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CSFA practice questions

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Question 1Preoperative Preparation and Patient Care

For an adult undergoing elective surgery, what is the minimum fasting interval for clear liquids before induction of anesthesia?

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

Explanation

Current anesthesia guidelines allow clear liquids up to 2 hours before elective anesthesia for adults. Longer intervals are required for breast milk and light meals. Prolonged fasting is discouraged because it causes dehydration and patient discomfort.

Question 2Preoperative Preparation and Patient Care

Which pair of identifiers is acceptable for verifying a patient's identity before surgery?

  1. Insurance number and admission date
  2. Full name and date of birth Correct answer.
  3. Room number and bed assignment
  4. Surgical procedure and diagnosis

Explanation

Two independent identifiers, such as full name and date of birth, must be used and matched to the armband and consent. Room or bed location is not a patient identifier. Procedure and diagnosis are not reliable identifiers because they may be incorrect.

Question 3Preoperative Preparation and Patient Care

Who is responsible for marking the surgical site before the patient enters the operating room?

  1. Operating surgeon Correct answer.
  2. Surgical first assistant
  3. Circulating nurse
  4. Anesthesia provider

Explanation

The operating surgeon marks the site, usually with the patient involved when possible. Marking is part of the Universal Protocol and must remain visible after prepping and draping. Other team members verify the mark but do not create it.

Question 4Preoperative Preparation and Patient Care

Which method of preoperative hair removal is associated with the lowest risk of surgical site infection?

  1. Clipping hair immediately before the incision Correct answer.
  2. Waxing the site in the preoperative holding area
  3. Applying depilatory cream 24 hours before
  4. Shaving with a disposable razor the night before

Explanation

Clipping immediately before surgery causes fewer skin micro-abrasions than shaving and is preferred when hair removal is necessary. Shaving the night before allows bacteria to colonize the abrasions. Depilatory creams and waxing can irritate or traumatize the skin.

Question 5Preoperative Preparation and Patient Care

For most procedures, prophylactic antibiotics should be fully infused within what time frame before the surgical incision?

  1. 24 hours
  2. 60 minutes Correct answer.
  3. 2 hours
  4. 4 hours

Explanation

Prophylactic antibiotics are usually given within 60 minutes before incision so tissue levels peak at the time of incision. Vancomycin and fluoroquinolones require a 120-minute window because of longer infusion times. Giving antibiotics too early allows levels to fall before incision.

Question 6Preoperative Preparation and Patient Care

Who may provide informed consent for a minor undergoing elective surgery?

  1. Parent or legal guardian Correct answer.
  2. The patient if over 16 years old
  3. The surgeon on the patient's behalf
  4. The circulating nurse as witness

Explanation

A minor generally cannot legally consent to surgery; consent is obtained from a parent or legal guardian unless an exception such as emancipation applies. A witness only attests to the signature. The surgeon must obtain consent rather than grant it for the patient.

Question 7Preoperative Preparation and Patient Care

Which preoperative laboratory test best reflects long-term glycemic control in a patient with diabetes?

  1. Blood urea nitrogen
  2. Fasting plasma glucose
  3. Hemoglobin A1c Correct answer.
  4. Serum potassium

Explanation

Hemoglobin A1c reflects average glucose over roughly the previous 2 to 3 months and helps estimate perioperative risk. Fasting glucose shows only a single point in time. Potassium and BUN reflect electrolyte and renal status rather than glycemic control.

Question 8Preoperative Preparation and Patient Care

Which preoperative measure is appropriate for a patient with a history of venous thromboembolism undergoing major abdominal surgery?

  1. Aspirin 81 mg daily as the only prophylaxis
  2. No prophylaxis unless the patient develops symptoms
  3. Early ambulation alone
  4. Pharmacologic plus mechanical prophylaxis as ordered Correct answer.

Explanation

High-risk patients generally receive combined pharmacologic and mechanical prophylaxis, with timing individualized by bleeding risk. Prophylaxis is started before or shortly after surgery per protocol. Waiting for symptoms ignores prevention and increases morbidity.

Question 9Preoperative Preparation and Patient Care

A patient with a severe documented latex allergy is scheduled for surgery. Which preoperative action is most appropriate?

