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NBCRNA QOTW AND SAMPLE QUESTIONS WITH 100% CORRECT ANSWERS 2026-2027!! The effects of carcinoid syndrome are related to the release of: (Select 2) A. Choline acetyltransferase B. Histamine C. Parathyroid Hormone D. Serotonin B. Histamine D. Serotonin Carcinoid tumors are most often in the gastrointestinal tract. Carcinoid tumors produce carcinoid syndrome if the tumor's secretory substances do not first drain into the hepatic system. The unmetabolized secretions include serotonin, histamine, kinins, prostaglandins E and F, and Substance P. Diarrhea, cutaneous flushing, bronchoconstriction, hypotension, abdominal pain, hepatomegaly, and heart disease can be symptoms. Which preanesthesia checkout recommendations on the anesthesia gas machine should be repeated before each case? (Select 2) A. Calibrate the oxygen sensor and check the low-oxygen alarm B. Conduct a breathing system pressure and leak test C. Perform a low-pressure leak test D. Verify patient suction is adequate to clear the airway B. Conduct a breathing system pressure and leak test D. Verify patient suction is adequate to clear the airway The FDA checkout recommends that a leak test is provided with the change of an anesthetic circuit to assure that it is patent, free of leaks, and withstands continuous pressure. Verify that suction is adequate to clear the patient's airway. An interincisor distance of how many centimeters is suggested to indicate a difficult intubation? A.3 B.5 C.7 D.9 A.3cm An interincisor distance less than 3 cm (2 fingerbreadths), measured from the upper to the lower incisors with maximal mouth opening, can suggest possible difficult intubation. Some studies have used 4 or 4.5 cm as the cutoff. Which drugs are dose based on total body weight in the patient with a BMI of 39 kg/m?? (Select 2) A. Cisatracurium (Nimbex) B. Lidocaine (Xylocaine) C. Propofol (Diprivan) D. Remifentanil (Ultiva) A. Cisatracurium (Nimbex) B. Lidocaine (Xylocaine) The increased fat content of obese patients affects the volume of distribution of drugs. Cisatracurium and lidocaine are dosed based on total body weight. Propofol and remifentanil are dosed based on lean body weight. C. Recurrent laryngeal The vocal cords are innervated by the recurrent laryngeal nerve. When the recurrent laryngeal nerve is damaged, the vocal cord assumes a position between adduction and abduction. Which medication should be avoided in the patient with elevated triiodothyronine (T3) and thyroxine (T4) levels? A. Adenosine (Adenocard) B. Amiodarone (Cordarone) C. Bupivacaine (Marcaine) D. Lidocaine (Xylocaine) B. Amiodarone (Cordarone) Elevated T3 and T4 levels indicate hyperthyroidism. Amiodarone is iodine rich and may cause either hypothyroidism or hyperthyroidism; it should be avoided. For which patient situation would metoclopramide (Reglan) be the BEST choice to include in medications for postoperative nausea and vomiting prophylaxis? A. Bowel obstruction B. History of gastroesophageal reflux disease C. History of seizures D. Takin haloperidol (Haldol) at home B. History of GERD Metoclopramide (Reglan) is a central-acting prokinetic gastrointestinal drug that should not be administered in those with Parkinson's disease, restless legs syndrome, or seizure disorder due to increased risk for extrapyramidal symptoms (EPS) and akathisia. It should not be coadministered with phenothiazines or butyrophenones due to increased central nervous system depression and increased incidence of EPS. And it should not be administered with a mechanical obstruction to gastric emptying or when an anastomosis is planned (bowel resection). Which temperature monitors BEST reflect core body temperature? (Select 2) A. Axillary B. Distal esophageal C. Pulmonary artery D. Skin B. Distal esophagus C. Pulmonary artery Axillary and skin temperature are variable and not reflective of core body temperature. Which risk factors place a 56-year-old male undergoing an exploratory laparotomy for colon cancer at an elevated risk for a major adverse cardiac event? (Select 2) A. Congestive heart failure B. Hyperthyroidism C. Serum