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Quiz Session - Attempts With Random Questions

NBCRNA CRNA Exam Questions

Page 9 of 50

161.

Which of the following are most important to evaluate after administering protamine? (Select 3.)

  • Blood pressure

  • Activated clotting time

  • Lung sounds

  • Platelet levels

  • Skin turgor

Protamine can cause three different types of reactions. A type 1 reaction causes transient hypotension, making an evaluation of blood pressure following administration advisable. A type 3 reaction can cause a pulmonary hypertensive crisis, making an evaluation of lung sounds important. Activated clotting time should be performed to confirm the normalization of values. Protamine neutralizes heparin and heparin does not typically affect platelet levels except in rare cases of HIT. Skin turgor is not a relevant assessment following the administration of protamine.

162.

All the following statements are true about cerebral aneurysms except:

  • Most congenital cerebral aneurysms occur at the vertebrobasilar artery

  • Rupture of a saccular aneurysm is the most common cause of subarachnoid hemorrhage

  • A sudden, severe headache is the most typical complaint of a person presenting with an acute subarachnoid hemorrhage

  • Ruptured aneurysms usually present acutely as subarachnoid hemorrhage, while less commonly they hemorrhage into the epidural space or the brain

Correct answer: Most congenital cerebral aneurysms occur at the vertebrobasilar artery

Cerebral aneurysms typically occur at the bifurcation of the large arteries at the base of the brain. The vast majority are located in the anterior Circle of Willis, not in the vertebrobasilar artery.

Subarachnoid Hemorrhage (SAH) occurs when blood enters into the space between the arachnoid membrane and the pia mater. It may be spontaneous with injury, but the most common cause is the rupture of a saccular aneurysm. Ruptured aneurysms usually present acutely as SAH, while less commonly they hemorrhage into the epidural space or the brain. Patients typically complain of a sudden, severe headache without focal neurological deficits. It is often associated with nausea and vomiting.

163.

A capnogram shows a slow rate of rise, no plateau is reached before the next inspiration, and the gradient between end-tidal carbon dioxide and arterial carbon dioxide is 20 mmHg. Which of the following conditions does this suggest?

  • Chronic obstructive pulmonary disease

  • A normal capnograph

  • An incompetent inspiratory valve

  • Incompetent expiratory valve

Correct answer: Chronic obstructive pulmonary disease

A slow rate of rise in the capnogram (prolonged and slanted phase 2) and increased End-Tidal CO2 (ETCO2) and arterial CO2 (PaCO2) gradient suggest chronic obstructive pulmonary disease or bronchospasm.

A normal capnograph consists of three phases of expiration: phase I—dead space; phase II—mixture of dead space and alveolar gas; phase III—alveolar gas plateau. Normal ETCO2/PaCO2 gradient is 5-10 mm Hg. Failure of the inspired CO2 to return to zero on the capnogram may indicate an incompetent expiratory valve; the persistence of exhaled gas during part of the inspiratory cycle signals the presence of an incompetent inspiratory valve.

164.

Which of the following surgical positions is most likely to result in compartment syndrome of the lower leg?

  • Lithotomy

  • Jack-knife

  • Lateral

  • Sitting

Correct answer: Lithotomy

The lithotomy position, which elevates the lower extremities, may reduce perfusion pressure in the lower limbs and increase the risk for compartment syndrome, especially when the extremities are elevated for prolonged periods.

Compartment syndrome may also occur in lateral positions, but laterally placed patients tend to have compartment syndrome of either arm rather than in the lower extremities. The jack-knife is a lateral position. Compartment syndrome is not typically a complication of sitting positions.

165.

Which of the following benefits are expected from using Enhanced Recovery After Surgery (ERAS) protocols?

Select all that apply.

  • Reduced complications

  • Reduced costs

  • Reduced length of stay

  • Reduced preoperative anxiety

  • Reduced risk of intraoperative errors

Enhanced Recovery After Surgery (ERAS) protocols focus on enhancing postsurgical care using a multidisciplinary approach. ERAS protocols are intended to reduce postsurgical complications, improve costs, and reduce a patient's length of stay. ERAS protocols are postoperative and do not address preoperative issues like anxiety or intraoperative interventions.

166.

What is the purpose of the ASA Closed Claims Project?

