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Perioperative Quiz 1 & 2 Actual Exam
2026/2027 – Complete Exam-Style
Questions with Detailed Rationales |
100% Verified | Pass Guaranteed – A+
Graded
1. A patient scheduled for elective cholecystectomy reports
taking aspirin 81 mg daily for primary prevention. The surgeon
asks you to cancel the surgery. What is the most appropriate
action?
A) Proceed with surgery because low-dose aspirin does not
increase bleeding risk.
B) Cancel the surgery and advise the patient to stop aspirin 7-10
days before rescheduling.
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C) Give the patient vitamin K to reverse the aspirin effect.
D) Administer protamine sulfate before surgery.
Answer: B
Rationale: Aspirin irreversibly inhibits cyclooxygenase, affecting
platelet function for 7-10 days (life of platelet). For most elective
surgeries, aspirin should be stopped 5-7 days prior. Option A is
incorrect – low-dose aspirin still increases bleeding. Vitamin K
reverses warfarin, not aspirin. Protamine reverses heparin.
2. A patient with type 2 diabetes takes metformin 1000 mg BID.
He is scheduled for coronary artery bypass grafting (CABG).
Regarding metformin, you should:
A) Continue metformin as usual on the morning of surgery.
B) Hold metformin on the day of surgery and for 48 hours
postoperatively due to risk of lactic acidosis.
C) Double the dose to improve glycemic control.
D) Switch to insulin the day before surgery.
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Answer: B
Rationale: Metformin is held before and after surgery (typically
48 hours) because of the risk of lactic acidosis, especially in
patients with reduced renal perfusion or contrast dye exposure.
Insulin is used for glycemic control perioperatively when needed.
3. A patient with a hip fracture requires emergency surgery. She
takes warfarin for atrial fibrillation, and her INR is 3.2. Which
intervention is most appropriate?
A) Proceed with surgery – INR 3.2 is safe.
B) Administer fresh frozen plasma (FFP) and vitamin K to reverse
anticoagulation.
C) Delay surgery for 5 days until INR <1.5.
D) Give protamine sulfate.
Answer: B
Rationale: For emergency surgery, rapid reversal of warfarin is
needed. FFP provides clotting factors, and vitamin K (slow)
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supports synthesis. INR should be ≤1.5 for most surgeries. Delay
is not possible for a hip fracture. Protamine reverses heparin.
4. A patient is NPO for 8 hours before surgery. He has been
sipping water up to 2 hours before the scheduled time. What is
your action?
A) Cancel surgery because any oral intake within 4 hours is
unsafe.
B) Proceed with surgery – clear liquids up to 2 hours before
general anesthesia are allowed per ASA guidelines.
C) Cancel and reschedule for next week.
D) Give a full stomach protocol only if he ate solid food.
Answer: B
Rationale: ASA guidelines allow clear liquids up to 2 hours
before elective procedures. Small volumes of water are not
associated with increased aspiration risk.
Perioperative Quiz 1 & 2 Actual Exam
2026/2027 – Complete Exam-Style
Questions with Detailed Rationales |
100% Verified | Pass Guaranteed – A+
Graded
1. A patient scheduled for elective cholecystectomy reports
taking aspirin 81 mg daily for primary prevention. The surgeon
asks you to cancel the surgery. What is the most appropriate
action?
A) Proceed with surgery because low-dose aspirin does not
increase bleeding risk.
B) Cancel the surgery and advise the patient to stop aspirin 7-10
days before rescheduling.
,Page 2 of 145
C) Give the patient vitamin K to reverse the aspirin effect.
D) Administer protamine sulfate before surgery.
Answer: B
Rationale: Aspirin irreversibly inhibits cyclooxygenase, affecting
platelet function for 7-10 days (life of platelet). For most elective
surgeries, aspirin should be stopped 5-7 days prior. Option A is
incorrect – low-dose aspirin still increases bleeding. Vitamin K
reverses warfarin, not aspirin. Protamine reverses heparin.
2. A patient with type 2 diabetes takes metformin 1000 mg BID.
He is scheduled for coronary artery bypass grafting (CABG).
Regarding metformin, you should:
A) Continue metformin as usual on the morning of surgery.
B) Hold metformin on the day of surgery and for 48 hours
postoperatively due to risk of lactic acidosis.
C) Double the dose to improve glycemic control.
D) Switch to insulin the day before surgery.
,Page 3 of 145
Answer: B
Rationale: Metformin is held before and after surgery (typically
48 hours) because of the risk of lactic acidosis, especially in
patients with reduced renal perfusion or contrast dye exposure.
Insulin is used for glycemic control perioperatively when needed.
3. A patient with a hip fracture requires emergency surgery. She
takes warfarin for atrial fibrillation, and her INR is 3.2. Which
intervention is most appropriate?
A) Proceed with surgery – INR 3.2 is safe.
B) Administer fresh frozen plasma (FFP) and vitamin K to reverse
anticoagulation.
C) Delay surgery for 5 days until INR <1.5.
D) Give protamine sulfate.
Answer: B
Rationale: For emergency surgery, rapid reversal of warfarin is
needed. FFP provides clotting factors, and vitamin K (slow)
, Page 4 of 145
supports synthesis. INR should be ≤1.5 for most surgeries. Delay
is not possible for a hip fracture. Protamine reverses heparin.
4. A patient is NPO for 8 hours before surgery. He has been
sipping water up to 2 hours before the scheduled time. What is
your action?
A) Cancel surgery because any oral intake within 4 hours is
unsafe.
B) Proceed with surgery – clear liquids up to 2 hours before
general anesthesia are allowed per ASA guidelines.
C) Cancel and reschedule for next week.
D) Give a full stomach protocol only if he ate solid food.
Answer: B
Rationale: ASA guidelines allow clear liquids up to 2 hours
before elective procedures. Small volumes of water are not
associated with increased aspiration risk.
