NBCRNA CRNA Exam Questions

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141.

Which of the following is most commonly used to manage chronic pain in the elderly? (Select 3.)

  • Pharmacotherapy

  • Physical therapy

  • Interventional pain procedures

  • Phototherapy

  • Psychotherapy

One of the most common approaches to managing chronic pain in the elderly is a combination of pharmacotherapy, physical therapy, and interventional pain procedures. Phototherapy is not commonly used in treating chronic pain, although it may serve as an adjunct in some situations. Psychotherapy can also be an adjunct to chronic pain treatments in some situations but is not typically a mainstay of treatment.

142.

All of the following statements are true about mannitol except:

  • Administration may cause transient hypernatremia

  • It is an osmotic diuretic

  • Administration may cause a transient and rapid intracellular to extracellular water shift, leading to pulmonary edema

  • It is filtered at the glomerulus

Correct answer: Administration may cause transient hypernatremia

Administration of mannitol may cause transient hyponatremia, rather than hypernatremia.

Mannitol is an osmotic diuretic. It is filtered at the glomerulus but does not get significant reabsorption in the proximal tubule. This osmotically prevents passive water reabsorption that would occur with the active sodium reabsorption in the proximal tubule. This occurs rapidly, so it acutely raises plasma/extracellular osmolarity and may lead to pulmonary edema and transient hyponatremia.

143.

Preoperative evaluation of a patient with a cardiac implantable device should include which of the following? (Select 3.)

  • Magnet mode setting

  • Mode of the device

  • Reason for implantation

  • Postsurgical recovery after implantation

  • History of device malfunction during previous surgery

Magnet mode setting, mode of the device, and the initial reason for implantation are all important to know when providing anesthesia care for a patient with a cardiac implantable device. Postsurgical recovery after implantation is not relevant unless implantation was recent. History of device malfunction during previous surgery is not routinely accessed prior to surgery.

144.

A 75-year-old post-surgical awake patient being cared for in the postanesthesia care unit (PACU) is demonstrating agitation. Which of the following medications commonly administered during surgery may cause an upper airway obstruction that manifests with symptoms of agitation?

  • Rocuronium

  • Sevoflurane

  • Propofol

  • Fentanyl

Correct answer: Rocuronium

One of the most common post-surgical complications during the immediate post-surgical period is upper airway obstruction. Patients may experience an upper airway obstruction as a result of loss of pharyngeal muscle tone, laryngospasm, previously undiagnosed obstructive sleep apnea, airway edema, or as the result of a residual neuromuscular blockade. Patients who receive one of the neuromuscular blockade agents (NMBAs), such as rocuronium, may experience only a partial reversal of the NMBA effects, even when a reversal agent such as neostigmine or edrophonium is administered. Often, the only symptom they exhibit is agitation. This is more common in elderly patients and should be closely watched for.

145.

Which of the following statements is true about fetal circulation?

  • Oxygenated blood leaving the placenta to enter fetal circulation is at approximately 80% oxygen saturation (PaO2)

  • Mixed venous blood returning to the placenta from the lower body is at approximately 55% oxygenation (PaO2)

  • Blood flows from the inferior vena cava through the ductus arteriosus into the left atrium

  • Fetal pulmonary and systemic circulations are in series, while they are parallel in adults

Correct answer: Oxygenated blood leaving the placenta to enter fetal circulation is at approximately 80% oxygen saturation (PaO2)

In fetal circulation, well-oxygenated blood from the placenta, which is approximately 80% oxygenated, mixes with venous blood returning from the lower body, which is at approximately 25% oxygen-saturation and flows through the inferior vena cava into the right atrium.

The ductus arteriosus connects the pulmonary artery to the descending aorta. It is not located between the right atrium and the inferior vena cava. In the adult, pulmonary and systemic circulations are in a series; fetal pulmonary and systemic circulations are parallel.

146.

Which of the following represents normal mixed venous blood oxygen saturation (SVO2)?

  • 75%

  • 60%

  • 40%

  • 90%

Correct answer: 75%

Mixed venous blood oxygen saturation can be referred to as SVO2 or MVO2. It reflects the total tissue oxygen consumption. Normal tissue oxygen extraction is 25%, leaving an oxygen balance of 75%, although a value of 65% to 77% may be considered normal.

147.

Which of the following are malabsorptive procedures performed to therapeutically treat obesity?

Select all that apply.

  • Jejunoileal bypass

  • Biliopancreatic diversion

  • Partial colectomy

  • Gastric banding

  • Sleeve gastrectomy

Jejunoileal bypass and biliopancreatic diversion are both malabsorptive procedures that are performed to therapeutically treat obesity. A partial colectomy is likely to cause malabsorption; however, this surgical option is not used to treat obesity, but rather to treat some pathologies affecting the large intestines. Gastric banding and sleeve gastrectomy are restrictive procedures, not malabsorptive procedures.

148.

In research, which of the following terms describes the variation of the sample mean for the collected data around the actual mean of the population?

  • Standard error of the mean

  • Standard deviation

  • Power

  • Variance

Correct answer: Standard error of the mean

The standard error of the mean describes the variation of the sample mean (for the actual data collected) around all possible observations (the true but unknown population mean).

Standard deviation is the positive square root of the variance. Power is the sensitivity of the planned experiment and analysis. Variance is the square of the sum of all of the deviations divided by the number of scores.

149.

Which of the following are contraindications for noninvasive positive-pressure ventilation? (Select 3.)

  • Vomiting

  • Impaired neurological state

  • Excessive airway secretions

  • Postoperative respiratory failure

  • Immunocompromise

Vomiting, impaired neurological state, and excessive airway secretions are all potential contraindications for noninvasive positive-pressure ventilation. Noninvasive positive-pressure ventilation can be used in immunocompromised patients and is used to treat postoperative respiratory failure.

150.

Which of the following effects should an anesthesia provider anticipate when providing care to an older adult who reports daily alcohol use? (Select 2.)

  • Delirium tremens

  • Increased anesthetic requirements

  • Decreased anesthetic requirements

  • Increased sensitivity to benzodiazepines

  • Cardiac dysrhythmias

Delirium tremens is a potential complication in a patient with frequent alcohol use. Alcohol will also lead to increased anesthetic requirements. Increased sensitivity to benzodiazepines and cardiac dysrhythmias are not commonly associated with providing anesthesia to someone who uses alcohol frequently.

151.

Which of the following structures are principally involved in radical neck dissection surgery?

Select all that apply.

  • The sternocleidomastoid muscle

  • The carotid artery

  • Cranial nerve IX

  • C3-C7

  • The trachea

Radical neck dissection principally involves the following structures:

  • The sternocleidomastoid muscle
  • Cranial nerve XI
  • Internal and external jugular veins
  • Carotid artery

Cranial nerve IX, the vertebrae, and the trachea are not structures principally involved in radical neck dissection surgery.

152.

All the following statements related to hypoglycemia are true except:

  • With hypoglycemia, there is a reflex catecholamine release that suppresses sympathetic activity

  • In anesthetized patients, signs of hypoglycemia may be misinterpreted as inadequate anesthesia

  • In patients being treated with beta-blockers, signs of hypoglycemia can be obscured

  • Diabetic patients who have chronically elevated blood glucose levels may be symptomatic at levels significantly above those of the normal, fasting patient

Correct answer: With hypoglycemia, there is a reflex catecholamine release that suppresses sympathetic activity

With hypoglycemia, there is a reflex catecholamine release that produces overt sympathetic hyperactivity. This causes tachycardia, lacrimation, diaphoresis, and hypertension.

In anesthetized patients, signs of sympathetic hyperactivity can be easily misinterpreted as "light" or inadequate anesthesia. In patients being treated with beta-blockers or in patients with advanced diabetic autonomic neuropathy, signs of hypoglycemia can be obscured. The normal, fasting patient may have blood sugar levels lower than 50 mg/dL without any symptoms. However, diabetic patients who have chronically elevated blood glucose levels may be symptomatic at levels significantly above those of the normal, fasting patient.

153.

Which of the following statements about clonidine is true?

  • If added to lidocaine in a peripheral nerve block, it will markedly prolong the anesthetic effects

  • Abrupt discontinuation following long-term administration can lead to severe hypotension and sympathetic depression

  • It poorly penetrates the blood-brain barrier

  • It does not cross the placenta

Correct answer: If added to lidocaine in a peripheral nerve block, it will markedly prolong the anesthetic effects

When added to local anesthetics of intermediate duration (for example, mepivacaine or lidocaine) given for epidural or peripheral nerve block, clonidine will markedly prolong both the anesthetic and analgesic effects.

Abrupt discontinuation of clonidine following long-term administration can lead to withdrawal symptoms characterized by agitation, rebound hypertension, and sympathetic overactivity. Clonidine readily penetrates the blood-brain barrier and the placenta.

154.

What is the greatest risk associated with administering flumazenil to a patient who is receiving chronic benzodiazepine therapy?

  • Seizures

  • Hemolytic drug interactions

  • Inadequate sedation

  • Resedation

Correct answer: Seizures

Flumazenil is a benzodiazepine antagonist, increasing the risk of seizures occurring when the effects of chronic benzodiazepine use are suddenly reversed. Hemolytic drug interactions are not a concern when combining benzodiazepines and flumazenil. Reduced or absent sedation is the desired effect of flumazenil administration, not a risk associated with the medication. Resedation is a potential risk of flumazenil use due to the short duration of action relative to benzodiazepines. However, seizures are a more significant risk.

155.

Which of the following reversal agents is best for a patient who has received the neuromuscular blocking agent (NMBA) rocuronium as part of the anesthesia "cocktail" during their surgery?

