Spring 25 - B.P.ofA. Final Review Flashcards
(412 cards)
1
Q
Which of the following anesthetic agents was first documented as being used for surgical anesthesia in 1846?
a) Nitrous oxide
b) Chloroform
c) Ether
d) Halothane
A
Answer: c) Ether
Rationale: Ether was the first widely used general anesthetic, introduced specifically for surgical anesthesia by William Morton in 1846. Morton was a Dentist from Boston who performed this experiment in a surgical operating room in Massachusetts General Hospital. This documented discovery would go on to revolutionize surgery, showing it was possible to perform surgery without causing pain, and it would birth the field of anesthesia.
2
Q
What is the significance of the critical temperature of a compressed gas?
A. Temperature where gas spontaneously combusts?
B. Temperature at which a compressed gas builds enough pressure to rupture the cylinder?
C. The temperature at which gas becomes a inert?
D. The critical temperature of a gas is a fictional concept.
A
Answer = A
Rationale: The critical temperature of a compressed gas is the temperature at which the gas cannot be compressed into a liquid if the temperature of the gas is above the critical point regardless of how much pressure is is used.
3
Q
According to the textbook, what color-coding scheme safety standards are used to identify oxygen in North America?
A. Brown
B. Green
C. Yellow
D. Black
A
Answer: B, Green
Rationale: In North America, the color-coding scheme follows as such: cylinders of oxygen are identified by the color green. Brown is identified as helium, nitrous oxide is identified as blue, yellow denotes air, carbon dioxide signifies gray, and finally nitrogen is identified with the color black. It is important to observe that the color scheme is not a world-wide standard. Therefore, it is essential to be aware of different color schemes. (Butterworth et al., 2022).
4
Q
In what year was the American Association of Nurse Anesthetists founded?
A. 1908.
B. 1931
C. 1946
D. 1953
A
Correct Answer: B; 1931
Rationale: Agatha Hodgins, a Canadian nurse, traveled to Cleveland to work as an anesthetist for Dr. George Crile at Lakeside Hospital. In 1931, Hodgins founded the AANA primarily to educate physicians and nurses in anesthesia.
5
Q
When should you avoid use of the oxygen flush valve?
a) During expiration
b) During inspiration
c) Between inspiratory and expiratory cycles
d) You should never use the oxygen flush valve
A
Answer: b; during inspiration
Rationale: During inspiration, the ventilator’s spill valve is closed and the adjustable pressure-limiting (APL) valve is excluded. The flood of oxygen and associated pressure would be delivered to the patient’s lungs at this time.
6
Q
Which statements contrast the Pin (PISS) vs the Diameter (DISS) Index Safety System? Select all that apply:
A) The PISS is used with portable gas cylinders, while the DISS is used with central gas pipelines.
B) The PISS uses unique pin and hole alignments to prevent the misconnection of gas cylinders.
C) The DISS prevents cross-connections by using color-coded fittings for different gases.
D) The DISS uses a noninterchangeable fitting that prevents incorrect hose attachment.
E) The PISS is designed for gas pipeline systems in hospitals.
A
Correct: A, B, and D
Rationale
“Cylinders attach to the machine via hanger-yoke assemblies, which use a pin index safety system to prevent the accidental connection of the wrong gas cylinder.”
“Gases are delivered from their central Supply source to the operating room through a piping network. The tubing is color-coded and connects to the anesthesia machine through a noninterchangeable diameter-index safety system (DISS) fitting that prevents incorrect hose attachment. Interchangeability is prevented by making the body’s bore diameter and connection nipple specific for each supplied gas”.
7
Q
Question: Select all gases that must pass through safety devices before reaching their flow control valve in an anesthesia machine (select all that apply):
A) Nitrous oxide
B) Air
C) Oxygen
D) Helium
A
Answer: A. Nitrous oxide, B. Air, and D. Helium
Rationale: Nitrous oxide, air, and other gases like helium must pass through safety devices before reaching their flow control valves. These devices ensure that these gases are only delivered when there is sufficient oxygen pressure, preventing the accidental delivery of a hypoxic gas mixture. Oxygen does not need to pass through these safety devices and goes directly to its flow control valve (Butterworth et al., 2022).
