Question 1

An experienced CRNA administered MAC to a 29-year-old female undergoing local scar revision surgery for an old abdominal incision.She titrated midazolam and propofol to dull the patient's level of consciousness.She was alerted by the dropping SpO₂ reading and the patient's loss of chest movement.The patient did not respond to a head-tilt/chin-lift maneuver.The CRNA's next response to this event is to:

Accepted Answer

A)  alert the surgeon and ventilate the patient's lungs with a self-inflating bag-valve-mask. 
B)  increase the O₂ to 10 L/min, gently tap the patient's shoulder, and call the patient's name. 
C)  begin chest compressions. 
D)  call for the code cart and difficult airway cart.

Question 2

While hypothermia was historically credited as a therapeutic modality benefitting all surgery patients because it decreases metabolism and reduces oxygen demand,inadvertent hypothermia is now recognized as impacting many critical physiologic functions and patient outcomes.Which of the following impairments related to hypothermia can contribute to surgical site infections?

Accepted Answer

A)  Altered drug uptake 
B)  Impaired wound healing 
C)  Impaired platelet function 
D)  Cardiac rhythm disturbances

Question 3

A 4-year-old preschool student was telling his friend about his operation.He had a hernia fixed and told his friend that the nurse put "magic cream on his hand before she stuck the ivy in" and then the doctor "gave him surgery sleep medicine that was like milk in his ivy" and "another doctor put a little needle stick in his back near his butt after he was asleep so he would not hurt when he woke up." Based on the child's self-report of his surgery experience,what three types of anesthesia,in the correct order of his story,did he receive?

Accepted Answer

A)  Local, general, spinal 
B)  Local, regional, general 
C)  Local, general, caudal 
D)  Regional, general, caudal

Question 4

Whenever regional anesthesia is used,resuscitative equipment and drugs must be immediately available and the patient monitored for any substantial change in vital signs or untoward reactions.An example of a risk with regional anesthesia is:

Accepted Answer

A)  temporary numbness distal to the injection. 
B)  temporary loss of motor function distal to the injection. 
C)  intravascular injection of the anesthetic agent. 
D)  diminished pain along nerve pathways.

Question 5

The ideal agent for pediatric anesthesia is one that offers a rapid and smooth induction with good relaxation,followed by rapid emergence.Which of the listed inhalational agents is the best choice for pediatric anesthesia?

Accepted Answer

A)  Isoflurane 
B)  Nitrous oxide 
C)  Sevoflurane 
D)  Halogen

Question 6

Pediatric,geriatric,and physiologically compromised patients have impaired thermal regulatory mechanisms that place them at risk for hypothermia.The perioperative nurse should prepare the OR bed before patient arrival by placing:

Accepted Answer

A)  an infrared warming lamp 18 inches from the OR bed surface. 
B)  hot bath blankets over the OR bed surface as the patient transport vehicle enters the room. 
C)  a forced air-warming hose towel clipped under the lifting sheet. 
D)  a patient-sized forced air-warming blanket on top of the OR bed surface.

Question 7

A 19-year-old male received an intravenous peripheral nerve block (PNB/Bier block)for an open reduction internal fixation (ORIF)of an ankle fracture.The anesthesia provider injected a distal dorsal vein of his right foot with 2% lidocaine,after placing a single cuffed pneumatic tourniquet circumferentially around his upper right thigh.The surgeon looked through the OR window to check on anesthesia progress as he scrubbed at the sink outside of the OR.The circulating nurse had his leg elevated and was prepping his ankle.The surgeon noticed that the cuff seemed to be deflating and that the anesthesia provider was turned away from the patient.The circulating nurse also noticed the movement under the protective towel placed over the cuff,and saw the tourniquet tubing fall to the floor.The nurse's first response should be to:

Accepted Answer

A)  alert the anesthesia provider, run for the code cart, and tell the scrub person to wrap the Esmarch bandage around the deflated cuff. 
B)  alert the anesthesia provider, reconnect the tubing to cuff and reinflate, and send for the code cart. 
C)  send the scrub person for the code cart, alert the anesthesia provider to reconnect the tubing and reinflate the cuff, and continue the skin prep. 
D)  alert the anesthesia provider, reconnect the tubing and reinflate the cuff, and send the surgeon for a replacement cuff.