  • To identify areas of anesthesia safety concerns

  • To help those in anesthesiology reduce their legal exposure

  • To support those in anesthesiology who are in the process of litigation

  • To reduce the incidence of anesthesiology-related litigation  

Correct answer: To identify areas of anesthesia safety concerns

The ASA Closed Claims Project reviews data from settled anesthesiology-related litigation to identify patient safety concerns. While the initiative does involve reviewing settled litigation, the focus of the project is to improve patient safety, not to directly influence litigation risks for anesthesiology practioners.

167.

All the following statements about cerebrospinal fluid are true except:

  • Small amounts of cerebrospinal fluid are absorbed into the bloodstream daily as compared to the amount required to surround and cushion the brain and spinal cord

  • Cerebrospinal fluid is produced predominantly in the choroid plexus

  • Approximately 500 mL of cerebrospinal fluid is produced daily

  • Normal pH of cerebrospinal fluid is between 7.28 and 7.32

Correct answer: Small amounts of cerebrospinal fluid are absorbed into the bloodstream daily as compared to the amount required to surround and cushion the brain and spinal cord

Cerebrospinal fluid (CSF) is produced primarily in the choroid plexus at a rate of about 500 mL per day. Only about 135 to 150 mL are required to cushion and surround the spinal cord and brain, thus rather large amounts of the fluid are absorbed into the bloodstream daily.

Normal pH of CSF ranges from 7.28 to 7.32.

168.

Which of the following tests is most sensitive in indicating severe hepatic dysfunction in acute or chronic liver disease?

  • Prothrombin time

  • Serum albumin level

  • Lactate dehydrogenase test

  • Alkaline phosphatase

Correct answer: Prothrombin time

Prothrombin time (PT) and international normalized ratio (INR) are sensitive indicators of both acute and chronic hepatic dysfunction because of the short half-life of factor VII.

Many factors influence the serum albumin level, independent of hepatic synthesis. Because the half-life in serum is as long as 20 days, the serum albumin level is not a reliable indicator of hepatic protein synthesis in acute liver disease. Lactate dehydrogenase (LDH) has poor diagnostic specificity for liver disease. The liver is the source of elevated levels of alkaline phosphatase in many cases, but in up to one-third, no evidence of hepatic disease is found.

169.

Which of the following variables is not associated with difficult facemask ventilation?

  • Female gender

  • History of neck radiation

  • Age older than 55 years

  • BMI higher than 30 kg/m2

Correct answer: Female gender

Male gender, not female gender, is associated with difficult facemask ventilation. History of neck radiation, age older than 55 years, and BMI higher than 30 kg/m2 are all variables that are associated with difficult facemask ventilation.

170.

Which of the following interventions are best for facilitating recovery from residual neuromuscular blockade?

Select all that apply.

  • Warming the patient

  • Airway support

  • Correction of electrolyte abnormalities

  • Carefully managing blood pressure to avoid hypertension 

  • Reducing stimuli

Simple measures are often best for facilitating recovery from residual neuromuscular blockade and can include warming the patient, providing airway support, and correcting any electrolyte abnormalities. Preventing hypertension and reducing stimuli are not likely to meaningfully promote recovery from residual neuromuscular blockade. 

171.

Which of the following structures are assessed during the Mallampati examination?

Select all that apply.

  • The soft palate

  • The uvula

  • The tonsillar pillars

  • The hard palate

  • The maxillary teeth

During the Mallampati examination, the visibility of several structures is assessed. These include the soft palate, fauces, uvular, and tonsillar pillars. The hard palate and maxillary teeth may be assessed in conjunction with the Mallampati examination; however, the visibility of these structures is not part of the Mallampati examination.

172.

A patient is to have knee arthroscopy, and a "three-in-one" femoral block is being used. Which of the following nerves can be blocked using this blockade?

  • Femoral, obturator, lateral femoral cutaneous

  • Femoral, lateral femoral cutaneous, popliteal saphenous

  • Femoral, obturator, posterior femoral cutaneous

  • Popliteal saphenous, obturator, lateral femoral cutaneous

Correct answer: Femoral, obturator, lateral femoral cutaneous

The "three-in-one" block involves sufficient placement of local anesthetic, directed proximally and with distal compression, to block not only the femoral nerve but also the obturator and the lateral femoral cutaneous nerves. It is useful in many procedures involving the knee and thigh; however, many practitioners view this as a femoral-nerve-only block, with little ability to provide additional nerve coverage.

173.

Which of the following are CDC guidelines for prescribing opioids for chronic, noncancer pain? (Select 2.)

