I85PREP
⌘ K
CNOR study materials
CNOR study resources

CNOR practice questions

One question at a time. Build your CNOR understanding.

First 50 of 200 questions. Each one lists the choices, the correct answer, and an explanation. The checker at the top of this page saves progress in this browser when it is available.

Continue in the practice tool above to load more questions, 50 at a time.

Question 1Preoperative Patient Assessment and Diagnosis

A patient scheduled for arthroscopy reports itching and hives after blowing up balloons and after eating bananas and avocados. Which preoperative action is most appropriate?

  1. No precautions, since the reaction followed food exposure rather than a medical device
  2. Premedicate with diphenhydramine and proceed using standard powdered gloves
  3. Delay surgery until skin-prick testing confirms a latex allergy
  4. Schedule the patient first with a latex-free cart and room Correct answer.

Explanation

Banana, avocado, kiwi, and chestnut cross-react with latex proteins, so this pattern suggests latex-fruit syndrome. Such patients should be scheduled as the first case of the day with all latex items removed from the room and cart. Premedication does not prevent anaphylaxis, and powdered gloves aerosolize latex allergen.

Question 2Preoperative Patient Assessment and Diagnosis

According to current ASA fasting guidance, how long before elective anesthesia should a patient stop drinking clear liquids?

  1. Four hours
  2. Eight hours
  3. Two hours Correct answer.
  4. Six hours

Explanation

Clear liquids may be taken until two hours before anesthesia. Breast milk requires four hours, infant formula and nonhuman milk six hours, and a light meal six hours, with fatty or fried meals requiring eight hours.

Question 3Preoperative Patient Assessment and Diagnosis

Which statement describes correct surgical site marking before an elective procedure?

  1. The surgeon marks the site with the patient involved, using a mark visible after prep Correct answer.
  2. The circulating nurse marks the site during the surgical time-out
  3. The site is marked before the consent form has been signed by the patient
  4. A small adhesive dot is applied so the mark will not interfere with the planned incision line

Explanation

Site marking is the surgeon's responsibility and is done with the patient involved whenever possible, using a mark that remains visible after skin preparation and draping. It follows, not precedes, informed consent and verification of laterality.

Question 4Preoperative Patient Assessment and Diagnosis

A preoperative airway assessment documents Mallampati class III. What does this classification indicate?

  1. Class I, in which the tonsillar pillars, uvula, and soft palate are all visible
  2. Class IV, in which only the hard palate is visible
  3. Class II, in which the soft palate, uvula, and fauces are visible
  4. Class III, in which the soft palate and base of the uvula are visible Correct answer.

Explanation

Mallampati class III describes visualization of only the soft palate and the base of the uvula, with the faucial pillars obscured. Higher classes correlate with greater likelihood of difficult laryngoscopy and prompt preparation for a difficult airway.

Question 5Preoperative Patient Assessment and Diagnosis

Which information is required when identifying a patient before administering a preoperative medication?

  1. Two independent patient identifiers Correct answer.
  2. The patient's room number and bed assignment
  3. The surgeon's name and the scheduled procedure time
  4. The patient's date of birth alone, confirmed verbally

Explanation

Identification requires two independent identifiers, such as name and date of birth or name and medical record number, verified against the armband and the order. Room number, bed, and procedure details change and are not unique to the person.

Question 6Preoperative Patient Assessment and Diagnosis

Which measurement must be obtained before a pediatric patient enters the operating room?

  1. Weight in kilograms recorded on the day of surgery Correct answer.
  2. Age in months, which determines all pediatric dose ranges
  3. Height in centimeters measured at the preoperative visit
  4. Body surface area calculated from a standard nomogram

Explanation

Weight in kilograms is the basis for pediatric drug dosing, fluid administration, and selection of airway equipment, and it should be measured rather than estimated. Age-based formulas are only rough approximations and can introduce dosing error.

Question 7Preoperative Patient Assessment and Diagnosis

A healthy 30-year-old nonsmoker with no medical problems and taking no medications is scheduled for elective knee arthroscopy. How is this patient classified under the ASA physical status system?

  1. ASA I, because the patient has no systemic disease Correct answer.
  2. ASA III, because general anesthesia is planned
  3. ASA II, because any surgical procedure adds systemic risk
  4. ASA IV, because the patient is undergoing an elective operation

Explanation

ASA I describes a healthy patient with no systemic disease, including a nonsmoker who takes no medications. The planned anesthetic technique and elective nature of surgery do not change the physical status classification.

Question 8Preoperative Patient Assessment and Diagnosis

Which action reflects the perioperative nurse's legal role in informed consent?

  1. The nurse explains the risks and benefits and obtains the patient's signature
  2. The nurse may sign as a witness for an unconscious patient without a surrogate
  3. Consent is valid if the patient signs while heavily sedated, provided a witness is present
  4. The nurse verifies the patient understands the procedure and witnesses the signature Correct answer.

Explanation

The surgeon is responsible for disclosing the diagnosis, procedure, risks, and alternatives; the nurse witnesses the signature, confirms voluntariness, and assesses comprehension. If the patient lacks capacity, consent must come from a legally authorized surrogate.

Question 9Preoperative Patient Assessment and Diagnosis

A patient reports that a parent died of malignant hyperthermia during a prior operation. Which preoperative action is most important?

  1. Proceed with standard anesthesia, since susceptibility is inherited only from the mother
  2. Give a prophylactic dose of dantrolene in the preoperative holding area
  3. Order a preoperative muscle biopsy to confirm susceptibility before surgery
  4. Flag the patient as MH-susceptible and plan a trigger-free anesthetic Correct answer.

Explanation

Malignant hyperthermia susceptibility follows an autosomal dominant pattern, so a first-degree relative with an MH-related death is a strong indicator. The patient should be identified as susceptible, volatile agents and succinylcholine avoided, and dantrolene made immediately available.

Question 10Preoperative Patient Assessment and Diagnosis

A patient taking warfarin for atrial fibrillation is scheduled for elective surgery. Which preoperative instruction is appropriate?

  1. Give vitamin K orally on the morning of surgery to reverse anticoagulation
  2. Do not change the warfarin dose unless the prescriber directs it Correct answer.
  3. Stop warfarin 10 days before surgery without notifying the prescriber
  4. Substitute aspirin for warfarin until the day of the procedure

Explanation

Perioperative anticoagulation is individualized by the prescriber and may involve holding warfarin about five days with an INR check or bridging for high thrombotic risk. The nurse verifies the most recent INR, reports abnormalities, and confirms the written plan rather than altering therapy independently.

Question 11Preoperative Patient Assessment and Diagnosis

A patient takes metoprolol daily for chronic stable angina. What is the recommended perioperative management?

  1. Continue metoprolol through the perioperative period as ordered Correct answer.
  2. Discontinue metoprolol 48 hours before surgery to prevent hypotension
  3. Hold metoprolol on the morning of surgery until the patient is awake
  4. Replace metoprolol with a shorter-acting agent on the day of surgery

Explanation

Chronic beta blockade should be continued through the perioperative period because abrupt withdrawal can precipitate rebound tachycardia, hypertension, and myocardial ischemia. Starting high-dose beta blockade on the day of surgery, by contrast, is not recommended.

Question 12Preoperative Patient Assessment and Diagnosis

A patient scores 5 on the STOP-BANG questionnaire during the preoperative interview. What does this score indicate?

  1. Risk related only to body mass index, not to airway anatomy
  2. A diagnosis of severe obstructive sleep apnea confirmed by the score
  3. Low risk, so standard postoperative monitoring is sufficient
  4. High risk for moderate-to-severe obstructive sleep apnea Correct answer.

Explanation

A STOP-BANG score of 5 or higher identifies high risk for moderate-to-severe obstructive sleep apnea, while 3 to 4 is intermediate risk. The tool is a screening instrument, not a diagnosis, and high scores prompt referral for testing plus planning for closer monitoring and opioid-sparing analgesia.

Question 13Preoperative Patient Assessment and Diagnosis

A 19-year-old scheduled for elective laparoscopy reports she is sexually active and her last menstrual period was six weeks ago. What is the most appropriate action?

  1. Obtain a pregnancy test as required by facility policy Correct answer.
  2. Defer testing, because laparoscopy does not affect a fetus
  3. Proceed, because she denies missing a period or nausea
  4. Perform a urine pregnancy test only if the patient requests one

Explanation

Patients of childbearing potential should be offered or given pregnancy testing according to facility policy before elective surgery, since anesthetic and surgical exposures carry fetal risk. A positive result generally leads to postponement and referral for counseling.

Question 14Preoperative Patient Assessment and Diagnosis

Which preoperative finding in a patient with type 2 diabetes most warrants notification of the surgeon before elective surgery?

  1. Hemoglobin A1c of 9.4% obtained one week ago Correct answer.
  2. Fasting glucose of 128 mg/dL on the morning of surgery
  3. A documented history of diet-controlled diabetes for five years
  4. Self-reported adherence to a daily walking program

Explanation

An A1c above roughly 8% reflects sustained poor glycemic control, which is associated with hyperglycemia during surgery, infection, and impaired wound healing, and surgeons often optimize control before elective procedures. A single mildly elevated fasting glucose is less informative about overall control.

Question 15Preoperative Patient Assessment and Diagnosis

A patient being assessed before elective surgery reports drinking a six-pack of beer every evening. Which preoperative concern is most significant?

  1. Enhanced response to opioid analgesics
  2. Decreased tolerance to inhaled anesthetic agents
  3. Risk of withdrawal seizures and delirium Correct answer.
  4. Reduced risk of postoperative nausea and vomiting

Explanation

Chronic heavy alcohol use creates tolerance to anesthetics and opioids and places the patient at risk for withdrawal, including tremor, seizures, and delirium tremens during admission. Perioperative management includes a CIWA protocol, benzodiazepines, thiamine, and glucose monitoring.

Question 16Preoperative Patient Assessment and Diagnosis

A patient reports daily cannabis use and is scheduled for general anesthesia. Which perioperative concern is most relevant?

  1. Cannabis use eliminates the need for a preoperative airway examination
  2. Higher risk of myocardial injury and airway irritation Correct answer.
  3. Cannabis reliably reduces anesthetic requirements
  4. Cannabis use has no effect on airway reactivity

Explanation

Cannabis can cause tachycardia, myocardial ischemia, and airway hyperreactivity, and heavy use may increase anesthetic requirements. Patients should be counseled about cessation, although the optimal interval before surgery is not firmly established.

Question 17Preoperative Patient Assessment and Diagnosis

Which preoperative laboratory value best suggests impaired nutritional status and increased risk of poor wound healing?

  1. Serum albumin 2.3 g/dL Correct answer.
  2. Serum albumin 4.1 g/dL
  3. Serum potassium 4.2 mEq/L
  4. Hemoglobin 13.5 g/dL

Explanation

Serum albumin below about 3.0 g/dL suggests protein depletion, which is associated with impaired wound healing, infection, and higher postoperative morbidity. Albumin also falls with inflammation, so it must be interpreted alongside the clinical picture.

Question 18Preoperative Patient Assessment and Diagnosis

Which patient has the highest risk for postoperative venous thromboembolism?

  1. A 30-year-old woman undergoing outpatient arthroscopy, BMI 23
  2. A 45-year-old man having a 45-minute skin excision under local
  3. A 52-year-old man with well-controlled asthma having cataract surgery
  4. A 70-year-old with prior pulmonary embolism having hip replacement Correct answer.

Explanation

Venous thromboembolism risk rises with major orthopedic surgery, older age, and a history of prior VTE, and this patient has all three. Such patients require a documented plan for mechanical and pharmacologic prophylaxis.

Question 19Preoperative Patient Assessment and Diagnosis

A patient who is a Jehovah's Witness declines blood transfusion and is scheduled for elective surgery. Which preoperative action is most appropriate?

  1. Document the specific products the patient will accept or refuse Correct answer.
  2. Proceed with the standard consent form without discussing blood products
  3. Assume all blood products are refused, including albumin and clotting factors
  4. Ask the family to sign a transfusion consent in case of emergency

Explanation

Beliefs vary widely, and some patients accept albumin, clotting factor concentrates, cell salvage, or preoperative autologous donation while refusing red cells. Documenting the exact accepted and refused interventions, notifying the blood bank, and planning blood conservation respects autonomy and prevents conflict.

Question 20Preoperative Patient Assessment and Diagnosis

A patient reports taking ginkgo biloba, garlic, and high-dose fish oil daily. Which preoperative risk should the nurse anticipate?

  1. Acute liver failure from herbal hepatotoxicity
  2. Increased bleeding risk Correct answer.
  3. Serotonin syndrome during general anesthesia
  4. Profound bradycardia requiring pacing

Explanation

Ginkgo, garlic, ginger, ginseng, and fish oil have antiplatelet or anticoagulant effects that can compound surgical bleeding. Patients are typically advised to stop these supplements about one to two weeks before elective surgery according to surgeon preference.

Question 21Preoperative Patient Assessment and Diagnosis

Which patient meets three criteria of the Revised Cardiac Risk Index?

  1. Prior MI, creatinine 2.4 mg/dL, open colectomy Correct answer.
  2. History of stroke, current smoker, and outpatient arthroscopy
  3. Age 75 years, hypertension, and a body mass index of 33
  4. Creatinine 1.1 mg/dL, diabetes, and cataract surgery

Explanation

The Revised Cardiac Risk Index counts ischemic heart disease, heart failure, cerebrovascular disease, insulin-treated diabetes, creatinine above 2.0 mg/dL, and high-risk surgery such as intraperitoneal, intrathoracic, or suprainguinal vascular procedures. This patient has ischemic heart disease, renal insufficiency, and intraperitoneal surgery for a score of three.

Question 22Preoperative Patient Assessment and Diagnosis

A patient with type 2 diabetes takes empagliflozin. What is the recommended management before elective surgery?

  1. Hold the drug only on the morning of surgery
  2. Hold the drug 3 to 4 days before surgery Correct answer.
  3. Give an extra dose with a carbohydrate load the night before
  4. Continue the drug and monitor glucose hourly during surgery

Explanation

SGLT2 inhibitors can precipitate euglycemic diabetic ketoacidosis during fasting, illness, or surgery, so regulators recommend considering discontinuation about three days before scheduled surgery, or four days for ertugliflozin. Normal or near-normal glucose does not exclude ketosis, so ketones should be checked if symptoms arise.

Question 23Preoperative Patient Assessment and Diagnosis

A patient with a drug-eluting coronary stent placed four months ago takes aspirin and clopidogrel. He is scheduled for elective inguinal hernia repair. What is the best action?

  1. Defer surgery and refer to cardiology for a plan Correct answer.
  2. Stop clopidogrel now and proceed, since aspirin alone is sufficient
  3. Proceed as scheduled and transfuse platelets if bleeding occurs
  4. Stop both antiplatelet agents five days before surgery

Explanation

Premature interruption of dual antiplatelet therapy after drug-eluting stent placement risks stent thrombosis and myocardial infarction, so elective surgery is generally deferred until at least six months, and often twelve months, after placement. Any change in antiplatelet therapy requires cardiology input.

Question 24Preoperative Patient Assessment and Diagnosis

A patient with severe aortic stenosis and no cardiac symptoms is scheduled for elective knee arthroscopy. What is the most appropriate preoperative action?

  1. Clear the patient for surgery, since the stenosis is asymptomatic
  2. Proceed with spinal anesthesia to minimize cardiac stress
  3. Order a preoperative exercise stress test to confirm reserve
  4. Refer for cardiology evaluation before elective surgery Correct answer.

Explanation

Severe aortic stenosis is a major independent predictor of perioperative cardiac events with noncardiac surgery, and elective procedures should be deferred pending cardiology evaluation and consideration of valve intervention. The absence of symptoms does not remove the risk.

Question 25Preoperative Patient Assessment and Diagnosis

Which patient profile places a patient at the highest risk for postoperative nausea and vomiting?

  1. Nonsmoking woman with prior PONV having laparoscopy Correct answer.
  2. Male smoker with no history of motion sickness having a hernia repair
  3. Young man with reflux taking no postoperative opioids
  4. Elderly man with hypertension having cataract surgery

Explanation

The Apfel score counts female sex, nonsmoking status, history of PONV or motion sickness, and expected postoperative opioid use, and laparoscopy adds further risk. Patients with three or more factors warrant multimodal prophylaxis.

Question 26Preoperative Patient Assessment and Diagnosis

A healthy adult is scheduled for elective surgery under general anesthesia. Which fasting instruction is consistent with current preoperative practice?

  1. Clear liquids may be taken until 6 hours before induction.
  2. All oral intake must stop at midnight the night before surgery.
  3. Clear liquids may be taken until 2 hours before induction. Correct answer.
  4. Solid food may be taken until 4 hours before induction.

Explanation

Standard fasting intervals are based on gastric emptying: about 2 hours for clear liquids, 4 hours for breast milk and infant formula, 6 hours for a light meal or nonhuman milk, and 8 hours for fatty or fried food. Prolonged fasting from midnight offers no added aspiration protection and causes dehydration and hypoglycemia.

Question 27Preoperative Patient Assessment and Diagnosis

During a preoperative interview, a patient states she can climb one flight of stairs without stopping but becomes short of breath when hurrying on level ground. How should the nurse interpret this report?

  1. Functional capacity cannot be estimated from self-reported activity.
  2. Roughly 1 to 2 METs, which indicates poor-risk functional capacity.
  3. Roughly 8 METs, which is typical for this level of activity.
  4. Roughly 4 METs, indicating adequate functional capacity. Correct answer.

Explanation

Climbing a flight of stairs approximates 4 METs, the threshold generally accepted as adequate functional capacity for intermediate-risk elective surgery. A capacity below 4 METs signals increased perioperative cardiac risk and supports further cardiac evaluation and optimization. Self-reported activity history is a validated way to estimate METs when formal testing is not planned.

Question 28Preoperative Patient Assessment and Diagnosis

A 24-year-old with spina bifida is scheduled for elective urologic surgery and reports hives and lip swelling after contact with rubber gloves. Which preoperative action is most important?

  1. Premedicate with diphenhydramine and proceed in the standard operating room.
  2. Schedule the procedure first of the day in a latex-safe environment. Correct answer.
  3. Ask the surgeon to switch to powder-free latex gloves for the case.
  4. Obtain latex-specific IgE and delay surgery until the result returns.

Explanation

Spina bifida is a high-risk condition for latex sensitization, and a reported contact reaction indicates the patient should be managed with latex precautions from the moment of entry into the perioperative area. Scheduling as the first case limits exposure to airborne latex aeroallergen released by previous cases. Diagnostic testing does not alter the need for these precautions and should not delay necessary care.

Question 29Preoperative Plan of Care

According to current anesthesia fasting guidance, the minimum fasting interval for clear liquids before elective surgery is:

  1. 2 hours Correct answer.
  2. 8 hours
  3. 4 hours
  4. 6 hours

Explanation

Clear liquids empty rapidly from the stomach, so current guidance permits intake up to 2 hours before anesthesia. Longer intervals apply to breast milk, formula, and solid food. Unnecessary prolonged fasting increases dehydration, hypoglycemia, and patient discomfort without adding safety.

Question 30Preoperative Plan of Care

Before administering a preoperative medication, the perioperative nurse confirms patient identity using:

  1. The admitting diagnosis
  2. Two independent identifiers Correct answer.
  3. The room and bed number
  4. The scheduled procedure time

Explanation

Two independent identifiers, such as full name plus date of birth or medical record number, must be used whenever care or medication is provided. Location, schedule details, and diagnosis are not unique to one person and cannot confirm identity.

Question 31Preoperative Plan of Care

A 15-year-old is scheduled for an elective arthroscopy. Who is authorized to sign the surgical consent?

  1. The patient, because the procedure is elective
  2. Any adult who accompanies the patient
  3. The circulating nurse as patient advocate
  4. A parent or legal guardian Correct answer.

Explanation

In most jurisdictions a minor cannot legally consent to surgery, so consent must be obtained from a parent or legal guardian unless the minor is emancipated or a legal exception applies. The nurse verifies that the signature comes from a person with legal authority.

Question 32Preoperative Plan of Care

When hair must be removed from a surgical site, the preferred method is:

  1. A razor the night before surgery
  2. A wet shave in the holding area
  3. A chemical depilatory cream
  4. Clippers immediately before surgery Correct answer.

Explanation

Clippers used just before the procedure remove hair with minimal skin trauma; razors create microabrasions where bacteria can colonize and increase surgical site infection risk. Hair is removed only when it would interfere with the procedure.

Question 33Preoperative Plan of Care

Which nursing action best supports an anxious patient during the preoperative interview?

  1. Delay all teaching until after surgery
  2. Limit questions to avoid raising anxiety
  3. Restrict family presence during preparation
  4. Provide information and allow time for questions Correct answer.

Explanation

Uncertainty is a major source of preoperative anxiety, and clear, unhurried information with opportunities for questions reduces it. Teaching is most useful before surgery, while the patient can still participate in decisions and practice coping strategies.

