CNOR Preoperative Patient Assessment 5 — Questions and Answers
Question 1: During the preoperative nursing assessment, a patient reports a previous adverse reaction to anesthesia involving prolonged paralysis after receiving succinylcholine. This history most likely indicates:
- Malignant hyperthermia susceptibility
- Pseudocholinesterase deficiency (Correct answer)
- Latex allergy
- Neuroleptic malignant syndrome
Correct answer: Pseudocholinesterase deficiency
Pseudocholinesterase deficiency impairs the metabolism of succinylcholine, leading to prolonged neuromuscular blockade.
Question 2: A pediatric patient is brought to the preoperative area accompanied by both parents and a stepparent. Which individual(s) can legally provide informed consent?
- Any of the three adults present
- The biological or legal guardian with legal custody (Correct answer)
- The stepparent if married to the custodial parent
- Only the biological mother
Correct answer: The biological or legal guardian with legal custody
Informed consent for a minor must be obtained from the individual with legal custody or legal guardianship.
Question 3: A patient is NPO but has been taking oral medications as prescribed. Which medication should be held before surgery?
- Beta-blocker for hypertension
- Proton pump inhibitor for GERD
- Oral hypoglycemic agent for Type 2 diabetes (Correct answer)
- Thyroid hormone replacement
Correct answer: Oral hypoglycemic agent for Type 2 diabetes
Oral hypoglycemics should typically be held preoperatively to prevent hypoglycemia during the fasting and surgical period.
Question 4: During preoperative assessment, a patient rates their pain as 8/10 at rest. The nurse's best action is to:
- Document the rating and proceed with surgical preparations
- Notify the surgeon and anesthesia provider, as uncontrolled pain may indicate a new or worsening condition (Correct answer)
- Administer the prescribed PRN analgesic and reassess
- Reassure the patient that postoperative pain will be controlled
Correct answer: Notify the surgeon and anesthesia provider, as uncontrolled pain may indicate a new or worsening condition
Severe uncontrolled preoperative pain at rest may signal a change in condition or complication that could affect the surgical plan.
Question 5: The nurse is reviewing a preoperative checklist and notes the surgical site has not been marked. What is the correct action?
- Mark the site using the operative report as a guide
- Proceed since the OR team will identify the site during the time-out
- Notify the surgeon to mark the site before the patient enters the OR (Correct answer)
- Ask the anesthesia provider to mark the site
Correct answer: Notify the surgeon to mark the site before the patient enters the OR
Per AORN guidelines and Universal Protocol, the surgeon (or licensed independent practitioner performing the procedure) is responsible for marking the surgical site.
Question 6: Which preoperative assessment finding requires the nurse to question the antibiotic prophylaxis order?
- The patient's weight is 95 kg
- The patient reports a severe allergy to penicillin with anaphylaxis (Correct answer)
- The patient has a history of MRSA decolonization
- The patient's surgery is scheduled to start in 2 hours
Correct answer: The patient reports a severe allergy to penicillin with anaphylaxis
A severe penicillin allergy with anaphylaxis requires verification and likely substitution of cephalosporins or other beta-lactam antibiotics in the prophylaxis order.
Question 7: A patient expresses significant fear and anxiety about the upcoming surgery. The perioperative nurse's most therapeutic response is to:
- Tell the patient everything will be fine and not to worry
- Acknowledge the patient's feelings and provide specific information about what to expect (Correct answer)
- Administer the prescribed anxiolytic immediately
- Refer all emotional concerns to the surgeon
Correct answer: Acknowledge the patient's feelings and provide specific information about what to expect
Acknowledging anxiety and providing accurate procedural information is evidence-based and helps reduce preoperative fear.
CNOR Preoperative Patient Assessment 5
During the preoperative nursing assessment, a patient reports a previous adverse reaction to anesthesia involving prolonged paralysis after receiving succinylcholine.
This history most likely indicates: