NBCRNA CRNA Exam Questions

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81.

Which of the following ASA Physical Status Classifications is most likely to be assigned to a pediatric patient receiving ECMO and is scheduled for emergency surgery?

  • ASA V

  • ASA VI

  • ASA IV

  • ASA III

Correct answer: ASA V

ASA V is used to describe a patient who is moribund and not expected to survive without the surgery or procedure. This category is typically reserved for patients undergoing emergency surgery. ASA VI describes a declared brain-dead patient whose organs are being removed for donor purposes. ASA IV describes a patient with severe systemic disease that is a constant threat to their life. ASA III describes a patient with severe systemic disease that limits their activity, but is not incapacitating.

82.

Which of the following are risk factors for perioperative mortality from bariatric surgery?

Select all that apply.

  • Advanced age

  • Presence of diabetes mellitus

  • Obstructive sleep apnea

  • Female sex

  • BMI >35.0 kg/m2

Advanced age, diabetes mellitus, male sex, and obstructive sleep apnea are all risk factors for perioperative mortality from bariatric surgery. A BMI >50.0 kg/m2 is also a risk factor for perioperative mortality from bariatric surgery, as is having surgery performed at a low-volume bariatric surgical center.

83.

The CRNA is treating a patient who has pulmonary hypertension. They understand that which of the following should be avoided due to the likelihood that it will elevate pulmonary artery pressures?

Select all that apply.

  • Hypercarbia

  • Hypoxemia

  • Acidosis

  • Hypothermia

  • Alkalosis

Hypercarbia, hypoxemia, acidosis, and hypothermia will all increase the risk of elevations in pulmonary artery pressures. Alkalosis is not likely to increase pulmonary artery pressures.

84.

Which of the following are direct thrombin inhibitors? (Select 3.)

  • Argatroban

  • Bivalirudin

  • Desirudin

  • Fondaparinux

  • Ticlopidine

Argatroban, bivalirudin, and desirudin are all direct thrombin inhibitors. Fondaparinux is a heparin and ticlopidine is an antiplatelet agent, specifically a P2Y12 receptor antagonist.

85.

Which of the following is a major hormone, is secreted by the adrenal cortex, and is involved with thirst and body fluid levels?

  • Aldosterone

  • Antidiuretic hormone

  • Vasopressin

  • Glucagon

Correct answer: Aldosterone

Aldosterone is secreted by the adrenal cortex and causes sodium retention from the kidneys, intestines, salivary glands, and sweat glands.

Antidiuretic hormone (ADH) is from the posterior pituitary, not the adrenal cortex. It retains water and is secreted when the plasma is hypertonic. Vasopressin is another name for ADH. Glucagon is produced in the pancreas and raises the concentration of glucose in the bloodstream.

86.

Indications for an emergency cesarean section include all the following except:

  • Dystocia

  • Umbilical cord prolapse

  • Placenta previa

  • Uterine rupture

Correct answer: Dystocia

Dystocia is difficult labor due to ineffective uterine contractions from abnormal lie, presentation, or position, or cephalopelvic disproportion due to either a small maternal pelvis or a large fetus. Dystocia does not indicate a "crash" or emergency cesarean section. However, shoulder dystocia is considered an obstetric emergency and if not resolved by full delivery of the infant within minutes of delivery of the head, an emergency cesarean section should be undertaken.

Indications for an emergency cesarean section include the following:

  • Placenta accreta
  • Placenta previa
  • Abruptio placentae
  • Umbilical cord prolapse
  • Uterine rupture
  • Severe fetal distress

87.

Which of the following would be considered to have moderate anemia using the World Health Organization anemia threshold? (Select 2.)

  • A male with a hemoglobin of 8.3 g/dL

  • A female with a hemoglobin of 10.3 g/dL

  • A male with a hemoglobin of 11.3 g/dL

  • A male with a hemoglobin of 5.3 g/dL

  • A female with a hemoglobin of 7.8 g/dL

The World Health Organization anemia threshold defines moderate anemia as being in the range of 8-11 g/dL for both males and females.

88.

A patient with an implantable cardiac defibrillator (ICD) is anticipated to be exposed to electromagnetic interference during surgery. Which of the following is ideal for this patient?

  • Deactivation of the ICD prior to surgery

  • Removal of the ICD prior to surgery

  • No interventions specific to the ICD are necessary

  • Having a magnet available to place over the device intraoperatively if necessary

Correct answer: Deactivation of the ICD prior to surgery

An ICD that is exposed to electromagnetic interference during surgery may inadvertently fire when not indicated. Because of the risks this possibility carries, deactivation of the ICD prior to surgery is ideal. Removal of the ICD prior to surgery is not necessary for modern models, as it can be controlled externally. Intraoperative management of the ICD would typically be reactive to inadvertently firing, potentially resulting in harm.

