NBCRNA Recertification Exam Questions and Answers, Exams of Nursing

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NBCRNA Recertification for Nurse

Anesthetists EXAM ACTUAL EXAM ALL

QUESTIONS AND CORRECT ANSWERS

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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

Page 2 of 53 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 Rationale: Aldosterone is the principal mineralcorticoid secreted by the

Page 3 of 53 mechanisms for aldosterone release are angiotensin II and serum potassium level. An understanding of aldosterone is necessary in relation to fluid management of patients and also in the impact it has on the kidneys. Which gives the MOST rapid detection of accidental extubation? A) BP monitoring B) Capnography C) EKG D) Pu lse Ox Answer: B Rationale: Extubation is more rapidly detected by monitoring ETCO2 than with pulse oximetry and other vital sign monitoring, as one would see a reading of little to no expired ETCO2 first. Damage to which nerve causes vocal cord paralysis? Answer: C Rationale: 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 a patient with elevated T3 and T4 levels? Answer: B

Page 5 of 53 C) pulmonary artery D) skin Answers: B, C Rationale: Axillary and skin temperature are variable and not reflective of core body temperature. 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

Page 6 of 53 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

Page 7 of 53 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 7

Page 8 of 53 In preparation for a fiberoptic nasal intubation, which pharmacological agent would provide local anesthesia as well as vasoconstrictive properties? B) Cocaine Cocaine is the only pharmacological agent listed that provides both local anesthesia and vasoconstrictive properties Following induction of general anesthesia with IV propofol, lidocaine, fentanyl, and succinylcholine, rigidity of the masseter muscle is noted. The end-tidal carbon dioxide sharply rises from 35 mmHg to 65 mmHg with adequate tidal volumes. Tachycardia and peripheral muscle rigidity were also noted. Which pharmacological agents would be most appropriate to administer? (select 2) A) Bicarbonate B) Dantrolene C) Diltiazem D) Rocuronium A)Bicarbonate B) Dantrolene Following induction of general anesthesia with IV propofol, lidocaine, fentanyl, and succinylcholine, rigidity of the masseter muscle is noted. The end-tidal carbon dioxide sharply rises from 35 mmHg to 65 mmHg with adequate tidal volumes. Tachycardia and peripheral muscle rigidity were also noted. Which pharmacological

Page 9 of 53 administer? (select 2) A) Bicarbonate B) Dantrolene Administering Dantrolene is the protocol when malignant hyperthermia (MH) is present. Diltiazem is contraindicated with Dantrolene. Bicarbonate is used to treat respiratory acidosis. Rocuronium has no indication for use with MH. Critical preoperative laboratory tests for a patient in end-stage renal disease include: (Select 2) Answers: C, D Rationale: Serum creatinine level reflects trends in renal filtration and is the most 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 9

Page 11 of 53 C) Serum creatinine >2mg/dL D) smo king 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

Page 12 of 53 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) Tach ycardia 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 C) Tachycardia D) Vasocon striction

Answers: B, C 12