  • Sugammadex

  • Neostigmine

  • Edrophonium

  • Glycopyrrolate

Correct answer: Sugammadex

Due to the risk of neuromuscular blockade in patients who have received one of the neuromuscular blocking agent (NMBA) drugs during surgery, reversal drugs must be co-administered. A partial, or incomplete, reversal of neuromuscular blockade may ultimately cause upper airway obstruction and respiratory depression, necessitating careful monitoring of patients in the PACU who have received an NMBA. Reversal agents such as neostigmine and edrophonium may be administered to patients who have received NMBAs. However, the reversal drug of choice for patients who have received rocuronium (or vecuronium) is sugammadex. 

Sugammadex works by transporting the NMBA away from the neuromuscular junction, unlike the other reversal agents (such as neostigmine or edrophonium) in which the mechanism of action is that of an anticholinesterase. Glycopyrrolate is not a reversal agent but must be administered with the cholinergic reversal agents (neostigmine and edrophonium) to prevent the development of bradycardia or excessive oral secretion from the cholinergic drug.

156.

Which of the following statements is true about variable decelerations in fetal monitoring?

  • They vary in onset, duration, and magnitude

  • They are thought to occur as a vagal response to compression of the fetal head

  • The fetal heart rate during variable decelerations forms a smooth mirror image of the uterine contraction

  • They are classified as severe if fetal heart rate decreases to 80 beats per minute or fewer

Correct answer: They vary in onset, duration, and magnitude

Variable decelerations are the most common type. They vary from deceleration to deceleration in a variety of ways, including onset, appearance, duration, magnitude or depth, and shape.

Variable decelerations are thought to be related to umbilical cord compression and intermittent decreases in umbilical blood flow. Early decelerations are thought to occur as a vagal response to compression of the fetal head and form a smooth mirror image of the uterine contraction. Variable decelerations are classified as severe if the fetal heart rate decreases by 60 beats per minute, and/or the fetal heart rate decreases to 60 beats per minute or fewer, and/or if the deceleration occurs for 60 seconds or longer.

157.

Which of the following is correct regarding administering opioids to patients who are near death and expected to die? (Select 3.)

  • Opioids may increase the time to death

  • The use of opioids at the end of life is medically indicated 

  • The use of opioids at the end of life is morally indicated 

  • Healthcare professionals are required to administer opioids for end-of-life care, even if it causes them moral distress

  • Opioids can be given for the purpose of reducing the time to death, as long as they also promote patient comfort

The use of opioids at the end of life is both medically and morally indicated. While opioids may hasten death, they may also increase the time to death in dying patients in some situations by decreasing patient distress. While opioids are appropriate for end-of-life care, other healthcare team members should be assigned to a patient if it causes a particular provider moral distress. Opioids should only be given to promote patient comfort, not for deliberately reducing the time to death.

158.

According to current contemporary standards and the information given, which of the following adult surgical patients is deemed most in need of a transfusion of blood products?

  • A patient with heart disease whose hematocrit is 27%

  • A patient with peripheral vascular disease whose hemoglobin is 11 g/dL

  • A patient with peripheral vascular disease whose hematocrit is 32%

  • A patient with chronic anemia whose hematocrit is 25%

Correct answer: A patient with heart disease whose hematocrit is 27%

According to contemporary trigger values, hemoglobin (Hgb) and hematocrit (Hct) levels are allowed to decrease to the following levels before transfusions are deemed necessary:

  • Healthy patients or patients with chronic anemia: Hgb 7-8 g/dL or Hct 21-24%
  • Unhealthy patients: Hgb 10 g/dL or Hct 30% with coronary disease or peripheral vascular disease

The practitioner must bear in mind that a decision to transfuse based solely on a laboratory value is neither recommended nor responsible, as it is multifactorial.

159.

Which complications are most common in interventional cardiology procedures? (Select 3.)

  • Bleeding

  • Vascular injury

  • Pneumothorax 

  • Cardiac tamponade

  • Endocarditis

Most common in interventional cardiology procedures are related to vascular access and include bleeding, vascular injury, and pneumothorax. Cardiac tamponade and endocarditis are not common complications of interventional cardiology procedures.

160.

Which of the following make barbiturates an ideal option for managing patients with space-occupying intracranial lesions?

Select all that apply.

  • They decrease intracranial pressure

  • They may provide neuroprotection from focal cerebral ischemia

  • They may provide neuroprotection from global cerebral ischemia

  • They decrease elevated cerebral perfusion pressures

  • They will likely decrease pressure caused by the space-occupying lesion

Barbiturates are an ideal option for managing patients with space-occupying intracranial lesions as they decrease intracranial pressure and may provide neuroprotection from focal cerebral ischemia. Neuroprotection from global cerebral ischemia (generally caused by cardiac arrest) is not likely. Decreased intracranial pressure leads to increased, not decreased, cerebral perfusion pressures. While decreased intracranial pressure is likely, this is not caused by reducing pressure caused by space-occupying intracranial lesions.