CSFA Preoperative Patient Preparation 4 — Questions and Answers
Question 1: When applying sequential compression devices (SCDs) preoperatively, they should be placed:
- After induction of anesthesia
- Before induction of anesthesia to prevent DVT from the start (Correct answer)
- Only after the incision is made
- When the patient is transferred to the PACU
Correct answer: Before induction of anesthesia to prevent DVT from the start
SCDs should be applied before induction to provide DVT prophylaxis from the beginning of the perioperative period.
Question 2: A patient with a pacemaker is scheduled for electrosurgery. The surgical first assistant should ensure:
- The pacemaker is removed preoperatively
- The dispersive electrode is placed on the chest near the pacemaker
- Cardiology is consulted and pacemaker settings are evaluated preoperatively (Correct answer)
- Only laser energy is used throughout the case
Correct answer: Cardiology is consulted and pacemaker settings are evaluated preoperatively
Pacemaker settings may need reprogramming to prevent ESU interference; cardiology consultation is mandatory preoperatively.
Question 3: Which preoperative skin preparation agent is contraindicated for use near the ears and eyes?
- Povidone-iodine
- Chlorhexidine gluconate (Correct answer)
- Isopropyl alcohol
- Benzalkonium chloride
Correct answer: Chlorhexidine gluconate
Chlorhexidine is ototoxic and can cause corneal injury; it must not be used near the ears or eyes.
Question 4: During the preoperative phase, the surgical first assistant notes the patient has not removed her tongue ring. The most appropriate action is:
- Leave it in place as it will not interfere with surgery
- Tape it in place so it does not dislodge
- Request the patient remove all oral jewelry to prevent airway complications (Correct answer)
- Contact the surgeon and leave the decision to them
Correct answer: Request the patient remove all oral jewelry to prevent airway complications
Oral jewelry can become dislodged during intubation, risking airway obstruction or aspiration, so removal is required.
Question 5: What is the rationale for assessing a patient's Mallampati score preoperatively?
- To estimate blood loss during surgery
- To predict difficulty of endotracheal intubation (Correct answer)
- To determine positioning requirements
- To assess nutritional status
Correct answer: To predict difficulty of endotracheal intubation
The Mallampati classification assesses oropharyngeal visibility to predict potential difficult airway and intubation challenges.
Question 6: A patient with a known aspirin allergy states she took aspirin two days ago. The most relevant concern is:
- Allergic reaction during surgery
- Impaired platelet function increasing intraoperative bleeding risk (Correct answer)
- Increased risk of postoperative nausea
- Reduced effectiveness of prophylactic antibiotics
Correct answer: Impaired platelet function increasing intraoperative bleeding risk
Aspirin irreversibly inhibits platelet function for the platelet lifespan (~7-10 days), increasing the risk of intraoperative bleeding.
Question 7: Which finding during a preoperative respiratory assessment would most likely cause a surgeon to delay an elective case?
- Mild seasonal allergies
- Active upper respiratory infection with productive cough and fever (Correct answer)
- History of childhood asthma, currently asymptomatic
- Occasional mild dyspnea with heavy exertion
Correct answer: Active upper respiratory infection with productive cough and fever
An active URI with productive cough and fever increases anesthesia and surgical risks; elective procedures are typically postponed.
CSFA Preoperative Patient Preparation 4
When applying sequential compression devices (SCDs) preoperatively, they should be placed: