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NBCRNA QOTW and Sample Questions
The effects of carcinoid syndrome are related to the release of: (Select 2) A. Choline acetyltransferase B. Histamine C. Parathyroid Hormone D. Serotonin - correct answer 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 - correct answer 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 - correct answer A. 3 cm 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/m²? (Select 2) A. Cisatracurium (Nimbex) B. Lidocaine (Xylocaine) C. Propofol (Diprivan) D. Remifentanil (Ultiva) - correct answer 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. Which is the major mineralcorticoid produced in the adrenal cortex?
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) - correct answer 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 - correct answer 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 - correct answer 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 - correct answer 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 (suprainguinal vascular surgery, intrathoracic surgery, or intraabdominal surgery are also risk factors.) All of the above, with the exception of smoking and hyperthyroidism, are considered risk factors for a major adverse cardiac event during noncardiac surgery. One other risk factor is cerebrovascular disease. Which factors can increase the chance of vitreous herniation during the induction of anesthesia in a patient with an open eye injury? (Select 2) A. Administration of rocuronium (Zemuron) B. Coughing, straining, and bucking C. Face mask pressure D. Initiation of hyperventilation - correct answer B. Coughing, straining, and bucking
A. Flumazenil (Romazicon) B. Naloxone (Narcan) C. Naltrexone (ReVia, Vivitrol) D. Neostigmine (Prostigmin) - correct answer 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) - correct answer 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 - correct answer 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) - correct answer 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. This should be preceded by a 1.5-mL/kg bolus IV over 1 minute. Follow with an infusion of 20% lipids at a rate of 0.25 mL/kg/min. Bolus may be repeated 1-2 times for continued cardiac resistance. Increase the infusion to 0.5 mL/kg/min for hypotension. A 10-minute infusion is recommended as vital signs are stable. Compared to atracurium (Tracrium), cisatracurium (Nimbex) causes less release of what substance? A. Acetylcholine B. Epinephrine C. Histamine D. Serotonin - correct answer C. Histamine Cisatracurium does not release clinically significant amounts of histamine within the recommended dose range. Atracurium causes histamine release in the recommended dose range.
A. Desflurane (Suprane) B. Isoflurane (Forane) C. Ketamine (Ketalar) D. Propofol (Diprivan) - correct answer 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 - correct answer 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 - correct answer 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) A. Cervical spine fracture B. Gastroparesis C. Hiatal hernia D. Partutient at 24 weeks' gestation - correct answer A. Cervical spine fracture C. Hiatal hernia Cricoid pressure is a technique used during rapid-sequence induction to prevent gastric contents from entering the pharynx. Cricoid pressure is contraindicated in patients with cervical spine fracture, active vomiting, or laryngeal fracture. Which muscle is tested to assess the return of function of the laryngeal adductor muscles? A. Adductor pollicis B. Corrugator supercilli C. Flexor carpi ulnaris D. Flexor hallucis brevis - correct answer B. Corrugator supercilli Paralysis of the laryngeal muscles approximates the neuromuscular block of the corrugator supercilii. Vocal cord paralysis is caused by damage to which nerve? A. Glossopharyngeal B. Hypoglossal
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 - correct answer 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? A. I B. II C. V₄ D. V₅ - correct answer B. II The right coronary artery supplies the inferior wall of the myocardium, which is best monitored with ECG leads II, III, and aVF. What is a complication of excessive endotracheal tube cuff pressure? A. Air leak B. Pneumonitis C. Pulmonary edema D. Tracheal mucosal injury - correct answer 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 C. Hydrocortisone (Cortef) D. Vasopressin - correct answer C. Hydrocortisone (Cortef) A patient who takes exogenous steroids may become hypotensive due to the lack of glucocorticoid and mineralocorticoid. Corticosteroid coverage in these patients may avoid hemodynamic instability due to adrenal suppression. Fever, sore throat, excessive drooling, and a preference for sitting up with the head extended are signs and symptoms of: A. Croup B. Epiglottitis C. Laryngospasm D. Tonsilitis - correct answer B. Epiglottitis Fever, sore throat, excessive drooling, and tripod position are all signs and symptoms of epiglottitis. Following denitrogenation, which local anesthetic used to perform an awake fiberoptic intubation could potentiate a sustained oxygen desaturation from 100% to 85%? A. Benzocaine (Hurricaine) B. Bupivacaine (Marcaine) C. Cocaine (Delcaine) D. Lidocaine (Xylocaine) - correct answer A. Benzocaine (Hurricaine)
B. ETCO2 monitoring C. Pulse oximetry D. Respiratory rate - correct answer 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 - correct answer 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 H2O D. Sodium citrate 20 minutes prior to induction - correct answer C. Maintaining peak airway pressures of 35 cm H2O Gastric aspiration into the lungs causes chemical destruction of lung tissue, microhemorrhage leading to hypoxia, alveolar membrane capillary edema and
degeneration, and alveolar type II pneumocyte destruction. High peak airway pressures contribute to gastric insufflation. What are the causes of acute prerenal injury in the anesthetized patient? (Select 2) A. Hemorrhage B. Hyperthyroidism C. Hyponatremia D. Hypotension - correct answer A. Hemorrhage D. Hypotension Decreases in renal blood flow are a common cause of acute renal injury in the anesthetized patient. Conditions that can lead to acute renal injury include intravascular volume depletion such as hemorrhage, heart failure, and any condition that leads to hypotension, such as sepsis. In caring for a patient with Clostridium difficile, what precautions should be taken? (Select 3) A. Eye protection B. Gloves C. Gown D. Mask E. Use of hand sanitizer F. Washing hands with soap and water - correct answer B. Gloves C. Gown F. Washing hands with soap and water Standard precautions are to be used, but alcohol-based hand sanitizer will not clear C. difficile, requiring hand washing between patients.
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 - correct answer 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 - correct answer 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 C. Hypothermia D. Respiratory alkalosis - correct answer A. Hypercapnia Cerebral blood flow (CBF) varies directly with PaCO2, especially within the range of physiologic variations. CBF changes 1-2 mL/100g/min for each 1 mm Hg change in PaCO2. What is one of the primary causes of upper airway obstruction in the anesthetized patient? A. Deviation in the nasal septum B. Hypertrophy of the thyroid cartilage C. Loss of pharyngeal muscle tone D. Small mouth opening - correct answer C. Loss of pharyngeal muscle tone The musculature of the pharynx helps maintain the airway open in the awake patient. The pharyngeal muscles relax in the anesthetized patient and can lead to airway obstruction. Which is the EARLIEST sign of malignant hyperthermia? A. Decreased oxygen saturation B. Hyperkalemia C. Rapid rise in core body temperature D. Unexpected, sudden rise in ETCO2 - correct answer D. Unexpected, sudden rise in ETCO The earliest sign of malignant hyperthermia (MH) is an unexplained and sudden increase in ETCO2 disproportionate to minute ventilation. Other early signs of MH crisis include tachycardia, cyanosis, decrease in SaO2, and jaw muscle or total body rigidity.