Question 34Preoperative Plan of Care

Before transfer to the operating room, the nurse's priority action regarding eyeglasses, dentures, and jewelry is to:

  1. Send them with the patient to the OR
  2. Keep them with the patient for comfort
  3. Place them in the bedside drawer
  4. Remove and secure them per facility policy Correct answer.

Explanation

Removable items are removed, documented, and secured according to policy to prevent loss, injury, and pressure injury during positioning. Dentures and hearing aids are often needed postoperatively, so they are labeled and stored where they can be retrieved.

Question 35Preoperative Plan of Care

Preoperative bathing with chlorhexidine gluconate is performed primarily to:

  1. Moisturize the skin before the prep
  2. Reduce bacterial skin counts Correct answer.
  3. Remove hair from the surgical site
  4. Loosen dried blood and debris

Explanation

Chlorhexidine gluconate bathing lowers the bacterial burden on the skin and is used as part of surgical site infection prevention bundles. It does not remove hair and does not replace the antiseptic skin prep performed in the operating room.

Question 36Preoperative Plan of Care

A patient scheduled for a colon resection tells the nurse he does not understand what a temporary colostomy is. The nurse should:

  1. Witness the signature and proceed with the case
  2. Explain the procedure and answer the questions
  3. Ask the spouse to explain the procedure
  4. Notify the surgeon to clarify before consent is signed Correct answer.

Explanation

Obtaining informed consent, including explaining risks, benefits, and alternatives, is the surgeon's responsibility. When a patient lacks understanding, the nurse pauses the process and notifies the surgeon so clarification occurs before the consent is witnessed.

Question 37Preoperative Plan of Care

A patient reports itching and hives after blowing up balloons. The preoperative plan should include:

  1. Reassuring the patient it is unrelated
  2. Asking the patient to supply gloves
  3. Documenting it as a drug allergy
  4. Implementing latex precautions Correct answer.

Explanation

Hives and itching after contact with balloons suggest natural rubber latex sensitivity, so latex precautions are implemented and documented, and the patient is scheduled early in the day to limit airborne aeroallergen exposure. Latex sensitivity is recorded as its own allergy category, not as a drug allergy.

Question 38Preoperative Plan of Care

Surgical site marking should be performed:

  1. By the admitting nurse during the preadmission phone call
  2. By the circulating nurse in the operating room after induction
  3. By the surgeon before sedation Correct answer.
  4. By the anesthesia provider during the preoperative visit

Explanation

The operating surgeon, or a designated practitioner, marks the site with the patient awake and involved whenever possible, and the mark is verified against the consent and schedule. Marking after sedation removes the patient's ability to confirm the correct side or site.

Question 39Preoperative Plan of Care

A patient takes metoprolol daily for hypertension. The perioperative medication plan generally calls for the beta blocker to be:

  1. Continued as scheduled Correct answer.
  2. Stopped one week before surgery
  3. Replaced with a calcium channel blocker
  4. Withheld on the morning of surgery

Explanation

Abrupt withdrawal of a chronic beta blocker can cause rebound tachycardia and hypertension and increases perioperative cardiac risk, so it is usually continued with adjustments for hypotension as ordered. Substitution requires cardiology direction.

Question 40Preoperative Plan of Care

A patient reports taking ginkgo biloba daily. The preoperative teaching should include:

  1. Take it together with aspirin
  2. Continue it to reduce preoperative anxiety
  3. Stop it two weeks before surgery Correct answer.
  4. Double the dose the week before surgery

Explanation

Ginkgo biloba inhibits platelet aggregation and has been linked to bleeding, so it is typically discontinued about one to two weeks before surgery. The preoperative plan must include a full supplement history, not only prescription drugs.

Question 41Preoperative Plan of Care

Which finding is a scoring item on the STOP-BANG screening tool for obstructive sleep apnea?

  1. Age younger than 40 years
  2. Serum albumin below 3.0 g/dL
  3. BMI greater than 35 kg/m2 Correct answer.
  4. Hemoglobin A1c greater than 8%

Explanation

STOP-BANG screens for Snoring, Tiredness, Observed apnea, Pressure (hypertension), BMI, Age, Neck circumference, and Gender. A BMI above 35 kg/m2 is one of the points and flags risk for sleep-disordered breathing and difficult airway.

Question 42Preoperative Plan of Care

A patient has well-controlled hypertension and no other systemic disease. This patient is classified as:

  1. ASA physical status I
  2. ASA physical status III
  3. ASA physical status IV
  4. ASA physical status II Correct answer.