89.

Which conditions are most likely to preclude organ transplantation? (Select 3.)

  • Untreated systemic infection

  • Anticipated inability to comply with post-transplant care

  • Untreated substance abuse

  • Any form of malignancy 

  • Advanced age

Untreated systemic infection, anticipated inability to comply with post-transplant care and untreated substance abuse are all likely to preclude organ transplantation. Incurable malignancy is also likely to preclude transplantation. However, not all forms of malignancy will preclude transplantation. Advanced age increases the risk of graft failure, but it does not necessarily preclude organ transplantation.

90.

A 29-week-gestation pre-term infant is undergoing emergent surgery for necrotizing enterocolitis (NEC). Which of the following choices of anesthesia is most appropriate for this patient?

  • Fentanyl and vecuronium

  • Nitrous oxide and midazolam

  • Nitrous oxide and ketamine

  • Isoflurane and rocuronium

Correct answer: Fentanyl and vecuronium

Necrotizing enterocolitis (NEC) is not uncommon in preterm infants born prior to 36 weeks and constitutes a surgical emergency. NEC is believed to occur as a result of premature oral feedings, lack of healthy bacterial colonization of the gut, concurrent exposure to potential nosocomial infection sources, and ischemia of the intestines as a result of decreased blood flow to the mesentery. 

The infant undergoing surgery for NEC is typically already intubated and critically ill, often already receiving vasopressor support, as well as other supportive measures. The best choice of anesthesia for this specific patient population is a narcotic (such as fentanyl) coupled with a muscle relaxant (such as vecuronium or rocuronium). The volatile gases, sevoflurane and isoflurane, are not well tolerated in this group, and their use should be avoided if possible. A benzodiazepine (such as midazolam or ketamine) may also be used as an adjunct to the administration of narcotics. Nitrous oxide should not be used due to its potential to cause dilation of the bowel loops.

91.

Which of the following are most important to consider when positioning a patient for surgery for an intracranial mass lesion? (Select 2.)

  • The location of the tumor

  • The surgical approach

  • The effect of the position on intracranial pressure

  • The size of the tumor

  • Whether antiepleptics have been administered or not

The location of the tumor and the surgical approach that will be used are the two most important factors to consider when positioning a patient for surgery for an intracranial mass lesion. While the effect on intracranial pressure should be considered, intracranial pressure can be optimized in other ways to ensure the best surgical approach is used. The size of the tumor is not as important a consideration as the location of the tumor and the surgical approach that will be used. The use of antiepileptics should not affect how the patient is positioned.

92.

Which of the following patients is at the highest risk of experiencing postoperative visual loss (POVL)?

  • A 74-year-old female patient positioned in Trendelenburg for a hysterectomy

  • A neonate undergoing repair of myelomeningocele

  • A 16-year-old female undergoing anterior lumbar fusion for scoliosis

  • A 35-year-old male with type 1 diabetes undergoing an emergency appendectomy

Correct answer: A 74-year-old female patient positioned in Trendelenburg for a hysterectomy

Postoperative visual loss (POVL) is an uncommon and potentially devastating condition of permanent blindness that occurs as a result of surgery having nothing to do with the eye. POVL may affect one or both eyes and results from occlusion of the retinal artery or vein, ischemia of the optic nerve, cortical blindness, or as a result of glycine toxicity. Spinal and cardiac surgeries are the surgeries most likely to contribute to the development of POVL, with males being affected more frequently than females. Diabetes, hypertension, and vascular disease may also play a role in the causation of POVL. 

Neonates undergoing repair of myelomeningocele and teenagers undergoing anterior spinal fusions are at less or no risk of POVL. Posterior spinal repairs pose the greatest risk of POVL, as does the use of the Trendelenburg position for surgery. 

93.

Which of the following statements about the opioid remifentanil is most accurate?

  • Intraoperative administration of a bolus dose of remifentanil is indicated when rapid recovery is required

  • Administering bolus doses of remifentanil is absolutely contraindicated due to its potential for respiratory depression

  • Its short half-life and rapid onset of action make remifentanil an excellent choice when bolus dosing is recommended

  • A bolus dose of remifentanil administered in the postanesthesia care unit (PACU) can aid in transitioning the patient to the inpatient unit

Correct answer: Intraoperative administration of a bolus dose of remifentanil is indicated when rapid recovery is required

Remifentanil is a narcotic drug that was specifically synthesized to meet a unique need within pain management. It is a fast-acting, rapidly metabolized opioid with excellent titration capabilities. Its potency is somewhat less than that of fentanyl, and its time to peak effect is most similar to alfentanil. Despite these advantages, remifentanil can cause significant respiratory depression and muscle stiffness, and for these reasons, bolus dosing should be done with caution. 

