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Quiz Session - Attempts With Random Questions

NBCRNA CRNA Exam Questions

Page 7 of 50

121.

All the following are used as oxygen supply pressure safety devices or processes except:

  • Positioning the oxygen flowmeter upstream from all other flowmeters

  • Oxygen failure cut-off valve

  • Pneumatic alarm

  • Second-stage oxygen pressure regulator

Correct answer: Positioning the oxygen flowmeter upstream from all other flowmeters

Each gas must pass through flow control valves, and each is measured by flowmeters before mixing with other gases, entering the vaporizer, and leaving the common gas outlet. The oxygen flowmeter is positioned farthest to the right, downstream rather than upstream, from the other flowmeters. This arrangement helps to prevent hypoxia if there is a leakage from a flowmeter positioned upstream. 

The oxygen failure cut-off valve, the pneumatic alarm, and the second-stage oxygen pressure regulator all help ensure that the concentration of delivered oxygen will not fall below 19% at the common gas outlet in the event of an oxygen pressure failure.

122.

Which procedures are performed in an ambulatory setting in more than 90% of cases? (Select 3.)

  • Lumpectomy of the breast

  • Inguinal hernia repair

  • Decompression of a peripheral nerve

  • Radical mastectomy

  • Appendectomy

Procedures that are performed in an ambulatory setting in more than 90% of cases include lumpectomy of the breast, inguinal hernia repair, and decompression of a peripheral nerve. Radical mastectomies and appendectomies are not performed in an ambulatory setting more than 90% of the time.

123.

Which type of glaucoma is commonly described as acute glaucoma?

  • Angle-closure glaucoma

  • Open-angle glaucoma

  • Infantile glaucoma

  • Congenital glaucoma

Correct answer: Angle-closure glaucoma

Angle-closure glaucoma is also referred to as acute glaucoma. Open-angle glaucoma generally refers to chronic glaucoma. Infantile glaucoma is a rare developmental defect. Congenital glaucoma is generally a component of other congenital conditions.

124.

All the following statements about hyperkalemia are true except:

  • Cardiac manifestations of hyperkalemia are consistently present when plasma potassium is greater than 5.8 mEq/L

  • Early signs of hyperkalemia include peaked T waves, often with a shortened QT interval on electrocardiogram

  • Signs of progressive hyperkalemia include widening of the QRS complex followed by prolongation of the P-R interval on electrocardiogram

  • Loss of the P wave followed by loss of R-wave amplitude and ST-segment depression are signs of severe hyperkalemia on electrocardiogram

Correct answer: Cardiac manifestations of hyperkalemia are consistently present when plasma potassium is greater than 5.8 mEq/L

Cardiac manifestations are primarily due to delayed depolarization and are consistently present when plasma potassium (K+) is greater than 8 mEq/L.

Electrocardiogram (ECG) changes associated with hyperkalemia characteristically progress in order from symmetrically peaked T waves (often with a shortened QT interval) to widening of the QRS complex to prolongation of the P-R interval to loss of the P wave to loss of R-wave amplitude to ST-segment depression (occasionally elevation) before progressing to ventricular fibrillation and asystole.

125.

All the following risk factors may increase the risk of barotrauma associated with positive end expiratory pressure (PEEP) except:

  • A low rate of mechanical breaths

  • Tidal volumes above 10 to 15 mL/kg

  • Young age

  • Underlying lung disease

Correct answer: A low rate of mechanical breaths

Ventilator settings with a high respiratory rate (such that a stacking of breaths occurs) can lead to the development of intrinsic PEEP and barotrauma.

Other factors that may increase the risk of barotrauma with PEEP include the following:

  • Higher inspiratory pressures that occur with increasing level of PEEP or continuous positive airway pressure
  • Underlying lung disease
  • Large tidal volumes (> 10 to 15 mL/kg)
  • Young age

126.

Which of the following are absolute contraindications to neuraxial analgesia? (Select 2.)

  • Patient inability to maintain stillness during needle puncture

  • Elevated intracranial pressure

  • Chronic low back pain without a neurologic deficit

  • Spinal stenosis

  • History of spine surgery

The inability to maintain stillness during needle puncture is an absolute contraindication to neuraxial analgesia due to the risk of traumatic injury to the neural structures. Elevated intracranial pressure carries an increased risk of brainstem herniation and is considered an absolute contraindication, as well. Chronic low back pain without a neurologic deficit, spinal stenosis, and a history of spine surgery are all relative contraindications to neuraxial analgesia.

127.

Invasive blood pressure measurement using which of the following is most likely to be affected by prone positioning?