Explanation

ASA physical status II describes mild systemic disease without substantive functional limitation, such as well-controlled hypertension. Status I is a healthy patient, and higher classes reflect increasingly severe disease.

Question 43Preoperative Plan of Care

Which statement about smoking cessation before surgery is most accurate?

  1. Cessation the day before surgery is sufficient
  2. Only cessation after discharge matters
  3. Cessation has no measurable effect on pulmonary or wound outcomes
  4. Four weeks of cessation reduces complications Correct answer.

Explanation

Cessation at least 4 weeks before surgery improves mucociliary clearance and tissue oxygenation, reducing pulmonary and wound-healing complications. Patients should be encouraged to remain abstinent permanently, not just perioperatively.

Question 44Preoperative Plan of Care

A patient who speaks limited English is scheduled for surgery. The best plan for consent and teaching is to use:

  1. Another patient who speaks the language
  2. The patient's adult child
  3. A qualified medical interpreter Correct answer.
  4. Written materials in English

Explanation

Informed consent and preoperative teaching require accurate communication, so a qualified medical interpreter is used and the encounter is documented. Family members, especially children, should not interpret clinical discussions, and untranslated written materials do not confirm comprehension.

Question 45Preoperative Plan of Care

The Caprini score is calculated preoperatively to:

  1. Assess nutritional status
  2. Stratify venous thromboembolism risk Correct answer.
  3. Estimate surgical site infection risk
  4. Predict postoperative nausea risk

Explanation

The Caprini score combines procedure type with patient risk factors to stratify venous thromboembolism risk and guide mechanical and pharmacologic prophylaxis. Other tools address infection, nausea, and nutrition.

Question 46Preoperative Plan of Care

Which approach best confirms that a patient understands preoperative instructions?

  1. Asking whether the patient has any questions about the instructions
  2. Giving the patient a printed handout
  3. Asking the patient to repeat instructions in their own words Correct answer.
  4. Documenting that teaching was completed

Explanation

Teach-back asks the patient to restate the instructions, revealing actual comprehension rather than polite agreement. It is the preferred method for verifying understanding before surgery and discharge.

Question 47Preoperative Plan of Care

A 3-year-old is scheduled for surgery. Under current fasting guidance, the interval for breast milk is:

  1. 8 hours
  2. 6 hours
  3. 4 hours Correct answer.
  4. 12 hours

Explanation

Current pediatric fasting intervals are 2 hours for clear liquids, 4 hours for breast milk, 6 hours for infant formula or a light meal, and 8 hours for fatty meals. These intervals limit aspiration risk while preventing unnecessary dehydration in children.

Question 48Preoperative Plan of Care

A patient with a do-not-resuscitate order is scheduled for a procedure under general anesthesia. The most appropriate preoperative action is to:

  1. Cancel the procedure unless the order is revoked
  2. Let the circulating nurse decide which measures will be used
  3. Suspend the order automatically for the entire hospital admission
  4. Discuss and document how the order applies during the procedure Correct answer.

Explanation

A do-not-resuscitate order is not automatically void in the perioperative period; the surgeon, anesthesia provider, and patient or surrogate discuss which resuscitative measures will apply during anesthesia and document the plan. This preserves patient autonomy while accounting for anesthesia-related interventions.

Question 49Preoperative Plan of Care

Which statement best reflects current evidence about preoperative laboratory testing for a healthy patient having low-risk surgery?

  1. A complete chemistry panel is required for every patient
  2. Coagulation studies should precede every procedure
  3. An ECG is required for every patient older than 40 years
  4. Testing should be guided by history and the planned procedure Correct answer.

Explanation

Evidence-based guidance recommends selective testing based on history, comorbidities, and the invasiveness of the procedure; routine panels for healthy patients add cost without improving outcomes. Abnormal results in low-risk patients rarely change management.

Question 50Preoperative Plan of Care

Which preoperative finding most strongly predicts postoperative complications in an older adult?

  1. Frailty and poor functional status Correct answer.
  2. Stable chronic kidney disease, stage 2
  3. Use of a single antihypertensive agent
  4. Mild bilateral hearing loss

Explanation

Frailty and poor functional status are strongly associated with postoperative complications, delirium, and mortality in older adults and should prompt preoperative optimization and goals-of-care discussion. Sensory deficits and stable early chronic disease carry far less risk.