient has an implanted cardiac pacemaker. The most critical action is to:
- Remove the pacemaker before surgery
- Notify the surgeon and determine if electrosurgery requires pacemaker management (Correct answer)
- Document the finding and proceed without further action
- Schedule a cardiology consult to reprogram the device to a fixed rate postoperatively
Correct answer: Notify the surgeon and determine if electrosurgery requires pacemaker management
Electrosurgical units can interfere with pacemaker function, requiring pre-planned management strategies before surgery begins.
Question 3: A patient scheduled for outpatient surgery under general anesthesia has a BMI of 42. Which preoperative assessment is most critical?
- Nutritional status and serum albumin
- Airway assessment and respiratory function (Correct answer)
- Serum lipid levels
- Liver function tests
Correct answer: Airway assessment and respiratory function
Morbid obesity significantly increases the risk of difficult intubation and respiratory complications requiring thorough airway and pulmonary assessment.
Question 4: Which question is most important when assessing fall risk during the preoperative period?
- Have you ever had a broken bone?
- Do you use any assistive devices for ambulation? (Correct answer)
- How many hours of sleep do you get per night?
- Do you follow a regular exercise program?
Correct answer: Do you use any assistive devices for ambulation?
Use of assistive devices indicates impaired mobility and balance, which are key indicators of fall risk in the perioperative setting.
Question 5: A patient reports a previous anesthetic complication where they experienced a very high fever and muscle rigidity during surgery. The nurse should prioritize communicating this history because it suggests:
- An allergy to latex
- Malignant hyperthermia susceptibility (Correct answer)
- Chronic pain disorder
- An adverse reaction to antibiotics
Correct answer: Malignant hyperthermia susceptibility
Malignant hyperthermia is a life-threatening pharmacogenetic disorder triggered by certain anesthetic agents, requiring specific preparation and alternative agents.
Question 6: When assessing a patient's social history preoperatively, which information is most relevant to postoperative planning and discharge safety?
- The patient's occupation and work schedule
- Whether the patient has a responsible adult to accompany them home (Correct answer)
- The patient's education level
- Whether the patient owns a car
Correct answer: Whether the patient has a responsible adult to accompany them home
Outpatient surgical patients must have a responsible adult to drive them home and monitor them, as anesthesia impairs judgment and reflexes.
Question 7: A preoperative patient with known renal insufficiency is scheduled for a procedure requiring IV contrast. The perioperative nurse's priority action is to:
- Administer the contrast without concern since it is IV
- Notify the radiologist and surgeon of the renal insufficiency before contrast administration (Correct answer)
- Increase oral fluid intake the morning of surgery
- Check creatinine level and hold the procedure if elevated
Correct answer: Notify the radiologist and surgeon of the renal insufficiency before contrast administration
Renal insufficiency is a major risk factor for contrast-induced nephropathy and must be communicated to allow for preventive strategies or alternative imaging.
CNOR Preoperative Patient Assessment 4
A patient who is a Jehovah's Witness is scheduled for a procedure with anticipated blood loss.
The preoperative nurse's priority is to: