NBCRNA CRNA Exam Questions

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1.

All the following will trigger an alarm except:

  • Nitrous oxide in the oxygen pipeline gas supply

  • Loss of pipeline oxygen pressure

  • Negative pressure circuit

  • Continuous high pressure circuit

Correct answer: Nitrous oxide in the oxygen pipeline gas supply

Cross-connection of gas delivery pipelines will not trigger an alarm. Cross-connection of gases can occur anywhere, from the liquid oxygen supply and piping to the wall outlets, hoses, and internal circuitry of the anesthesia gas machine.

The oxygen low-pressure alarm sounds if loss of pipeline oxygen pressure occurs. A high-priority pressure alarm must sound if user-adjustable limits are exceeded, if continuing high pressure is sensed, or for negative pressure.

2.

Which of the following considerations is correct when considering the preoperative assessment of glycemic control?

  • Hyperglycemia increases the risk of perioperative mortality

  • Hypoglycemia increases the risk of postoperative complications

  • Intraoperative normoglycemia is essential for a good outcome

  • Preoperative assessment of glycemic control is unlikely to impact patient outcomes

Correct answer: Hyperglycemia increases the risk of perioperative mortality

Hyperglycemia increases the risk of perioperative mortality and postoperative complications. Because of this, preoperative assessment of glycemic control is an important part of the preoperative assessment.

3.

Which medication is best used for routine aspiration prophylaxis?

  • Aspiration prophylaxis should not be routinely used

  • Antacids

  • Proton pump inhibitors

  • Histamine blockers

Correct answer: Aspiration prophylaxis should not be routinely used

Routine aspiration prophylaxis is not supported by scientific evidence. However, practitioners may administer them when indicated to patients at risk of aspiration.

4.

Which of the following statements is true about somatosensory evoked potentials?

  • They monitor the dorsal (sensory) spinal column

  • They are stimulated centrally and recorded peripherally

  • Signal averaging with repetitive stimuli is not required

  • They assess the integrity of the descending motor pathway in the ventral spinal cord

Correct answer: They monitor the dorsal (sensory) spinal column

Somatosensory evoked potentials (SSEPs) monitor the dorsal (sensory) spinal column and are stimulated peripherally and recorded centrally.

Motor evoked potentials (MEPs) assess the integrity of the descending motor pathway in the ventral spinal cord. Because of the presence of spontaneous electroencephalogram activity, summation followed by signal averaging of repetitive stimuli is necessary to extract meaningful signals with SSEP. Repetitive stimuli and signal averaging is not needed with MEP.

5.

What of the following is the most common indication for liver transplantation?

  • Alcoholic liver disease

  • Cholestatic disease

  • Hepatitis C

  • Acute liver failure

Correct answer: Alcoholic liver disease 

Alcoholic liver disease is the most common indication for liver transplantation. Other indications for liver transplantation include cholestatic disease, hepatitis C, and acute liver failure. However, these indications are not as common as alcoholic liver disease.

6.

In which of the following patient scenarios is it least likely that pulse oximetry readings using modern equipment will be inaccurate?

  • In a 51-year-old female admitted for cholecystitis and wearing nail polish

  • In a 6-year-old male who was admitted for sickle cell pain crisis

  • In a 19-year-old male who attempted suicide by carbon monoxide poisoning

  • In a 35-year-old female with breast cancer who is undergoing sentinel node biopsy using methylene blue

Correct answer: In a 51-year-old female admitted for cholecystitis and wearing nail polish

Pulse oximetry, simply due to its ease of use, continues to be used as part of standard monitoring in all areas of the hospital. It measures oxygen saturation in the hemoglobin through the use of infrared light. It is accurate in determining oxygen saturation to within 2% to 5%. In the past, limitations in technology did not allow for accurate measurement of oxygen saturation when patients wore nail polish. More modern pulse oximetry units with their advancements in technology have made this concern an issue of the past. 

Pulse oximetry readings may be inaccurate (i.e., may not reflect accurate oxygen saturation levels) in patients who have sickle cell anemia or some of the other anemias, those who are experiencing carbon monoxide poisoning (or other causes of methemoglobinemias), and patients who have undergone dye studies using methylene blue or other blue dyes.

