CJE READINESS PRACTICE EXAM — 230
Questions (2026/2027)
Topics covered: Perioperative care, postoperative complications, surgical emergencies,
medication management, malignant hyperthermia, fluid/electrolyte imbalance, critical care
interventions, wound care, anesthesia complications, and nursing priority decision-making.
SECTION 1: PREOPERATIVE CARE
1. A nurse is completing a preoperative assessment. Which finding should be reported to the
surgeon IMMEDIATELY before proceeding?
A) The client took an antihypertensive medication this morning B) The client has a latex allergy
and the OR uses latex gloves C) The client last ate 8 hours ago D) The client reports mild anxiety
about the procedure
(Correct answer: B) Rationale: A latex allergy in a patient scheduled for a procedure using
latex products is a serious, life-threatening risk. The OR must be notified immediately to prepare
a latex-free environment and prevent anaphylaxis.
2. A client is NPO for surgery scheduled at 10 AM. At 7 AM, the client asks if they can take
their morning dose of metformin. What is the nurse's best response?
A) "Yes, take it with a small sip of water." B) "No, all medications are held when you are NPO."
C) "Metformin is typically withheld before surgery; I will clarify with the physician." D) "Take
half the usual dose."
(Correct answer: C) Rationale: Metformin is generally held before surgery due to risk of lactic
acidosis, especially if contrast dye is used or renal perfusion is compromised. The nurse should
clarify with the physician rather than independently administer or withhold it.
3. Which laboratory result from preoperative testing should the nurse report to the surgeon
before proceeding with an elective surgery?
A) Hemoglobin 8.0 g/dL B) Sodium 138 mEq/L C) Potassium 3.8 mEq/L D) Blood glucose 95
mg/dL
,(Correct answer: A) Rationale: A hemoglobin of 8.0 g/dL indicates anemia, which
compromises oxygen-carrying capacity and increases surgical risk. This must be reported to the
surgeon for evaluation before elective surgery proceeds.
4. A client scheduled for surgery reports taking aspirin daily for cardiac prophylaxis. The nurse
understands that aspirin should ideally be stopped how long before surgery?
A) 24 hours B) 48 hours C) 5–7 days D) 2 weeks
(Correct answer: C) Rationale: Aspirin inhibits platelet aggregation irreversibly. Since
platelets survive 7–10 days, aspirin should be stopped 5–7 days before surgery to minimize
bleeding risk.
5. Which client is at HIGHEST risk for postoperative complications related to anesthesia?
A) A 25-year-old with no medical history undergoing appendectomy B) A 70-year-old smoker
with COPD undergoing elective hip replacement C) A 45-year-old with controlled hypertension
undergoing cholecystectomy D) A 30-year-old pregnant woman at 10 weeks undergoing
laparoscopy
(Correct answer: B) Rationale: Advanced age, smoking history, and COPD all significantly
increase the risk of respiratory complications related to anesthesia and surgery. These factors
impair ventilation, gas exchange, and recovery.
6. During the preoperative assessment, the nurse asks the client about alcohol use. This is MOST
important because alcohol use can:
A) Increase the risk of wound infection B) Alter metabolism of anesthetic agents and increase
bleeding risk C) Cause hypoglycemia intraoperatively D) Reduce the effectiveness of
postoperative antibiotics
(Correct answer: B) Rationale: Alcohol affects liver enzyme function, altering how anesthetic
agents are metabolized. It also impairs coagulation, increasing the risk of intraoperative and
postoperative bleeding.
7. A client is scheduled for surgery and states, "I take herbal supplements including St. John's
Wort." The nurse should be MOST concerned because:
,A) Herbal supplements are not regulated and may be ineffective B) St. John's Wort can cause
serotonin syndrome with anesthetic agents C) It may interact with postoperative antibiotics D) It
may cause intraoperative hypertension
(Correct answer: B) Rationale: St. John's Wort can interact with anesthetic agents and other
medications to increase the risk of serotonin syndrome. It should be discontinued at least 2 weeks
before surgery.
8. The nurse is obtaining informed consent from a client scheduled for surgery. The client states,
"I don't really understand what the doctor told me." What should the nurse do?
A) Explain the procedure in detail using medical terms B) Have the client sign the consent form
and document that education was provided C) Notify the surgeon that the client requires further
explanation before signing D) Ask the client's family to explain the procedure
(Correct answer: C) Rationale: Informed consent is the physician's responsibility. The nurse
acts as a patient advocate and must notify the surgeon when the client does not understand the
procedure, ensuring truly informed consent.
9. Which health history finding most significantly increases a client's risk for surgery?
A) History of seasonal allergies B) Abuse of street drugs C) Family history of hypertension D)
Prior hospitalization for pneumonia 10 years ago
(Correct answer: B) Rationale: Street drug use can cause unpredictable interactions with
anesthesia, cardiovascular instability, altered pain perception, and withdrawal complications
perioperatively, making it a significant surgical risk factor.
