NBCRNA CRNA Exam Questions

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101.

Which of the following best describes the rationale for normovolemic hemodilution?

  • To minimize the loss of blood cells during surgery

  • To maintain a normal blood volume during surgery

  • To maximize the oxygen-carrying capacity of the blood during surgery

  • To reduce blood pressure during surgery for therapeutic reasons

Correct answer: To minimize the loss of blood cells during surgery

Normovolemic hemodilution involves removing a volume of the patient's blood and replacing the volume with crystalloids or colloids. The blood is replaced following surgery. The purpose of this is to minimize the loss of blood cells during surgery, not to alter or maintain blood volume. This technique reduces the oxygen-carrying capacity of the blood during surgery and maximizes it afterwards.

102.

Which of the following is a common reason for increases in inspired carbon dioxide?

  • Faulty unidirectional valves

  • Malignant hyperthermia

  • Abdominal insufflation with carbon dioxide

  • High fresh gas flows

Correct answer: Faulty unidirectional valves

Faulty unidirectional valves and exhausted absorbent granules are the only two common reasons for increased levels of inspired carbon dioxide (CO2). Unidirectional valves enforce a pattern of gas flow by which exhalations are made to pass through the CO2 absorbent granules. If the inspiratory or expiratory valve is faulty, the entire corrugated limb becomes dead space and can result in an increase in inspired and expired CO2.

In malignant hyperthermia, hypercapnia occurs because the body cannot remove CO2, rather than an increase in inspired carbon dioxide. Abdominal insufflation with carbon dioxide does not cause an increase in inspired CO2. High fresh gas flows decrease the amount of inspired CO2.

103.

Which of the following statements is true about adenosine when used as part of cardiovascular testing?

  • It is used as a coronary vasodilator to assess flow heterogeneity for patients who are unable to exercise

  • It increases myocardial oxygen demands by increasing heart rate and blood pressure in patients who cannot exercise

  • It quickly produces maximal hyperemia in patients who are unable to exercise

  • Using adenosine for stress testing in patients who cannot exercise provides anatomic rather than functional information

Correct answer: It is used as a coronary vasodilator to assess flow heterogeneity for patients who are unable to exercise

Adenosine is administered to patients who are unable to exercise as a coronary vasodilator to assess flow heterogeneity. The presence of a redistribution defect is predictive of postoperative cardiac events, especially in patients undergoing peripheral vascular surgery.

Dobutamine increases myocardial oxygen demands by increasing heart rate and blood pressure. Lexiscan, not adenosine, quickly produces maximal hyperemia. Unlike exercise or pharmacological stress testing, coronary angiography provides anatomic rather than functional information. Stress tests provide functional information.

104.

Which of the following is used in the treatment of citrate toxicity?

  • Calcium chloride

  • Potassium

  • Corticosteroids

  • Heparin

Correct answer: Calcium chloride

Citrate is added to blood products to prevent clotting during the interval between donation and transfusion. It binds to serum calcium, removing it from physiological availability. Large volumes of blood transfusions incur large quantities of citrate and may produce hypocalcemia as a result. It is treated with either calcium gluconate or calcium chloride.

105.

All the following may stimulate the release of antidiuretic hormone except:

  • Decrease in serum osmolality

  • Increased anxiety

  • Positive-pressure ventilation of the lungs

  • Hyperthermia

Correct answer: Decrease in serum osmolality

The secretion of antidiuretic hormone (ADH), also known as vasopressin, is stimulated by increased serum osmolality (not decreased) because the increase indicates insufficient water content.

ADH secretion may also be stimulated by the following:

  • Beta-adrenergic stimulation
  • Stress and anxiety
  • Hyperthermia
  • Histamine-releasing stimuli
  • Positive-pressure ventilation

106.

A patient with herniated nucleus pulposus (HNP) of the lumbar spine and radicular pain has been treated with an epidural steroid in combination with a local anesthetic. Which of the following injection methods is believed to have a more effective therapeutic effect than other injection methods and routes?

  • Injection via the transforaminal route

  • Injection via interlaminar route

  • Injection via the facet joint space

  • Injection via the sacroiliac joint

Correct answer: Injection via the transforaminal route

Epidural steroid injection, often in combination with a local anesthetic, is the most frequently utilized treatment for radicular pain that results from herniated nucleus pulposus (HNP). These injections are most effective if administered to patients whose pain has begun in the preceding 3 to 6 weeks. They do not typically provide any relief if the pain has persisted longer than 3 months. Epidural steroid injections for the pain of HNP may be administered via the transforaminal route, which provides the most effective pain relief, or via the interlaminar route. Interlaminar route injection is a technically more simple (and safer) injection than injection via the transforaminal route but does not provide the most effective pain relief.