Bolus dosing should not be administered preoperatively or postoperatively but in the intraoperative period. When the anesthetized surgical patient is monitored and rapid recovery is needed, bolus dosing of remifentanil may be used to provide a brief surge of the opioid's effects.

94.

Which of the following statements is true in regards to a Thorpe tube?

  • It is a gas-specific tapered tube, narrower at the base than at the top

  • It is a gas-specific tapered tube, wider at the base than at the top

  • It is not calibrated for specific gases, and it is not tapered

  • It is gas-specific, but it is not tapered

Correct answer: It is a gas-specific tapered tube, narrower at the base than at the top

The Thorpe tube flowmeter is used to directly measure the flowrate of a gas. An indicator ball or float is supported by the flow of gas through this tapered tube. The diameter is smaller at the base of the tube and is calibrated for specific gases.

95.

Which of the following statements is true about nerve blocks used for ophthalmic surgery?

  • Peribulbar blockade has a slower rate of onset than retrobulbar blockade

  • Retrobulbar blockade is more likely than peribulbar blockade to result in ecchymosis

  • Peribulbar blockade cannot achieve akinesia of the eye

  • Complications with sub-Tenon blocks occur significantly more often than with retrobulbar or peribulbar techniques

Correct answer: Peribulbar blockade has a slower rate of onset than retrobulbar blockade

Disadvantages of peribulbar blockade include a slower rate of onset (due to the need for injection of larger anesthetic volumes than those required for retrobulbar injection) than retrobulbar blockade and an increased risk of ecchymosis.

Both peribulbar and retrobulbar blockade achieve akinesia of the eye. Complications with sub-Tenon blocks are significantly less than with retrobulbar or peribulbar techniques.

96.

A 41-week pregnant female who was attempting an unmedicated birth before becoming hemodynamically unstable now requires an emergency Cesarean section. Which of the following induction drugs is the best choice for this patient's general anesthesia?

  • Etomidate

  • Succinylcholine

  • Sevoflurane

  • Nitrous oxide

Correct answer: Etomidate

Under ideal circumstances, Cesarean section deliveries should take place after the administration of a regional anesthetic. However, in the event of an emergency delivery, delivery of regional anesthesia is neither a practical nor safe option, and general anesthesia should be administered. If the laboring woman is hemodynamically stable and requires rapid induction, propofol is the drug of choice, although this does cause a degree of depression in the neonate. In situations where the laboring female is hemodynamically unstable, either ketamine or etomidate should be utilized for induction of anesthesia. 

Succinylcholine is typically utilized for induction of general anesthesia of the laboring patient when rapid induction is not indicated and the patient is hemodynamically stable. Sevoflurane is a volatile gas considered to have tocolytic properties, causing concern for significant postpartum blood loss. In the United Kingdom, nitrous oxide is often used for pain relief by laboring women as an alternative to epidural anesthesia.

97.

Which of the following antibiotics contain β-lactams rings in their chemical structure? (Select 3.)

  • Cephalosporins

  • Carbapenems

  • Monobactams

  • Vancomycin

  • Clindamycin

β-lactam antibiotics include cephalosporins, carbapenems, and monobactams. Vancomycin and clindamycin are both not β-lactam antibiotics.

98.

All the following steps in the research process must be completed before an approach for testing the hypothesis is developed except:

  • Analysis and interpretation of the data

  • Identification of the problem

  • Review of the relevant knowledge and literature

  • Formulation of the hypothesis

Correct answer: Analysis and interpretation of the data

Analysis and interpretation of data will be completed after the development of an approach for testing the hypothesis and execution of the research plan.

Before the development of an approach for testing the hypothesis, the problem must be identified, a review of the relevant knowledge and literature must be completed, and the hypothesis must be formulated.

99.

Which of the following can be used to reverse the effects of a direct oral anticoagulant?

  • Andexanet alfa

  • Protamine

  • Vitamin K

  • Platelet transfusion 

Correct answer: Andexanet alfa

Antidotes to direct oral anticoagulants include andexanet alfa and idarucizumab. Protamine can neutralize heparin, not direct oral anticoagulants. Vitamin K is used to reverse warfarin and platelet transfusions are used to treat thrombocytopenia.

100.

Possible causes of adrenal gland destruction include all the following except:

  • Diabetic ketoacidosis

  • Fungal infections

  • Bacterial infections

  • Hemorrhagic shock

Correct answer: Diabetic ketoacidosis

Diabetic ketoacidosis is not associated with adrenal gland destruction.

The primary cause of adrenal insufficiency is autoimmune destruction of the adrenal gland. Other possible causes include:

  • Certain bacterial, fungal, and viral infections (advanced HIV)
  • Metastatic cancer
  • Sepsis
  • Hemorrhage