CRNA Interview Questions and Answers, Exams of Nursing

Download CRNA Interview Questions and Answers and more Exams Nursing in PDF only on Docsity! CRNA Interview Questions and answers rated A What are the interventions for cardiogenic shock? - -Fluids -Vasopressors (Dopamine) -Inotropes (Dobutamine, Milrinone for heart failure) -IABP, ECMO Your ventilator is peak pressure alarming. What could be the problem? - -Normal plateau pressure - Kink in tubing, patient biting tube, mucous plug, bronchospasm, ETT too small -If high plateau pressure - there is an issue with lung compliance ie: developing PNA, pulmonary edema, auto PEEP, pneumothorax, right main stem, ARDS, ILD Your patient needs to be intubated soon. What items do you want at the bedside? - -suction -appropriate-sized bag and mask -oxygen source -appropriate size endotracheal tubes including a size larger and one size smaller -laryngoscope and appropriate-sized laryngoscope blades (including one size smaller and one size larger) CRNA Interview Questions and answers rated A -endotracheal tube-securing equipment (tape or other) -stylet -syringe -pillow, blanket roll -stethoscope -IVF, pressure bag -pressors depending on status -sedation -appropriate sized nasogastric tubes -x-ray on standby What are some reasons for post operative tachycardia? - Postoperative sinus tachycardia is often attributed to catecholamine release in response to surgical stress or anemia. -Pain -Hypovolemia -Anemia -Drug induced CRNA Interview Questions and answers rated A -Neurotransmitters involved: Acetylcholine, Epi, Norepi Discuss the role of the parasympathetic nervous system. - -Subdivision of the autonomic nervous system - "rest and digest" - keeps the basic functions of your body working as they should. -PSNS starts in your brain and extends out via long fibers that connect with special neurons near the organ they intend to act on -Constricts pupils, causes salivation, slows down the heart rate, tightens the bronchi in the lungs, enacts digestion, releases bile, makes the bladder contract Tell us about a critical patient you had and the pathophysiology behind their disease. - Urosepsis -> Septic Shock -> ARDS -> HFOV How does IABP work? - -The IABP consists of a thin, flexible tube called a catheter. Attached to the tip of the catheter is a long balloon. The other end of the catheter attaches to a computer console which has a mechanism for inflating and deflating the balloon at the proper time when your heart beats. CRNA Interview Questions and answers rated A -An IABP allows blood to flow more easily into your coronary arteries. It also helps your heart pump more blood with each contraction. -How it works: 1. Deflated in systole (heart contracts) so blood can be ejected with less resistance & also has a vacuum effect pulling blood forward 2. In diastole, balloon inflates & pushes blood back towards coronary arteries, improving perfusion -Indications: MI, CHF, defects, arrhythmia, myocarditis What coronary is affected in an anterior lateral MI? - **Left anterior descending coronary artery (LAD)** -Also known as anterior wall MI, or AWMI, or anterior ST segment elevation MI, or anterior STEMI -Occurs when anterior myocardial tissue usually supplied by the left anterior descending coronary artery suffers injury due to lack of blood supply. -Poorest prognosis CRNA Interview Questions and answers rated A How can you lower ICP? - -Elevate HOB -Hyperventilate - to cause vasoconstriction -Mannitol 0.25-1g/kg (elevates blood plasma osmolality, resulting in enhanced flow of water from tissues into interstitial fluid and plasma) -Hypertonic saline -Restrict fluids -Therapeutic hypothermia, prevent shivering -Avoid fevers (increased metabolic demand & vasodilation) -Maintain normotension -Treat pain, anxiety & seizures -Sedate -Craniectomy What kind of patients and drips do you take care of? - -Patient population: Respiratory failure (adults and peds), ARDS, SIDS, s/p cardiac arrest, overdose, complex care -Pressors/Cardiac: Epi, Norepi (Levo), Vaso, Dopamine, Dobutamine, Milrinone CRNA Interview Questions and answers rated A -Causes: Excessive breathing r/t anxiety, pain, fever, trauma, PE -Treatment: Correct cause, breathe into paper bag, treat anxiety, fever, etc Interpret an EKG strip and tell us what you would do for the patient - Sinus Brady - -Asymptomatic: No treatment required, correct cause ie: hypothermia -Symptomatic: Atropine .5 mg Q3-5 mins up to 3 mg, pacemaker Interpret an EKG strip and tell us what you would do for the patient - Sinus Tachy - Treat underlying cause; fever, anxiety, pain etc. Interpret an