7.

Which of the following can be preoperative evidence of increased intracranial pressure?

Select all that apply.

  • Positional headache

  • Nausea and vomiting

  • Papilledema

  • Hyperalertness

  • Hypotension and tachycardia

Positional headache, nausea and vomiting, and papilledema are all preoperative evidence of increased intracranial pressure. Hyperalertness is not typically seen, rather a decreased level of consciousness may be present. Hypertension and bradycardia may be present with increased intracranial pressure.

8.

Shivering causes oxygen consumption to increase by up to which of the following?

  • 400% to 500%

  • 50% to 100%

  • 200% to 300%

  • 25% to 50%

Correct answer: 400% to 500%

Shivering, regardless of its cause, markedly increases oxygen demand by 400% to 500%. Small doses of meperidine (20 to 50 mg intravenously) can frequently stop shivering, more so than other opioid agonists.

9.

Which of the following is least likely to increase the risk of graft failure with kidney transplantation?

  • Dependence on dialysis

  • Advanced age

  • Diabetes

  • High panel reactive antibody levels

Correct answer: Dependence on dialysis

Dependence on dialysis is common in those who require kidney transplantation and does not increase the risk of graft failure post-transplantation. Advanced age, diabetes, and high panel reactive antibody levels all increase the risk of graft failure.

10.

Malignant hyperthermia is suspected in a patient weighing 154 pounds. Which of the following represents the correct starting dose of dantrolene (Ryanodex, Dantrium) to be administered?

  • 175 mg

  • 70 mg

  • 1.4 mg

  • 140 mg

Correct answer: 175 mg

The correct starting dose of dantrolene (Ryanodex, Dantrium) is 2.5 mg/kg.

  • 154 pounds = 70 kg
  • 1 kg = 2.2 pounds
  • 154 / 2.2 = 70
  • 70 x 2.5 = 175 mg

11.

What are the three diagnostic criteria for preeclampsia?

  • Hypertension, edema, proteinuria

  • Central nervous system dysfunction, edema, hypertension

  • Hypertension, edema, glycosuria

  • Hypertension, central nervous system dysfunction, glycosuria

Correct answer: Hypertension, edema, proteinuria

Preeclampsia, sometimes referred to as toxemia, refers to the following three symptoms:

  • Hypertension
  • Proteinuria (greater than 500 mg/dL)
  • Edema of the hands and face

When seizures occur, the syndrome is referred to as eclampsia.

12.

Which of the following bariatric procedures would the CNRA anticipate being associated with the lowest incidence of complications and lowest morbidity?

  • Gastric banding

  • Sleeve gastrectomy

  • Jejunoileal bypass

  • Biliopancreatic diversion

Correct answer: Gastric banding

Restrictive procedures like gastric banding and sleeve gastrectomy are typically associated with a lower rate of complications than malabsorptive procedures like jejunoileal bypass and biliopancreatic diversion, as malabsorptive procedures lead to nutritional and metabolic complications. Of these two procedures, gastric banding has a lower rate of complications than sleeve gastrectomy, as not cutting into the gastrointestinal structures is necessary. 

13.

A patient presenting with gallbladder disease is most likely to present with abnormal findings in which of the following laboratory values?

  • Alkaline phosphatase and serum bilirubin

  • Total bilirubin and total protein

  • Serum bilirubin and alanine transaminase

  • Amylase and alanine transaminase

Correct answer: Alkaline phosphatase and serum bilirubin

Gallbladder disease, or cholecystitis, typically is caused by the presence of gallstones (cholelithiasis) either within the gallbladder itself or within the ductal network in 90% to 95% of cases. The other 5% to 10% of cholecystitis cases are caused by non-stone-related concerns, such as malignancies. Patients who present with cholecystitis are most likely to experience an increase in serum bilirubin, alkaline phosphatase, and amylase levels. Increases in the more liver-specific laboratory studies, such as total protein and alanine transaminase, are more likely to occur in patients with true liver disorders.

14.

Which of the following conditions most increases the risk of the endotracheal tube being misplaced outside the larynx? (Select 2.)

