CRNA Interview Preparation: Questions and Answers, Exams of Nursing

Download CRNA Interview Preparation: Questions and Answers and more Exams Nursing in PDF only on Docsity! CRNA Interview Questions and answers rated A Why do you want to be a CRNA? - -My why stems from my experience with a code two months into orientation. a. Patient died after prolonged resuscitation effort b. Anxious to return to work due to the traumatic nature of code c. I had an attending tell me that being able to honestly reflect and improve yourself on the basis of experience is one of the most important things in this profession. Put a lot of effort into continued learning and understanding critical care physiology and pharmacology and felt that preparation helped make me feel more comfortable and confident at work. As I did more self-reflection and research, I realized that being a CRNA is what I wanted for my career. Ultimately: 1. Enjoy critical care and learning about pharmacology and physiology and want to apply it through anesthesia. 2. Want to provide individualized attention and care to a patient. CRNA Interview Questions and answers rated A 3. Eagerness to continue learning and pursue higher education as a first generation college graduate and want to be a first generation graduate student. What are your strengths? - 1. Introspective: a. always self-reflecting, strong desire for self improvement b. and as such, I am intellectually curious, receptive to feedback and always willing to learn. 2. Self motivated 3. Diligent, resilience What are your weaknesses? - 1. Sometimes I try to do too much on my own. a. It stems from the pandemic. My family was financially burdened and I felt obligated to work more. b. Picked up more shifts and felt myself being miserable and both mentally and physically burdened. c. My first experience with the importance of knowing your own limitations. d. Cut back on number of shifts worked and focusing on other aspects of my life such as friendships and fitness. CRNA Interview Questions and answers rated A -Some of the things about your program that draw me to it is the availability of the clinical correlations lab to reinforce didactic teaching, as well as the teaching assistant program, which allows you as a student to gain experience to become a future anesthesia educator, which is a goal of mine. -Online research through forums have only said good things about the program and the support of the faculty members for their students. -Appreciation for the clinical correlations lab and weaving of didactic curriculum and clinical correlation is appealing to me. Why Johns Hopkins? - -Hopkins is a powerhouse in healthcare and is globally known for being a standard of excellence and innovation in healthcare. -Having worked and trained at another globally known and established facility at Mayo Clinic, I appreciate the resources and opportunities offered to me and expect the same at Johns Hopkins, such as cases that other places cannot offer to expose students to. -JHU has one of the strongest anesthesia residency programs and my understanding from watching prior information sessions is that the CRNA program CRNA Interview Questions and answers rated A at JHU is a collaboration between the SOM and SON and students will interact with and learn from both MDA and CRNA's and will receive similarly strong clinical training. -Also Johns Hopkins puts a great deal of value into achieving diversity, equity, and inclusion of all for the purpose of dismantling system barriers to success, as well as bringing together a variety of backgrounds and viewpoints for the benefit of all. -I've also spoken to current SRNA's at JHU. One of them being Aly in her second year. She was a former CVS ICU nurse at Mayo and I connected with her through a mutual friend and she has spoken highly of the program and its dedication to the program and its students, despite being a newly incepted program. Tell me about diversity and inclusion - What does diversity and inclusion mean to you? -Diversity and inclusion to me means equal opportunity for everyone to experience the best position they can be in. -I think that in the context of academics, it is equal opportunity for all to achieve their dreams and pursue the education that they wish to. CRNA Interview Questions and answers rated A -In the context of healthcare, I think that it is equally as important for patients to also have equal opportunity to receive the best care that they can, and I think diversity and inclusion is an important factor in that. -Having grown up in NYC, I took for granted diversity and how important it can be. Coming to Minnesota for the first time, being one of it not the only Chinese nurse on my unit, I felt isolated. -Without people of similar backgrounds or experiences to relate