EKG strip and tell us what you would do for the patient - Sinus Arrhythmia - Common, typically doesn't require treatment Interpret an EKG strip and tell us what you would do for the patient - SVT - 1. Vagal maneuvers (if stable) 2. Adenosine (6 mg then 12 mg or .1mg/kg then .2 mg/kg pediatrics) 3. Synchronized Cardioversion (50J then 100J for adults, 1J/kg then 2J/kg peds) 4. Catheter ablation for long term therapy (uses cold or heat energy to create tiny scars in your heart to block abnormal electrical signals) CRNA Interview Questions and answers rated A *HR > 220 in infants, >180 in children, >150 in adults* Interpret an EKG strip and tell us what you would do for the patient - PACS - - Causes: Stress, stimulants, cardiac disease, dig toxicity, abnormal electrolytes -Treatment: Mostly benign and don't require treatment, reduce stimulants or triggering factors, rule out underlying heart disease Interpret an EKG strip and tell us what you would do for the patient - PVCs - - Causes: Stimulants, heart disease -Premature and bizarrely shaped QRS complexes that are unusually long & wide. Not preceded by a P wave, T wave is usually large and oriented in a direction opposite the major deflection of the QRS. -Treatment: Mostly benign and don't require treatment. If frequent, reduce stimulants/triggers, beta blockers, catheter ablation Interpret an EKG strip and tell us what you would do for the patient - Atrial Fibrillation - -The signals in the upper chambers of your heart are chaotic. As a result, they quiver. -Causes: HTN, MI, CAD, heart defects, stimulants CRNA Interview Questions and answers rated A -A fib RVR treatments: -Diltiazem 0.25 mg/kg IVP 1st dose, 0.35 mg/kg 2nd dose -Diltiazem 5-15 mg/hr -Metoprolol -Amiodarone 150 mg bolus -Amiodarone gtt t 1 mg/minute x6 hours, followed by 0.5 mg/minute x18 hrs -Transition to oral meds -Blood thinners Interpret an EKG strip and tell us what you would do for the patient - Atrial Flutter - -Amiodarone bolus 150 mg -> -Amiodarone 1 mg/min x 6 hours -> -Amiodarone .5 mg/min x 18 hours -Antiarrhythmic: Digoxin, Pacerone, -Anticoagulants ie: Lovenox, Warfarin, Eliquis -Catheter ablation -Cardioversion CRNA Interview Questions and answers rated A -Atropine (short term) & pacemaker Interpret an EKG strip and tell us what you would do for the patient - Bundle branch block - -Bundle branch block might not need treatment. When it does, treatment involves managing the underlying health condition, such as heart disease, that caused bundle branch block -Pacemaker if issues with fainting Run a theoretical code. - PALS / ACLS Describe a difficult patient and what you did for them. - -Clinically - Sepsis, ARDS, HFOV -Socially - Logan's parents Describe an experience you had with a difficult doctor and how you handled the situation. - -Untreated hypotension ?? A doctor tells you to give a medication you don't feel is beneficial. What would you do? - Ask to have a discussion about the reasoning, purpose or benefit behind CRNA Interview Questions and answers rated A giving the medication. Have open communication about my concerns or questions. Ultimately, if uncomfortable moving forward, request that the MD administer the medication themselves to protect my license. If you found a classmate was involved with a preceptor, what would you do? - Inform appropriate superiors within the institution. Boundaries are in place for a reason, and to maintain the integrity of the program and school, they must be respected and followed. In pre-op, a patient says they want an anesthesiologist, not a nurse. What would you do? - Ask patient to discuss their concerns and address any questions they may have. Offer reassurance by informing them of time spent in schooling and training as well as degrees held, and educating them on requirements that CRNA's are supervised by physicians in the state of Texas. Attempt to alleviate any concerns with an open, informative conversation but ultimately, respect the patients wishes. Functional group identification - Ketones - Oxygen = Carbon Carbon - two additional carbon chains Functional group identification - Aldehyde - Oxygen = Carbon CRNA Interview Questions and answers rated A Carbon - One carbon chain & one hydrogen Functional group identification - Alkane - Contain ONLY C & H Contain ONLY single bonds Functional group identification - Carboxylic Acid - Oxygen = Carbon Carbon bonded to an OH group Functional group identification - Alkene - Contain ONLY C & H Contain at least one double bond Functional group identification - Alkyne - Contain ONLY C & H Contain at least one triple bond Functional group identification - Alcohol - Contains an alcohol (OH) bonded to a single bonded carbon atom Describe the techniques you have used to manage a patient airway or pulmonary status. - -Suctioning CRNA Interview Questions and answers rated A A2 agonist B1 agonist -> Increased HR & contractility to overcome increase in SVR created by A1 agonism -Immediate onset -Drug of choice for septic shock -Dosage 1-20 or 30 mcg/min -Pediatric dosage .05-2 mcg/kg/min -Side effects: Anxiety, tremors, headache, n/v, reflex bradycardia Epinephrine - Nonselective alpha & beta adrenergic receptor agonist A1 - Vasoconstriction A2 B1 - Increase contractility, increased heart rate B2 - Smooth muscle relaxation -> bronchodilation, coronary arterial dilation. CRNA Interview Questions and answers rated A B3 - Increase lipolysis and thermogenesis in brown adipose tissue. Uses: Cardiogenic shock, adjunctive therapy in severe septic shock Dosage: 1 mg IVP adults, .01mg/kg IVP pediatrics .05-2 mcg/kg/min - titrate by .01-.05 q15 min Precedex - MOA: Alpha 2 agonist -> Inhibiting norepinephrine release pre- synaptically reduces/halts the transmission of pain, while post-synaptically acts to reduce sympathetic tone -> anesthesia with analgesia and anxiolysis. Dosage: 1 mg/kg .2-1.5 mg/kg/hr Uses: Sedation, ETOH withdrawal CRNA Interview Questions and answers rated A Common side effect: Bradycardia Propofol - Enhances the effects of GABA on GABAa receptors by increasing the duration that Cl ion channels are open -> hyperpolarization 2-3.5 mg/kg IVP 5-50 mcg/kg/min Phenylephrine - MOA: A1 Agonist -> increase in SVR through systemic arterial vasoconstriction. A2 Agonist -> Minimal effects Dosage: 40-100 mcg IVP or 5-20 mcg/kg IVP for hypotension during anesthesia Titrated as a drip from .5-9 mcg/kg/min Uses: Neurogenic shock, hypotension w/ anesthesia CRNA Interview Questions and answers rated A 2. cAMP accumulation in vascular tissue -> results in decreased CA ion influx -> vasodilation. Dosage: .25-1 mcg/kg/min Use: Heart failure S/E: Hypotension Dobutamine - MOA: B1 agonist -> Increased HR and contractility -> Increased CO Some effects on B2 -> Can have some vasodilation Dosage: 2-20 mcg/kg/min Use: Heart failure, not used for septic shock due to potential vasodilatory effects CRNA Interview Questions and answers rated A Atropine - MOA: Muscarinic acetylcholine receptor antagonist (anticholinergic) -> Increase firing at SA node, conduction through AV node, opposes action of vagus nerve, decreases bronchial secretions Dosage: .02 mg/kg Min dose .1 mg Max dose .5 mg Use: Symptomatic bradycardia Dopamine - MOA: D1 & D2 agonist -> Increased renal blood flow + vasodilation B1 agonist -> Increased heart rate and contractility A1 agonist -> Vasoconstriction Dosage: 2- 20 mcg/kg/min 2-5 mcg/kg/min = dopaminergic stimulation 5-10 mcg/kg/min = beta 1 stimulation 10-20 mcg/kg/min predominant Alpha stimulation CRNA Interview Questions and answers rated A Use: Cardiogenic shock, septic shock, cardiac surgery Why do you want to be a CRNA? - -Want to further my education -more independence and autonomy -more direct, involved role in my patients plan of care and outcome. -I get to take some of my favorite things about what I do now (sedation, titrating gtts, managing airways hemodynamics, intense monitoring) and do them on a larger, more involved scale, while doing less of things that I am ready to move on from (juggling multiple patients, multiple families, ADLs, going to the bathroom, etc) -More secure financial future in which I can support my family while continuing to enjoy my hobbies such as traveling. Why should we pick you over the other candidates? - -My wide range of experience will help me to be successful both in school and on the job - I have CRNA Interview Questions and answers rated A continue saving for school. I would also spend that year learning and growing in my field, obtaining certifications, and gaining experience. Lastly, I would apply again to multiple schools on the next round of admissions. How would you handle travel for clinical? - I am very used to traveling, as is my family. Travel would be no issue. Have you applied for other programs? Gotten interviews? - Texas Wesleyan - the application only closed yesterday so I've not heard back about an interview yet, however UTH is my first choice. What would you do if a senior threatened you? - I would first try to understand the situation - why the threat was made, what could have happened to cause it. What I did next would depend on the severity and safety of the situation. If the "threat" was something minor and I felt comfortable enough with the senior, I would try to pull them aside for a conversation about what was going on, how I felt about it and what we can do moving forward. However if this was not an option based on the scenario, I would report to my appropriate supervisors and take action recommended from there. CRNA Interview Questions and answers rated A What is your experience in the ICU? - -Almost 5 years in the PICU - I have worked at both Texas Childrens Main Campus and The Woodlands. I am proud to say I helped to prepare and open the brand new Woodlands campus. It was a unique experience. -1.5 years in the adult ICU, many of which were spent in COVID ICU. -Staff & traveler -Level one trauma & community settings What does a CRNA do? - -Start with a physical assessment and review of history which will then help to make a unique, personalized plan for anesthesia. Establish rapport with their patients prior to surgery and educate them and their families extensively on risks, benefits, side effects, etc. -In surgery, they are responsible for the initial anesthetic administration/management of hemodynamics continual assessment and communication with providers. -They perform line placement, intubation, spinal/regional nerve blocks/epidural administration, and many other invasive procedures. CRNA Interview Questions and answers rated A -In the event of an emergency, they respond with medication, airway management, and life support techniques. They must remain calm, and display leadership at all times. -At the conclusion of surgery, they are responsible for evaluating the safety of lifting sedation and extubating the patient if relevant, and maintaining patient safety through to the PACU setting. What do you know about our program? - -First program in Texas to offer the BSN- DNP program -112 credits/9 semesters/36 months -100 percent of 2021 BSN-DNP nurse anesthesia program graduates passed the NCE on the first attempt. -9/10 graduating classes have achieved 100-percent pass rates on the first attempt of the NCE -The NCE first-time test-taker pass rate for the most recent five-year composite was 99.12 percent. -For the most recent graduating cohort, 100 percent of UTHealth nurse anesthesia graduates were employed as nurse anesthetists within six months of program completion. -Class size is small - about 20 people. CRNA Interview Questions and answers rated A Give us an example of when you made a mistake. - Following an emergent intubation, I wasted medications at the bedside with my charge nurse. However, in the midst of the chaos and with all of the tasks that kept coming my way, I failed to waste my medications in the omnicell. It was one of those things where you go home after a long day, but something is nagging at you in the back of your head and you keep wondering what did I miss, what did I miss? Then it hit me. I handled it proactively. I texted the nurse I wasted with to let her know that we had forgotten to waste in the omnicell, and I texted my manager who gave pharmacy a heads up as well. When I returned to work the next day, I wasted in the omnicell with the same nurse from the day before, and filled out a discrepancy form for the pharmacy. Thankfully I had wasted the medications at bedside so I had a witness and there was no question about diversion, but it was definitely an unnecessary headache that had made me extremely attentive to my wastes now. How do you describe success? - To me, success is not necessarily something that comes at the end of a long road. Success can be incremental. For example, I have had many great successes on my journey to this chair today. I had the success of getting into nursing school, graduating nursing school, graduating with honors, I had the success of getting a job in the ICU and the success of becoming a travel nurse. My latest success was landing this interview and I hope to add admission to CRNA school on the list of successes soon. Ultimately, I think any good thing, or CRNA Interview Questions and answers rated A milestone that you worked toward and accomplished can be counted as a success. Success is achieving a goal - no matter how big or small, whether it is academic, personal, or physical. How do you handle conflict? Give an example. - I try to handle conflict proactively, but privately. I am a pretty easy going person, so I've not had direct conflict with coworkers or superiors, though I have handled conflict with patients and families as charge nurse. On one occasion, the staff noticed a patients grandmother with passive aggressive behavior towards the staff - they said she was staring at people, giving