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National Board Of Certification And
Recertification For Nurse Anesthetists
(Nbcrna) National Certification
Examination Questions And Correct
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- A 67-year-old patient with severe aortic stenosis is scheduled for noncardiac surgery. Which anesthetic consideration is most appropriate? A. Decrease afterload aggressively B. Maintain sinus rhythm and preload C. Use high-dose spinal anesthesia D. Induce hypotension to reduce cardiac workload Correct Answer: B. Maintain sinus rhythm and preload Rationale: Patients with aortic stenosis depend heavily on atrial kick and adequate preload to maintain cardiac output. Hypotension or loss of atrial contraction can severely reduce coronary perfusion and lead to cardiovascular collapse.
- Which drug is most appropriate for rapid sequence induction in a patient with hyperkalemia? A. Succinylcholine
B. Rocuronium C. Vecuronium D. Pancuronium Correct Answer: B. Rocuronium Rationale: Succinylcholine increases serum potassium and may worsen hyperkalemia, potentially causing fatal arrhythmias. Rocuronium provides rapid neuromuscular blockade without increasing potassium levels.
- The primary mechanism of action of propofol is: A. NMDA receptor antagonism B. GABA-A receptor potentiation C. Dopamine receptor blockade D. Sodium channel inhibition Correct Answer: B. GABA-A receptor potentiation Rationale: Propofol enhances inhibitory neurotransmission by potentiating GABA-A receptors, leading to sedation, hypnosis, and amnesia.
- A patient develops malignant hyperthermia. What is the first-line treatment? A. Dantrolene B. Atropine C. Calcium chloride D. Propranolol Correct Answer: A. Dantrolene Rationale: Dantrolene directly reduces skeletal muscle calcium release from the sarcoplasmic reticulum, reversing hypermetabolism seen in malignant hyperthermia.
B. Hypernatremia C. Hypomagnesemia D. Hypercalcemia Correct Answer: C. Hypomagnesemia Rationale: Low magnesium prolongs QT interval and predisposes to torsades de pointes by destabilizing cardiac repolarization.
- Minimum alveolar concentration (MAC) is defined as the concentration preventing movement in: A. 50% of patients B. 95% of patients C. 100% of patients D. 25% of patients Correct Answer: A. 50% of patients Rationale: MAC is the alveolar concentration of anesthetic that prevents movement in response to surgical stimulus in 50% of patients. 10.The antidote for heparin overdose is: A. Vitamin K B. Protamine sulfate C. Idarucizumab D. Flumazenil Correct Answer: B. Protamine sulfate Rationale: Protamine sulfate binds and neutralizes heparin, reversing its anticoagulant effects. 11.A spinal anesthetic most commonly causes hypotension due to: A. Increased heart rate B. Sympathetic blockade
C. Increased venous return D. Respiratory alkalosis Correct Answer: B. Sympathetic blockade Rationale: Spinal anesthesia blocks sympathetic fibers, leading to vasodilation and decreased systemic vascular resistance. 12.Which opioid has the shortest duration of action? A. Morphine B. Fentanyl C. Remifentanil D. Hydromorphone Correct Answer: C. Remifentanil Rationale: Remifentanil is metabolized by plasma esterases, resulting in ultra- short duration regardless of infusion length. 13.The primary site of action for local anesthetics is: A. Potassium channels B. Sodium channels C. Calcium channels D. Chloride channels Correct Answer: B. Sodium channels Rationale: Local anesthetics block voltage-gated sodium channels, preventing nerve impulse conduction. 14.Which condition is a contraindication to neuraxial anesthesia? A. Hypertension B. Sepsis C. Diabetes D. Asthma
