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Santa Clara County Perioperative Nurse
Examination Comprehensive Advanced Practice
Examination: 150 Multiple-Choice Questions
Covering Preoperative Assessment, Intraoperative
Safety, Aseptic Technique, Postoperative Care,
Anesthesia Management, Surgical Instrumentation,
Emergency Response, Legal-Ethical Standards, and
Professional Accountability for Perioperative
Nursing Practice in Santa Clara County Surgical
Settings a well detailed one written
and graded A+ upgraded
SECTION 1: PREOPERATIVE ASSESSMENT AND PATIENT PREPARATION
Question 1
A 72-year-old patient with a history of hypertension, diabetes mellitus type 2, and chronic
kidney disease stage 3 is scheduled for an elective cholecystectomy. Which preoperative
laboratory value should the perioperative nurse prioritize for reporting to the anesthesia
provider before surgery?
, 2
A. Hemoglobin 11.2 g/dL
B. Serum potassium 5.8 mEq/L
C. Blood glucose 168 mg/dL
D. Serum creatinine 1.9 mg/dL
-detailed answer 100% correct :- B
Rationale: Hyperkalemia (potassium >5.5 mEq/L) in a patient with chronic kidney disease poses
significant risk for cardiac dysrhythmias during anesthesia induction and surgery. The serum
potassium of 5.8 mEq/L requires immediate intervention and potential postponement of
surgery. While the other values are abnormal, they do not present the same immediate life-
threatening risk.
Question 2
The perioperative nurse is conducting a preoperative assessment on a patient scheduled for
total knee arthroplasty. The patient reports taking an herbal supplement for joint pain. Which
herbal supplement is MOST concerning due to its antiplatelet effects and risk of increased
bleeding during surgery?
A. Echinacea
B. Garlic
C. St. John's wort
D. Ginseng
-detailed answer 100% correct :- B
Rationale: Garlic has significant antiplatelet activity and can increase bleeding risk during
surgery. Patients should be advised to discontinue garlic supplements at least 7 days before
surgery. Echinacea affects immune function, St. John's wort affects anesthesia metabolism, and
ginseng can cause hypoglycemia and bleeding, but garlic poses the most significant bleeding
risk.
Question 3
A patient scheduled for an abdominal hysterectomy reports a history of malignant hyperthermia
in a family member. Which action should the perioperative nurse take FIRST?
A. Notify the anesthesia provider immediately
B. Document the finding in the patient's chart
, 3
C. Ask the patient about personal history of adverse reactions to anesthesia
D. Prepare dantrolene sodium for intraoperative availability
-detailed answer 100% correct :- A
Rationale: Malignant hyperthermia is a life-threatening genetic disorder with autosomal
dominant inheritance. The anesthesia provider must be notified immediately to plan for a
trigger-free anesthetic using non-triggering agents and to ensure dantrolene is readily available.
While documentation, history-taking, and preparation are important, immediate notification of
the anesthesia team is the priority.
Question 4
What is the PRIMARY purpose of the preoperative nursing assessment?
A. To obtain the patient's surgical history
B. To identify risk factors and plan interventions to reduce surgical complications
C. To complete required hospital paperwork
D. To establish a therapeutic nurse-patient relationship
-detailed answer 100% correct :- B
Rationale: The primary goal of preoperative nursing assessment is to identify risk factors and
develop a plan of care to minimize surgical complications. While obtaining history, completing
paperwork, and establishing rapport are components of the assessment, the fundamental
purpose is risk identification and intervention planning to promote optimal patient outcomes.
Question 5
A patient presents for surgery with a signed informed consent form. The patient now states,
"I'm not sure I understand what they're going to do to me." What is the nurse's BEST action?
A. Explain the procedure to the patient in simple terms
B. Contact the surgeon to review the procedure with the patient again
C. Have the patient sign a new consent form
D. Proceed with surgery as the consent is already signed
-detailed answer 100% correct :- B
Rationale: Informed consent requires that the patient fully understands the procedure, risks,
benefits, and alternatives. The surgeon is legally responsible for obtaining informed consent and
providing procedure-specific information. If the patient expresses uncertainty or lack of
, 4
understanding, the nurse must notify the surgeon to revisit the discussion. The nurse should not
provide medical information beyond the nursing scope or proceed without ensuring patient
understanding.
Question 6
Which preoperative medication order should the nurse question for a patient scheduled for
surgery?
A. Metoprolol 25 mg PO
B. Lisinopril 10 mg PO
C. Insulin glargine 20 units SQ
D. Albuterol inhaler 2 puffs
-detailed answer 100% correct :- B
Rationale: ACE inhibitors such as lisinopril are often held 24 hours before surgery due to the risk
of intraoperative hypotension. Beta-blockers (metoprolol) are typically continued, insulin is
often held or adjusted per sliding scale, and bronchodilators are continued. The nurse should
verify this order with the provider.
Question 7
During the preoperative interview, the patient reports using a continuous positive airway
pressure (CPAP) machine for obstructive sleep apnea. Which assessment finding is MOST
concerning?
A. Body mass index of 32
B. Neck circumference of 18 inches
C. Mallampati score of IV
D. History of snoring
-detailed answer 100% correct :- C
Rationale: A Mallampati score of IV indicates the hardest airway to manage, with only the soft
palate visible. This significantly increases the risk of difficult intubation and airway complications
during anesthesia induction. While obesity, large neck circumference, and snoring are risk
factors for sleep apnea, a Mallampati IV represents the most immediate airway management
concern.
Santa Clara County Perioperative Nurse
Examination Comprehensive Advanced Practice
Examination: 150 Multiple-Choice Questions
Covering Preoperative Assessment, Intraoperative
Safety, Aseptic Technique, Postoperative Care,
Anesthesia Management, Surgical Instrumentation,
Emergency Response, Legal-Ethical Standards, and
Professional Accountability for Perioperative
Nursing Practice in Santa Clara County Surgical
Settings a well detailed one written
and graded A+ upgraded
SECTION 1: PREOPERATIVE ASSESSMENT AND PATIENT PREPARATION
Question 1
A 72-year-old patient with a history of hypertension, diabetes mellitus type 2, and chronic
kidney disease stage 3 is scheduled for an elective cholecystectomy. Which preoperative
laboratory value should the perioperative nurse prioritize for reporting to the anesthesia
provider before surgery?
, 2
A. Hemoglobin 11.2 g/dL
B. Serum potassium 5.8 mEq/L
C. Blood glucose 168 mg/dL
D. Serum creatinine 1.9 mg/dL
-detailed answer 100% correct :- B
Rationale: Hyperkalemia (potassium >5.5 mEq/L) in a patient with chronic kidney disease poses
significant risk for cardiac dysrhythmias during anesthesia induction and surgery. The serum
potassium of 5.8 mEq/L requires immediate intervention and potential postponement of
surgery. While the other values are abnormal, they do not present the same immediate life-
threatening risk.
Question 2
The perioperative nurse is conducting a preoperative assessment on a patient scheduled for
total knee arthroplasty. The patient reports taking an herbal supplement for joint pain. Which
herbal supplement is MOST concerning due to its antiplatelet effects and risk of increased
bleeding during surgery?
A. Echinacea
B. Garlic
C. St. John's wort
D. Ginseng
-detailed answer 100% correct :- B
Rationale: Garlic has significant antiplatelet activity and can increase bleeding risk during
surgery. Patients should be advised to discontinue garlic supplements at least 7 days before
surgery. Echinacea affects immune function, St. John's wort affects anesthesia metabolism, and
ginseng can cause hypoglycemia and bleeding, but garlic poses the most significant bleeding
risk.
Question 3
A patient scheduled for an abdominal hysterectomy reports a history of malignant hyperthermia
in a family member. Which action should the perioperative nurse take FIRST?
A. Notify the anesthesia provider immediately
B. Document the finding in the patient's chart
, 3
C. Ask the patient about personal history of adverse reactions to anesthesia
D. Prepare dantrolene sodium for intraoperative availability
-detailed answer 100% correct :- A
Rationale: Malignant hyperthermia is a life-threatening genetic disorder with autosomal
dominant inheritance. The anesthesia provider must be notified immediately to plan for a
trigger-free anesthetic using non-triggering agents and to ensure dantrolene is readily available.
While documentation, history-taking, and preparation are important, immediate notification of
the anesthesia team is the priority.
Question 4
What is the PRIMARY purpose of the preoperative nursing assessment?
A. To obtain the patient's surgical history
B. To identify risk factors and plan interventions to reduce surgical complications
C. To complete required hospital paperwork
D. To establish a therapeutic nurse-patient relationship
-detailed answer 100% correct :- B
Rationale: The primary goal of preoperative nursing assessment is to identify risk factors and
develop a plan of care to minimize surgical complications. While obtaining history, completing
paperwork, and establishing rapport are components of the assessment, the fundamental
purpose is risk identification and intervention planning to promote optimal patient outcomes.
Question 5
A patient presents for surgery with a signed informed consent form. The patient now states,
"I'm not sure I understand what they're going to do to me." What is the nurse's BEST action?
A. Explain the procedure to the patient in simple terms
B. Contact the surgeon to review the procedure with the patient again
C. Have the patient sign a new consent form
D. Proceed with surgery as the consent is already signed
-detailed answer 100% correct :- B
Rationale: Informed consent requires that the patient fully understands the procedure, risks,
benefits, and alternatives. The surgeon is legally responsible for obtaining informed consent and
providing procedure-specific information. If the patient expresses uncertainty or lack of
, 4
understanding, the nurse must notify the surgeon to revisit the discussion. The nurse should not
provide medical information beyond the nursing scope or proceed without ensuring patient
understanding.
Question 6
Which preoperative medication order should the nurse question for a patient scheduled for
surgery?
A. Metoprolol 25 mg PO
B. Lisinopril 10 mg PO
C. Insulin glargine 20 units SQ
D. Albuterol inhaler 2 puffs
-detailed answer 100% correct :- B
Rationale: ACE inhibitors such as lisinopril are often held 24 hours before surgery due to the risk
of intraoperative hypotension. Beta-blockers (metoprolol) are typically continued, insulin is
often held or adjusted per sliding scale, and bronchodilators are continued. The nurse should
verify this order with the provider.
Question 7
During the preoperative interview, the patient reports using a continuous positive airway
pressure (CPAP) machine for obstructive sleep apnea. Which assessment finding is MOST
concerning?
A. Body mass index of 32
B. Neck circumference of 18 inches
C. Mallampati score of IV
D. History of snoring
-detailed answer 100% correct :- C
Rationale: A Mallampati score of IV indicates the hardest airway to manage, with only the soft
palate visible. This significantly increases the risk of difficult intubation and airway complications
during anesthesia induction. While obesity, large neck circumference, and snoring are risk
factors for sleep apnea, a Mallampati IV represents the most immediate airway management
concern.
