CRNA Interview Questions and Answers, Exams of Nursing

Download CRNA Interview Questions and Answers and more Exams Nursing in PDF only on Docsity!

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)

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

rated A

-Cardiac problem (MI, tamponade) -Pulmonary problem (Pneumothorax, PE) What is the difference between CRNA and MDA? - -Schooling: MDA is a licensed medical doctor with 12 years of schooling, CRNA requires 6-7 years of schooling -In most states, nurse anesthetists cannot administer anesthesia without the supervision of a board certified doctor (19 states removed - Texas still requires) -Similar job roles & responsibilities -Rural areas more commonly have CRNAs, hospitals have both Do you understand "opt out"? - -The federal requirement has been that CRNAs must be supervised by a physician. The November 13, 2001 rule allows states to "opt-out" or be "exempted" from the federal supervision requirement. -For a state to "opt-out" of the federal supervision requirement, the state's governor must send a letter of attestation to CMS. The letter must attest that:

1. The state's governor has consulted with the state's boards of medicine and nursing about issues related to access to and the quality of anesthesia services in the state; and

rated A

2. That it is in the best interests of the state's citizens to opt-out of the current federal physician supervision requirement; and
3. That the opt-out is consistent with state law. Discuss the role of the sympathetic nervous system. - -Subdivision of the autonomic nervous system - "fight or flight" -Involved in preparing the body for stress-related activities, slows bodily processes that are less important in emergencies such as digestion -Patho: The amygdala will send a distress signal to the hypothalamus. Impulses are then transmitted through the SNS to the adrenal glands, which then pumps adrenaline into the blood stream. -Increase heart rate, Dilation of the pupil, Secretion of sweat glands, Increased alertness, Slowing down or stopping digestion, Relaxation of the bladder -There are two types of neurons within the sympathetic nervous system: the preganglionic neurons (originate in brain and spinal cord) and the postganglionic neurons (outside spinal cords), or ganglion cells.

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.

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

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

rated A

-Sedation: Fentanyl, Versed, Precedex, Propofol, Ketamine Are there any political or legal issues involving CRNA's lately? - Opt out Diagnose an ABG strip and tell us how you'd treat the patient - Metabolic Acidosis

• -Uncompensated: LOW ph, LOW bicarb, NORMAL pco -Partially compensated: ALL LOW -Compensated: NORMAL ph, LOW bicarb, LOW pco -Causes: DKA, kidney disease, diarrhea, dehydration, septic shock -Treatment: Treat the cause, sodium bicarb 1-2 meq/kg, fluids Diagnose an ABG strip and tell us how you'd treat the patient - Metabolic Alkalosis
• -Uncompensated: HIGH ph, HIGH bicarb, NORMAL pco -Partially Compensated: ALL HIGH -Compensated: NORMAL ph, HIGH bicarb, HIGH pco

rated A

-Causes: Excess of bicarb (a base) in the body; medications (diuretics, laxatives, steroids, antacids), vomiting, dehydration, electrolyte imbalances -Treatment: IVF, electrolyte repletion, stop medications involved (antacid, diuretic) Diagnose an ABG strip and tell us how you'd treat the patient - Respiratory Acidosis - -Uncompensated: LOW ph, HIGH, pco2, NORMAL hco -Partially Compensated: lOW ph, HIGH pco3, HIGH hco -Compensated: NORMAL ph, HIGH pco2, HIGH hco -Causes: Depressed respirations - airway disease (asthma, COPD), overdose, OSA, neuromuscular disease -Treatment: Oxygen, PPV, intubation, bronchodilators Diagnose an ABG strip and tell us how you'd treat the patient - Respiratory Alkalosis - -Uncompensated: HIGH ph, LOW pco2, NORMAL hco -Partially Compensated: HIGH ph, LOW pco2, LOW hco -Compensated: NORMAL ph, LOW pco2, LOW hco

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)