10. The nurse is preparing a client for surgery. The client mentions they are allergic to shellfish.
The nurse's PRIORITY action is:
A) Administer diphenhydramine prophylactically B) Note the allergy in the chart and apply an
allergy wristband C) Notify anesthesia and the surgeon, as the client may have an iodine/contrast
allergy D) Cancel the surgery until allergy testing is complete
(Correct answer: C) Rationale: Shellfish allergy may correlate with reactions to iodine-based
contrast dye and povidone-iodine. The surgical team and anesthesiologist must be alerted to take
precautions and have emergency medications available.
, SECTION 2: INTRAOPERATIVE CARE & ANESTHESIA
11. A patient in the OR suddenly develops a temperature of 40.2°C (104.4°F), muscle rigidity,
and tachycardia after receiving succinylcholine. The nurse should suspect:
A) Septic shock B) Neuroleptic malignant syndrome C) Malignant hyperthermia D) Thyroid
storm
(Correct answer: C) Rationale: Malignant hyperthermia (MH) is a life-threatening
hypermetabolic reaction triggered by volatile anesthetic agents (e.g., halothane) and depolarizing
muscle relaxants like succinylcholine. Classic signs include hyperthermia, muscle rigidity, and
tachycardia.
12. The FIRST drug administered in the management of malignant hyperthermia is:
A) Morphine sulfate B) Dantrolene sodium C) Propofol D) Naloxone
(Correct answer: B) Rationale: Dantrolene sodium is the specific antidote for malignant
hyperthermia. It works by inhibiting calcium release from the sarcoplasmic reticulum, reducing
muscle hypermetabolism and hyperthermia.
13. Which assessment finding is the EARLIEST indicator of malignant hyperthermia?
A) Elevated temperature B) Muscle rigidity C) Increased end-tidal CO2 D) Skin mottling
(Correct answer: C) Rationale: The earliest sign of malignant hyperthermia is a rising end-
tidal CO2 (hypercarbia) due to increased CO2 production from hypermetabolism. Temperature
elevation is a late sign.
14. A client undergoing general anesthesia is positioned in the lithotomy position. Which
postoperative complication should the nurse assess for related to this positioning?
A) Brachial plexus injury B) Deep vein thrombosis in the lower extremities C) Pressure ulcer on
the occiput D) Corneal abrasion
(Correct answer: B) Rationale: The lithotomy position places the legs elevated and in stirrups,
which can impair venous return and increase the risk of deep vein thrombosis (DVT) in the lower
extremities.
Questions (2026/2027)
Topics covered: Perioperative care, postoperative complications, surgical emergencies,
medication management, malignant hyperthermia, fluid/electrolyte imbalance, critical care
interventions, wound care, anesthesia complications, and nursing priority decision-making.
SECTION 1: PREOPERATIVE CARE
1. A nurse is completing a preoperative assessment. Which finding should be reported to the
surgeon IMMEDIATELY before proceeding?
A) The client took an antihypertensive medication this morning B) The client has a latex allergy
and the OR uses latex gloves C) The client last ate 8 hours ago D) The client reports mild anxiety
about the procedure
(Correct answer: B) Rationale: A latex allergy in a patient scheduled for a procedure using
latex products is a serious, life-threatening risk. The OR must be notified immediately to prepare
a latex-free environment and prevent anaphylaxis.
2. A client is NPO for surgery scheduled at 10 AM. At 7 AM, the client asks if they can take
their morning dose of metformin. What is the nurse's best response?
A) "Yes, take it with a small sip of water." B) "No, all medications are held when you are NPO."
C) "Metformin is typically withheld before surgery; I will clarify with the physician." D) "Take
half the usual dose."
(Correct answer: C) Rationale: Metformin is generally held before surgery due to risk of lactic
acidosis, especially if contrast dye is used or renal perfusion is compromised. The nurse should
clarify with the physician rather than independently administer or withhold it.
3. Which laboratory result from preoperative testing should the nurse report to the surgeon
before proceeding with an elective surgery?
A) Hemoglobin 8.0 g/dL B) Sodium 138 mEq/L C) Potassium 3.8 mEq/L D) Blood glucose 95
mg/dL
,(Correct answer: A) Rationale: A hemoglobin of 8.0 g/dL indicates anemia, which
compromises oxygen-carrying capacity and increases surgical risk. This must be reported to the
surgeon for evaluation before elective surgery proceeds.
4. A client scheduled for surgery reports taking aspirin daily for cardiac prophylaxis. The nurse
understands that aspirin should ideally be stopped how long before surgery?
A) 24 hours B) 48 hours C) 5–7 days D) 2 weeks
(Correct answer: C) Rationale: Aspirin inhibits platelet aggregation irreversibly. Since
platelets survive 7–10 days, aspirin should be stopped 5–7 days before surgery to minimize
bleeding risk.