dirty looks, making rude comments. I handled it proactively but going to her before the situation escalated, and I handled it privately by speaking to her in her room just the two of us. I was able to figure out what and who she was frustrated with, diffuse the situation and suggest a resolution in a way that ensured she felt understood and respected. What leadership experience do you have? - I have experience as a team leader, a charge nurse and a preceptor. I have been a team lead and preceptor at Texas Children's for almost five years, and I have been a charge nurse for three years. I have also precepted some fellow travelers in extenuating circumstances while traveling myself. CRNA Interview Questions and answers rated A Tell us about volunteer or community service work you have done. - When I was full time with Texas Children's, I did some volunteer work with them. I took part in a few vaccine clinics for underserved communities, and volunteered at the hospital fun run for two years. I've also done a lot of volunteering outside of the medical field. I have spent a lot of time at my local animal shelter where I walk dogs, play with them, bathe them, and sometimes just sit with them if they are scared. I also fostered prior to becoming a travel nurse. This was and is one of my favorite things to do. What are your roles and responsibilities? - I play the role of bedside nurse, charge nurse and team lead. My biggest responsibilities include providing quality patient care, keeping my patients safe, and advocating for my patients. Who is the greatest influence in your life? - My mom. CRNA Interview Questions and answers rated A then I take what they say to me and really think on it and consider if and how I can grow from it. There is ALWAYS something to be learned. And you can't learn if you can't take criticism and coaching from a peer or superior. What are your career goals? - I would definitely like to work full time as a CRNA obviously, but in addition to that I would like to contribute to teaching and research in some form to give back. Why this program over others? - -Home & Support -Alumni -Cost -Class size Tell me about yourself. - I am a Pediatric Intensive Care and Adult Intensive Care nurse. This is a field I've wanted to be in as long as I can remember, and was sparked by watching my mom become a nurse when I was young. I started doing health classes and clinical rotations in high school, and went straight for nursing school once I graduated. I started out on a Medical Surgical floor, and jumped at CRNA Interview Questions and answers rated A the first chance I got to enter the Pediatric and even better, PICU world. I started my PICU career at Texas Children's Downtown, and soon after transferred out and helped open up a brand new branch in The Woodlands. I was there on our very first night and witnessed our very first patient admission. While I am still PRN, after a few years I meshed my love for PICU and my love for travel and became a travel nurse. It was one of the scariest and greatest things I have ever done. Once COVID hit, I felt an immense calling to help, and so I dove head first into the adult ICU world where I grew so much more as a nurse and where I finally felt like I had what it took to pursue my dream of becoming a CRNA. I am hoping to gain admittance to a program starting next year and take the next step in my career and professional growth. Tell me about your work history. - I started out on a Medical Surgical floor, and jumped at the first chance I got to enter the Pediatric and even better, PICU world. I started my PICU career at Texas Children's Downtown, and soon after transferred out and helped open up a brand new branch in The Woodlands. I was there on our very first night and witnessed our very first patient admission. During my time here I fulfilled the roles of charge nurse, team leader and preceptor. While I am still PRN, after a few years I meshed my love for PICU and my love for travel and became a travel nurse. It was one of the scariest and greatest things I have ever done. Once COVID hit, I felt an immense calling to help, and so I dove head first into the adult ICU world where I grew so much more as a nurse and where I finally felt like I had what it took to pursue my dream of becoming a CRNA. CRNA Interview Questions and answers rated A How well have you prepared for this program? - I have spent a great deal of time and energy preparing for this program. The nearly five years I have spent in the ICU I have spent learning. I have spent many years but especially the last two years preparing myself