  • Preference for short-acting over long-acting formulations

  • Avoiding co-prescription of an opioid with a benzodiazepine

  • Using doses below 100 morphine milligram equivalents per day

  • Avoiding the use of fentanyl if possible alternatives are available

  • Providing nasal naloxone with every opioid prescription

Preference for short-acting over long-acting formulations, ideally using doses below 50 morphine milligram equivalents per day, and avoiding co-prescription of an opioid with a benzodiazepine are components of the CDC guidelines for prescribing opioids for chronic, noncancer pain. The CDC guidelines do not recommend avoiding fentanyl specifically or providing nasal naloxone with every opioid prescription.

174.

Which statements describe the lithotomy position? (Select 3.)

  • The legs are abducted 30-45 degrees from the midline

  • The knees are flexed

  • The legs are held up by supports

  • The hips are always flexed 30-40 degrees

  • The head of the patient's bed is lowered, slanting downwards

In the lithotomy position, the legs are abducted 30-45 degrees from the midline, the knees are flexed, and the legs are held up by supports. The hips are flexed to various extents depending on the type of procedure. In the Trendelenburg position, the head of the patient's bed is lowered, slanting downwards. While the Trendelenburg position is often combined with the lithotomy position, it is considered a different position.

175.

Which of the following values are normal for a neonate?

Select all that apply.

  • Arterial pH 7.30

  • PaO2 65 mm Hg

  • Respiratory rate of 50 breaths/min

  • Hematocrite of 40%

  • PaCO2 40 mmHg

Normal values for a neonate include an arterial pH 7.30–7.40, PaO2 60–90 mm Hg, respiratory rate of 40–60 breaths/min, hematocrite of 48–62%, and PaCO2 30–35 mmHg.

176.

Which of the following systems utilizes a nonrebreathing valve?

  • A resuscitation breathing system

  • A Mapleson circuit

  • A circle breathing system

  • A Bain circuit

Correct answer: A resuscitation breathing system

A resuscitation breathing system (AMBU bags or bag-mask units) contains nonrebreathing valves. The patient valve opens during controlled or spontaneous inspiration to allow gas flow from the ventilation bag to the patient. Rebreathing is prevented by venting exhaled gas into the atmosphere through exhalation ports in this valve. 

A Mapleson circuit is valveless. A circle (breathing) system has one-direction valves that direct flow through an absorber but allow rebreathing of exhaled gases. The Bain circuit is a modified Mapleson D circuit and does not contain a nonrebreathing valve.

177.

The most common cause of secondary hypertension in adults is which of the following?

  • Renal artery stenosis

  • Pregnancy

  • Obesity

  • Cigarette smoking

Correct answer: Renal artery stenosis

The most common cause of secondary hypertension is renal artery stenosis. Renal artery stenosis is a narrowing or blockage of the arteries that supply blood to the kidneys. Loss of blood flow to the kidneys increases cardiac output to compensate so it can maintain a minimal glomerular filtration rate. The increase in cardiac output cannot make up for the deficiency, resulting in chronic elevation of cardiac output through a stenotic renal artery.

Obesity, pregnancy, and unhealthy lifestyle habits such as cigarette smoking, are all risk factors for secondary hypertension, but the most common cause is renal artery stenosis.

178.

Which gas is turned off by modern fail-safe valves?

  • Nitrous oxide

  • Oxygen

  • Carbon dioxide

  • Desflurane

Correct answer: Nitrous oxide

A fail-safe valve will stop the flow of nitrous oxide if the pipeline oxygen pressure fails. It ensures that when the oxygen pressure is lowered, the oxygen concentration will not decrease at the common gas outlet.

179.

Which of the following is correct regarding chronic postsurgical pain (CPSP)?

  • It is a common postoperative problem

  • It primarily only occurs following amputation 

  • It primarily only occurs in those who have chronic pain prior to surgery

  • It primarily only occurs when postsurgical wound complications occur

Correct answer: It is a common postoperative problem

Chronic postsurgical pain (CPSP) is a common, but largely unrecognized postoperative problem that occurs in 10% to 65% of postoperative patients. It is more likely to occur following amputation but affects many surgical patients, not just those with chronic pain prior to surgery, who have an amputation or have postsurgical wound complications.

180.

Which of the following is the most important rationale outlined for supporting the well-being of other clinicians?

  • Moral and ethical

  • Business

  • Regulatory

  • Recognition

Correct answer: Moral and ethical

The American Medical Association (AMA) has outlined five critical arguments for supporting well-being and reducing clinician burnout. Moral and ethical, business, recognition, and regulatory arguments are all part of this outline. However, the moral and ethical argument is recognized as being the most important.

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