CPAN Paranesthesia Nursing Certification Exam 2026:
Comprehensive Professional Practice Test — Preoperative
Assessment, Anaesthesia, Postanesthetic Recovery, Pain
Management, Complications & Patient Safety — 190 Multiple-Choice
Questions with Answers & Detailed Rationales
Section 1: Preoperative Assessment and Patient Preparation
Question 1
A 68-year-old patient scheduled for elective knee arthroplasty reports taking ginkgo biloba
daily for memory support. Which assessment finding is the priority concern for the
perianesthesia nurse?
A. Potential for increased blood pressure during surgery
B. Risk of prolonged bleeding and hematoma formation
C. Increased risk of malignant hyperthermia
D. Potential for severe postoperative nausea and vomiting
Correct Answer: B
Explanation: Ginkgo biloba inhibits platelet aggregation and can increase bleeding risk.
Discontinue 7 days before surgery to prevent hemorrhagic complications.
Question 2
During preoperative assessment, a patient with a BMI of 42 and known obstructive sleep
apnea states he uses his CPAP machine every night. What is the most important
perioperative consideration?
A. The patient can discontinue CPAP use immediately after surgery
,B. The patient should bring his CPAP machine to the surgical facility
C. CPAP is contraindicated during the postoperative period
D. The patient requires a preoperative sleep study before clearance
Correct Answer: B
Explanation: Patients should bring their own CPAP devices to maintain airway patency
postoperatively. OSA patients are opioid-sensitive and require extended monitoring.
Question 3
A 72-year-old patient on chronic warfarin therapy for atrial fibrillation presents for
colonoscopy. The patient's INR is 2.8. What is the perianesthesia nurse's priority action?
A. Proceed with the procedure as scheduled
B. Administer vitamin K 10 mg IV immediately
C. Notify the anesthesia provider and proceduralist
D. Place the patient in Trendelenburg position
Correct Answer: C
Explanation: An elevated INR indicates coagulopathy and increased bleeding risk. The
procedural team must determine whether to postpone or adjust therapy.
Question 4
A patient reports a family history of malignant hyperthermia. Which anesthetic agent should
the perianesthesia nurse anticipate will be avoided?
,A. Propofol
B. Remifentanil
C. Succinylcholine
D. Rocuronium
Correct Answer: C
Explanation: Succinylcholine and volatile anesthetics are triggering agents for MH. Non-
triggering agents include propofol, opioids, and non-depolarizing muscle relaxants.
Question 5
A 45-year-old patient with type 2 diabetes is scheduled for surgery at 10:00 AM. The patient
took half the usual dose of glargine insulin this morning. The patient's blood glucose is 142
mg/dL. What is the priority nursing action?
A. Administer the remaining glargine dose immediately
B. Document the glucose value and proceed with surgery
C. Hold all insulin and notify the anesthesia provider
D. Initiate a 10% dextrose infusion
Correct Answer: B
Explanation: A glucose of 142 mg/dL is acceptable for surgery. Split-dose glargine is standard
practice to prevent intraoperative hypoglycemia while maintaining basal control.
Question 6
, A patient reports taking St. John's wort for depression. Which perioperative risk is most
concerning?
A. Hypertensive crisis
B. Prolonged neuromuscular blockade
C. Increased risk of serotonin syndrome
D. Severe hypotension
Correct Answer: C
Explanation: St. John's wort has serotonergic activity. Combined with other serotonergic
agents in the perioperative period, it increases serotonin syndrome risk.
Question 7
During preoperative assessment, a patient with a history of pseudocholinesterase deficiency
asks why this matters for anesthesia. The nurse's best explanation is:
A. "It affects how your body breaks down certain muscle relaxants"
B. "It increases your risk for malignant hyperthermia"
C. "It means you are allergic to local anesthetics"
D. "It requires you to receive additional opioid medication"
Correct Answer: A
Explanation: Pseudocholinesterase deficiency prolongs the effect of succinylcholine and
mivacurium. Patients may require prolonged ventilatory support until paralysis resolves.
