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NBCRNA QUESTIONS OF THE WEEK WITH 100% VERIFIED SOLUTIONS 2026-20271! Failure of the scavenging system due to obstruction could cause Obstruction of scavenging pathways can cause excessive positive pressure in the breathing circuit, and barotrauma can occur. Failure of the scavenging system due to obstruction could cause A) A hypoxic gas mixture B) A low-pressure alarm C) Carbon dioxide absorbent failure D) Increases positive pressure within the circuit Increases positive pressure within the clot Succinylcholine (Anectine), 1.2 mg/kg is administered on induction. Throughout the short-duration case, small doses of succinylcholine were given in anticipation of a quick closure. Upon emergence, the patient is unable to raise her head or arms, and appears generally weak. What is the most likely issue? the patient has a phase II block Succinylcholine (Anectine), 1.2 mg/kg is administered on induction. Throughout the short-duration case, small doses of succinylcholine were given in anticipation of a quick closure. Upon emergence, the patient is unable to raise her head or arms, and appears generally weak. What is the most likely issue? The patient has a phase II block A desensitizing succinylcholine (SCh) neuromuscular blockade or phase II block can occur after large doses of SCh administration over a prolonged period of time. Muscle cell membrane gradually repolarizes, but transmission of the neuromuscular membrane remains blocked. Clinical symptoms are apparent weakness on emergence. Which are clinical features of bushings syndrome? A) Alkalosis B) Hypoglycemia C) Muscle Weakness D) Weight Loss Alkalosis and muscle weakness Which are clinical features of bushings syndrome? Alkalosis & Muscle Weakness Cushing's disease causes excess glucocorticoid release from the adrenal cortex, causing hyperglycemia. The catabolic effects of cortisol result in muscle atrophy and therefore muscle weakness. Weight gain is a result of fluid retention, and alkalosis is a result of altered metablic conditions from the excess glucocorticoid hormone. The diameter index safety system (DISS) is a national standard that that ensures that the correct: A) gas hose enters the machine from the wall connection B) gas tank fits onto the hanger yoke C) Oxygen tank is attached to the auxiliary oxygen source D) vaporizer is filled with the same halogenated agent A) gas hose enters the machine from the wall connection The diameter index safety system (DISS) is a national standard that that ensures that the correct: A) gas hose enters the machine from the wall connection DISS ensures that the correct pipeline gas enters the correct part of the anesthesia machine. Blue is nitrous oxide, green is oxygen, yellow is room air, white is the hospital vacuum, and purple is the waste gas scavenging vacuum. In preparation for a fiberoptic nasal intubation, which pharmacological agent would provide local anesthesia as well as vasoconstrictive properties? A) Cetacaine B) Cocaine C) Lidocaine D) Phenylephrine B) cocaine commonly used renal test available. Hyperkalemia is present in end-stage renal disease. During surgery for a laparoscopic fundoplication, the patient becomes hypoxic and hypotensive upon insufflation. What should be the first course of action? A: administer ephedrine B: Administer rocuronium C: Remove the pneumoperitoneum D: With draw the ETT Answer: C, Remove the pneumoperitoneum The signs demonstrate a restrictive lung issue related to the increased peak inspiratory pressure. The likely cause is carbon dioxide tracking around the aortic, caval, and esophageal hiatuses. If it were an improperly placed endotracheal tube, such as a mainstem intubation, the ETCO2 would be expected to decrease. The hypotension would be a result of decreased preload, so ephedrine would not be of benefit. Administration of paralytics would not treat the cause. The effects of carcinoid syndrome are related to the release of? A) choline acetyltransferase B) histamine C) parathyroid hormone D) serotonin Answers: B, D Rationale: 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 pre-anesthesia 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 Answers: B, D Rationale: 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? 3 5 7 9 Answer: A Rationale: 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 dosed based on total body weight in the patient with a BMI of 39 kg/m2? (Select 2) Cisatracurium (Nimbex) Lidocaine (Xylocaine) Propofol (Diprovan) Remifentanil (Ultiva) Answers: A,B Rationale: The increased fat content of obese patients affects the volume of distrubution 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? Answer: A C) Hx of seizures D) Taking haloperidol (Haldol) at home Answer: B Rationale: 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 also 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 temp? (select two) A) axillary B) distal esophageal C) pulmonary artery D) skin Answers: B, C Rationale: Axillary and skin temperature are variable and not reflective of core body temperature. Which risk factors place a 56yo male undergoing an Ex lap for colon CA at an elevated risk for major adverse cardiac events? (select 2) A) CHF B) Hyperthyroidism C) Serum creatinine >2mg/dL D) smoking Answers: A, C Rationale: The American College of Cardiology (ACC)/American Heart Association (AHA) Guidelines on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery recommend 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 open eye injury? (select 2) A) Rocuronium B) Coughing, straining, bucking C) Face mask pressure D) Hyperventilation Answers: B, C Rationale: There is an increase in vitreal herniation with the use of depolarizing muscle relaxants; pressure on the eyeball; coughing, straining, and bucking; and hypercarbia. Which adverse effect would MOST likely result from administration of dexamethasone 10mg? A) Akathisia B) hyperglycemia C) Hypertension D) Tachycardia Answer: B Rationale: High-dose dexamethasone causes an increase in blood glucose level; obese and diabetic patients are at the highest risk for perioperative hyperglycemia. Which symptoms are related to histamine release in a patient exhibiting an allergic reaction? (select 2) A) Decreased vascular permeability B) Increased gastric secretion 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) Versed C) Propofol D) Thiopental Answer: A Rationale: 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. Boluses may be repeated 1-2 times for continued cardiac resistance. Increase the bolus to 0.5 mL/kg/min for hypotension. A 10-minute infusion is recommended as vital signs are stable. Compared to atracurium (Tracurium), cistracurium (Nimbex) causes less release of what substance? A) Acetylcholine B) Epinephrine C) Histamine D) Serotonin Answer: C Rationale: Cisatracurium does not release clinically significant amounts of histamine within the recommended dose range. Atracurium causes histamine release in the recommended dose range. Which are the INITIAL steps to take when a low pressure alarm sounds during mechanical ventilation of an incubated pt? (select 2) A) attempt manual ventilation B) check for total circuit disconnect C) check the scavenger system pressure D) replace the O2 reserve tank Answers: A, B Rationale: When a low-pressure alarm sounds on the anesthesia machine, the initial steps are to quickly check for total circuit disconnections and then attempt to manually ventilate the patient. Replacing the oxygen reserve cylinder and checking the scavenger system pressure would not be initial steps. Which anesthetic agent should ideally be avoided in the asthmatic patient? A) Desflurane B) Isoflurane C) Ketamine D) Propofol Answer: A Rationale: 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 muscle is tested to assess the return of function of laryngeal adductor muscles Answer: B Rationale: 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 C) RLN D) SLN Answer: C Rationale: The recurrent laryngeal nerve innervates all of the muscles of the larynx except for the cricothyroid muscle (which is innervated by the superior laryngeal nerve). Vocal cord paralysis is caused by a recurrent laryngeal nerve. C) Pulmonary Edema D) Tracheal mucosal injury Answer: D Rationale: 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 B) Calcium Chloride C) Hydrocrotisone D) Vasopressin Answer: C Rationale: 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. Following denitrogenation, which local anesthetic used to perform an awake fiberoptic intubation could potentiate a sustained oxygen desaturation from 100% - 85%? A) Benzocaine (Hurricane) B) Bupivacaine (Marcaine) C) Cocaine (Delcaine) D) Lidocaine (Xylocaine) Answer: A Rationale: Benzocaine, when systemically absorbed, can produce methemoglobinemia resulting in compromised oxygen transport and