CSFA Preoperative Patient Preparation 5 — Questions and Answers
Question 1: Which preoperative measure is most important when preparing a patient with a known difficult airway?
- Administering a sedative premedication to relax the patient
- Ensuring availability of difficult airway equipment and a backup airway plan (Correct answer)
- Applying a cervical collar for stability
- Scheduling the case at the start of the day only
Correct answer: Ensuring availability of difficult airway equipment and a backup airway plan
For difficult airway patients, the team must ensure specialized equipment (video laryngoscope, LMA, surgical airway tools) and a clear backup plan are ready.
Question 2: A preoperative patient is found to have a hemoglobin of 7.2 g/dL. Which intervention is the surgeon most likely to order before an elective major abdominal procedure?
- Proceed with surgery and transfuse intraoperatively as needed
- Postpone surgery and treat the anemia preoperatively (Correct answer)
- Administer epinephrine and proceed
- Order a bone marrow biopsy before any decision
Correct answer: Postpone surgery and treat the anemia preoperatively
A hemoglobin of 7.2 g/dL indicates significant anemia; elective major surgery is typically deferred until anemia is investigated and corrected.
Question 3: When preparing a patient with a history of MRSA for surgery, which preoperative decolonization protocol is commonly used?
- Vancomycin oral tablets for 5 days
- Intranasal mupirocin and chlorhexidine body wash (Correct answer)
- Systemic fluconazole prophylaxis
- Topical povidone-iodine to all skin surfaces daily
Correct answer: Intranasal mupirocin and chlorhexidine body wash
MRSA decolonization protocols commonly involve intranasal mupirocin ointment and chlorhexidine gluconate body wash before surgery.
Question 4: A preoperative patient discloses using herbal supplement St. John's Wort daily. The primary concern for the surgical team is:
- Increased risk of malignant hyperthermia
- Potential drug interactions affecting anesthesia metabolism and platelet function (Correct answer)
- Increased risk of latex allergy reaction
- Decreased wound healing postoperatively
Correct answer: Potential drug interactions affecting anesthesia metabolism and platelet function
St. John's Wort induces cytochrome P450 enzymes, affecting anesthesia drug metabolism, and may also inhibit platelet aggregation.
Question 5: What is the correct sequence for the preoperative skin preparation of an abdominal surgical site?
- Prep from the outer periphery toward the incision site
- Prep from the incision site outward toward the periphery (Correct answer)
- Apply prep solution simultaneously across the entire field
- Begin prep at the umbilicus and move only downward
Correct answer: Prep from the incision site outward toward the periphery
Skin prep begins at the cleanest area (intended incision site) and moves outward to prevent dragging bacteria toward the surgical site.
Question 6: A Jehovah's Witness patient undergoing surgery has refused blood transfusion even in life-threatening circumstances. The surgical first assistant should:
- Override the refusal in an emergency as the patient's life takes precedence
- Document the refusal, ensure a signed refusal form is in the chart, and inform the surgeon and anesthesia team (Correct answer)
- Proceed with surgery but order blood products to be kept on standby
- Contact ethics only after the case is complete
Correct answer: Document the refusal, ensure a signed refusal form is in the chart, and inform the surgeon and anesthesia team
A competent adult's refusal of blood products is legally and ethically binding; the team must document it, inform all providers, and plan bloodless surgical strategies.
Question 7: Which preoperative positioning consideration is most critical for a patient with severe osteoporosis scheduled for a prolonged orthopedic procedure?
- Placing the patient in steep Trendelenburg to improve venous return
- Using padding and careful positioning to prevent fractures and pressure injuries (Correct answer)
- Avoiding all pillow supports to keep the spine neutral
- Positioning the patient immediately after induction without assessment
Correct answer: Using padding and careful positioning to prevent fractures and pressure injuries
Osteoporotic bones are highly susceptible to fracture under pressure; meticulous padding and gentle positioning are essential to prevent injury.
CSFA Preoperative Patient Preparation 5
Which preoperative measure is most important when preparing a patient with a known difficult airway?