LATEST NR 324 ADULT HEALTH I:
PREOPERATIVE ASSESSMENT EXAM|
COMPLETE QUESTION BANK WITH
CORRECT ANSWERS WITH RATIONALES
1. A 65-year-old patient with a history of type 2
diabetes and hypertension is scheduled for a total
knee arthroplasty. The patient's current medications
include metformin, lisinopril, and atorvastatin. The
preoperative assessment reveals a blood glucose
level of 210 mg/dL. Which of the following is the most
appropriate preoperative intervention for this
patient?
A) Hold metformin for 24 hours prior to surgery
B) Administer regular insulin per sliding scale
C) Continue metformin as scheduled
D) Administer oral glucose solution
Answer: A
Rationale: Metformin should be held for 24-48 hours
before surgery to reduce the risk of lactic acidosis,
especially in patients with renal impairment or
undergoing major surgery.
,2. A patient is scheduled for an elective
cholecystectomy. During the preoperative
assessment, the patient reports a history of a
previous allergic reaction to penicillin. Which of the
following is the most appropriate action?
A) Document the allergy and administer cefazolin as
prophylactic antibiotic
B) Document the allergy and administer vancomycin
as prophylactic antibiotic
C) Administer penicillin and monitor for reaction
D) Withhold prophylactic antibiotics
Answer: B
Rationale: Patients with a penicillin allergy should
receive an alternative prophylactic antibiotic, such as
vancomycin, to prevent surgical site infections.
3. A 72-year-old patient is scheduled for a hip
replacement. The patient reports taking warfarin for
atrial fibrillation. The patient's international
normalized ratio (INR) is 3.2. Which of the following is
the most appropriate preoperative management for
this patient's anticoagulation?
A) Continue warfarin at the current dose
B) Hold warfarin for 5 days and bridge with low
molecular weight heparin
,C) Increase the warfarin dose to achieve an INR of
4.0
D) Administer fresh frozen plasma preoperatively
Answer: B
Rationale: Warfarin should be held for 5 days prior to
surgery to allow the INR to normalize. Bridging with
low molecular weight heparin is indicated for patients
at high risk for thromboembolism.
4. A patient is scheduled for a colonoscopy with
polypectomy. The patient is currently taking
clopidogrel for a history of coronary stent placement.
Which of the following is the most appropriate
recommendation for clopidogrel management?
A) Continue clopidogrel throughout the perioperative
period
B) Hold clopidogrel 5 days prior to the procedure
C) Hold clopidogrel 24 hours prior to the procedure
D) Replace clopidogrel with aspirin
Answer: B
Rationale: Clopidogrel should be held for 5 days
before a procedure with a high risk of bleeding, such
as polypectomy, to reduce bleeding risk.
, 5. A 55-year-old patient with a history of obstructive
sleep apnea is scheduled for bariatric surgery. The
preoperative assessment reveals a body mass index
(BMI) of 42 kg/m². Which of the following is the most
important preoperative intervention for this patient?
A) Prescribe a low-calorie diet for 2 weeks before
surgery
B) Administer continuous positive airway pressure
(CPAP) preoperatively
C) Start an exercise program 4 weeks before surgery
D) Administer preoperative steroids
Answer: B
Rationale: Patients with obstructive sleep apnea
should use CPAP preoperatively to optimize
respiratory function and reduce the risk of
postoperative complications.
6. A 68-year-old patient is scheduled for a coronary
artery bypass grafting (CABG). The preoperative
assessment reveals a serum creatinine level of 2.0
mg/dL. Which of the following is the most appropriate
preoperative intervention?
A) Administer intravenous fluids to maintain
hydration
B) Prescribe oral N-acetylcysteine
PREOPERATIVE ASSESSMENT EXAM|
COMPLETE QUESTION BANK WITH
CORRECT ANSWERS WITH RATIONALES
1. A 65-year-old patient with a history of type 2
diabetes and hypertension is scheduled for a total
knee arthroplasty. The patient's current medications
include metformin, lisinopril, and atorvastatin. The
preoperative assessment reveals a blood glucose
level of 210 mg/dL. Which of the following is the most
appropriate preoperative intervention for this
patient?
A) Hold metformin for 24 hours prior to surgery
B) Administer regular insulin per sliding scale
C) Continue metformin as scheduled
D) Administer oral glucose solution
Answer: A
Rationale: Metformin should be held for 24-48 hours
before surgery to reduce the risk of lactic acidosis,
especially in patients with renal impairment or
undergoing major surgery.
,2. A patient is scheduled for an elective
cholecystectomy. During the preoperative
assessment, the patient reports a history of a
previous allergic reaction to penicillin. Which of the
following is the most appropriate action?
A) Document the allergy and administer cefazolin as
prophylactic antibiotic
B) Document the allergy and administer vancomycin
as prophylactic antibiotic
C) Administer penicillin and monitor for reaction
D) Withhold prophylactic antibiotics
Answer: B
Rationale: Patients with a penicillin allergy should
receive an alternative prophylactic antibiotic, such as
vancomycin, to prevent surgical site infections.
3. A 72-year-old patient is scheduled for a hip
replacement. The patient reports taking warfarin for
atrial fibrillation. The patient's international
normalized ratio (INR) is 3.2. Which of the following is
the most appropriate preoperative management for
this patient's anticoagulation?
A) Continue warfarin at the current dose
B) Hold warfarin for 5 days and bridge with low
molecular weight heparin
,C) Increase the warfarin dose to achieve an INR of
4.0
D) Administer fresh frozen plasma preoperatively
Answer: B
Rationale: Warfarin should be held for 5 days prior to
surgery to allow the INR to normalize. Bridging with
low molecular weight heparin is indicated for patients
at high risk for thromboembolism.
4. A patient is scheduled for a colonoscopy with
polypectomy. The patient is currently taking
clopidogrel for a history of coronary stent placement.
Which of the following is the most appropriate
recommendation for clopidogrel management?
A) Continue clopidogrel throughout the perioperative
period
B) Hold clopidogrel 5 days prior to the procedure
C) Hold clopidogrel 24 hours prior to the procedure
D) Replace clopidogrel with aspirin
Answer: B
Rationale: Clopidogrel should be held for 5 days
before a procedure with a high risk of bleeding, such
as polypectomy, to reduce bleeding risk.
, 5. A 55-year-old patient with a history of obstructive
sleep apnea is scheduled for bariatric surgery. The
preoperative assessment reveals a body mass index
(BMI) of 42 kg/m². Which of the following is the most
important preoperative intervention for this patient?
A) Prescribe a low-calorie diet for 2 weeks before
surgery
B) Administer continuous positive airway pressure
(CPAP) preoperatively
C) Start an exercise program 4 weeks before surgery
D) Administer preoperative steroids
Answer: B
Rationale: Patients with obstructive sleep apnea
should use CPAP preoperatively to optimize
respiratory function and reduce the risk of
postoperative complications.
6. A 68-year-old patient is scheduled for a coronary
artery bypass grafting (CABG). The preoperative
assessment reveals a serum creatinine level of 2.0
mg/dL. Which of the following is the most appropriate
preoperative intervention?
A) Administer intravenous fluids to maintain
hydration
B) Prescribe oral N-acetylcysteine
