NBCRNA Perioperative Patient Assessment 1 — Questions and Answers
Question 1: The ASA Physical Status Classification System assigns ASA III to a patient who has what?
- Severe systemic disease with functional limitation but not incapacitating (Correct answer)
- Mild systemic disease without functional limitation
- Incapacitating systemic disease that is a constant threat to life
- An otherwise healthy patient
Correct answer: Severe systemic disease with functional limitation but not incapacitating
ASA III indicates severe systemic disease that limits activity but is not incapacitating; examples include poorly controlled DM, COPD, morbid obesity (BMI >40), and symptomatic CHF.
Question 2: A patient with a history of recent myocardial infarction (within 60 days) presenting for elective non-cardiac surgery should ideally have surgery:
- Postponed at least 60 days after MI unless the surgery is truly urgent (Correct answer)
- Performed with intensive monitoring regardless of timing
- Rescheduled only if ejection fraction is below 35%
- Cancelled indefinitely
Correct answer: Postponed at least 60 days after MI unless the surgery is truly urgent
ACC/AHA guidelines recommend delaying elective non-cardiac surgery for at least 60 days after MI to allow myocardial healing and reduce perioperative cardiac morbidity.
Question 3: The Revised Cardiac Risk Index (RCRI) includes which of the following as a risk factor?
- History of ischemic heart disease, heart failure, or cerebrovascular disease, insulin-dependent diabetes, preoperative creatinine >2.0, and high-risk surgery (Correct answer)
- Age >65, smoking history, hypertension
- Atrial fibrillation, prior CABG, low ejection fraction
- Obesity, sleep apnea, and renal failure
Correct answer: History of ischemic heart disease, heart failure, or cerebrovascular disease, insulin-dependent diabetes, preoperative creatinine >2.0, and high-risk surgery
The 6-factor RCRI (Lee Index) predicts perioperative major adverse cardiac events using: high-risk surgery, ischemic heart disease, CHF, cerebrovascular disease, insulin-dependent DM, and Cr >2.0 mg/dL.
Question 4: Which preoperative lab is most indicated before major elective surgery in a patient on warfarin?
- Prothrombin time/INR (Correct answer)
- Complete blood count
- Serum creatinine
- Liver function tests
Correct answer: Prothrombin time/INR
INR directly measures the anticoagulation effect of warfarin and determines whether adequate reversal has been achieved before proceeding with surgery.
Question 5: In the preoperative airway assessment, which physical finding is most predictive of difficult bag-mask ventilation?
- Beard, obesity (BMI >26), lack of teeth, age >55, and history of snoring (BONES mnemonic) (Correct answer)
- Mallampati III or IV
- Mouth opening less than 3 cm
- Short thyromental distance
Correct answer: Beard, obesity (BMI >26), lack of teeth, age >55, and history of snoring (BONES mnemonic)
The BONES factors (Beard, Obesity, No teeth, Elderly, Snoring/OSA) identify patients likely to be difficult to ventilate with a mask, which is a separate assessment from difficult intubation.
Question 6: According to current ASA fasting guidelines, clear liquids may be consumed up to how many hours before elective anesthesia in adults?
- 2 hours (Correct answer)
- 4 hours
- 6 hours
- 8 hours
Correct answer: 2 hours
ASA guidelines permit clear liquids (water, fruit juice without pulp, carbonated beverages, tea, black coffee) up to 2 hours before elective procedures with general, regional, or monitored anesthesia care.
NBCRNA Perioperative Patient Assessment 1
The ASA Physical Status Classification System assigns ASA III to a patient who has what?