DAANCE Patient Assessment and Preparation 4 — Questions and Answers
Question 1: A patient reports taking warfarin daily. What is the most important pre-anesthesia consideration?
- Schedule the procedure without modification
- Obtain a current INR value and consult with the patient's physician (Correct answer)
- Discontinue warfarin 24 hours before the procedure
- Administer vitamin K prior to sedation
Correct answer: Obtain a current INR value and consult with the patient's physician
Current INR must be evaluated and the prescribing physician consulted before proceeding with sedation to assess bleeding risk.
Question 2: Which ASA physical status classification describes a patient with well-controlled type 2 diabetes and mild hypertension?
- ASA I
- ASA II (Correct answer)
- ASA III
- ASA IV
Correct answer: ASA II
ASA II applies to patients with mild systemic disease that is well-controlled and presents no functional limitation.
Question 3: During pre-anesthesia assessment, a patient's blood pressure reads 178/104 mmHg on two separate readings. What is the appropriate action?
- Proceed with sedation using reduced drug doses
- Document and proceed if the patient feels well
- Postpone elective sedation and refer for medical evaluation (Correct answer)
- Administer an anxiolytic to lower blood pressure before proceeding
Correct answer: Postpone elective sedation and refer for medical evaluation
A blood pressure of 178/104 mmHg indicates stage 2 hypertension, and elective procedures should be deferred pending medical clearance.
Question 4: Which of the following best describes the purpose of the Mallampati classification in pre-anesthesia assessment?
- Evaluates the patient's cardiac risk
- Predicts difficulty of airway management (Correct answer)
- Assesses the degree of patient anxiety
- Determines appropriate drug dosage
Correct answer: Predicts difficulty of airway management
The Mallampati classification scores oropharyngeal visibility to predict potential difficulty with airway management during sedation.
Question 5: A patient discloses a latex allergy during the health history review. Which preparation step is most critical?
- Premedicate with antihistamines only
- Schedule the patient as the first case of the day to ensure a latex-free environment (Correct answer)
- Note the allergy in the chart and proceed normally
- Use extra gloves to prevent exposure
Correct answer: Schedule the patient as the first case of the day to ensure a latex-free environment
Scheduling the patient first minimizes latex particle accumulation in the environment, reducing risk of allergic reaction.
Question 6: What fasting guideline applies to clear liquids before moderate sedation in a healthy adult undergoing elective dental treatment?
- No restriction on clear liquids
- 2 hours NPO for clear liquids (Correct answer)
- 4 hours NPO for clear liquids
- 6 hours NPO for clear liquids
Correct answer: 2 hours NPO for clear liquids
Current AAPD and ASA guidelines allow clear liquids up to 2 hours before moderate sedation in healthy patients.
Question 7: During pre-procedure preparation, you note the patient's oxygen saturation is 93% on room air at rest. How should this be interpreted?
- Normal; proceed with sedation
- Borderline low; document and monitor closely during sedation
- Abnormal; postpone sedation and seek medical evaluation (Correct answer)
- Acceptable only for pediatric patients
Correct answer: Abnormal; postpone sedation and seek medical evaluation
A resting SpO2 of 93% is below the normal threshold of 95% or greater and warrants medical evaluation before elective sedation.
DAANCE Patient Assessment and Preparation 4
A patient reports taking warfarin daily.
What is the most important pre-anesthesia consideration?