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

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

rated A

Interpret an EKG strip and tell us what you would do for the patient - Premature Junctional Contractions - -Causes: Heart failure, dig toxicity, MI -Inverted or absent p wave -Treatment: Underlying disorder Interpret an EKG strip and tell us what you would do for the patient - Ventricular Tachycardia - -Causes: Abnormalities of the heart that result in scarring of heart tissue (MI), CAD, congenital heart conditions, electrolyte imbalance, drugs -Treatment w/ pulse: Synchronized cardioversion 100J if unstable, Amiodarone -Treatment if pulseless: CPR, Epinephrine, defibrillation Interpret an EKG strip and tell us what you would do for the patient - Ventricular Fibrillation - CPR, Epi (1mg adults, .01 mg/kg peds), defibrillation (120-200J adults, 2-4J/kg peds) Interpret an EKG strip and tell us what you would do for the patient - Asystole - CPR, Epi (1mg adults, .01 mg/kg peds), defibrillation if achieve shockable rhythm (120-200J adults, 2-4J/kg peds)

rated A

Interpret an EKG strip and tell us what you would do for the patient - First degree block - -Abnormally slow conduction through the AV node -Prolonged PR -For the majority of patients with first-degree AV block, there is no need for treatment. Interpret an EKG strip and tell us what you would do for the patient - Second degree block type 1 (Wenckebach) - -Longer, longer, longer, drop - then you have a Wenckebach -Generally asymptomatic and doesn't require treatment Interpret an EKG strip and tell us what you would do for the patient - Second degree block type 2 (Mobitz II) - -If some p's just don't get through, then you have a Mobitz II -can rapidly progress to complete heart block so needs immediate treatment -Treatment: transcutaneous pacing, transvenous pacing Interpret an EKG strip and tell us what you would do for the patient - Third degree block - -AKA complete heart block -Typically have a very slow heart rate

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

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

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

rated A

-Oral airway -Neck roll -Intubation What's a TIPS - -Transjugular intrahepatic portosystemic shunt (TIPS) -Used to treat portal vein hypertension and other complications of advanced liver disease -Stent to keep the channel between the portal and hepatic veins open -Blood flow from the digestive system organs will flow through the stent and into the hepatic veins, reducing the pressure in the portal vein. What clotting factors does the liver make? - Fibrinogen, Prothrombin, factor V, VII, IX, X, XI, XII, as well as protein C and S, antithrombin, factor VIII and von Willebrand factor What vasoactive and sedative medications do you use? - -Vasoactives: Epi, Norepi (Levo), Vaso, Dopamine, Dobutamine, Milrinone -Sedation: Fentanyl, Versed, Precedex, Propofol, Ketamine

rated A

Minute Ventilation - -the amount of air a person breaths in a minute. The minute ventilation is calculated by the multiplication of the tidal volume and the respiratory rate. -Tidal volume (8-10 ml/kg) x RR (10-20) -To increase -> increase RR or TV -Normal MV is 6-8L min Alveolar Ventilation - AV = (TV-dead space) * RR -the volume of air entering and leaving the alveoli per minute; dead space is not included -measured in ml/min -higher alveolar ventilation -> higher concentration of oxygen & lower concentration of carbon dioxide within alveoli. -lower alveolar ventilation - > lower concentration of oxygen & higher concentration of carbon dioxide within the alveolus Norepinephrine - MOA: A1 agonist -> Vasoconstriction

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 A B1 - Increase contractility, increased heart rate B2 - Smooth muscle relaxation -> bronchodilation, coronary arterial dilation.

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

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

rated A

Side effect: Reflex bradycardia Vasopressin - MOA: V1 agonist -> vascular smooth muscle vasoconstriction V2 agonist -> increase reabsorption of h20 in distal convoluted tubules, increases Na reabsorption in ascending loop of Henle V3 agonist Dosage: .01-.12 u/kg/hr or .01-.48 u/kg/hr peds Uses: DI, adjunctive therapy in septic shock Ketamine - NMDA receptor antagonist blocking glutamate, preventing influx of cations thus preventing depolarization --> cateleptic/dissociative state. NMDA is a receptor in the CNS responsible for conduction of action potentials associated with memory. 1-5 mg/kg IVP

rated A

15-90 mcg/kg/min s/e: hallucination, confusion, HTN Nicardipine - MOA: Calcium channel blocker - the inhibition of calcium into cells results in vasodilation more specific to coronary and cerebral vessels -> decreased SVR, decreased afterload, increased oxygen delivery Dosage: 5-15 mg/hr Use: Regulates blood pressure during hypertensive emergencies and post transplantation where goal blood pressures need to be tightly met. Milrinone - MOA: Phosphodiasterase III inhibitor ->

1. increased intracellular cAMP and subsequently, increased CA ion influx into cardiac muscle cells -> increased force of contraction

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