decreased oxygen saturations. Which medication is contraindicated in a patient with Parkinson's disease taking levodopa (Sinemet)? A) Fentanyl B) Metoclopramide C) Midazolam D) Propofol Answer: B Rationale: 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. Which intervention potentially increases the risk of aspiration pneumonitis? A) Cricoid pressure B) Gastroprokinetic agent 30min prior to induction C) Maintaining peak airway pressures of 35cmH20 D) Na+ citrate 20min prior to induction Answer: C Rationale: 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? A) Hemorrhage B) Hyperthyroidism C) Hyponatremia D) Hypotension Answers: A, D Rationale: 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 pt with clostridium difficile, what precautions should be taken? A) Eye protection B) Gloves C) Gown 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 LMA C) Pretreatment with Versed D) RSI Answer: D Rationale: 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 Answer: A Rationale: 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 Answer: A Rationale: 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 Answer: C Rationale: 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 of the following are risks of transtracheal jet ventilation? A) Barotrauma B) Nasal Fracture C) Hypocarbia D) Subcutaneous emphysema A,D Rationale: Transtracheal jet ventilation is done in connection with a needle cricothyrotomy for emergency ventilation. Ventilation is done using an oxygen regulator and a high-pressure oxygen source. The oxygen regulator controls ventilation through tubing that is refractory to expansion. Complications include pneumothorax, subcutaneous emphysema, barotrauma, esophageal puncture, catheter kinking, pneumomediastinum, hypercarbia, and accidental removal. Risk factors for surgical site infections include (select 2): A)DM B) HTN C) Hyperthyroidism D) Smoking Answers: A, D 10-25 g IV (20-50 mL). The goal should be to arrive at a glucose level of 100 mg/dL. Blood glucose should increase approximately 30 mg/dL for every 15 mL of 50% dextrose in water. The onset of a phase 1 NMB is preceded by A) double burst fade B) fasciculation's C) posttetanic twitch D) TOF ratio <0.6 Answer: B Rationale: When succinylcholine (Anectine) is administered, the muscle response is a depolarizing block. A depolarizing block is also called a phase | block, and fasciculations are seen. Which opioid should be avoided for a pt undergoing resection of pheochromocytoma? A) Fentanyl B) Dilaudid C) Morphine D) Sufentanil Answer: C Rationale: In the perioperative period, factors that stimulate catecholamine release need to be minimized. Morphine can cause histamine release, which may cause catecholamine release from the tumor. What paralytic would be used for intubation in an 83kg parturient presenting with hx of MH requiring emergent laparoscopic cholecystectomy? A) Cis 10mg B) Roc 100mg C) Sch 120 mg D) Vec 6mg Answer: B Rationale: This patient requires a rapid-sequence induction due to pregnancy, but she has a history of malignant hyperthermia, where succinylcholine is a triggering agent. Rocuronium is the best choice with sugammadex (Bridion) available for reversal. Vecuronium could be an option but would need to be a much higher dose. Which Cormack-Lehane airway assessment grade is attributed to a view of the epiglottis but without a view of the larynx? A)1 B)2 c)3 D)4 Answer: C Rationale: The Cormack-Lehane grade 1 view is the entire glottic opening. Grade 2 view is the posterior laryngeal aperture but not the anterior portion. Grade 3 view is the epiglottis but not part of the larynx. Grade 4 view is the soft palate but not the epiglottis. Contraction of which muscle during peripheral nerve stimulation is the preferred site for the monitoring of NMB reversal during extubation? A) Adductor pollicis B) Corrugator supercilii C) Flexor carpi ulnaris D) Orbicularis oculi Answer: A Rationale: Recovery from relaxant is best measured in the hand via stimulation of the ulnar nerve with contraction of the adductor pollicis of the thumb. The hand muscles are more sensitive than the diaphragm to relaxants. Relaxant onset with induction is best monitored via the facial nerve with stimulation of the orbicularis oculi of the eye or corrugator supercilii of the eyebrow. With a train of four count of 4, what percentage of postsynaptic receptors are potentially occupied by NDNMB? A)75 B) 80 