Question 8
Comprehensive Professional Practice Test — Preoperative
Assessment, Anaesthesia, Postanesthetic Recovery, Pain
Management, Complications & Patient Safety — 190 Multiple-Choice
Questions with Answers & Detailed Rationales
Section 1: Preoperative Assessment and Patient Preparation
Question 1
A 68-year-old patient scheduled for elective knee arthroplasty reports taking ginkgo biloba
daily for memory support. Which assessment finding is the priority concern for the
perianesthesia nurse?
A. Potential for increased blood pressure during surgery
B. Risk of prolonged bleeding and hematoma formation
C. Increased risk of malignant hyperthermia
D. Potential for severe postoperative nausea and vomiting
Correct Answer: B
Explanation: Ginkgo biloba inhibits platelet aggregation and can increase bleeding risk.
Discontinue 7 days before surgery to prevent hemorrhagic complications.
Question 2
During preoperative assessment, a patient with a BMI of 42 and known obstructive sleep
apnea states he uses his CPAP machine every night. What is the most important
perioperative consideration?
A. The patient can discontinue CPAP use immediately after surgery
,B. The patient should bring his CPAP machine to the surgical facility
C. CPAP is contraindicated during the postoperative period
D. The patient requires a preoperative sleep study before clearance
Correct Answer: B
Explanation: Patients should bring their own CPAP devices to maintain airway patency
postoperatively. OSA patients are opioid-sensitive and require extended monitoring.
Question 3
A 72-year-old patient on chronic warfarin therapy for atrial fibrillation presents for
colonoscopy. The patient's INR is 2.8. What is the perianesthesia nurse's priority action?
A. Proceed with the procedure as scheduled
B. Administer vitamin K 10 mg IV immediately
C. Notify the anesthesia provider and proceduralist
D. Place the patient in Trendelenburg position
Correct Answer: C
Explanation: An elevated INR indicates coagulopathy and increased bleeding risk. The
procedural team must determine whether to postpone or adjust therapy.
Question 4
A patient reports a family history of malignant hyperthermia. Which anesthetic agent should
the perianesthesia nurse anticipate will be avoided?
,A. Propofol
B. Remifentanil
C. Succinylcholine
D. Rocuronium
Correct Answer: C
Explanation: Succinylcholine and volatile anesthetics are triggering agents for MH. Non-
triggering agents include propofol, opioids, and non-depolarizing muscle relaxants.
Question 5
A 45-year-old patient with type 2 diabetes is scheduled for surgery at 10:00 AM. The patient
took half the usual dose of glargine insulin this morning. The patient's blood glucose is 142
mg/dL. What is the priority nursing action?
A. Administer the remaining glargine dose immediately
B. Document the glucose value and proceed with surgery
C. Hold all insulin and notify the anesthesia provider
D. Initiate a 10% dextrose infusion
Correct Answer: B
Explanation: A glucose of 142 mg/dL is acceptable for surgery. Split-dose glargine is standard
practice to prevent intraoperative hypoglycemia while maintaining basal control.
Question 6
, A patient reports taking St. John's wort for depression. Which perioperative risk is most
concerning?
A. Hypertensive crisis
B. Prolonged neuromuscular blockade
C. Increased risk of serotonin syndrome
D. Severe hypotension
Correct Answer: C
Explanation: St. John's wort has serotonergic activity. Combined with other serotonergic
agents in the perioperative period, it increases serotonin syndrome risk.
Question 7
During preoperative assessment, a patient with a history of pseudocholinesterase deficiency
asks why this matters for anesthesia. The nurse's best explanation is:
A. "It affects how your body breaks down certain muscle relaxants"
B. "It increases your risk for malignant hyperthermia"
C. "It means you are allergic to local anesthetics"
D. "It requires you to receive additional opioid medication"
Correct Answer: A
Explanation: Pseudocholinesterase deficiency prolongs the effect of succinylcholine and
mivacurium. Patients may require prolonged ventilatory support until paralysis resolves.
Question 8
