CNAMB Ambulatory surgery nursing
certification recognizing specialized
knowledge in outpatient procedures, patient
safety, and perioperative management.
Question 1
A 68-year-old patient is scheduled for an outpatient cholecystectomy. During the
preoperative assessment, the patient reports taking aspirin 81 mg daily for
cardiovascular prevention. Which action should the nurse take?
A) Instruct the patient to take the aspirin as scheduled on the morning of surgery
B) Notify the surgeon and anesthesia provider to determine if the aspirin
should be held
C) Administer the aspirin with a sip of water
D) Document the medication and proceed with surgery
Rationale: Aspirin and other antiplatelet agents increase the risk of bleeding
during surgery. The decision to hold or continue these medications must be made
by the surgeon and anesthesia provider based on the patient's individual risk-
benefit profile. The nurse should not independently make this decision.
Question 2
A 45-year-old patient with a BMI of 38 is scheduled for an outpatient hernia repair.
Which preoperative assessment finding is MOST concerning?
A) History of well-controlled hypertension
B) Obstructive sleep apnea diagnosed 2 years ago, not using CPAP
C) History of smoking 5 cigarettes per day
D) Family history of diabetes
Rationale: Obesity (BMI > 30) and untreated obstructive sleep apnea are
significant risk factors for perioperative complications, including difficult airway
management and respiratory depression. The patient's BMI of 38 combined with
untreated sleep apnea poses a high risk for anesthesia-related complications.
,Question 3
A patient is scheduled for an outpatient procedure requiring moderate sedation.
Which fasting guideline should the nurse reinforce?
A) NPO after midnight for all food and liquids
B) Clear liquids up to 2 hours before the procedure; light meal up to 6 hours
before
C) Nothing by mouth for 12 hours
D) Only water is permitted up to 1 hour before
Rationale: Current anesthesia guidelines recommend clear liquids up to 2 hours
before procedures and light meals up to 6 hours before. This reduces the risk of
aspiration while minimizing dehydration and discomfort. The nurse should verify
NPO status as part of the preoperative assessment.
Question 4
A 72-year-old patient is scheduled for an outpatient cataract surgery. The patient's
medication list includes warfarin for atrial fibrillation. Which preoperative action is
MOST appropriate?
A) Coordinate with the provider regarding the need to hold warfarin and
bridging therapy
B) Administer warfarin as scheduled
C) Discontinue warfarin immediately
D) Schedule the surgery without changes
Rationale: Anticoagulants such as warfarin must be managed perioperatively to
balance the risk of bleeding against the risk of thromboembolism. The nurse should
coordinate with the provider to determine the appropriate plan, which may include
holding warfarin and using bridging therapy.
Question 5
During the preoperative assessment, a patient reports a allergy to latex. Which
action should the nurse prioritize?
,A) Document the allergy in the medical record
B) Flag the allergy in the chart and ensure all latex-containing products are
removed from the operating room
C) Ask the patient to bring their own gloves
D) Notify the patient that latex is rarely used
Rationale: Latex allergy requires a comprehensive approach to prevent exposure.
The nurse must document the allergy, flag the chart, and ensure that all latex-
containing products (gloves, catheters, tapes, etc.) are removed from the patient's
environment. A latex-safe cart should be available.
Question 6
A 55-year-old patient is scheduled for an outpatient knee arthroscopy. The patient's
preoperative laboratory results show a hemoglobin of 10.2 g/dL. Which action
should the nurse take?
A) Notify the surgeon and anesthesia provider of the abnormal result
B) Proceed with the surgery as scheduled
C) Instruct the patient to take iron supplements
D) Repeat the hemoglobin test
Rationale: A hemoglobin of 10.2 g/dL is below the normal range and may indicate
anemia. The nurse should notify the provider to determine if further evaluation or
intervention is needed before proceeding with surgery.
Question 7
A patient with a history of diabetes is scheduled for surgery. The patient's morning
blood glucose is 280 mg/dL. Which action should the nurse take?
A) Notify the provider and implement the hyperglycemia management
protocol
B) Proceed with surgery as scheduled
C) Instruct the patient to take their usual insulin dose
D) Administer oral hypoglycemic medication
Rationale: Hyperglycemia (blood glucose > 250 mg/dL) is associated with
increased risk of surgical site infections and poor wound healing. The nurse should
notify the provider and follow the facility's hyperglycemia management protocol.
, Question 8
Which assessment finding would be MOST indicative of a need to postpone
outpatient surgery?
A) Blood pressure 148/88 mmHg
B) Chest pain with exertion and new-onset shortness of breath
C) Hemoglobin A1c of 7.2%
D) History of smoking
Rationale: Chest pain with exertion and new-onset shortness of breath suggest
possible acute coronary syndrome or worsening cardiac status. This requires
further evaluation before proceeding with elective surgery. Outpatient surgery may
need to be postponed for cardiac clearance.
Question 9
A patient is being prepared for surgery and the nurse is reviewing the informed
consent. The patient states, "I'm not really sure what they are going to do." Which
action should the nurse take?
A) Notify the surgeon that the patient has questions about the procedure
B) Explain the procedure to the patient
C) Have the patient sign the consent form
D) Document that the patient was informed
Rationale: Informed consent requires that the patient understands the procedure,
risks, benefits, and alternatives. The surgeon is responsible for obtaining informed
consent. If the patient has questions, the nurse should notify the surgeon to provide
further explanation.
Question 10
A 60-year-old patient with a history of chronic kidney disease is scheduled for
surgery. Which laboratory value requires the MOST immediate attention?