  • Femoral

  • Brachial

  • Radial

  • Dorsalis pedis

Correct answer: Femoral

Invasive blood pressure measurement using the femoral artery is most likely to be affected by prone positioning, as prone positioning will directly affect the insertion site. While other forms of invasive blood pressure measurement may be affected by positioning, the femoral site is most affected by prone positioning specifically.

128.

Type 2 diabetics can experience all the following except:

  • A complete absence of endogenous insulin production

  • An increase in the release of endogenous insulin

  • A relative decrease in endogenous insulin production coupled with resistance to endogenous insulin

  • No change in or normal endogenous insulin levels

Correct answer: A complete absence of endogenous insulin production

Type 2 diabetics may experience several effects on or changes in endogenous insulin as a result of the disorder. Initially, patients may experience an increase in the release of endogenous insulin as a result of insulin resistance. As the disease progresses, endogenous insulin production gradually declines, causing a relative (versus absolute) lack of endogenous insulin. Endogenous insulin levels may remain normal, be lowered, or be higher than normal. 

A complete absence of endogenous insulin production is a characteristic of type 1 diabetes.

129.

Cystic fibrosis results in impaired transport of which of the following? (Select 3.)

  • Sodium

  • Chloride

  • Water

  • Potassium

  • Calcium

Cystic fibrosis affects the function of a transmembraneous protein called the cystic fibrosis transmembrane conductance regulator (CFTR). Malfunction of CFTR affects the transport of sodium, chloride, and water across epithelial tissues. 

130.

A two-year-old boy is being admitted to same-day surgery for strabismus repair. Which of the following induction agents is the most appropriate choice for this patient's surgery?

  • Propofol

  • Ketamine

  • Sevoflurane

  • Isoflurane

Correct answer: Propofol

The most commonly utilized induction agent in the pediatric population is propofol. It is beneficial when used in children undergoing strabismus surgery, as the drug has a strong antiemetic property. Postoperative nausea and vomiting after strabismus repair can occur as much as 80% of the time, making propofol an excellent choice for induction among this age group. Propofol is generally preferred over volatile anesthetics like sevoflurane in children ages three or younger.

131.

Which of the following will cognitive behavior therapy always address in managing chronic pain? (Select 2.)

  • Distorted thoughts

  • Actions

  • Adherence to recommended treatments

  • Mindfulness

  • Fear of pain

Cognitive behavioral therapy (CBT) focuses on how cognition (distorted thoughts) ultimately affects behaviors (actions). Fear of pain and mindfulness are types of cognition. Adherence to recommended treatments is a type of behavior. These factors will be addressed based on each specific case. 

132.

Which of the following breathing circuit risks and disadvantages are specific to the Bain system?

  • Kinking of an inner fresh gas tube

  • High gas flow is required to prevent rebreathing

  • Potential for the delivery of insufficient oxygen concentrations

  • An increase in resistance to breathing as a result of unidirectional valves

Correct answer: Kinking of an inner fresh gas tube

Only the Bain circuit system (also known as a modified version of the Mapleson D system) is characterized by the presence of an inner tube, which delivers fresh gases, within the corrugated outer tube, which is in place for the removal of waste anesthetic gases. Because this inner tube can become kinked or disconnected, patients are at risk of severe respiratory acidosis. The anesthesia provider must thoroughly assess the Bain system prior to connecting the patient to lower the risk of this hidden complication.

High gas flow is required to prevent rebreathing with a Mapleson F system. Insufficient oxygen concentrations may be delivered by a closed anesthetic breathing system. The unidirectional valves within the circle breathing system may increase resistance to breathing.

133.

Which of the following is the most common cause of cirrhosis in the United States?

  • Alcohol use

  • Chronic active hepatitis

  • Chronic right-sided congestive heart failure

  • Chronic biliary inflammation

Correct answer: Alcohol use

Cirrhosis is a serious and progressive disease that eventually results in hepatic failure. The most common cause of cirrhosis in the United States is alcohol use (Laennec's cirrhosis).

Other causes of cirrhosis include the following:

  • Chronic active hepatitis
  • Chronic biliary inflammation or obstruction
  • Chronic right-sided congestive heart failure
  • Autoimmune hepatitis
  • Hemochromatosis
  • Wilson's disease
  • Nonalcoholic steatohepatitis
  • Cryptogenic cirrhosis

134.

In an intubated patient undergoing general anesthesia, which of the following symptoms would most likely be seen in a patient experiencing massive pulmonary embolism?