  • Laryngeal fracture

  • Basilar skull fracture

  • Tetanus

  • Tracheal tumors

  • Cervical spine injury

A laryngeal fracture may result in endotracheal tube placement outside the larynx. A basilar skull fracture can result in intracranial tube placement during nasotracheal intubation.

Tetanus makes oral intubation difficult or impossible but does not significantly increase the risk of a misplaced tube. Tracheal tumors can affect the advancement of the endotracheal tube but do not significantly increase the risk of a misplaced tube. Cervical spine injury increases the risk of spinal cord trauma, not the risk of a misplaced tube

15.

Which of the following statements is true about the two-level technique for combined spinal and epidural anesthesia?

  • The epidural catheter is inserted and tested prior to placement of the spinal anesthetic needle

  • An appropriate anesthetic solution for the spinal component should be hypobaric

  • A needle-through-needle technique is used

  • There is less risk of tissue trauma than with single-level technique

Correct answer: The epidural catheter is inserted and tested prior to placement of the spinal anesthetic needle

The main advantage of the two-level technique of combined spinal and epidural anesthesia is the ability to insert and test the epidural catheter prior to the placement of the spinal anesthetic needle.

Hypobaric solutions can lead to a "high" spinal. Appropriate spinal anesthetics should be either hyperbaric or isobaric. The needle-through-needle technique is used in the single-level technique. In the two-level technique, each component is performed separately. There is more risk of tissue trauma with the two-level technique than with the single-level technique.

16.

Which of the following is considered the best "one-size-fits-all" method for managing acute pain in elderly, medically complex patients?

  • There are no "one-size-fits-all" methods for managing pain in these patients

  • Patient-controlled analgesia

  • Scheduled acetaminophen or NSAIDs combined with PRN opioid 

  • Non-pharmacological interventions supported by PRN pain medications

Correct answer: There are no "one-size-fits-all" methods for managing pain in these patients

Managing acute pain in elderly, medically complex patients requires pain management solutions that are tailored to each patient's specific situation. It is not appropriate to try to treat acute pain the same way in every situation.

17.

A patient's blood pressure is 120/60. What is the patient's mean arterial blood pressure?

  • 80 mmHg

  • 60 mmHg

  • 180 mmHg

  • 100 mmHg

Correct answer: 80 mmHg

Mean Arterial Pressure (MAP) is calculated using the following formula: 2 x diastolic blood pressure + systolic blood pressure divided by 3, or (2DBP+SBP) / 3.  In this example, the equation would be the following:

  • MAP = (60 x 2) + 120 / 3
  • MAP = 120 + 120 / 3
  • MAP = 240 / 3
  • MAP = 80

18.

Injuries to the sciatic and common peroneal nerves are most common in which of the following positions?

  • Lithotomy position

  • Beach chair position

  • Trendelenberg position

  • Lateral decubitus position

Correct answer: Lithotomy position

Nerve injury is a risk with any kind of surgical position. However, injury to the sciatic and common peroneal nerves is most common with the lithotomy position. The beach chair position, Trendelenberg position, and lateral decubitus position are not as commonly associated with injuries to these nerves.

19.

How can the CRNA best determine if a facemask is properly sized?

  • The top of the facemask sits on the bridge of the nose and the bottom sits between the lower lip and chin

  • The facemask covers both the mouth and nares, but does not cover the eyes

  • The top of the facemask sits on or above the bridge of the nose and the bottom sits on the angle of the chin

  • The facemask covers the lower two-thirds of the face

Correct answer: The top of the facemask sits on the bridge of the nose and the bottom sits between the lower lip and chin

The top of a properly-sized facemask will sit on the bridge of the nose and the bottom will sit between the lower lip and chin. This provides the best seal. Other descriptions of facemask fits may allow for leaking of air from the facemask in certain conditions.

20.

Which of the following are most likely to be postoperative risks in patients taking opioids for chronic pain relief preoperatively? (Select 3.)

  • High opioid consumption

  • Higher pain scores

  • Lower pain thresholds

  • Increased duration of wound healing

  • Respiratory depression

The use of opioids preoperatively to treat chronic pain can lead to high opioid consumption, higher pain scores, and lower pain thresholds postoperatively. Opioid use preoperatively does not affect wound healing. Respiratory depression is less likely to occur in those who have an increased tolerance to opioids.