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NCLEX-RN Preoperative care practice questions

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These are original practice items written to the NCLEX-RN blueprint (4 options, no penalty for wrong answers), not actual exam questions. Try each one before you open the answer.

What this topic covers

Preoperative care sits inside the Reduction of Risk Potential category of the NCLEX-RN. Our bank holds 33 verified items tagged to it, and the 4 below are a fixed sample so the page stays the same every time you open it. Each one shows the reasoning, not just the letter.

The topic tag comes from our own items rather than from a published syllabus, so treat it as a map of what we cover. For the official category breakdown see the NCLEX-RN page.

Preoperative care sample questions

Question 1

A 58-year-old client is scheduled for an elective laparoscopic cholecystectomy in the morning. The nurse reviews the preoperative orders and notes that the client takes metformin 1000 mg orally twice daily for type 2 diabetes. Which preoperative instruction should the nurse clarify with the prescribing provider?

  1. A Take the morning dose of metformin with a sip of water on the day of surgery.
  2. B Continue the metformin as usual until midnight before surgery.
  3. C Hold all oral antidiabetic medications 24 hours before the procedure.
  4. D Take half the usual dose of metformin on the evening before surgery.
Show the answer and explanation

Correct answer: A

Metformin is usually held on the morning of surgery because fasting and surgical stress increase the risk of lactic acidosis. An instruction to take the morning dose conflicts with standard practice and should be clarified.

Why the other options are wrong:
B: Taking metformin as usual through the evening before surgery is consistent with standard guidance.
C: Holding oral agents for 24 hours is a cautious plan that still avoids metformin on the day of surgery.
D: A smaller evening dose the night before does not carry the risk that a day-of-surgery dose does.

Question 2

A 70-year-old client is scheduled for an elective abdominal aortic aneurysm repair. The nurse reviews the preoperative orders and identifies that the client takes warfarin 5 mg daily for atrial fibrillation. Which preoperative nursing action is most appropriate?

  1. A Check the international normalized ratio and proceed with surgery.
  2. B Give vitamin K 10 mg orally to reverse the warfarin effect.
  3. C Administer the warfarin as ordered the morning of surgery.
  4. D Hold the warfarin and notify the provider for bridging therapy.
Show the answer and explanation

Correct answer: D

Warfarin must be stopped before major elective surgery, usually about 5 days ahead, to reduce bleeding risk. The nurse holds it and notifies the provider, who decides whether bridging anticoagulation is needed based on the client's clotting risk.

Why the other options are wrong:
A: Proceeding while the client is still taking warfarin risks major bleeding; the INR must be near normal before surgery.
B: High-dose vitamin K is not used for routine elective reversal and requires a prescription.
C: Giving warfarin the morning of surgery increases the risk of serious bleeding.

Question 3

A 74-year-old male is scheduled for a total hip arthroplasty under general anesthesia. The nurse reviews the preoperative orders and the client's history. The client's current medications include metoprolol 50 mg daily, warfarin 2 mg daily, and lisinopril 10 mg daily. Which order should the nurse question before the procedure?

  1. A Continue metoprolol 50 mg orally on the morning of surgery
  2. B Administer cefazolin 1 gram IV 30 minutes before incision
  3. C Administer warfarin 2 mg orally on the morning of surgery
  4. D Hold lisinopril 10 mg orally on the morning of surgery
Show the answer and explanation

Correct answer: C

Warfarin is usually stopped about 5 days before elective surgery such as hip arthroplasty so that the INR can normalize. Giving it on the morning of surgery increases the risk of bleeding during and after the procedure, so the nurse should question this order.

Why the other options are wrong:
A: Beta blockers are usually continued on the morning of surgery to prevent rebound tachycardia and cardiac events.
B: Cefazolin given within 60 minutes before incision is standard surgical infection prophylaxis.
D: Holding an ACE inhibitor on the morning of surgery is common to reduce the risk of intraoperative hypotension.

Question 4

A 75-year-old client with a history of type 2 diabetes and hypertension is scheduled for elective cholecystectomy. The client's morning blood glucose is 218 mg/dL, and the client took their usual dose of metformin 2 hours ago. Which action should the nurse take first?

  1. A Proceed with the surgery as planned since the glucose is only mildly elevated
  2. B Hold all oral intake and administer 0.9% sodium chloride intravenously at 125 mL/hr
  3. C Notify the surgeon and anesthesia provider of the blood glucose level
  4. D Administer regular insulin 4 units subcutaneously as per sliding scale
Show the answer and explanation

Correct answer: C

A glucose of 218 mg/dL on the morning of surgery, plus a metformin dose taken 2 hours ago, are findings the surgical team must know before an elective procedure. The nurse should notify the surgeon and anesthesia provider so they can decide whether to proceed and how to manage glucose.

Why the other options are wrong:
A: The nurse cannot decide to proceed; elevated glucose and the morning metformin dose must be reported.
B: Starting IV fluids requires an order and does not address the glucose or the metformin dose.
D: Insulin for a fasting surgical client needs a specific perioperative order and could cause hypoglycemia.

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