  1. Use standard latex gloves but double-glove
  2. Schedule the patient as the first case of the day Correct answer.
  3. Remove latex items only after induction
  4. Place the patient in the general holding area with other patients

Explanation

Latex-allergic patients are often scheduled first to allow a latex-safe environment before airborne latex particles accumulate. The operating room should be cleared of latex-containing supplies. Double-gloving does not prevent latex exposure.

Question 10Preoperative Preparation and Patient Care

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

  1. Check INR and follow the bridging plan Correct answer.
  2. Double the dose the night before surgery
  3. Give vitamin K routinely on the morning of surgery
  4. Continue warfarin at the usual dose

Explanation

Warfarin is usually held before elective surgery, and the INR is checked to guide reversal or bridging. The plan depends on the procedure's bleeding risk and the patient's thrombotic risk. Routine vitamin K can cause rebound thrombosis and is not given without a plan.

Question 11Preoperative Preparation and Patient Care

Which preoperative skin cleansing instruction is recommended to reduce surgical site infection?

  1. Take a shower using only plain soap on the morning of surgery
  2. Apply isopropyl alcohol to the surgical site the night before
  3. Chlorhexidine shower the night before and morning of surgery Correct answer.
  4. Shave the site and apply a moisturizing lotion before surgery

Explanation

Chlorhexidine gluconate showers the night before and the morning of surgery reduce skin bacterial counts when used according to protocol. Alcohol at home is drying and flammable. Shaving and lotion increase skin irritation and bacterial colonization.

Question 12Preoperative Preparation and Patient Care

At what point should the surgical time-out be performed?

  1. Just before the incision Correct answer.
  2. At the end of the procedure
  3. After the incision is made
  4. During preoperative holding

Explanation

The time-out occurs immediately before incision with the entire team present to confirm patient, procedure, site, and special requirements. It is the final safety check after prep and draping. Holding-area verification occurs earlier and does not replace the time-out.

Question 13Preoperative Preparation and Patient Care

To reduce pulmonary complications, how long before elective surgery should a patient ideally stop smoking?

  1. At least 24 hours
  2. At least 4 weeks Correct answer.
  3. No cessation is needed if a nicotine patch is used
  4. At least 3 days

Explanation

Smoking cessation at least 4 weeks before surgery improves mucociliary clearance and reduces pulmonary complications. Longer cessation is better, but even short-term cessation has some benefit. Nicotine replacement does not eliminate smoke-related risk.

Question 14Preoperative Preparation and Patient Care

Which preoperative action is correct for a patient wearing dentures and a necklace?

  1. Leave both in place until anesthesia induction in the OR
  2. Tape the jewelry securely to the skin with medical tape
  3. Remove dentures and jewelry before transfer to the OR Correct answer.
  4. Remove only the necklace

Explanation

Dentures can obstruct the airway and jewelry can cause pressure injury or burns from electrocautery, so both are removed before transfer. Valuables are documented and secured. Retained dentures can dislodge during induction.

Question 15Preoperative Preparation and Patient Care

What does an ASA physical status classification of III indicate?

  1. A moribund patient not expected to survive
  2. A normal healthy patient
  3. Severe systemic disease Correct answer.
  4. Mild systemic disease

Explanation

ASA III describes severe systemic disease that is not incapacitating and limits activity. ASA I is healthy, II is mild systemic disease, and IV is incapacitating disease. ASA V is a moribund patient not expected to survive.

Question 16Preoperative Preparation and Patient Care

Which element is essential for valid surgical informed consent?

  1. A family member's verbal agreement
  2. Written insurance authorization for the procedure
  3. Discussion of risks, benefits, alternatives Correct answer.
  4. A nurse's signature as a witness alone

Explanation

Valid informed consent requires the patient to understand the diagnosis, procedure, risks, benefits, and alternatives and to consent voluntarily. A witness signature only documents the process. Insurance authorization is administrative, not consent.

Question 17Preoperative Preparation and Patient Care

Which preoperative blood glucose target is generally appropriate for a patient with diabetes undergoing surgery?