A) Serum potassium of 6.2 mEq/L
B) Hemoglobin of 11.0 g/dL
certification recognizing specialized
knowledge in outpatient procedures, patient
safety, and perioperative management.
Question 1
A 68-year-old patient is scheduled for an outpatient cholecystectomy. During the
preoperative assessment, the patient reports taking aspirin 81 mg daily for
cardiovascular prevention. Which action should the nurse take?
A) Instruct the patient to take the aspirin as scheduled on the morning of surgery
B) Notify the surgeon and anesthesia provider to determine if the aspirin
should be held
C) Administer the aspirin with a sip of water
D) Document the medication and proceed with surgery
Rationale: Aspirin and other antiplatelet agents increase the risk of bleeding
during surgery. The decision to hold or continue these medications must be made
by the surgeon and anesthesia provider based on the patient's individual risk-
benefit profile. The nurse should not independently make this decision.
Question 2
A 45-year-old patient with a BMI of 38 is scheduled for an outpatient hernia repair.
Which preoperative assessment finding is MOST concerning?
A) History of well-controlled hypertension
B) Obstructive sleep apnea diagnosed 2 years ago, not using CPAP
C) History of smoking 5 cigarettes per day
D) Family history of diabetes
Rationale: Obesity (BMI > 30) and untreated obstructive sleep apnea are
significant risk factors for perioperative complications, including difficult airway
management and respiratory depression. The patient's BMI of 38 combined with
untreated sleep apnea poses a high risk for anesthesia-related complications.
,Question 3
A patient is scheduled for an outpatient procedure requiring moderate sedation.
Which fasting guideline should the nurse reinforce?
A) NPO after midnight for all food and liquids
B) Clear liquids up to 2 hours before the procedure; light meal up to 6 hours
before
C) Nothing by mouth for 12 hours
D) Only water is permitted up to 1 hour before
Rationale: Current anesthesia guidelines recommend clear liquids up to 2 hours
before procedures and light meals up to 6 hours before. This reduces the risk of
aspiration while minimizing dehydration and discomfort. The nurse should verify
NPO status as part of the preoperative assessment.
Question 4
A 72-year-old patient is scheduled for an outpatient cataract surgery. The patient's
medication list includes warfarin for atrial fibrillation. Which preoperative action is
MOST appropriate?
A) Coordinate with the provider regarding the need to hold warfarin and
bridging therapy
B) Administer warfarin as scheduled
C) Discontinue warfarin immediately
D) Schedule the surgery without changes
Rationale: Anticoagulants such as warfarin must be managed perioperatively to
balance the risk of bleeding against the risk of thromboembolism. The nurse should
coordinate with the provider to determine the appropriate plan, which may include
holding warfarin and using bridging therapy.
Question 5
During the preoperative assessment, a patient reports a allergy to latex. Which
action should the nurse prioritize?
,A) Document the allergy in the medical record
B) Flag the allergy in the chart and ensure all latex-containing products are
removed from the operating room
C) Ask the patient to bring their own gloves
D) Notify the patient that latex is rarely used
Rationale: Latex allergy requires a comprehensive approach to prevent exposure.
The nurse must document the allergy, flag the chart, and ensure that all latex-
containing products (gloves, catheters, tapes, etc.) are removed from the patient's
environment. A latex-safe cart should be available.
Question 6
A 55-year-old patient is scheduled for an outpatient knee arthroscopy. The patient's
preoperative laboratory results show a hemoglobin of 10.2 g/dL. Which action
should the nurse take?
A) Notify the surgeon and anesthesia provider of the abnormal result
B) Proceed with the surgery as scheduled
C) Instruct the patient to take iron supplements
D) Repeat the hemoglobin test
Rationale: A hemoglobin of 10.2 g/dL is below the normal range and may indicate
anemia. The nurse should notify the provider to determine if further evaluation or
intervention is needed before proceeding with surgery.
Question 7
A patient with a history of diabetes is scheduled for surgery. The patient's morning
blood glucose is 280 mg/dL. Which action should the nurse take?
A) Notify the provider and implement the hyperglycemia management
protocol
B) Proceed with surgery as scheduled
C) Instruct the patient to take their usual insulin dose
D) Administer oral hypoglycemic medication
Rationale: Hyperglycemia (blood glucose > 250 mg/dL) is associated with
increased risk of surgical site infections and poor wound healing. The nurse should
notify the provider and follow the facility's hyperglycemia management protocol.
, Question 8
Which assessment finding would be MOST indicative of a need to postpone
outpatient surgery?
A) Blood pressure 148/88 mmHg
B) Chest pain with exertion and new-onset shortness of breath
C) Hemoglobin A1c of 7.2%
D) History of smoking
Rationale: Chest pain with exertion and new-onset shortness of breath suggest
possible acute coronary syndrome or worsening cardiac status. This requires
further evaluation before proceeding with elective surgery. Outpatient surgery may
need to be postponed for cardiac clearance.
Question 9
A patient is being prepared for surgery and the nurse is reviewing the informed
consent. The patient states, "I'm not really sure what they are going to do." Which
action should the nurse take?
A) Notify the surgeon that the patient has questions about the procedure
B) Explain the procedure to the patient
C) Have the patient sign the consent form
D) Document that the patient was informed
Rationale: Informed consent requires that the patient understands the procedure,
risks, benefits, and alternatives. The surgeon is responsible for obtaining informed
consent. If the patient has questions, the nurse should notify the surgeon to provide
further explanation.
Question 10
A 60-year-old patient with a history of chronic kidney disease is scheduled for
surgery. Which laboratory value requires the MOST immediate attention?
A) Serum potassium of 6.2 mEq/L
B) Hemoglobin of 11.0 g/dL