Facet joint space injections are injections of the zygapophyseal joints that lie along the lateral aspect of the vertebrae. Pain from these joints typically is muscular in origin, and patients often complain of muscle spasms.

Injection of the sacroIliac (SI) joint is reserved for the treatment of pain originating in the SI joint, not the lumbar spine.

107.

Which of the following considerations is least important when performing a retrobulbar block?

  • The needle tip shape

  • The patient's gaze

  • The depth of needle insertion

  • The angle of needle insertion

Correct answer: The needle tip shape

The needle tip shape that is optimal for performing a retrobulbar block is debated in the literature, with dull or flat-grind needles preferred by some clinicians for safety reasons. It is generally accepted that where the needle is placed is more important for safety than the needle tip shape. The patient's gaze, the depth of needle insertion, and the angle of needle insertion all affect needle placement.

108.

Methyl methacrylate (MMA) is being used during orthopedic surgery. All the following are known potential cardiovascular complications associated with the use of this material except:

  • Tachycardia

  • Bradycardia

  • Hypotension

  • Cardiac arrest

Correct answer: Tachycardia

Methyl MethAcrylate (MMA) is used to repair bone defects or to cement a prosthesis to bone. Known cardiovascular complications of this material in surgical patients include: 

  • Bradycardia
  • Hypotension
  • Cardiac arrest

109.

Which of the following conditions is most likely to cause cervical spine changes that may lead to airway complications?

  • Rheumatoid arthritis

  • Osteoarthritis

  • Ankylosing spondylitis

  • Amyotrophic lateral sclerosis

Correct answer: Rheumatoid arthritis

Rheumatoid arthritis causes cervical spine changes in 80% of patients, increasing the likelihood of airway complications. While ankylosing spondylitis can lead to vertebral fusion, this is more common in the lower spine. Osteoarthritis does not cause cervical spine changes in most patients. Amyotrophic lateral sclerosis does not affect cervical spine structure.

110.

In pulmonary function testing, which of the following is considered normal adult vital capacity?

  • 60 - 70 mL/kg

  • 40 - 50 mL/kg

  • 90 - 100 mL/kg

  • 110 - 125 mL/kg

Correct answer: 60 - 70 mL/kg

Normal Vital Capacity (VC) in pulmonary function testing is the maximum volume of gas that can be exhaled following maximal inspiration. Normal VC is about 60 - 70 mL/kg.

111.

Which of the following statements regarding anesthesia induction time in the elderly population is most accurate?

  • Induction time using inhaled agents is faster

  • Induction time using intravenous agents is faster

  • Induction time is not affected positively or negatively by aging

  • Induction time is generally delayed regardless of induction agent

Correct answer: Induction time using inhaled agents is faster

Many cardiovascular changes occur as a result of aging, some of which directly affect anesthesia metabolism or the effects of anesthesia itself. Circulation time in the elderly population is generally slowed, which impacts when the anesthesia induction agents may take effect. Inhaled induction agents generally produce a quicker than normal response in the elderly due to a change in circulation, while intravenous induction agents generally take longer to take effect. The anesthesia provider must keep these considerations in mind when administering the induction agent to the elderly patient.

112.

Which of the following are ways that heavy alcohol use most directly leads to hypokalemia? (Select 3.)

  • Renal loss

  • Increased nonrenal loss

  • Decreased intake

  • Intracellular shift

  • Endocrinopathy

Heavy ethanol ingestion increases the renal loss of potassium, induces nonrenal potassium loss by acting as an emetic and laxative, and leads to decreased oral intake of potassium. Alcohol is unlikely to cause a meaningful intracellular potassium shift in most situations and does not commonly lead to endocrinopathy.

113.

Which of the following conditions is least likely to influence airway management?

  • Thoracic spine injury

  • Ludwig's angina

  • Basilar skull fracture

  • Epiglottitis

Correct answer: Thoracic spine injury

Cervical spine injury (not thoracic spine injury) is likely to influence airway management. Ludwig's angina, basilar skull fractures, and epiglottitis are all likely to have a significant influence on airway management. 

114.

Which of the following describes the second gas effect most accurately?