  1. 200 to 250 mg/dL
  2. Less than 50 mg/dL
  3. Above 300 mg/dL
  4. Less than 180 mg/dL Correct answer.

Explanation

Perioperative glucose is commonly kept below about 180 mg/dL to reduce infection and wound complications while avoiding hypoglycemia. Tight control below 110 mg/dL has not shown benefit and increases hypoglycemia risk. Marked hyperglycemia and hypoglycemia are both unsafe.

Question 18Preoperative Preparation and Patient Care

A patient has an active herpes simplex lesion near the planned incision site. What is the most appropriate preoperative action?

  1. Notify the surgeon; postponement may be needed Correct answer.
  2. Apply antibiotic ointment and proceed
  3. Proceed and cover the lesion with a sterile drape
  4. Mark the site through the lesion

Explanation

Active skin infection near the surgical site increases contamination risk and may require postponement until resolved. The surgeon makes the final decision after assessment. Draping does not eliminate contamination.

Question 19Preoperative Preparation and Patient Care

Which elements make up the Universal Protocol for preventing wrong-site surgery?

  1. History and physical, laboratory tests, and ECG
  2. Anesthesia clearance, NPO status, and IV access
  3. Consent, shaving, and prophylactic antibiotics
  4. Verification, site marking, and time-out Correct answer.

Explanation

The Universal Protocol consists of preoperative verification, marking of the operative site, and a time-out before the procedure. These steps are required for all invasive procedures. Consent, shaving, and antibiotics are perioperative tasks but are not the Universal Protocol.

Question 20Preoperative Preparation and Patient Care

Which statement reflects appropriate preoperative urinary catheter use?

  1. Catheters are preferred over voiding for short procedures
  2. Limit catheterization to specific indications Correct answer.
  3. Catheters should be placed in the holding area for all cases
  4. Every surgical patient should receive a catheter

Explanation

Urinary catheters are placed only when indicated, such as long procedures, urologic surgery, or monitoring of output, because they increase the risk of infection. Routine catheterization is discouraged. Short procedures usually do not require a catheter.

Question 21Preoperative Preparation and Patient Care

A serum albumin of 2.8 g/dL in a patient scheduled for major surgery most likely indicates which condition?

  1. A normal nutritional status with no added risk
  2. Malnutrition with impaired wound healing Correct answer.
  3. Enhanced wound healing from improved protein intake
  4. Dehydration as the only explanation for the value

Explanation

Albumin below about 3.0 g/dL suggests malnutrition and is associated with impaired healing, infection, and prolonged recovery. Preoperative nutritional optimization may be needed. Normal albumin is roughly 3.5 to 5.0 g/dL.

Question 22Preoperative Preparation and Patient Care

A patient taking a chronic beta-blocker for coronary artery disease is scheduled for surgery. What is the recommended preoperative management?

  1. Hold the beta-blocker until postoperative day 2
  2. Continue the beta-blocker perioperatively Correct answer.
  3. Stop the beta-blocker 24 hours before surgery
  4. Replace it with a calcium channel blocker

Explanation

Chronic beta-blockers should generally be continued perioperatively to avoid rebound tachycardia, hypertension, and myocardial ischemia. Abrupt withdrawal can precipitate cardiac events. Calcium channel blockers are not an automatic substitute.

Question 23Preoperative Preparation and Patient Care

Which preoperative measure helps prevent both surgical site infection and coagulopathy?

  1. Maintaining normothermia with active warming Correct answer.
  2. Active warming only after induction
  3. Withholding blankets until the incision
  4. Keeping the operating room cold to limit bacterial growth

Explanation

Perioperative hypothermia impairs immune function, reduces wound perfusion, and interferes with clotting. Active warming beginning in the preoperative phase helps maintain normothermia. Cold rooms promote hypothermia and do not reduce infection.

Question 24Preoperative Preparation and Patient Care

A patient with diabetes who takes long-acting insulin is scheduled for morning surgery. Which preoperative plan is most appropriate?

  1. Take the full usual dose despite NPO status
  2. Double the dose the night before
  3. Follow an individualized reduced-dose plan Correct answer.
  4. Skip all insulin until discharge

Explanation

Long-acting insulin is usually reduced or held on the morning of surgery, with the plan individualized by anesthesia and the surgeon based on glucose and type of surgery. Glucose is monitored perioperatively. Full dosing during fasting risks hypoglycemia.