Correct Answer: B. Nitrous oxide Rationale: Nitrous oxide accelerates uptake of volatile anesthetics by concentrating alveolar gases. 18.A prolonged QT interval increases risk for: A. Asystole B. Ventricular fibrillation C. Torsades de pointes D. Sinus bradycardia Correct Answer: C. Torsades de pointes Rationale: QT prolongation predisposes to polymorphic ventricular tachycardia known as torsades de pointes. 19.Which intravenous fluid is most appropriate for initial resuscitation in hemorrhagic shock? A. D5W B. 0.45% saline C. Lactated Ringer’s D. Albumin 25% Correct Answer: C. Lactated Ringer’s Rationale: Balanced crystalloids like LR restore intravascular volume without causing significant acidosis or hyperchloremia. 20.The primary complication of high spinal anesthesia is: A. Hypertension B. Respiratory depression C. Tachycardia D. Hyperthermia
Correct Answer: B. Respiratory depression Rationale: High spinal blocks can affect cervical nerves, impairing respiratory muscle function and leading to hypoventilation. 21.Which drug is a benzodiazepine antagonist? A. Naloxone B. Flumazenil C. Physostigmine D. Atropine Correct Answer: B. Flumazenil Rationale: Flumazenil competitively inhibits benzodiazepine binding at GABA receptors, reversing sedation. 22.The most common cause of postoperative nausea and vomiting is: A. Age B. Opioid use C. Hypotension D. Hypothermia Correct Answer: B. Opioid use Rationale: Opioids stimulate the chemoreceptor trigger zone, significantly increasing PONV risk. 23.Which nerve block is used for shoulder surgery? A. Femoral block B. Sciatic block C. Interscalene block D. TAP block
C. Vasoconstriction of skin D. Decreased renin release Correct Answer: B. Increased heart rate and contractility Rationale: Beta-1 receptors primarily affect the heart, increasing chronotropy and inotropy. 27.Which condition increases MAC requirements? A. Hypothermia B. Elderly age C. Chronic alcohol use D. Pregnancy Correct Answer: C. Chronic alcohol use Rationale: Chronic alcohol use increases tolerance to anesthetics, raising MAC. 28.The reversal agent for opioid overdose is: A. Flumazenil B. Naloxone C. Atropine D. Neostigmine Correct Answer: B. Naloxone Rationale: Naloxone competitively displaces opioids at mu receptors, reversing respiratory depression. 29.Which anesthetic is most associated with airway irritation? A. Sevoflurane B. Desflurane C. Halothane D. Isoflurane
Correct Answer: B. Desflurane Rationale: Desflurane is pungent and can cause bronchospasm and airway irritation. 30.A common complication of succinylcholine is: A. Hypoglycemia B. Hyperkalemia C. Hypocalcemia D. Bradycardia only Correct Answer: B. Hyperkalemia Rationale: Succinylcholine causes potassium release from muscle cells, increasing serum potassium. 31.The main benefit of epidural anesthesia over spinal anesthesia is: A. Faster onset B. Greater control of block level C. Lower infection risk D. No hypotension risk Correct Answer: B. Greater control of block level Rationale: Epidurals allow titratable dosing and segmental anesthesia. 32.Which drug is contraindicated in porphyria? A. Propofol B. Barbiturates C. Fentanyl D. Ketamine Correct Answer: B. Barbiturates Rationale: Barbiturates can trigger acute porphyric attacks by inducing hepatic enzymes.
