×

Quiz Session - Attempts With Random Questions

NBCRNA CRNA Exam Questions

Page 2 of 50

21.

In which of the following types of hypersensitivity reactions do circulating soluble antigens and antibodies bind to form insoluble complexes that deposit in microvasculature?

  • Type III

  • Type I

  • Type II

  • Type IV

Correct answer: Type III

In Type III hypersensitivity reactions, circulating soluble antigens and antibodies bind to form insoluble complexes that deposit in microvasculature.

In Type I hypersensitivity reactions, mediators are released from mast cells and basophils after the antigen binds to IgE antibodies on cell membranes. Type II hypersensitivity reactions are antibody-dependent cell-mediated cytotoxic hypersensitive reactions, IgG or IgM-mediated. Type IV hypersensitivity reactions are characterized by interactions of sensitized cytotoxic T-cells with specific antigens or delayed sensitivity reactions.

22.

When should tricyclic antidepressants generally be used to manage cancer pain?

  • For neuropathic pain that is refractory to opioids

  • As the primary choice for neuropathic pain

  • As an adjunct pain medication for any type of cancer pain

  • Tricyclic antidepressants should not be used to manage pain, only to manage psychological symptoms 

Correct answer: For neuropathic pain that is refractory to opioids

Tricyclic antidepressants are conventionally used in cancer patients to treat neuropathic pain that is refractory to opioids. Tricyclic antidepressants are not conventionally used for any kind of pain but can be used for neuropathic pain in addition to psychological indications.

23.

Which of the following best describes catastrophizing?

  • A negative cognitive process that occurs during pain or anticipated pain

  • An extreme emotional response to a negative event

  • An extremely negative event that causes severe psychological distress

  • Emotional duress caused by anticipation of a negative event

Correct answer: A negative cognitive process that occurs during pain or anticipated pain

Catastrophizing is a negative cognitive process that occurs during pain or anticipated pain and can significantly increase the risk that chronic pain will develop. Catastrophizing is not an extreme emotional response to a negative event or an event that causes severe psychological distress. Catastrophizing can refer to the anticipation of pain, but it is not the emotional duress caused by anticipation of a negative event.

24.

During which of the following surgical procedures is the patient most likely to be positioned using the hemilithotomy position?

  • Gastrocnemius recession

  • Vaginal delivery

  • Transurethral resection of the prostate (TURP)

  • Abdominoperineal (AP) resection

Correct answer: Gastrocnemius recession

The lithotomy position (in which the patient is placed supine and then the lower extremities are flexed and abducted above the torso) is used for several types of surgeries, including urological, rectal, and pelvic surgeries. The lithotomy position has several variations, including the hemilithotomy position in which only one extremity is flexed and abducted above the level of the torso, and is used at times during orthopedic surgeries, such as gastrocnemius recession. 

Patients undergoing transurethral resection of the prostate (TURP) may be positioned using a lithotomy position (without elevation of the legs) or with the patient in Trendelenburg. Abdominoperineal (AP) resection may be undertaken with the patient positioned prone or using the lithotomy position. While laboring women continue to be positioned in lithotomy position for childbirth in many Western countries, the use of this position during labor is not supported by evidence, nor is vaginal delivery considered a surgical procedure.

25.

Manifestations of an acute hemolytic reaction in an anesthetized patient include which of the following?

  • Hypotension, diffuse oozing of blood in the surgical field, hemoglobinuria

  • Unexplained bradycardia, hypotension, oozing of blood in the surgical field

  • Sudden hypertension, hyperthermia, unexplained tachycardia

  • Massive bleeding in the surgical field, hypertension, hemoglobinuria

Correct answer: Hypotension, diffuse oozing of blood in the surgical field, hemoglobinuria 

In an anesthetized patient, signs of an acute hemolytic reaction include the following:

  • A rapid increase in temperature
  • Sudden unexplained tachycardia
  • Refractory hypotension
  • Hemoglobinuria
  • Diffuse oozing in the surgical field

Bradycardia, hypertension, and massive bleeding are not signs of an acute hemolytic reaction.

26.

Which are most likely to be triggers for a sickle cell crisis in a patient with sickle cell disease? (Select 3.)

  • Infection

  • Venous stasis

  • Dehydration

  • Alkalosis

  • Hyperthermia

Sickle cell crisis is triggered by conditions that increase the concentration of red blood cells, the stasis of red blood cells, or inflammation. Infection, venous stasis, and dehydration can all trigger sickle cell disease.

Acidosis (not alkalosis) and hypothermia (not hyperthermia) are sickle cell triggers.

27.

Which of the following is most likely to make oral endotracheal intubation impossible?

  • Trismus

  • Epiglottitis 

  • Basilar skull fracture

  • Ludwig's angina

Correct answer: Trismus

Trismus causes a limited range of motion of the jaw, making oral endotracheal intubation impossible in most situations. While epiglottitis and Ludwig's angina can affect oral endotracheal intubation, they are not as impactful as trismus. Basilar skull fracture makes nasotracheal intubation, not oral, a higher risk due to the risk of intracranial tube placement. 