Question 25Preoperative Preparation and Patient Care

A patient with a do-not-resuscitate order is scheduled for elective surgery. Which preoperative action is most appropriate?

  1. Discuss and document the perioperative plan for the DNR order Correct answer.
  2. Have a family member sign a waiver before surgery
  3. Automatically suspend the DNR order in the operating room without discussion
  4. Cancel surgery for all patients with DNR orders

Explanation

DNR orders are reviewed before surgery, and the patient, family, and team agree on which interventions will be used perioperatively. The plan is documented in the record. Automatic suspension without discussion disregards patient autonomy.

Question 26Preoperative Preparation and Patient Care

According to standard fasting guidelines for elective surgery, how long before induction must a patient abstain from clear liquids?

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

Explanation

Standard fasting guidance permits clear liquids up to 2 hours before induction because they empty from the stomach rapidly. Breast milk requires 4 hours and a light meal 6 hours, with longer intervals for fatty meals. Prolonged clear-liquid fasting offers no added safety and worsens dehydration and patient comfort.

Question 27Preoperative Preparation and Patient Care

Which method of hair removal at the surgical site is preferred when hair must be removed?

  1. Clipping with electric clippers just before surgery Correct answer.
  2. Waxing the site in the preoperative area
  3. Shaving with a razor the night before surgery
  4. Depilatory cream the evening before surgery

Explanation

Clipping immediately before the incision causes fewer microscopic skin injuries than shaving and therefore lowers surgical site infection risk. Razor shaving the night before creates abrasions that harbor bacteria as they multiply overnight. Depilatory creams may cause chemical irritation and are not used near the operative field.

Question 28Preoperative Preparation and Patient Care

For most surgical procedures, prophylactic antibiotics should be fully infused within which window before the incision?

  1. Within 12 hours before incision
  2. Within 4 hours before incision
  3. Within 60 minutes before incision Correct answer.
  4. Within 24 hours before incision

Explanation

Prophylactic antimicrobials must achieve adequate tissue levels at the moment of incision, which for most agents means completing the infusion within 60 minutes beforehand. Dosing earlier provides no benefit and promotes resistance, while dosing after incision misses the critical contamination window. Agents such as vancomycin that require longer infusions are started within about 120 minutes.

Question 29Preoperative Preparation and Patient Care

An alcohol-based preoperative skin antiseptic has been applied. What should happen before drapes are placed?

  1. The area is wiped with saline to remove residue
  2. Drapes are applied while the skin is still wet
  3. The area is blotted dry with a sterile towel
  4. The solution is allowed to dry completely Correct answer.

Explanation

Alcohol-based antiseptics must be allowed to dry on the skin to achieve full antimicrobial kill and to eliminate flammable vapor. Blotting or wiping removes the active agent before it works, and draping over wet solution traps vapor near ignition sources. Drying time is a documented fire-safety step as well as an infection-prevention step.

Question 30Preoperative Preparation and Patient Care

Which practice correctly verifies patient identity before surgery?

  1. Using two independent identifiers such as name and birth date Correct answer.
  2. Matching the chart against the assigned room number
  3. Asking the patient to state their full name and date of birth only
  4. Confirming identity with family in the waiting room

Explanation

Two independent identifiers, neither of which is a room or bed number, must be used and actively confirmed with the patient when possible. Verbal confirmation plus a wristband check prevents wrong-patient errors. Room numbers and family reports are not acceptable substitutes.

Question 31Preoperative Preparation and Patient Care

A patient scheduled for a long open abdominal procedure arrives in the preoperative holding area. Which measure best supports maintenance of normothermia?

  1. Applying a warmed blanket only after induction
  2. Initiating active forced-air warming before induction Correct answer.
  3. Infusing room-temperature intravenous fluids rapidly
  4. Raising the room temperature to 30 degrees Celsius

Explanation

Prewarming before induction reduces the initial heat loss that occurs with anesthesia-induced vasodilation and redistribution. Active warming started after induction allows core temperature to fall first and is harder to correct. Warm ambient air alone and cool intravenous fluids do not prevent the drop.

Question 32Preoperative Preparation and Patient Care

A patient scheduled for surgery reports daily use of ginkgo biloba and high-dose garlic. What is the most appropriate preoperative response?

  1. Stop them only on the morning of surgery
  2. Continue them unchanged through the day of surgery
  3. Replace them with a standard multivitamin
  4. Stop them about 1 to 2 weeks before surgery Correct answer.

Explanation

Ginkgo, garlic, ginseng, ginger, fish oil, and high-dose vitamin E can potentiate bleeding through antiplatelet or anticoagulant effects. They are typically discontinued 1 to 2 weeks before elective surgery so that effect wears off. Stopping only on the day of surgery leaves the pharmacologic effect present at the time of incision.

Question 33Preoperative Preparation and Patient Care

Which statement about preoperative oral carbohydrate loading within an enhanced recovery protocol is correct?

  1. It is given to every patient regardless of diabetes or glycemic control
  2. It replaces the need for prophylactic antibiotics
  3. It is a clear carbohydrate drink given about 2 hours preoperatively Correct answer.
  4. It must be given together with a large volume of milk

Explanation

Carbohydrate loading uses a clear, rapidly emptying drink typically given about 2 hours before surgery to reduce insulin resistance and preoperative thirst. Because it is a clear liquid, it is compatible with standard fasting limits for clear fluids. It is used selectively, not in every patient, and has no antimicrobial effect.

Question 34Preoperative Preparation and Patient Care

Which preoperative medication is commonly ordered for an anxious adult with no contraindications?

  1. Oral potassium chloride
  2. Intravenous furosemide
  3. Oral midazolam Correct answer.
  4. Regular insulin sliding scale

Explanation

Benzodiazepines such as midazolam provide anxiolysis and light sedation with a rapid onset and are the standard preoperative anxiolytic. Insulin, potassium, and diuretics are given for specific metabolic indications, not for anxiety. Any sedative premedication still requires monitoring of oxygenation and ventilation.

Question 35Preoperative Preparation and Patient Care

Which patient should have a pregnancy test before elective surgery according to common policy?

  1. A patient who reports regular monthly menses
  2. A 28-year-old with an uncertain last period Correct answer.
  3. Only patients who request the test
  4. A postmenopausal patient aged 62 years

Explanation

Pregnancy testing is indicated when the history is uncertain, menses are missed or irregular, or the patient cannot reliably report status, because anesthesia and surgery pose fetal risk. Reporting regular menses does not exclude early pregnancy. Testing is policy-driven rather than patient-requested.

Question 36Preoperative Preparation and Patient Care

Which preoperative teaching best helps prevent postoperative pulmonary complications?

  1. Practicing incentive spirometry and coughing Correct answer.
  2. Splinting the abdomen with a pillow only at night
  3. Limiting oral fluids after surgery
  4. Avoiding all activity for the first week

Explanation

Teaching deep breathing, incentive spirometry, and effective coughing before surgery gives patients the skills to expand the lungs and clear secretions afterward. Early ambulation and adequate hydration further reduce atelectasis and pneumonia. Immobility and restricted fluids promote secretions and complications.

Question 37Preoperative Preparation and Patient Care

A patient reports a documented chlorhexidine allergy. Which preoperative skin antiseptic is the most appropriate alternative for most procedures?

  1. Chlorhexidine-alcohol at half strength
  2. Sterile water irrigation alone
  3. An iodine-based preparation such as povidone-iodine Correct answer.
  4. Isopropyl alcohol without any other agent

Explanation

When chlorhexidine allergy is documented, an iodine-based antiseptic is the standard substitute because it provides broad-spectrum antimicrobial activity. Diluting the allergen does not prevent an allergic reaction. Water alone is not antiseptic, and plain alcohol lacks the residual activity of a formulated surgical preparation.

Question 38Preoperative Preparation and Patient Care

A preoperative baseline set of vital signs is being recorded. Which finding should be reported to the surgeon and anesthesia team before transport to the operating room?

