Preoperative Patient Assessment and Diagnosis
Building the preoperative database
Preoperative assessment is a risk-stratification process, not a checklist to complete. The perioperative RN gathers a medical and surgical history; a full medication history (anticoagulants, antiplatelets, insulin, herbal products, GLP-1 agonists); allergies with the specific reaction described; prior anesthetic events (malignant hyperthermia, difficult intubation, prolonged emergence, severe postoperative nausea and vomiting); NPO status; tobacco and alcohol use; and the patient's functional and cognitive baseline. Physical assessment centers on airway anatomy (Mallampati class, thyromental distance, cervical mobility, loose or capped teeth, dentures), skin integrity, nutritional and hydration status, baseline vital signs, and potential IV and positioning sites. Diagnostics follow policy and findings: CBC, chemistry, coagulation studies, ECG, type and screen, pregnancy testing, and any study the anesthesia professional requests.
Where questions trip candidates
Two recurring traps. First, confusing nursing and medical roles: the surgeon obtains informed consent and the anesthesia professional assigns ASA physical status; the RN verifies, witnesses, clarifies, and advocates, but does neither of those tasks. Second, accepting a vague allergy history. 'Allergic to codeine' is not sufficient - the RN documents the specific sign (rash, hives, hypotension, vomiting), because nausea is an intolerance rather than a true allergy and the distinction changes which drugs may be given.
Rule of thumb
Use the 2-4-6-8 fasting framework as a starting point (2 hours clear liquids, 4 hours breast milk, 6 hours light meal, 8 hours fatty meal), then defer to surgeon and anesthesia orders. Answer choices that read 'assess, document, and communicate to the anesthesia professional' are usually correct.