  • Sudden hypotension

  • Bradycardia

  • Decreased pulmonary artery pressure

  • Decreased central venous pressure

Correct answer: Sudden hypotension

Pulmonary embolism is the blockage of a vessel or a network of vessels in the vasculature of the lungs. Signs of the condition in a patient under general anesthesia include:

  • Sudden hypotension
  • Tachycardia, rather than bradycardia
  • Significantly decreased end-tidal carbon dioxide
  • Hypoxemia
  • Bronchospasm

Increased (rather than decreased) pulmonary artery pressure and central venous pressure may be seen in combination with a decrease in systolic and diastolic blood pressure.

135.

Of the following congenital conditions, which are most associated with difficult laryngoscopy and endotracheal intubation? (Select 3.)

  • Trisomy 21

  • Klippel-Feil syndrome

  • Turner syndrome

  • Dandy-Walker syndrome

  • Cystic fibrosis

Trisomy 21 causes a small mouth, large tongue, and small subglottic diameter. Klippel-Feil syndrome causes reduced neck mobility. Turner syndrome causes several deformities affecting the airway. Dandy-Walker syndrome does not significantly affect the airway. While cystic fibrosis causes many pulmonary problems, it does not affect the structure of the upper airways.

136.

All the following drugs are appropriate for use in a patient with hypertrophic cardiomyopathy except:

  • Mannitol

  • Amiodarone

  • Enflurane

  • Phenylephrine

Correct answer: Mannitol

Anesthetic goals in a patient with hypertrophic cardiomyopathy are to minimize sympathetic stimulation and increase systemic vascular resistance (ventricular afterload). Mannitol is an osmotic diuretic. It should not be given to a patient with hypertrophic cardiomyopathy because it will decrease ventricular volume.

Amiodarone helps to maintain normal sinus rhythm. In patients with hypertrophic cardiomyopathy, some degree of cardiac depression is typically desirable, and this can be obtained with enflurane. Phenylephrine helps to increase systemic vascular resistance while minimizing sympathetic stimulation.

137.

Neuraxial anesthesia to which of the following sensory levels provides anesthesia for transurethral resection of the prostate? 

  • T10

  • T8

  • T6

  • L1

Correct answer: T10

Neuraxial anesthesia to sensory level T10 provides excellent anesthesia for transurethral resection of the prostate (TURP). It provides anesthesia for nearly all cystoscopic procedures.

138.

Which of the following medications should be avoided in a client who has asthma?

  • Meperidine

  • Ketamine

  • Halothane

  • Sevoflurane

Correct answer: Meperidine

The use of drugs often associated with histamine release should be avoided in patients with asthma, including curare, atracurium, mivacurium, morphine, and meperidine.

Ketamine is the only intravenous agent with bronchodilating properties and is a good choice for patients who are also hemodynamically unstable. Halothane and sevoflurane usually provide the smoothest inhalation induction with bronchodilation in asthmatic children.

139.

A 16-year-old female who is being prepared for an emergency appendectomy is placed on the operating room table in a supine position. How should her arms be positioned for this surgery?

  • Abducted less than 90 degrees

  • Arms tucked with elbow extending slightly over the edge of the table

  • Neutral position with palms facing away from the body

  • Placed on armboards and pronated

Correct answer: Abducted less than 90 degrees

The supine position, also referred to as the dorsal decubitus position, is frequently used during surgeries of the chest and abdomen. When placing the patient in a supine position in preparation for surgery, care must be taken when positioning the arms to prevent nerve damage to both the ulnar nerve and the brachial plexus. Gel pads or other padding should be placed under the elbows, and arms may either be tucked in at the sides with hands in a neutral position and facing the patient's hips (toward the body,) or abducted less than 90 degrees to prevent overstretching of the brachial plexus. 

If arms are tucked in, elbows must not extend over the edge of the table, which would place the patient at risk for ulnar nerve injury. If the arms are secured to armboards, they should be supinated.

140.

Which of the following best describes a defibrillation threshold test?

  • Fibrillation is deliberately induced to test a device's ability to sense and terminate it

  • Different doses of electricity are used to determine the minimum amount needed to cardiovert

  • Defibrillation is delayed until hemodynamic changes occur with a convertible rhythm to evaluate the need for intervention

  • A device's response to different intensities of naturally occurring fibrillation is evaluated 

Correct answer: Fibrillation is deliberately induced to test a device's ability to sense and terminate it

A defibrillation threshold test is used to test an implantable cardiac defibrillator's ability to sense and terminate it. Fibrillation is deliberately induced, not allowed to occur naturally. The threshold being evaluated is fibrillation, not hemodynamic stability or dose needed.

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