creatinine > 2.0 mg/dL D. Smoking A. Congestive heart failure C. Serum creatinine > 2.0 mg/dL The American College of Cardiology (ACC)/American Heart Association (AHA) Guidelines on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery recommended using the Revised Cardiac Risk Index to determine if a patient has an elevated risk of a major adverse cardiac event. Patients with 2 or more of these risk factors are at elevated risk for a major adverse cardiac event during the perioperative period. This patient already has 1 risk factor: he is undergoing intraabdominal surgery A. Decreased vascular permeability B. Increased gastric secretion C. Tachycardia D. Vasoconstriction B. Increased gastric secretion C. Tachycardia Histamine reactions are mediated by H1 and H2 receptors on target cells. The correct answers are positive in these reactions. Which drug will reverse the life-threatening respiratory depressant effects of opioids in a patient with obstructive sleep apnea? A. Flumazenil (Romazicon) B. Naloxone (Narcan) C. Naltrexone (ReVia, Vivitrol) D. Neostigmine (Prostigmin) B. Naloxone (Narcan) The drug of choice for life-threatening respiratory depression is naloxone. Patients with OSA are at an even greater risk of respiratory compromise as a result of excessive opioids. Which IV induction drug could be administered to treat persistent bronchospasm? A. Dexmedetomidine (Precedex) B. Etomidate (Amidate) C. Ketamine (Ketalar) D. Propofol (Diprivan) C. Ketamine Ketamine is a potent bronchodilator and can be used to treat persistent bronchospasm. A 70-kg patient is having a left lung partial lobectomy for lung cancer. He consents for general anesthesia with the addition of a left intercostal nerve block for postoperative pain management. What is the maximum dose in milligrams of lidocaine 2% (Xylocaine) with epinephrine for this patient's block? A.70 B. 140 C. 350 D. 490 D. 490 Local anesthetic toxicity usually occurs from an inadvertently large amount of drug being administered into the IV system. It can also occur from a large amount of drug absorption from a nerve block administration. The maximum dose of lidocaine with epinephrine is recommended at 7 mg/kg: 7 mg x 70 kg = 490 mg What is the definitive treatment for a patient with local anesthetic systemic toxicity? A. Intralipid B. Midazolam (Versed) C. Propofol (Diprivan) D. Thiopental (Pentothal) A. Intralipid A lipid infusion begun immediately after suspected local anesthetic toxicity improves the rate of success of resuscitation from cardiac arrest. An infusion of 20% lipids is recommended. ventilate the patient. Replacing the oxygen reserve cylinder and checking the scavenger system pressure would not be initial steps. Which cardiopulmonary symptoms occur with the application of acrylic bone cement during hip replacement surgery? (Select 2) . Hypercarbia . Hyperemia . Hypotension . Hypoxemia . Hypotension 009N 090 DW Pp . Hypoxemia Cardiopulmonary changes associated with the application of acrylic bone cement during hip replacement surgery include hypotension secondary to cement monomer absorption, hypoxemia secondary to air embolization, and hypoxemia secondary to fat embolization. Hypotension has been attributed to absorption of methyl methacrylate monomer, embolization of air and bone marrow, lysis of red cells and marrow, and conversion of methyl methacrylate to methacrylic acid. Hypoxemia commonly occurs. Embolic events cause increased dead space, with reduced ETCO, and increased PaCO,. Which anesthetic agent should ideally be avoided in the asthmatic patient? A. Desflurane (Suprane) B. Isoflurane (Forane) C. Ketamine (Ketalar) D. Propofol (Diprivan) A. Desflurane (Suprane) Anesthetic agents should be selected for their bronchodilating effects in the asthmatic patient. With the exception of desflurane, all of the inhalation anesthetics produce bronchodilation. Both the IV agents ketamine and propofol produce bronchodilation. Which nerve innervates all of the intrinsic muscles of the larynx EXCEPT the cricothyroid muscle? A. Hypoglossal B. Recurrent laryngeal C. Superior laryngeal D. Trigeminal B. Recurrent laryngeal