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Quiz Session - Attempts With Random Questions

NBCRNA CRNA Exam Questions

Page 3 of 50

41.

All the following are signs expected with tension pneumothorax except:

  • Hypertension

  • Diminished breath sounds on the affected side

  • Deviation of the trachea toward the unaffected lung

  • Neck vein distention

Correct answer: Hypertension

Hypotension, not hypertension, is a classic sign of tension pneumothorax.

Other classic signs of tension pneumothorax include the following:

  • Cyanosis
  • Tachypnea
  • Neck vein distention
  • Tracheal deviation to the unaffected lung
  • Diminished breath sounds on the affected side

42.

The anion gap is used when attempting to identify the type and cause of which of the following conditions?

  • Metabolic acidosis

  • Metabolic alkalosis

  • Respiratory acidosis

  • Respiratory alkalosis

Correct answer: Metabolic acidosis

The two major forms of acidosis are respiratory or metabolic in origin. Metabolic acidosis occurs as a consequence of buffering by bicarbonate of endogenous or exogenous acid loads or as a consequence of abnormal external loss of bicarbonate. Calculation of the anion gap distinguishes between the two types of metabolic acidosis. Metabolic acidosis with a high anion gap occurs because of excess production or decreased excretion of organic acids or ingestion of one of several toxic compounds. 

The anion gap is normal in situations such as diarrhea, biliary drainage, and renal tubular acidosis in which bicarbonate is lost externally. The anion gap is also normal or reduced in hyperchloremic acidosis associated with perioperative infusion of substantial amounts of 0.9% normal saline.

43.

Which of the following are relative contraindications to surgical cricothyrotomy? (Select 3.)

  • Neck tumors

  • Coagulopathy

  • Tracheal stenosis

  • Oropharyngeal tumor

  • Trauma of the cervical spine

Neck tumors, coagulopathy, and tracheal stenosis are all relative contraindications to surgical cricothyrotomy as they can affect the efficacy or safety of this intervention. Trauma of the cervical spine could affect the ability to perform a surgical cricothyrotomy, but it is not considered a relative contraindication unless it disrupts the trachea or larynx. Stabilization of the spine will, however, be necessary during the procedure. Oropharyngeal tumors do not affect the ability to perform a surgical cricothyrotomy and could even be an indication for this procedure.

44.

Of the following monitoring methods, which is the best to measure oxygen and hemodynamic status in a pediatric patient?

  • Pulse oximetry

  • Clinical observation to detect pulmonary compliance

  • Precordial stethoscope

  • End-tidal carbon dioxide monitor

Correct answer: Pulse oximetry

Pulse oximetry can detect hypoxemia that can occur in healthy children and infants who undergo even simple surgical procedures.

Pulse oximetry is superior to clinical observation, monitoring of end-tidal carbon dioxide per capnography, and monitoring per precordial stethoscope.

45.

Which of the following are typical signs of amniotic fluid embolism?

  • Sudden tachypnea and uterine atony

  • Sudden dyspnea and uterine hypertonicity

  • Sudden dyspnea and hypertension

  • Sudden uterine atony and hypertension

Correct answer: Sudden tachypnea and uterine atony

An amniotic fluid embolism can occur during labor, delivery, cesarean section, or postpartum. It occurs when amniotic fluid enters the maternal circulation through any break in the uteroplacental membranes. Patients typically present with symptoms that include the following:

  • Chills, shivering, and anxiety
  • Coughing and dyspnea
  • Cyanosis
  • Tachypnea
  • Hypotension
  • Uterine atony
  • Pulmonary edema
  • Cardiovascular collapse

Hypertension and uterine hypertonicity are not typical signs of amniotic fluid embolism.

46.

A patient who has just undergone lengthy cardiac surgery develops new symptoms that include unilateral wrist drop and the inability to extend the fingers or wrist of the same upper extremity. Which of the following conditions is suspected?

  • Radial nerve compression

  • Median nerve dysfunction

  • Ulnar nerve dysfunction

  • Brachial plexus block

Correct answer: Radial nerve compression

Wrist drop and weak abduction of the thumb are signs of radial nerve compression.

Median nerve dysfunction is evidenced by decreased sensation over the dorsal and palmar surfaces of the distal phalanges of the first and second fingers. Ulnar nerve dysfunction is characterized by numbness along half of the ring finger and the fifth digit, with the two fingers curling up (the "ulnar claw").  Signs of a brachial plexus block include decreased strength with an attempt to flex the elbow against resistance.

47.

Which of the following are considered components of the triad of death? (Select 3.)

  • Hypothermia

  • Coagulopathy

  • Acidosis

  • Alkalosis

  • Widening pulse pressures

The triad of death is a triad of findings that create a positive feedback loop in trauma patients that typically results in death. Components include hypothermia, coagulopathy, and acidosis. Alkalosis and widening pulse pressures are not part of the triad of death.

48.

Functional residual capacity is the combination of residual volume and what other factor?

  • Expiratory reserve volume

  • Tidal volume

  • Inspiratory reserve volume

  • Chest wall compliance

Correct answer: Expiratory reserve volume

Residual volume plus expiratory reserve volume equals functional residual capacity (RV + ERV = FRC). Functional residual capacity is the lung volume at the end of normal exhalation. At this volume, the inward elastic recoil of the lung approximates the outward elastic recoil of the chest, including resting diaphragmatic tone.

49.

Which of the following is not an example of an advanced directive?

  • Physician Orders for Life-Sustaining Treatment (POLST)

  • Living will

  • Healthcare power of attorney

  • State-specific advanced directives

Correct answer: Physician Orders for Life-Sustaining Treatment (POLST)

An advanced directive is a legal document that outlines patients' wishes when they are unable to make decisions for themselves. Physician Orders for Life-Sustaining Treatment (POLST) is a set of orders, not a legal advanced directive. Living wills, healthcare power of attorneys, and state-specific advanced directives are all examples of advanced directives.

50.

Which of the following views classified by the Cormack and Lehane classification system are associated with difficult intubation?

Select all that apply.

  • Grade III

  • Grade IV

  • Grade V

  • Grade II

  • Grade I

Grade III or IV views are associated with difficult intubation. There is no Grade V view associated with the Cormack and Lehane classification system. Grade I and II views are not associated with difficult intubation.

51.

For which of the following patients undergoing surgery would a Bier block be indicated?

  • A 46-year-old female with a history of mitral valve prolapse scheduled to undergo carpal tunnel release of her right upper extremity

  • A 34-year-old female with a history of sickle cell disease scheduled to undergo open reduction and internal fixation (ORIF) to repair a traumatic fracture of her left upper extremity

  • A 59-year-old male with a history of hypertension and type 2 diabetes scheduled to undergo surgical debridement of an infected diabetic foot ulcer

  • A 17-year-old male with a history of asthma scheduled to undergo repair of a torn meniscus of the right knee sustained while playing soccer

Correct answer: A 46-year-old female with a history of mitral valve prolapse scheduled to undergo carpal tunnel release of her right upper extremity

A Bier block (also known as intravenous regional anesthesia) is indicated for producing regional anesthesia of the upper or lower extremity. In this block, a tourniquet is applied to the operative extremity to produce exsanguination of the extremity. Then large volumes of a dilute local anesthetic solution are injected into the extremity. This technique provides direct application of the anesthetic to the nerve endings and is best utilized during surgeries lasting less than 2 hours. 

While a Bier block can be used as a local anesthetic to both the upper and lower extremity, it is most often used for surgeries of the upper extremities, such as carpal tunnel release, ganglionectomy, and ORIF. Patients with a history of sickle cell disease, any ischemic heart disease, or infections in an extremity are not candidates for a Bier block.

52.

Which of the following statements is true about a sciatic nerve block?

  • In the lateral decubitus position, the operative extremity is nondependent

  • In the lateral position, the nonoperative hip and knee are flexed

  • Motor response is confirmed by visualizing gastrocnemius twitching

  • In the lateral decubitus position, a line is drawn connecting the greater trochanter and the ischial tuberosity

Correct answer: In the lateral decubitus position, the operative extremity is nondependent

In this position, also called the posterior or classic approach, a line is drawn from the greater trochanter to the posterior superior iliac spine, and a second line is drawn from the greater trochanter to the sacral hiatus. The midpoint along the line of the greater trochanter-posterior superior iliac spine is marked, and a line is drawn perpendicular to the feet. The intersection of this line and the greater trochanter-sacral hiatus line is the insertion point for the block.

In the lateral position, the operative hip and knee are flexed. Motor response is observed in the ankle, foot, and toes, not in the calf (gastrocnemius) muscle. In the lithotomy position, a line is drawn connecting the greater trochanter and the ischial tuberosity.

53.

What is the best way for the CRNA to determine which size laryngeal mask airway (LMA) to use on a pediatric patient? 

  • Comparing their weight against the recommended weight range on the LMA's packaging

  • LMAs are not designed for use in pediatric patients

  • The size should be determined by dividing the age of the child in years by four, then adding four

  • The width of the LMA should be approximately two-thirds the width of the patient's mouth

Correct answer: Comparing their weight against the recommended weight range on the LMA's packaging

Determining the correct size LMA to use for a pediatric patient should be based on the patient's weight. Dividing the age of the child in years by four, then adding four is a formula for determining the correct size for an uncuffed ET tube. LMAs are designed for use in pediatric patients. However, selecting an LMA with a width approximately two-thirds the width of the patient's mouth is not correct.

54.

Which of the following is a potential complication associated with the malfunction of a Bain breathing system?