financially. Within the last year, I have increased my studying exponentially in anticipation of this interview being a possibility. Do you have support? - I do. I have great support. I have a fiancé that I have been with since high school - we have overcome military, nursing school, and long distance so we are no strangers to adversity. I also have my whole family here, all of which are fortunately very supportive of me furthering my education and would help to support me in any way they can to help me reach my goals. I am extremely fortunate to have the support system that I do. How do you feel about giving up a paying job? What financial preparations have you made? - It's definitely nerve wracking, but I have been preparing financially for two years. I worked a lot, and I mean a lot of overtime this past year in COVID ICU's and every cent I had leftover went to saving for this program. I feel confident that my finances are in order and I am able to focus on my studies the next 3 years without a paying job. In addition, I am fortunate to have a fiance who is currently working who can help to support me as well. CRNA Interview Questions and answers rated A What is your single strongest personality trait that will help you in your academic and professional career as a CRNA? - Dedication. What obligations will you have toward this profession? - -Advocacy -Time and financial help -Contribution to research to advance the field -Participate in educating the future waves of CRNAs Tell me about your shadow experience. - Unfortunately I was unable to get recent shadow experience. With COVID restrictions I was not able to find a hospital willing to put an additional body in the OR. I did spend a couple shifts shadowing a CRNA at the very beginning of my career and it further motivated me to do what I needed to do to get to this seat I am in right now. What have you done to develop and change the last few years? - CRNA Interview Questions and answers rated A What makes someone difficult to work with? - I think more than anything, what makes someone difficult to work with is being unwilling to receive feedback, advice, constructive criticism, or suggestions. Why would your coworkers say you are difficult to work with? - While I like to think that my coworkers enjoy working with me, if they had to complain about anything, I imagine it would be my lack of willingness to accept help. I am constantly offering my help to others, however I rarely accept help myself. I tend to want to do things myself to ensure they are done correctly and how I would want them done. What do you like to do in your free time? - -Spend time with my family -Spend time with my dogs -Get outdoors - Beach & hike -Read Pathophysiology of drowning - **ARDS & cerebral edema** -Hypoxia r/t pulmonary edema -Surfactant wash out -> Atelectasis -> v/q mismatch -Aspiration PNA CRNA Interview Questions and answers rated A -Hypothermia -Anoxic brain injury -> Cerebral edema Pathophysiology of ARDS - - Damage to alveolar-capillary membrane --> increased permeability --> leakage -> protein rich fluid moves into sacs -> interstitial edema - > pulmonary edema -> decreased gas exchange, hypoxia, v/q mismatch -Loss of surfactant/damage to surfactant cells -> Atelectasis -Hyaline membrane forms of dead cells & protein -> stiffness, decreased compliance, v/q mismatch + **refractory hypoxemia** -Direct causes: PNA, aspiration, drowning, embolism, inhalation injury -Indirect causes: Sepsis (#1), burns, overdose Pathophysiology of sepsis - 1. WBC recruitment -> release of substances that -> vasodilation and decreased SVR 2. Vasodilation and increased permeability/leakiness of blood vessels -> fluid build up in tissues -> difficult for oxygen exchange -> cells starved of O2 3. WBC release enzymes to destroy pathogens but damage blood vessels as well - > exaggerated clotting response -> coag factors get used up and can -> DIC -> microvascular thrombosis & bleeding CRNA Interview Questions and answers rated A ratio is less than 1:2, progressive hyperinflation may result. ACV is particularly undesirable for patients who breathe rapidly - they may induce both hyperinflation and respiratory alkalosis. Synchronized Intermittent Mandatory Ventilation (SIMV) - Guarantees a certain number of breaths, but unlike ACV, patient breaths are partially their own, reducing the risk of hyperinflation or alkalosis. Mandatory breaths are synchronized to coincide with spontaneous respirations. Disadvantages of SIMV are increased work of breathing and a tendency to reduce cardiac output, which may prolong ventilator dependency Pressure Control