to. -And it wasn't until just recently I realized the importance of diversity for patient's sake. -Taking care of a Chinese patient who had a congenital MV stenosis and had a valve replacement about 20 years ago. Her valve had dehisced and she had severe HF symptoms and had a multiple valve replacement and was on our unit and at this point she had been trached for respiratory failure. -She was still relatively young, so her parents were the ones visiting her and they reminded me a lot of my own parents. They were immigrants from China who CRNA Interview Questions and answers rated A dexmedetomidine for anxiolytic and sedation, which we titrated up to about 1mcg/kg/hr. -In the morning, when the surgeon rounded during my handoff, he saw that the patient was on dex and started yelling at me, saying that dex was a terrible drug with many adverse effects and there are studies showing increased mortality and that none of his patients should ever be on dex. -I told him that we tried other things first and ultimately the provider decided to put in the order for dexmedetomidine, so while I understand his frustrations, he shouldn't be directing his anger towards me or speaking to anyone like this in general. He apologized for expressing his anger towards me and spoke to the team and they made a note that it was his surgeon preference and to not use the drug. -From then, we have a good working relationship and jokes around about making sure his patients aren't on preceded. Discuss an issue with a coworker (nurse) - Cody's story about NGT -Just off orientation and had to place an NGT for one the first times, with the CORTRAK device, so I asked a nurse for help. CRNA Interview Questions and answers rated A -Kim said she did not need it and would help place it. The patient was deeply sedated there was no coughing. She placed in and ended up being in the lung when they got the x-ray. -Provider was upset and she blamed me for it and being new -Embarrassed me in front of the provider and the team. -Pulled her aside afterwards and spoke to her in private about how she blamed me for her own mistake and I don't think that it was appropriate or professional. -She began to apologize and said that she would own up to her mistake and told the team that in was in fact her. -Being able to speak to others in private. Discuss an issue with a family member - -I was taking care of a lung transplant patient who had bounced back from PCU for respiratory distress and had quickly escalating respiratory needs and needed to be reintubated. CRNA Interview Questions and answers rated A -He had been bronched multiple times and part of their differential diagnosis was acute rejection, but they also sent a bronchial washing for COVID just to rule it out and so they were on modified droplet. -The family had not visited because they did not want to be in the room while on rule out. I had spoken to the spouse for the first time on the phone that night and told her we were just waiting until the test came back negative, which would likely result overnight. -The test was cancelled by lab and they didn't notify us until the morning and I told the provider and they said to wait for another bronch this morning to send another washing. I called the wife and told her it might be better for her to come later in the day because he will still be on precautions, but she was very upset at me and said that she will be in anyways. -She came in at 6:30am and was telling me that I had lied to her and that she would not leave his side, and that she did not want to speak to me. -I told the provider and asked if it was okay to just get a nasal PCR test, so we could remove isolation precautions and the family could be with the patient. CRNA Interview Questions and answers rated A -Cooking. Since I moved out to Rochester and have a larger living space than I did at home, I have been cooking more frequently. I enjoy the technical aspect of it and like to follow different recipes because they usually turn out pretty well if done properly. I like to make food for my roommate and invite friends over for dinner because I enjoy seeing others enjoy my food. How do you handle conflict? - Being respectful and logical Acknowledge their position and try to come to a mutual agreement Tell me about a time you made a mistake - Patient R on T Addy Asked a senior nurse and they said it was ok Shocked, converted back to SR She yelled at me CRNA Interview Questions and answers rated A I acknowledged my mistake, but I spoke to her in private about how I thought it was inappropriate to berate me in front of the patient and their family Decrease their trust in my competency Two wrongs don't make a right She apologized to me and apologized to the family and now I fold over a corner of the wound vac onto itself