28.

For a patient undergoing neurosurgery, it is important to understand the relationship between cerebral metabolic rate (CMR) and brain temperature. Which of the following statements correctly defines this relationship? (C = Celsius)

  • For every 10-degree C increase in brain temperature, the CMR doubles

  • For every 10-degree C increase in brain temperature, the CMR increases by 10%

  • If brain temperature decreases by 10 degrees C, the CMR decreases by 25%

  • For every 1-degree C decrease in brain temperature, the CMR increases by 1%

Correct answer: For every 10-degree C increase in brain temperature, the CMR doubles

Cerebral blood flow (CBF) changes 5 to 7% per 1-degree C change in temperature. Hypothermia decreases CBF and CMR, and hyperthermia increases both. For every 10-degree C increase in temperature, the CMR doubles; it is a linear relationship.

A 5-degree C increase in brain temperature would result in a 25% or greater increase in CMR. A decrease in brain temperature by 10 degrees C results in a 50% decrease in CMR. A decrease in temperature results in a decrease, rather than an increase, of CMR.

29.

Which of the following is an indication for hypotensive anesthesia?

  • Excessive blood loss

  • Hypertension

  • Polyuria

  • Hyperkalemia

Correct answer: Excessive blood loss

Hypotensive anesthesia can be used as a technique for minimizing bleeding during surgery. Hypertension does not require hypotensive anesthesia, as the goal in treating hypertension should typically be to restore a normotensive state, not induce hypotension. Polyuria and hyperkalemia and not indications for hypotensive anesthesia.

30.

Of the following causes of postoperative visual loss (POVL), which is the most likely cause of this disorder?

  • Ischemia of the optic nerve

  • Glycine toxicity

  • Cortical blindness

  • Occlusion of the central artery

Correct answer: Ischemia of the optic nerve

Five causes of postoperative visual loss (POVL) currently exist: ischemia of the optic nerve, glycine toxicity, cortical blindness, and occlusion of the central artery or occlusion of the central vein. POVL most often occurs after spinal or cardiac surgery. It is most likely to affect males, diabetics, those at the extremes of the age-range, and patients with hypertension or vascular disease. Ischemia of the optic nerve is the most likely cause of POVL, with as many as 83 of 93 cases of POVL attributable to its development. 

Glycine may be administered during transurethral resection of the prostate (TURP). Toxicity may develop from the absorption of large amounts of the glycine solution resulting in transient POVL.

31.

Which of the following is normal cerebral perfusion pressure (CPP)?

  • 60 to 150 mmHg

  • > 150 mmHg

  • 75 mmHg

  • 25 to 50 mmHg

Correct answer: 60-150 mmHg

Cerebral perfusion pressure (CPP) is the difference between mean arterial pressure (MAP) and intracranial pressure (ICP) [or central venous pressure (CPV), whichever is greater]. Young, healthy adults typically possess a CPP that falls within a range of 60 mmHg to 150 mmHg. Individuals with co-existing morbidities, such as chronic uncontrolled hypertension, will typically demonstrate a higher minimum CPP, which is necessary to sustain adequate cerebral blood flow.

CPP is normally 60 to150 mmHg. Patients with CPP values less than 50 mmHg often show slowing on electroencephalogram (EEG). Those with CPP values between 25 and 40 mmHg typically have a flat EEG. Sustained perfusion pressure of less than 25 mmHg results in irreversible brain damage.

32.

An E-cylinder service pressure reading is at 1000 pounds per square inch. If the oxygen is exhausted at a rate of 3 liters per minute, the cylinder will be empty in approximately:

  • 110 minutes

  • 60 minutes

  • 45 minutes

  • 150 minutes

Correct answer: 110 minutes

Oxygen cylinders in the United States have a service pressure of 1900 pounds per square inch (psi) and a capacity of 660 liters. This E-cylinder is approximately half full, containing 330 liters. If the oxygen is exhausted at a rate of 3 liters per minute, a cylinder that is half full will be empty in 110 minutes.

330 liters / 3 = 110

The relationship for determining how long an oxygen cylinder will last is represented by Capacity L/Service Pressure psi = Contents Remaining L/Gauge Pressure psi.

Oxygen cylinder pressure should be checked before use and closely monitored during use.

33.

In which of the following settings should the anesthesia provider anticipate that they will typically not be continuously in direct proximity to the patient?

Select all that apply.

  • During MRI 

  • During CT imaging

  • During radiation therapy

  • During chemotherapy administration

  • During a nuclear medicine scan

The anesthesia provider should anticipate that they will not be continuously in direct proximity to the patient when the patient is undergoing a procedure or treatment in which the provider's presence may be unsafe. During MRI, the strong magnetic field and limited accessibility of the patient generally requires the provider not be in direct proximity to the patient. During CT imaging or radiation therapy, the risk of radiation exposure requires separation of the provider from the patient. Chemotherapy administration and nuclear medicine scans are generally safe for the provider to be in direct proximity to the patient; however, there may be some circumstances where they may require limited proximity to the patient.

34.

Which of the following characteristics of remifentanil has increased the frequency with which it is used in anesthesia and which makes it most useful during surgery?

  • Remifentanil has a rapid onset of action and is rapidly metabolized

  • Remifentanil has a rapid onset of action and a longer duration of action

  • Remifentanil has a longer duration of action, and its metabolism is not impaired by concurrent administration of succinylcholine

  • Remifentanil can be used concurrently with succinylcholine and is slightly more potent than fentanyl

Correct answer: Remifentanil has a rapid onset of action and is rapidly metabolized

Remifentanil is one of the several examples of engineered narcotics that have been designed with specific patient needs in mind. Its rapid onset coupled with rapid metabolism makes for a half-life of approximately 8 to 20 minutes, making it the ideal drug for titrating both up and down when needed. Remifentanil can be safely used with the concurrent administration of succinylcholine. Its potency is slightly less than that of fentanyl.

35.

Which of the following statements related to surgical positioning and the respiratory system is most accurate?

  • Use of the lithotomy position has little effect on lung compliance

  • Pulmonary blood flow is greater in the nondependent lung with use of the lateral decubitus position

  • Use of the beach chair position has more effect on lung volumes than other positions

  • Trendelenburg position may result in displacement of the tip of the endotracheal tube from the right mainstem bronchus

Correct answer: Use of the lithotomy position has little effect on lung compliance

The human body undergoes a multitude of physiologic changes and shifts as a result of positional changes, which may be used for surgery. The respiratory system is accustomed to function at its peak when an individual is upright. Alterations to lung compliance and volume, limitations to diaphragmatic excursion, changes in pulmonary blood flow, and alterations in ventilation-perfusion (V/Q), and other changes occur when the patient's position is altered.

Use of the standard lithotomy position does little to affect lung compliance; however, placing the patient in an exaggerated lithotomy position with hyperflexion of the thighs may limit diaphragmatic excursion.

When the patient is placed in the lateral decubitus position, perfusion is greater in the dependent lung versus the nondependent lung.

Use of the beach chair (or sitting position) has less effect on overall lung volume than use of alternate positions.

Placing a patient in the Trendelenburg position may result in displacement of the tip of the endotracheal tube into the right mainstem bronchus.

36.

Which of the following ASA Physical Status Classifications should be assigned to a pediatric patient with an asthama exacerbation?

  • ASA III

  • ASA II

  • ASA I

  • ASA IV

Correct answer: ASA III

ASA describes a normal healthy patient. ASA II describes a patient with mild to moderate systemic disease, not a severe systemic disease. ASA III describes a patient with severe systemic disease. ASA IV describes a patient with a severe systemic disease that is a constant threat to their life. An asthma exacerbation is considered a severe systemic disease but due to its acute nature, it is not a constant, ongoing threat to their life.

37.

Which of the following is a classification system used to describe laryngoscopic views?

  • Cormack-Lehane classification

  • Mallampati classification

  • American Society of Anesthesiologists classification scale

  • LEMON criteria

Correct answer: Cormack-Lehane classification

Cormack-Lehane classification is used to describe the visibility of the glottis during laryngoscopy. Mallampati classification is not based on laryngoscopy, it is based solely on unassisted visualization of the airways. The American Society of Anesthesiologists classification scale is used to assess the physical status of patients prior to surgery. LEMON (Look, Evaluate the 3-3-2 rule, Mallampati score, Obstruction, and Neck mobility) criteria is a mnemonic used to assess the airway before intubation, not a classification system.

38.

Which of the following considerations are important when considering the use of a supraglottic airway?

  • It may be ideal for patients at risk of difficult mask ventilation and intubation

  • It should not be used as the primary mode of airway management

  • It is unlikely to be a successful method of airway management in a patient with a failed orotracheal intubation

  • Muscle relaxants should be used when employing this type of airway

Correct answer: It may be ideal for patients at risk of difficult mask ventilation and intubation

Many of the factors that increase the risk of difficult mask ventilation and intubation do not overlap with those that increase the risk of difficulty using a Supraglottic Airway (SGA). SGAs may be used as the primary mode of airway management. SGAs may be a successful method of airway management in a patient with a failed orotracheal intubation and do not require muscle relaxants to use.

39.

Which of the following instructions should a CRNA not give during a modified Mallampati examination? 

  • "Say 'ahh.' "

  • "Hold your head straight."

  • "Stick out your tongue."

  • "Open your mouth as wide as you can."

Correct answer: "Say 'ahh.' "

During a modified Mallampati examination, the patient should not phonate. The head should be in a neutral position, the mouth should be opened as wide as possible, and the tongue should be protruded.

40.

Which of the following ASA Physical Status Classifications should a parturient with an uncomplicated pregnancy be assigned?

  • ASA II

  • ASA I

  • ASA III

  • ASA IV

Correct answer: ASA II

While pregnancy is not a disease state, a pregnant woman's physiological state is significantly altered to such an extent that even a parturient with an uncomplicated pregnancy will be assigned ASA II. ASA I is not a correct assignment for this patient and ASA assignments higher than ASA II are not appropriate for an uncomplicated pregnancy.

×