  1. Temperature 36.5 C, pulse 88, blood pressure 118/70
  2. Temperature 36.8 C, pulse 78, blood pressure 122/76
  3. Temperature 38.4 C, pulse 104, blood pressure 100/60 Correct answer.
  4. Temperature 36.6 C, pulse 70, blood pressure 130/80

Explanation

Fever combined with tachycardia and hypotension suggests an active infection or hypovolemia and may warrant postponing elective surgery. Baseline values falling outside expected ranges must be communicated rather than simply documented. Normal temperature, pulse, and blood pressure readings do not require escalation.

Question 39Preoperative Preparation and Patient Care

A patient with an implanted cardioverter-defibrillator is scheduled for an elective abdominal procedure using monopolar electrocautery. Which preoperative action is most important?

  1. Arrange device interrogation and reprogramming preoperatively Correct answer.
  2. Discontinue antiarrhythmics 48 hours before surgery
  3. Obtain a chest radiograph on the morning of surgery
  4. Place a magnet over the device in the holding area

Explanation

Electromagnetic interference from monopolar cautery can inhibit or inappropriately trigger an implanted defibrillator, so the device is interrogated and typically reprogrammed with tachycardia therapies suspended before the case. A magnet applied ad hoc does not replace interrogation and does not protect against all interference. Antiarrhythmic therapy is continued, and a radiograph is irrelevant to interference risk.

Question 40Preoperative Preparation and Patient Care

A patient with a colostomy is scheduled for surgery. Which preoperative measure is appropriate?

  1. Place the return electrode over the stoma
  2. Empty and secure the pouch and assess peristomal skin Correct answer.
  3. Routinely remove the appliance in the holding area
  4. Cancel the case because of the stoma

Explanation

An ostomy does not contraindicate surgery; the pouch is emptied and sealed to prevent leakage during transfer and positioning, and the surrounding skin is inspected for breakdown. The appliance is usually left in place until the operative field is prepared. Return electrodes are never placed over a stoma.

Question 41Preoperative Preparation and Patient Care

Which action is correct regarding contact lenses before surgery?

  1. Leave them in place to protect the cornea
  2. Remove them only if the patient wears hard lenses
  3. Remove them and store them with patient belongings Correct answer.
  4. Ask anesthesia to remove them after induction

Explanation

Contact lenses are removed before surgery because they can dry, abrade the cornea, or be dislodged when the eyelids are taped or the patient is positioned. They are stored with the patient's belongings and documented. Removal after induction risks corneal injury while the patient cannot protect the eye.

Question 42Preoperative Preparation and Patient Care

Why is nail polish typically removed from at least one finger before surgery?

  1. It increases the risk of surgical site infection
  2. It is a fire hazard in the operating room
  3. It interferes with blood pressure cuff accuracy
  4. It can interfere with pulse oximetry Correct answer.

Explanation

Opaque or dark polish can distort the light transmission used by a pulse oximeter, so at least one digit is left bare for monitoring. Polish on the hands does not affect blood pressure accuracy or create a meaningful fire hazard. It also has no relationship to surgical site infection at the incision.

Question 43Preoperative Preparation and Patient Care

For an elective colorectal resection, which preoperative preparation has been associated with reduced surgical site infection?

  1. Oral antibiotics with mechanical bowel preparation Correct answer.
  2. A clear liquid diet for 24 hours only
  3. No bowel preparation of any kind
  4. Mechanical bowel preparation used by itself

Explanation

Combining oral antimicrobials with mechanical bowel preparation reduces intraluminal bacterial load and has been associated with lower surgical site infection rates in colorectal surgery. Mechanical preparation alone reduces stool volume but not bacterial counts. Diet restriction alone does not decontaminate the colon.

Question 44Preoperative Preparation and Patient Care

A trauma patient arrives with a full stomach and requires emergency surgery. Which preoperative measure best reduces aspiration risk?

  1. Insert a nasogastric tube and proceed as usual
  2. Rapid sequence induction with airway protection Correct answer.
  3. Give oral antacid and wait 30 minutes
  4. Delay surgery until 8 hours have passed

Explanation

When fasting cannot be achieved, the airway is secured rapidly with cricoid pressure and tracheal intubation to prevent gastric contents from entering the lungs. Delaying definitive surgery for fasting is unsafe in an emergent trauma patient. Nasogastric drainage and antacids reduce but do not eliminate aspiration risk.