Ventilation - Pressure-Controlled Ventilation (PCV) Less risk of barotrauma as compared to ACV and SIMV. Does not allow for patient- initiated breaths. The inspiratory flow pattern decreases exponentially, reducing peak pressures and improving gas exchange. The major disadvantage is that there are no guarantees for volume, especially when lung mechanics are changing. Thus, PCV has traditionally been preferred for patients with neuromuscular disease but otherwise normal lungs Pressure Support Ventilation (PSV) - Pressure Support Ventilation (PSV) CRNA Interview Questions and answers rated A Allows the patient to determine inflation volume and respiratory frequency thus can only be used to augment spontaneous breathing. Pressure support can be used to overcome the resistance of ventilator tubing in another cycle (5 - 10 cm H20 are generally used, especially during weaning), or to augment spontaneous breathing. airway pressure release ventilation (APRV) - Airway Pressure Release Ventilation (APRV) Airway pressure release ventilation is similar to PCIRV - instead of being a variation of PCV in which the I:E ratio is reversed, APRV is a variation of CPAP that releases pressure temporarily on exhalation. This unique mode of ventilation results in higher average airway pressures. Patients are able to spontaneously ventilate at both low and high pressures, although typically most (or all) ventilation occurs at the high pressure. As in PCIRV, hemodynamic compromise is a concern in APRV. Additionally, APRV typically requires increased sedation Pressure Regulated Volume Control (PRVC) - A volume target backup is added to a pressure assist-control mode High frequency oscillatory ventilation (HFOV) - -Recruits collapsed alveoli and reduces the risk of VILI CRNA Interview Questions and answers rated A -Improves oxygenation in patients with severe ling injury, such as ARDS -Oscillates gas at high frequencies (respiratory rate) in 3-15 (Hz) range +1 Hz = 60 cycles per second +Frequency of 5 Hz = 60 x 5 = 300 breaths/min. Requires sedation and NMBA, thus minimizing spont. breathing RM may be used when the patient is initially set up or when disconnected from ventilator -Very high respiratory rates result in low alveolar pressure change -Very low tidal volumes, typically 3-5 mL -Ventilator settings are significantly different than conventional ventilation Alpha 1 receptors - -on vascular smooth muscle -causes vasoconstriction Alpha 2 receptors - -located on nerve endings -Inhibits neurotransmitter release CRNA Interview Questions and answers rated A -What qualities are you look for in a potential SRNA? -I know your class size is small - how would you describe the relationship between your students and faculty? -How does clinical rotation placement work? Are we able to make requests? -Do you have any concerns about me that might impact your decision on whether or not to choose me for this program? DIC - -Hemostasis out of control -Microthrombi form -> organ ischemia -Clotting factors & platelets are consumed -> excessive bleeding **Too much & too little clotting** DKA - -Low insulin, high blood sugar -Low insulin = glucose stays in the blood, cells are starved CRNA Interview Questions and answers rated A -Metabolic starvation -> counterregulatory hormones are produced to increase glucose supply which further increases bg -> glucose overflows into urine & takes h2o and electrolytes with it (osmotic diuresis) -> polyuria, polydipsia, dehydration -Metabolic starvation -> lipolysis (fat to fatty acids) for alternative energy source -> production of ketones, beta -> metabolic acidosis -Insulin pulls K into cells, without it K appears elevated in the blood. Expect a high potassium, don't treat. With insulin, k will move into cells, lowering k levels. Treat low potassium -Complication: Cerebral edema - osmolar gradiant caused by increased bg -> h2o shift from ICF -> ECF Correction of bg and fluids can cause rapid change in osmolarity and thus a rapid shift of h2o back to ICF and thus cause cell swelling -> cerebral edema Correct slowly! V/Q mismatch - V=Ventilation P=Perfusion Part of the lung receives either 1. Oxygen without blood flow (dead space) - embolism CRNA Interview Questions and answers rated A 2. Blood flow without oxygen (intrapulmonary shunting) - alveolar collapse, pulmonary edema, ARDS, foreign body Vecuronium/Rocuronium - -Nicotinic ACH receptor antagonist --> block acetylcholine from binding -> no depolarization -> no muscle contraction -Reversal agent - Neostigmine or Suggamadex -Dosage Roc - 0.5 mg/kg IVP, 5-10 mcg/kg/min gtt -Dosage Vec - 0.1 mg/kg IVP