5. Which client is at HIGHEST risk for postoperative complications related to anesthesia?
A) A 25-year-old with no medical history undergoing appendectomy B) A 70-year-old smoker
with COPD undergoing elective hip replacement C) A 45-year-old with controlled hypertension
undergoing cholecystectomy D) A 30-year-old pregnant woman at 10 weeks undergoing
laparoscopy
(Correct answer: B) Rationale: Advanced age, smoking history, and COPD all significantly
increase the risk of respiratory complications related to anesthesia and surgery. These factors
impair ventilation, gas exchange, and recovery.
6. During the preoperative assessment, the nurse asks the client about alcohol use. This is MOST
important because alcohol use can:
A) Increase the risk of wound infection B) Alter metabolism of anesthetic agents and increase
bleeding risk C) Cause hypoglycemia intraoperatively D) Reduce the effectiveness of
postoperative antibiotics
(Correct answer: B) Rationale: Alcohol affects liver enzyme function, altering how anesthetic
agents are metabolized. It also impairs coagulation, increasing the risk of intraoperative and
postoperative bleeding.
7. A client is scheduled for surgery and states, "I take herbal supplements including St. John's
Wort." The nurse should be MOST concerned because:
,A) Herbal supplements are not regulated and may be ineffective B) St. John's Wort can cause
serotonin syndrome with anesthetic agents C) It may interact with postoperative antibiotics D) It
may cause intraoperative hypertension
(Correct answer: B) Rationale: St. John's Wort can interact with anesthetic agents and other
medications to increase the risk of serotonin syndrome. It should be discontinued at least 2 weeks
before surgery.
8. The nurse is obtaining informed consent from a client scheduled for surgery. The client states,
"I don't really understand what the doctor told me." What should the nurse do?
A) Explain the procedure in detail using medical terms B) Have the client sign the consent form
and document that education was provided C) Notify the surgeon that the client requires further
explanation before signing D) Ask the client's family to explain the procedure
(Correct answer: C) Rationale: Informed consent is the physician's responsibility. The nurse
acts as a patient advocate and must notify the surgeon when the client does not understand the
procedure, ensuring truly informed consent.
9. Which health history finding most significantly increases a client's risk for surgery?
A) History of seasonal allergies B) Abuse of street drugs C) Family history of hypertension D)
Prior hospitalization for pneumonia 10 years ago
(Correct answer: B) Rationale: Street drug use can cause unpredictable interactions with
anesthesia, cardiovascular instability, altered pain perception, and withdrawal complications
perioperatively, making it a significant surgical risk factor.
10. The nurse is preparing a client for surgery. The client mentions they are allergic to shellfish.
The nurse's PRIORITY action is:
A) Administer diphenhydramine prophylactically B) Note the allergy in the chart and apply an
allergy wristband C) Notify anesthesia and the surgeon, as the client may have an iodine/contrast
allergy D) Cancel the surgery until allergy testing is complete
(Correct answer: C) Rationale: Shellfish allergy may correlate with reactions to iodine-based
contrast dye and povidone-iodine. The surgical team and anesthesiologist must be alerted to take
precautions and have emergency medications available.
, SECTION 2: INTRAOPERATIVE CARE & ANESTHESIA
11. A patient in the OR suddenly develops a temperature of 40.2°C (104.4°F), muscle rigidity,
and tachycardia after receiving succinylcholine. The nurse should suspect:
A) Septic shock B) Neuroleptic malignant syndrome C) Malignant hyperthermia D) Thyroid
storm
(Correct answer: C) Rationale: Malignant hyperthermia (MH) is a life-threatening
hypermetabolic reaction triggered by volatile anesthetic agents (e.g., halothane) and depolarizing
muscle relaxants like succinylcholine. Classic signs include hyperthermia, muscle rigidity, and
tachycardia.
12. The FIRST drug administered in the management of malignant hyperthermia is:
A) Morphine sulfate B) Dantrolene sodium C) Propofol D) Naloxone
(Correct answer: B) Rationale: Dantrolene sodium is the specific antidote for malignant
hyperthermia. It works by inhibiting calcium release from the sarcoplasmic reticulum, reducing
muscle hypermetabolism and hyperthermia.
13. Which assessment finding is the EARLIEST indicator of malignant hyperthermia?
A) Elevated temperature B) Muscle rigidity C) Increased end-tidal CO2 D) Skin mottling
(Correct answer: C) Rationale: The earliest sign of malignant hyperthermia is a rising end-
tidal CO2 (hypercarbia) due to increased CO2 production from hypermetabolism. Temperature
elevation is a late sign.
14. A client undergoing general anesthesia is positioned in the lithotomy position. Which
postoperative complication should the nurse assess for related to this positioning?
A) Brachial plexus injury B) Deep vein thrombosis in the lower extremities C) Pressure ulcer on
the occiput D) Corneal abrasion
(Correct answer: B) Rationale: The lithotomy position places the legs elevated and in stirrups,
which can impair venous return and increase the risk of deep vein thrombosis (DVT) in the lower
extremities.