  • Respiratory acidosis due to accidental disconnection of the fresh gas hose

  • Respiratory alkalosis due to unrecognized excessive blow-off of carbon dioxide

  • Barotrauma may result from failure of the expiratory unidirectional valve

  • Respiratory alkalosis due to unintentional kinking of the fresh gas hose

Correct answer: Respiratory acidosis due to accidental disconnection of the fresh gas hose

Inadvertent disconnection or kinking of the fresh gas hose results in the length of the limb being converted into dead space, which leads to respiratory acidosis.

Respiratory acidosis is the result of increased dead space in the case of accidental loss of fresh gas in the Bain system. The Bain system does not have unidirectional valves.

55.

Which of the following is most likely to be caused by iatrogenic sympathectomy? 

  • Distributive shock

  • Systemic vasoconstriction

  • Hypovolemic shock

  • Spinal cord ischemia

Correct answer: Distributive shock

Iatrogenic sympathectomy can be caused by regional or neuraxial anesthetic techniques. This results in decreased vascular tone and blocks cardioaccelerator fibers, leading to potential distributive shock and potentially cardiac arrest. Systemic vasoconstriction does not occur with iatrogenic sympathectomy. Distributive, not hypovolemic shock results. Spinal cord ischemia is not directly caused by iatrogenic sympathectomy.

56.

Diazepam can be administered by any of the following routes except:

  • Intrathecal

  • Intranasal

  • Buccal

  • Sublingual

Correct answer: Intrathecal

Diazepam is a benzodiazepine. These medications may be appropriately administered via any route except intrathecally. However, because diazepam and lorazepam are hydrophobic, they must be dissolved in propylene glycol for parenteral administration. Propylene glycol is extremely irritating to veins, so venous irritation is associated with injection of these benzodiazepines.

57.

Which of the following statements is true about the use of anesthetic agents in the elderly?

  • Epidural anesthesia has a shorter duration of action and motor block in an elderly patient

  • Minimum alveolar concentration requirements are increased in the elderly

  • Spinal anesthetics always have a shorter duration of action in elderly patients

  • Dosage requirements for local anesthetics are increased in elderly patients

Correct answer: Epidural anesthesia has a shorter duration of action and motor block in an elderly patient

Epidural anesthesia tends to result in more extensive cephalad spread in elderly patients but with a shorter duration of analgesia and motor block.

Dosage requirements for local anesthetics are reduced in elderly patients. Spinal anesthetics typically have a longer duration of action in the elderly. Minimum alveolar concentration requirements are reduced in the elderly.

58.

A 1-degree Celsius change in temperature will result in a linear change in cerebral blood flow of which of the following?

  • 7%

  • 2%

  • 10%

  • 1%

Correct answer: 7%

A 1-degree Celsius change in temperature will result in a 7% linear change in cerebral blood flow.

Cerebral metabolism decreases exponentially with a reduction in temperature. On average, the Cerebral Metabolic Rate of oxygen (CMRO2) decreases by 7% for each degree Celsius decrease in body temperature.

59.

Which of the following are risk factors for postoperative delirium?

Select all that apply.

  • Alcohol abuse

  • Malnutrition

  • Active infection

  • Age over 50 years old

  • History of diabetes

There are several risk factors for Postoperative Delirium (POD). These can include a history of alcohol abuse, active infection, malnutrition, and an age of 65 years old. Diabetes is not generally considered to be a risk factor for postoperative delirium unless there are specific secondary effects that cause a predisposition to delirium or a severe illness such as DKA.

60.

The Certified Registered Nurse Anesthetist is checking the readings on a flowmeter. Which of the following is least likely to be the cause of malfunction in a constant-pressure variable-orifice flowmeter?

  • Decreasing the flow of gas has caused the float to rise and become concealed at the top of the tube

  • There is debris in the flow tube

  • Vertical tube misalignment

  • The Certified Nurse Anesthetist is incorrectly reading the ball-type flowmeter from the top of the float

Correct answer: Decreasing the flow of gas has caused the float to rise and become concealed at the top of the tube

In constant-pressure variable-orifice flowmeters, an indicator ball, bobbin, or float is supported by the flow of gas through a tube with a tapered bore. Near the bottom of the tube, gas flowing into the tube will create enough pressure under the float to make it rise in the tube. As the float rises, the orifice of the tube widens, allowing more gas to pass around the float. The float stops rising when its weight is supported by the difference in pressure above and below it. When the flow of gas is increased, the float rises higher and may be concealed in the top of the tube. A low flow of gas will make the float drop lower in the flowmeter.

Causes of flowmeter malfunction include:

  • Debris in the flow tube
  • Vertical tube misalignment
  • Sticking or concealment of a float at the top of a tube

Ball-type floats are to be read in the center of the float, and plumb-type floats are to be read at the top of the float.

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