The cricothyroid is an extrinsic muscle and is the only muscle of the larynx not innervated by the recurrent laryngeal nerve. It is part of the anterior larynx innervated by a branch of the vagus nerve known as the external laryngeal branch of the superior laryngeal nerve. A common fibular nerve injury is suspected following a lengthy laparoscopic- assisted vaginal hysterectomy. Which findings confirm this diagnosis? (Select 2) A. Footdrop B. Loss of cutaneous sensation in the anterior aspect of the upper leg C. Loss of cutaneous sensation in the lateral and anterior aspect of the lower leg D. Motor weakness of lower extremities A. Footdrop C. Loss of cutaneous sensation in the lateral and anterior aspect of the lower leg Common peroneal nerve injury may result from direct pressure, excessive stretch due to prolonged flexion of the knee, and excessive external rotation of the hip. Injury manifests as loss of cutaneous sensation in the lateral and anterior aspect of the lower leg or footdrop Cricoid pressure applied during a rapid-sequence induction is CONTRAINDICATED in which patient condition? (Select 2) for the cricothyroid muscle (which is innervated by the superior laryngeal nerve). Vocal cord paralysis is caused by a damaged recurrent laryngeal nerve. In the elderly patient population, propofol (Diprivan) sensitivity causes a decrease in a dosage requirement of: A. < 5% B. 10% - 20% C. 30% - 50% D. 65% - 85% C. 30% - 50% Sensitivity to propofol in the elderly patient population is increased by 30%-50% as a result of decreased clearance and increased brain sensitivity. Which is the MOST common cause of an allergic reaction in the patient under general anesthesia? A. Antibiotics B. Latex C. Opioids D. Nondepolarizing neuromuscular blockers D. Nondepolarizing neuromuscular blockers While allergic reactions to latex (16.7%) and antibiotics (15.1%) are common, neuromuscular blockers are the most common culprit, accounting for 58.2% of allergic reactions. Allergic reactions to narcotics are rare. Most commonly seen are signs and symptoms of histamine release. Risk factors for a sore throat following the use of a laryngeal mask airway (LMA) include: A. A down-folded epiglottis B. Higher cuff pressures C. Too small of an LMA D. Use of 100% oxygen B. Higher cuff pressures Incidence of sore throat is approximately 10%-20% and has been linked to higher cuff pressures and larger LMA sizes. Which ECG lead would BEST detect occlusion of the right coronary artery? Al B. Il Com D. Vs B.II The right coronary artery supplies the inferior wall of the myocardium, which is best monitored with ECG leads Il, Ill, and aVF. What is a complication of excessive endotracheal tube cuff pressure? A. Air leak B. Pneumonitis C. Pulmonary edema D. Tracheal mucosal injury D. Tracheal mucosal injury Excessive endotracheal cuff pressure may result in tracheal mucosal injury, vocal cord dysfunction due to recurrent laryngeal nerve palsy, and a sore throat. Which is an appropriate intervention in the patient taking exogenous steroids who develops severe hypotension unresponsive to vasopressor medications? A. Atropine (Atropen) B. Calcium chloride Which medication is CONTRAINDICATED in a patient with Parkinson's disease taking carbidopa/levodopa (Sinemet)? A. Fentanyl (Sublimaze) B. Metoclopramide (Reglan) C. Midazolam (Versed) D. Propofol (Diprivan) B. Metoclopramide (Reglan) Metoclopramide is a dopamine antagonist and should be avoided in patients with Parkinson's disease. Rapid administration of fentanyl can produce dystonic reactions, but it can be given. Propofol and midazolam do appreciably increase adverse responses, but can also be given. When is it an acceptable practice to reuse a medication-filled syringe? A. After replacing the needle on a used syringe to access a single dose vial B. During sequential medication doses using a single syringe C. When accessing a multidose vial with a used needle D. When accessing medication from a multidose vial with a used syringe B. During sequential medication doses using a single syringe According to the Centers for Disease Control and Prevention (CDC), there are