to help remove it in case. What do you think makes a successful CRNA? - -Critical thinking -Ability to work under stress -Ability to work both autonomously and collaboratively -Willingness to learn -Communication skills What was your last difficult patient? What made it difficult? - One time I was taking care of a patient who was very needy and would constantly hit the call CRNA Interview Questions and answers rated A light. The nurse who handed off to me told me ahead of time that she has been very difficult. She was a lung transplant patient who was about a week out from surgery and had not had much sleep at all throughout her hospital stay. I had another patient who was a standard postop and so I told her that I would quickly get him ready for the night and that I would spend some more time with her in a bit. So I spent a couple hours cleaning her up, washing her hair, and just talking to her and she told me her husband died a few months ago from COVID and that she has not been letting family visit her because she wants to see them when she is stronger. I spent the time just actively listening to her concerns and showing empathy and compassion and asked for some sleep aids and she slept throughout the night In the morning, she thanked me for just being there and listening to her and she gave me a bracelet. CRNA Interview Questions and answers rated A -Ultimately the goal is to provide the best patient care for the patient, so it is important to acknowledge their personal and cultural preferences. -One time I was caring for a Muslim patient and I was her nurse. The first thing I asked was was she comfortable with having a male nurse, which she said yes. -Then I asked what are things that she feels comfortable with me doing. -Can I touch her to ambulate her. -Getting a female PCA to help bathe the patient. -Making sure that food restrictions are accurately reflected in the orders. -Using a portable translator when language barriers arise. Personalizing their care for the best patient experience and best patient outcomes. What does success mean to you - Success to me means being better than you were yesterday. CRNA Interview Questions and answers rated A I have an older brother who is a year older than me. We went to the same middle school and high school and always was compared to him. I always felt inferior because he was academically more gifted and hit puberty earlier, so was taller. I told a guidance counselor about how I felt and she told me that just because others succeed, doesn't mean that you are failing. And that you have your own path. Took it to heart and don't compare myself to others and has been very pivotal in the way that I carry myself in life. What do coworkers say about you? - -Easy to talk to. ICU breeds people who have very type A personalities and can be hard to get along with. People have said that I am very approachable and I'm always flexible in terms of breaks and assignments and willing to help. My first orientee asked me to be her primary preceptor because she felt that I was nonjudgmental of her and listened to her and made her feel welcomed. CRNA Interview Questions and answers rated A Who is the greatest influence on your life? - My sister What is your spirit animal? - Carp Tell me about a time you failed - Tell me about a time you stood up for something you believed in - Describe a time you went above and beyond for a patient - Postop patient, Earlier -> SVT -> adenosine x2 His wife had been there and when she left, i bathed him He started talking about what happened and he started crying about how Explained how arrhythmias are common and that he is closely monitored CRNA Interview Questions and answers rated A He didn't realize until he had to waste the rest of the medication in the 20mL vial. He said that the patient was fine and that because we were friends, he asked if I could help cover it up for him. I immediately said no and told him that he should tell the provider and charge nurse or else I will tell them. He ended up telling the provider, who was upset, but the patient ultimately was fine and the charge nurse had him fill out an event. We haven't spoken much since then, but I think that integrity and ultimately patient safety should trump personal relationships. Discuss a situation in which you showed leadership ability. Tell me a suggestion you have made that was implemented. - Tell me about a professor whom you did not like. Why? - .What do you believe your greatest challenge will be if you are accepted into this program? - -I think that my biggest challenge will actually just be moving again and being accustomed to a new city. CRNA Interview Questions and answers rated A -When I moved to Rochester, MN it was incredibly hard because I was a thousand miles away from family and friends for the first time. -The good thing about RFU and JHU is that the first couple of semesters are online and I can do distance learning for most of the first year. -I don't think I'll have the same challenge as most nurses who have been out of school for a long time as I just finished and have been studying all of this year for certification exams and GRE, class, etc. If I were to sit down with every single person you have ever worked with in your entire adult career, co-workers, leaders, everybody, who would give me the worst feedback about you and what exactly would they say? - Hypercritical of myself Describe an example of when you have had to be confrontational to achieve results. What did you do and how was it received? - What would you do/ say if we told you that you didn't make it into the program this year? - Applied to multiple programs because I really want to become a CRNA. CRNA Interview Questions and answers rated A If I did not receive any acceptances, I would gain more experience as that is the weakest part of my application and Explain what diversity, equity, and inclusion mean to you. - What are your expectations of the program? - .Do you have any questions for us? - What kind of patients do you take care of? What is your favorite and why? - My favorite type of patient to take care is a fresh postoperative cardiac surgery patient. -Explain patho of their condition, What kind of fluids would you give a septic patient and why? - ACLS - CRNA Interview Questions and answers rated A What is pressure support? - Support given by the ventilator during inspiration in order to overcome the airway resistance of breathing through an artificial airway. This decreases the work of breathing with spontaneous breathing. This is usually at a minimum 8-10cm H2O to overcome the resistance of the artificial airway. What is pressure support ventilation? - Is a form of spontaneous ventilation -Only has an FiO2, PEEP, PS. No Vt or RR. -Last trial before extubation. -Typically 10/5 is the least amount of support for (PS/PEEP) CRNA Interview Questions and answers rated A What is Adaptive Support Ventilation (ASV)? - -Form of ventilation that adjusts amount of support for the patient by ensuring that they receive a certain percent mandatory minute ventilation. -If patient does not take a breath, they will receive pressure control breath (entire tidal volume) -If the patient does take a breath, they will have an adjusted PS to make sure they receive that set tidal volume What is peak inspiratory pressure? - Max pressure during inspiration Typically <35 What is plateau pressure? - Done with an inspiratory hold at the end of inspiration and measures lung compliance. Should be <30 to prevent barotrauma CRNA Interview Questions and answers rated A Your ventilator is alarming you with a high peak pressure alarm, what do you do next? - a. Examine patient and ventilator waveforms. If evidence of dyssynchrony (e.g. grimacing, biting the ETT, double triggering), increase sedation. b. Listen for breath sounds. Rule out pneumothorax, bronchospasm, ETT migration and apply the appropriate treatment. c. Rule out an obstruction from secretions. Use in-line suctioning. d. Perform an inspiratory pause. The alarm may be due to a decrease in compliance e. Examine the circuit. Rule out kinked ventilator tubing, condensation, and clogged filter. Avoid disconnecting the circuit if possible. f. Bag the patient if all else fails. What are some interventions that can be done to improve oxygenation on a ventilated patient besides increasing FiO2? - a. Increasing oxygen-carrying capacity (hemoglobin) CRNA Interview Questions and answers rated A -Hypoxia without hypoxemia can occur if tissues cannot use the oxygen provided by the blood, such as in cyanide poisoning. How do you determine if a sedated patient is in pain? - CPOT + RASS score Trace a drop of blood through the heart, starting with blood entering the heart through 2 large veins - SVC+IVC+ coronary sinus > RA> TV> RV> PV> PA > Pulm circulation > PV > LA > MV> LV> AV > Aorta Tell me about how CVP works.. Know normal range and unit of measurement. - Central venous pressure is the measure of the pressure in the central vein. There are no valves between the RIJ, IVC, RA, so CVP and RAP are effectively the same thing. It is a representation of right sided venous return. (indicative of fluid status in normal patients) Tell me everything you know about Precedex. (MOA, side effects, dosage) - Is a centrally acting alpha-2 agonist. It inhibits sympathetic activity and lowers blood pressure CRNA Interview Questions and answers rated A 0.2-1.5mcg/kg/hr What is the average cardiac output? - 5-6L/min .What complications can occur with the placement of a central line. a. Where does a central line terminate? - Placement of a central line can cause a pneumothorax if placed via subclavian vein. The central line terminates either in the SVC, cavoatrial junction, or RA. What is the normal range for a swan (CVP, Pulmonary artery systolic, diastolic & mean pressure, PCWP) - CVP: 2-8mmHg PAP: 25/10 mmHg PCWP: 8-12mmHg What is the difference between a pacemaker and AICD? - ICD is an implantable cardioverter defibrillator. It defibrillates the heart when a lethal rhythm is detected. A pacemaker is for bradycardia and will pace the patient when below a preset rate. CRNA Interview Questions and answers rated A AICD's typically function as both a pacemaker and defibrillator. Tell me about Vasopressin. Where does Vasopressin work? - Vasopressin works on V1 and V2 receptors. V1 receptors are located on vascular smooth muscle, which causes vasoconstriction when stimulated V2 receptors are in the collecting duct of the nephron, which when stimulated cause water reabsorption. Discuss the pharmacologic differences between dopamine and dobutamine. - What is the FIRST thing you would do if you looked up and saw a 2nd-degree type 2 heart block and the BP was low? - Transcutaneously pace . How does Atropine work? - Potassium hyperpolarizes the cell when acetylcholine binds to muscarinic receptors, causing bradycardia. CRNA Interview Questions and answers rated A What increases ICP? a. What is normal ICP? - How do you calculate cerebral perfusion pressure? (CPP) - How does CO2 affect cerebral blood flow? - . Should hyperventilation be used to decrease the ICP? - What induction agent is to be avoided with high ICP? - What are the contraindications to beta blockers? - What EKG lead is used to monitor arrhythmias? - What electrolyte do you need to watch when giving blood? - Describe signs of a tension pneumothorax. - CRNA Interview Questions and answers rated A What do the terms: inotropic, chronotropic, dromotropic mean? - What is the normal values of & how to calculate: ICP, Coronary Perfusion Pressure, CO, CI, MAP, Cerebral Perfusion Pressure, SVR & PVR - ICP: 5-15mmHg Coronary Perfusion Pressure: Pressure gradient responsible for myocardial perfusion. (Aortic DBP- LVEDP) LVEDP can be estimated by PCWP CO = HR x SV CI = CO/BSA BSA= sqrt ((ht(cm) x wt(kg))/3600) L/min/m2 MAP= (s + 2d)/3 Cerebral Perfusion Pressure: MAP - ICP (60-80 mmHg normal) SVR: 800-1200 dynes/second/cm-5 ((MAP-CVP)/CO) x80 SVRI: PVR: Cm to inches (2.54) - .Ideal Body Weight - Kg = ht (cm)-100 CRNA Interview Questions and answers rated A .How many ml/kg is normal for TV? - 6ml/kg Ideal BW: ht(cm) -100 for men, ht(cm) - 105 for women Dead space/Resp physiology - Volume of ventilated air that does that participate in gas exchange. Anatomical dead space (fills up the conducting zone aka nose, trachea, bronchi) = 30% of normal tidal volume Physiological dead space is anatomic { alveolar dead space. (ARDS, Emphysemma) Windkessel effect - Elasticity of arteries, such that during systole, the arteries are elastic and distend, then during diastole, they recoil and blood is discharged (effectively a second pump in diastole), which helps perfuse the coronaries during diastole. The IABP uses this same principle by inflating the balloon at the dicrotic notch, at the start of diastole and the inflation of the balloon displaces blood volume retrograde to perfuse coronaries. CRNA Interview Questions and answers rated A HCM Anesthetic goals: Heart rate -> Avoid tachycardia to fill ventricles Rhythm -> Maintain NSR for atrial kick Preload -> Increase to maintain filling of ventricles Aortic Insufficiency: - Acute or chronic Incompetent aortic valve causes backflow of blood into the ventricle Volume overload of the left ventricle and eccentric hypertrophy Anesthetic goals: Keep HR up Decrease diastolic time Less regurg r/t forward flow of blood Decrease afterload Maintain contractility and preload Mitral Stenosis: - Smaller the mitral valve area, more pressure the LA must produce to move blood to LV Causes: CRNA Interview Questions and answers rated A Endocarditis Rheumatic fever Progression: LA chronically overfilled, LV chronically underfilled Lower stroke volumes Increased SVR to compensate LA dilated causes atrial arrhythmias LA pressure can cause pulm HTN Avoid hypoxia, hypercarbia, acidosis Mitral Regurg: - An incompetent mitral valve causes the backflow of blood into LA, which returns back to LV, causing eccentric hypertrophy Causes: MV prolapse Ischemic heart disease Acute or chronic Anesthetic goals: Full, fast, forward Increase HR CRNA Interview Questions and answers rated A Reduces regurgitant volume Increase preload Some volume lost to LA during ejection Compensate for lost volume Decrease afterload Promotes forward flow After repair: Risk of SAM Increase intravascular volume Increase afterload