  • Nitrous oxide administered concurrently with isoflurane causes significantly faster uptake of isoflurane

  • The second gas effect does not occur during emergence

  • The second gas effect is highly dependent upon the concentration of administered volatile anesthetics

  • Nitrous oxide administered concurrently with sevoflurane causes significantly faster uptake of sevoflurane

Correct answer: Nitrous oxide administered concurrently with isoflurane causes significantly faster uptake of isoflurane

The second gas effect is so named because of the effect that the second gas has upon the uptake of the first administered gas. This second gas is sometimes referred to as a companion gas and can be used to modulate speed of uptake of volatile anesthetics. Typically, nitrous oxide is administered as the second gas due to its own rapid uptake, and when administered with a volatile anesthetic with a slow uptake, such as isoflurane, the uptake of the initial gas (isoflurane) is significantly sped up. Administering nitrous oxide with an already rapid volatile anesthetic, such as sevoflurane, the uptake of the first gas (sevoflurane) is increased, but not significantly. The second gas effect also occurs during emergence, as nitrous oxide's rapid elimination leads to accelerated removal of the accompanying volatile agent.

The second gas effect is not dependent upon the concentration of the first gas administered.

115.

Which of the following factors are likely to affect the degree of vasodilitation experienced when administering propofol?

Select all that apply.

  • Obesity

  • Age

  • Diabetes

  • Substance abuse

  • Renal function

Obesity, advanced age, diabetes, and hypertension are all factors that are likely to affect the degree of vasodilitation that occurs when administering propofol. Substance abuse is not likely to affect the degree of vasodilitation experienced. While renal failure could cause hypertension that could affect the degree of vasodilitation experienced, it is not likely to by itself.

116.

Which of the following muscles is controlled by the external branch of the superior laryngeal nerve?

  • Cricothyroid muscle

  • Posterior cricoarytenoid muscle

  • Lateral cricoarytenoid muscle

  • Thyroarytenoid

Correct answer: Cricothyroid muscle

The external branch of the superior laryngeal nerve controls the cricothyroid muscle.

All other muscles of the larynx are controlled by the recurrent laryngeal muscle.

117.

How can a CRNA verify that the oxygen pressure safety devices are working? 

  • Disconnect wall oxygen and shut off the oxygen supply tank

  • Disconnect wall oxygen

  • Shut off the oxygen supply tank

  • Disconnect wall oxygen and self-inflating manual ventilation device

Correct answer: Disconnect wall oxygen and shut off the oxygen supply tank

The only way to verify that the oxygen pressure safety devices are working is by both disconnecting wall oxygen and shutting off the oxygen supply tank. This maneuver, however, is not generally recommended.

118.

Which of the following will not reduce cerebral edema? 

  • Decompressive craniectomy

  • Furosemide

  • Mannitol

  • Hypertonic saline

Correct answer: Decompressive craniectomy

A decompressive craniectomy will reduce intracranial pressure caused by cerebral edema, but will not reduce cerebral edema itself. Furosemide, hypertonic saline, and mannitol are all possible therapeutics for reducing cerebral edema. 

119.

All the following statements regarding use of an active anesthesia scavenging system are true except:

  • Within the United States, hospitals may elect to use either active or passive scavenging systems

  • Active scavenging systems utilize the hospital's vacuum system

  • Open interface systems require active scavenging systems, while closed interface systems are utilized where passive scavenging systems are in place

  • Without appropriate protections in place, the use of active scavenging systems may result in the development of barotrauma in the patient

Correct answer: Within the United States, hospitals may elect to use either active or passive scavenging systems.

Due to the concern of exposure to waste anesthetic gases, the use of anesthesia scavenging systems is required in the operating room environment. Within the United States, hospitals are required to use active scavenging systems or risk losing accreditation. The interface is the most critical component of the scavenger system, and in newer anesthesia machines, an open interface is most often utilized (older machines most often have a closed interface and use a passive scavenging system). The open interface requires an active scavenging system, and precautions need to be taken to prevent the build-up of positive pressure that may cause barotrauma in the surgical patient.

120.

Which of the following is most correct regarding the biopsychosocial model of chronic pain?

  • Pain and mood are considered to have a bidirectional link to each other

  • Psychological well-being is thought to be the primary influencing factor in the development of chronic pain

  • Those most ambivalent about the idea of pain are considered to be at greater risk of developing chronic pain

  • Chronic pain is considered to be a psychological, not a physiological problem

Correct answer: Pain and mood are considered to have a bidirectional link to each other

The biopsychosocial model of chronic pain holds that pain and mood have a bidirectional link to each other, with pain causing psychological distress and psychological distress increasing the physical perception of pain. In the biopsychosocial model of chronic pain, psychological well-being and physical pain are both thought to be the influencing factors in the development of chronic pain. Those most fearful of pain, not most ambivalent about the idea of pain, are considered to be at the greatest risk of developing chronic pain in the biopsychosocial model of chronic pain. In the biopsychosocial model of chronic pain, chronic pain is considered to be both a psychological and a physiological problem.