only 2 acceptable occasions for administering medications to the same patient using a multidose vial: 1) the entire vial must be drawn in a single syringe for sequential dosing on the same patient, or 2) a multidose vial may be accessed for the same patient using a new sterile needle and syringe for each use. What is the MOST sensitive indicator of hypoventilaton? A. Clinical observation B. ETCO2 monitoring C. Pulse oximetry D. Respiratory rate B. ETCO2 monitoring ETCO2 monitoring is the most sensitive indicator of hypoventilation and a standard of care. ETCO2 can increase due to: (Select 2) A. Hypothermia B. Pulmonary artery embolism C. Seizures D. Sepsis C. Seizures D. Sepsis ETCO2 can be altered based on a patient's pathophysiologic condition. For example, increased ETCO2 occurs with malignant hyperthermia, sepsis, tourniquet release, fever, and seizures. Decreased ETCO2 can occur with conditions that can decrease the manufacture or delivery of carbon dioxide. Some examples of this are pulmonary embolism, hypovolemia, low metabolism, hemorrhage, and decreased temperature. Which intervention potentially increases the risk of aspiration pneumonitis? A. Cricoid pressure B. Gastroprokinetic agent 30 minutes prior to induction C. Maintaining peak airway pressures of 35 cm H20 D. Sodium citrate 20 minutes prior to induction C. Maintaining peak airway pressures of 35 cm H20 Gastric aspiration into the lungs causes chemical destruction of lung tissue, microhemorrhage leading to hypoxia, alveolar membrane capillary edema and How is sevoflurane (Ultane) administration affected by the tipping of the vaporizer when it is not in transport mode? A. A higher concentration of sevoflurane may be delivered B. A lower concentration of sevoflurane may be delivered C. If no sevoflurane liquid is visible, the vaporier is safe to use D. The vaporizer will no longer work until properly flushed A.A higher concentration of sevoflurane may be delivered Tipping of the vaporizer can allow liquid agent to enter the bypass chamber, allowing for very high concentrations of agent to be delivered. Stimulation of which sensory nerve may trigger a laryngospasm? A. Glossopharyngeal B. Hypoglossal C. Recurrent laryngeal D. Superior laryngeal D. Superior laryngeal A laryngospasm is initiated by stimulation of the superior laryngeal nerve. Airway exchange catheters are BEST used in which situations? (Select 2) A. During trial extubation of a known difficult airway B. In place of an endotracheal tube C. To allow gas exchange through jet ventilation D. To facilitate laryngeal mask placement A. During trial extubation of a known difficult airway C. To allow gas exchange through jet ventilation Airway exchange catheters may be used to change an endotracheal tube (ETT), provide assurance for reintubation during extubation, and allow for gas exchange through jet ventilation or bag ventilation using an adaptor. It is not used in place of an ETT or to aid in laryngeal mask airway placement. Which is the MOST appropriate anesthetic consideration for a 26-week parturient who is scheduled for laparoscopic cholecystectomy? A. Conscious sedation B. General anesthesia using laryngeal mask airway C. Pretreatment with midazolam (Versed) D. Rapid-sequence induction D. Rapid-sequence induction Due to physiologic changes with pregnancy, most patients beyond 12 weeks’ gestation are considered full stomachs and should have a rapid-sequence induction. Conscious sedation and laryngeal mask airway do not prevent airway aspiration. Midazolam should not be administered during pregnancy. Which classification of drug is frequently used in combination with beta2- agonists in the treatment of asthma? A. Inhaled corticosteroids B. IV cholinergic antagonists C. Mast cell stabilizers D. Methylxanthines A. Inhaled corticosteroids In asthma, inhaled corticosteroids are used in combination with long-acting beta2-agonists. Cholinergic antagonists are not popular due to their side effects. Methylxanthines and mast cell stabilizers are not first-line choices. Which condition would cause an increase in cerebral blood flow? A. Hypercapnia B. Hypotension 
