NBCRNA Perioperative Patient Assessment 3

Question 1

A patient taking clopidogrel for a coronary stent placed 4 months ago requires urgent hip fracture surgery. The recommended management is:

Accepted Answer

Proceed with surgery; withholding antiplatelet therapy risks in-stent thrombosis

Answer

For urgent surgery, the risk of delaying outweighs the bleeding risk; proceeding is recommended, and neuraxial anesthesia would be contraindicated per ASRA guidelines if clopidogrel was recently taken.

Question 2

The normal adult functional residual capacity (FRC) is significantly reduced by which factor that increases aspiration and desaturation risk?

Accepted Answer

Supine positioning and induction of general anesthesia

Answer

Supine position and induction of general anesthesia reduce FRC by 20–30% due to cephalad diaphragmatic displacement and loss of awake respiratory muscle tone, decreasing the oxygen reservoir and safe apnea time.

Question 3

Which preoperative finding on ECG most significantly increases perioperative risk for non-cardiac surgery?

Accepted Answer

Left bundle branch block (new or unknown onset)

Answer

New or unknown LBBB can mask ST changes of ischemia, may indicate severe underlying cardiac disease (cardiomyopathy, CAD), and requires further cardiac evaluation before elective surgery.

Question 4

In pediatric patients, which calculation is used to estimate blood volume for transfusion planning?

Accepted Answer

Estimated blood volume = weight (kg) × 70–80 mL/kg for term neonates

Answer

Term neonates have approximately 80–90 mL/kg blood volume, older infants 70–80 mL/kg, and children 70 mL/kg; this estimate guides allowable blood loss calculations and transfusion thresholds.

Question 5

A patient's preoperative HbA1c of 10.5% suggests what and has what implication for elective surgery?

Accepted Answer

Poorly controlled diabetes associated with increased risk of surgical site infection and cardiovascular complications; consider optimizing glycemic control

Answer

HbA1c >8% reflects chronic hyperglycemia and is associated with impaired wound healing, infection, and perioperative cardiovascular events; HbA1c >9–10% often warrants preoperative optimization for elective cases.

NBCRNA - National Board of Certification and Recertification for Nurse Anesthetists Practice Test

NBCRNA - National Board of Certification and Recertification for Nurse Anesthetists Practice Test

NBCRNA Perioperative Patient Assessment 3