36.Which electrolyte imbalance is most dangerous intraoperatively? A. Mild hyponatremia B. Severe hyperkalemia C. Mild hypocalcemia D. Mild hypermagnesemia Correct Answer: B. Severe hyperkalemia Rationale: Severe hyperkalemia can cause lethal arrhythmias and cardiac arrest. 37.The primary function of the laryngeal mask airway is: A. Definitive airway protection B. Ventilation without tracheal intubation C. Prevention of aspiration D. Oxygen transport Correct Answer: B. Ventilation without tracheal intubation Rationale: LMA provides a supraglottic airway for ventilation but does not fully protect against aspiration. 38.Which drug reduces MAC most significantly? A. Ketamine B. Alcohol C. Hypothermia D. Thyroid hormone excess Correct Answer: C. Hypothermia Rationale: Hypothermia decreases metabolic rate and reduces anesthetic requirements. 39.The primary site of action of volatile anesthetics is: A. Liver B. CNS
C. Kidney D. Neuromuscular junction Correct Answer: B. CNS Rationale: Volatile anesthetics act on the brain to produce unconsciousness and amnesia. 40.Which condition requires preoperative antibiotic prophylaxis for endocarditis? A. Asthma B. Prosthetic heart valve C. Diabetes D. Hypertension Correct Answer: B. Prosthetic heart valve Rationale: Patients with prosthetic valves are at high risk for infective endocarditis. 41.The most common cause of intraoperative hypotension is: A. Hypothermia B. Anesthetic agents C. Hyperglycemia D. Hyperventilation Correct Answer: B. Anesthetic agents Rationale: Most anesthetic drugs cause vasodilation and myocardial depression. 42.Which drug is used for reversal of nondepolarizing neuromuscular blockade? A. Neostigmine B. Succinylcholine
Correct Answer: B. Airway obstruction Rationale: Loss of airway tone or improper positioning commonly leads to obstruction. 46.Which drug is safest in renal failure? A. Morphine B. Meperidine C. Fentanyl D. Codeine Correct Answer: C. Fentanyl Rationale: Fentanyl has inactive metabolites and is safer in renal impairment. 47.The primary sign of hypoxia under anesthesia is: A. Hypertension B. Bradycardia C. Tachycardia D. Cyanosis Correct Answer: C. Tachycardia Rationale: Early hypoxia often triggers sympathetic response leading to tachycardia. 48.Which inhalational agent is metabolized the least? A. Halothane B. Sevoflurane C. Desflurane D. Isoflurane Correct Answer: C. Desflurane Rationale: Desflurane undergoes minimal metabolism, reducing toxicity risk.
49.The primary treatment for laryngospasm is: A. Oxygen only B. Positive pressure ventilation C. Lidocaine IV only D. Atropine Correct Answer: B. Positive pressure ventilation Rationale: Applying CPAP helps break laryngospasm by forcing vocal cords open. 50.The most important monitoring standard in anesthesia is: A. EEG B. Pulse oximetry C. Urine output D. Blood glucose Correct Answer: B. Pulse oximetry Rationale: Pulse oximetry provides continuous monitoring of oxygen saturation, critical for patient safety. 51.A patient receiving a monoamine oxidase inhibitor (MAOI) is at highest risk of severe interaction with which opioid? A. Fentanyl B. Morphine C. Meperidine D. Hydromorphone Correct Answer: C. Meperidine Meperidine inhibits serotonin reuptake and can precipitate life-threatening serotonin syndrome when combined with MAOIs, causing hyperthermia, agitation, and autonomic instability.
B. Pneumothorax C. Diabetes D. Hypertension Correct Answer: B. Pneumothorax Nitrous oxide diffuses into air-filled spaces faster than nitrogen leaves, expanding closed cavities such as pneumothorax. 56.The primary pharmacologic effect of atropine is: A. Beta-adrenergic stimulation B. Muscarinic receptor blockade C. Dopamine antagonism D. Alpha-adrenergic blockade Correct Answer: B. Muscarinic receptor blockade Atropine inhibits parasympathetic activity, increasing heart rate and reducing secretions. 57.During central line placement, the most likely serious complication is: A. Hyperglycemia B. Pneumothorax C. Arrhythmia D. Hypotension Correct Answer: B. Pneumothorax Accidental puncture of the pleura can cause lung collapse, especially during subclavian access. 58.The earliest and most sensitive sign of malignant hyperthermia is: A. Muscle rigidity B. Hyperkalemia
C. Rising end-tidal CO₂ D. Fever Correct Answer: C. Rising end-tidal CO₂ Increased CO₂ production is the earliest indicator due to uncontrolled skeletal muscle metabolism. 59.Which medication is most appropriate for acute intraoperative hypertension? A. Nitroglycerin B. Atropine C. Naloxone D. Flumazenil Correct Answer: A. Nitroglycerin Nitroglycerin causes venous and arterial vasodilation, reducing blood pressure and myocardial oxygen demand. 60.The primary mechanism of intraoperative hypothermia is: A. Increased evaporation B. Heat redistribution from core to periphery C. Increased metabolism D. Excess oxygen delivery Correct Answer: B. Heat redistribution from core to periphery Anesthesia-induced vasodilation causes core heat to shift outward, leading to rapid temperature drop. 61.Which volatile anesthetic may provoke seizures? A. Sevoflurane B. Isoflurane