Question 8

Ketamine is a short-acting induction and IV or intramuscular (IM)maintenance agent.Patients are able to maintain their airways.It is a suitable agent to use with small children and burn patients.The concern with this agent is that in large doses it may cause:

Accepted Answer

A)  hallucinations. 
B)  thrombocytopenia. 
C)  respiratory depression. 
D)  hallucinations and respiratory depression.

Question 9

A basic anesthesia monitoring device that is used during general anesthesia to confirm successful endotracheal tube placement and determine the presence of gas exchange is the:

Accepted Answer

A)  pulse oximetry device placed on the finger, toe, or ear lobe to measure oxygen saturation. 
B)  precordial stethoscope to listen to breath sounds in all lung fields. 
C)  capnometer/end-tidal CO₂ monitor to identify expired CO₂ in the breathing circuit. 
D)  postintubation arterial blood gas monitoring with a point-of-care testing device.

Question 10

Which inhalation anesthetic gas can cause retinopathy in premature infants?

Accepted Answer

A)  Oxygen 
B)  Sevoflurane 
C)  Desflurane 
D)  Nitrous oxide

Question 11

Two monitoring devices that are commonly used to determine ventilatory status are recommended by anesthesia provider professional organizations as a standard of care.These two devices are:

Accepted Answer

A)  pulse oximetry and capnography. 
B)  oxygen analyzer and low-limit alarm system. 
C)  electrocardiography and capnography. 
D)  electrocardiography and pulse oximetry.

Question 12

The instillation of a local anesthetic into the subarachnoid space is termed:

Accepted Answer

A)  spinal anesthesia. 
B)  epidural anesthesia. 
C)  perfusion block. 
D)  stellate ganglion block.

Question 13

The pulse oximeter is used during perioperative anesthesia monitoring.The "pulse ox" reading can be adversely affected by a number of events.Pulsatile blood flow to the distal extremities may be inadequate because of:

Accepted Answer

A)  hyperthermia. 
B)  increased cardiac output. 
C)  hypervolemia. 
D)  malpositioning.

Question 14

A 24-year-old tennis coach was scheduled for an arthroscopy for recurrent knee pain.He has a family history of anesthesia and surgery complications and did his best to provide a thorough preanesthetic assessment history.He denied any history of allergies,musculoskeletal abnormalities,obstructive sleep apnea,or reflux disease.He admitted to eating a cheese steak and drinking two cans of beer the night before at 11:30 PM,but promised that he finished food and fluid intake before midnight and did not eat or drink anything else.The induction was smooth.On attempt at intubation,it was evident that total muscle relaxation had not been achieved.The circulating nurse gently restrained his arms as he began to move and gag on the laryngoscope.The patient vomited undigested stomach contents.His nasopharynx was suctioned and cleared,intubation was achieved,and a nasogastric tube was inserted and connected to suction.The patient experienced respiratory distress on extubation and was transferred to the intensive care unit (ICU)with acute respiratory distress syndrome.Based on his preanesthetic history,the incidence of aspiration could have been reduced by which measure?

Accepted Answer

A)  The perioperative nurse applying cricoid pressure during induction through intubation 
B)  The anesthesia provider inserting a nasogastric tube to suction before induction 
C)  Intravenous proton pump inhibitors and an oral antacid being given 1 hour before induction 
D)  Intubating with a nasotracheal tube instead of per ora

Question 15

Which of the following medications is a specific depolarizing muscle relaxant than can produce generalized fasciculations?

Accepted Answer

A)  Succinylcholine 
B)  Mivacurium 
C)  Pancuronium 
D)  Rocuronium

Question 16

Which inhalational anesthetic agents have the fastest onset of induction,emergence,and recovery?

Accepted Answer

A)  Nitrous oxide and sevoflurane 
B)  Isoflurane and cycloflurane 
C)  Desflurane and isoflurane 
D)  Nitrous oxide and cyclopropane

Exam 5: Anesthesia