Question 45Preoperative Preparation and Patient Care

A patient is scheduled for a procedure with a moderate chance of transfusion. Which preoperative order is most appropriate?

  1. Order fresh frozen plasma for all cases
  2. Order a type and screen with a hold on units Correct answer.
  3. Order a full crossmatch of 6 units of packed red cells
  4. Order nothing until blood loss begins

Explanation

A type and screen establishes ABO/Rh status and screens for unexpected antibodies so that crossmatched units can be supplied quickly if needed. Reserving large numbers of crossmatched units for a moderate-risk case wastes a scarce resource. Waiting until hemorrhage begins delays availability.

Question 46Preoperative Preparation and Patient Care

A patient reports that a sibling developed a high fever and muscle rigidity during a previous anesthetic. Which preoperative action is most appropriate?

  1. Notify anesthesia and confirm dantrolene is available Correct answer.
  2. Proceed with the same anesthetic agents and monitor closely
  3. Give a prophylactic antibiotic before induction
  4. Order a routine chest radiograph and proceed

Explanation

A family history of fever with rigidity during anesthesia suggests susceptibility to malignant hyperthermia, so triggering agents are avoided and dantrolene is stocked and verified. Proceeding with the same agents risks a life-threatening hypermetabolic crisis. Antibiotics and radiographs do not address this risk.

Question 47Preoperative Preparation and Patient Care

A patient who takes prednisone 20 mg daily for adrenal insufficiency is scheduled for major surgery. Which preoperative plan is most appropriate?

  1. Stop the steroid 1 week before surgery
  2. Withhold all steroids on the day of surgery
  3. Plan perioperative stress-dose corticosteroid coverage Correct answer.
  4. Give the usual dose and add nothing else

Explanation

Chronic exogenous steroids suppress the adrenal axis, and the stress of major surgery can precipitate adrenal crisis. Additional intravenous hydrocortisone is given perioperatively and tapered back to the maintenance dose. Abrupt withdrawal risks hypotension and cardiovascular collapse.

Question 48Preoperative Preparation and Patient Care

Which finding most strongly suggests a patient is at elevated risk for obstructive sleep apnea and perioperative respiratory complications?

  1. Body mass index of 22 with a 30-year smoking history
  2. Fasting glucose of 95 mg/dL
  3. Controlled hypertension with no other symptoms
  4. Witnessed apneas with a Mallampati score of III Correct answer.

Explanation

Witnessed apneas, loud snoring, and a high Mallampati score are established screening features for obstructive sleep apnea and predict difficult mask ventilation and postoperative desaturation. These patients require closer monitoring and thoughtful opioid and sedative dosing. Isolated hypertension or normal glucose does not carry the same weight.

Question 49Preoperative Preparation and Patient Care

A patient with a known history of MRSA colonization is scheduled for elective joint replacement. Which preoperative measure is appropriate?

  1. A single dose of vancomycin for all patients
  2. No additional measures beyond routine skin prep
  3. Cancellation of surgery until cultures are negative
  4. Mupirocin nasal decolonization plus chlorhexidine bathing Correct answer.

Explanation

For known MRSA carriers undergoing implant surgery, nasal mupirocin and chlorhexidine bathing before the procedure reduce the bioburden and associated periprosthetic infection risk. Routine prep alone does not address nasal carriage. Universal vancomycin is not appropriate and chronic colonization does not require cancellation.

Question 50Preoperative Preparation and Patient Care

Which electrolyte abnormality is the greatest immediate preoperative concern in a patient receiving chronic hemodialysis who is scheduled for elective surgery?

  1. Hyperkalemia Correct answer.
  2. Hypochloremia
  3. Hypercalcemia
  4. Hypophosphatemia

Explanation

Patients on chronic dialysis are at risk for potassium accumulation between sessions, and hyperkalemia can precipitate lethal ventricular arrhythmias with induction and succinylcholine. Surgery is therefore timed in relation to dialysis and potassium is reviewed immediately before the case. The other listed abnormalities are less acutely life-threatening.