8
Q
In the United States of America, what color is used to represent a cylinder of Nitrous Oxide (N20)?
Black
Green
Blue
Yellow
A
Answer: C, Blue.
Rationale: In the United States, cylinders of Nitrous Oxide (N2O) are color coded blue. Yellow represents medical air, green represents oxygen, and black represents nitrogen gas (N2) (Butterworth et al., 2022).
9
Q
In the event of the anesthesia machine experiencing a maximum supply pressure of 95-110 psi for a specific gas, what safety mechanisms would alleviate elevated pressures with single-stage pressure regulation?
A. Proportional reduction in nitrous oxide and other gas pressures
B. Opening of a high-pressure relief valve for the supplied gas
C. Closure of shut-off valves, preventing further gas delivery
D. Presence of a one-way check valve limiting retrograde flow
A
Correct Answer: B, Opening of a high-pressure relief valve for the supplied gas
Rationale
The correct answer to this question is B because, within a single-stage pressure-regulated system, high-pressure relief valves are utilized for each gas to expel excess gas during elevated supply pressures (Butterworth et al., 2022). Answer choices A and C are incorrect because these are both safety features in response to diminished oxygen supply within a system. Answer choice D is incorrect because one-way check valves are only effective at preventing retrograde flow and not for alleviating excess pressure.
10
Q
What is the purpose of the oxygen supply failure protection device on anesthesia machines?
A) Monitor the patient’s oxygen saturation levels
B) Ensure nitrous oxide and air are delivered directly to the flow control valve
C) Prevent the delivery of a hypoxic gas mixture by sensing oxygen pressure and regulating the flow of other gases
D) Reduce the pipeline pressure of oxygen
A
Answer: C
Rational: Nitrous oxide, air (in some machines), and other gases pass through safety devices before reaching flow control valves, while oxygen passes directly to its flow control valve. Adequate oxygen pressure is required to allow the flow of other gases. If there is an oxygen supply failure, this safety feature helps prevent the delivery of a hypoxic mixture.
11
Q
Which gas cylinders have a size opening and thread pattern similar to oxygen cylinders, making accidental interchange possible?
A. Nitrous Oxide
B. Carbon Dioxide
C. Medical Air
D. Nitrogen
A
Correct Answer: B. Carbon Dioxide
Rationale: Understanding the physical and safety features of gas cylinders is essential for preventing potentially life-threatening errors, such as accidental administration of the wrong gas. This topic aligns with the principles of anesthesia covered in the text (Butterworth et al., 2022), emphasizing the importance of the pin index safety system (PISS) designed to prevent gas cylinder interchange. However, instances of equipment failure or improper maintenance can still occur, making it vital for anesthesia providers to be vigilant about the compatibility and markings of gas cylinders.
12
Q
What maximum pressure is an N2O (Nitrous Oxide) E-cylinder pressurized to?
A. 600 psi
B. 838 psi
C. 1900 psi
D. 745 psi
A
Correct Answer: D
Rationale: At 20˚C, a full E-cylinder of oxygen contains a pressure of 1900 psi, and holds 600 L of volume, while nitrous oxide includes a pressure of 745 psi. 838 psi is incorrect, as this refers to service pressure of carbon dioxide (CO2).
13
Q
Which of the following gases, commonly seen on anesthesia machines and used in operating rooms, exists in its gaseous form at room temperature inside standard cylinders? Select all that apply.
A. Oxygen
B. Hydrogen
C. Medical Air
D. Nitrous Oxide
A
Answer: (A and C)
The critical temperature of nitrous oxide is 36.5 Celsius, which is higher than room temperature (20 Celsius). Gases can only be liquified under pressure if they are stored below their critical temperature. Therefore, under pressure inside a cylinder, nitrous oxide will exist as a liquid. The critical temperature of oxygen is -119 Celsius, therefore in a typical cylinder at room temperature, it will exist in its gaseous form. Medical air is a blend of oxygen and nitrogen, and its critical temperature is -140.6 Celsius, therefore it also exists in its gaseous form inside a cylinder at room temperature. Hydrogen gas is not commonly used in the operating room (Butterworth et al., 2022).
14
Q
Question: How much more likely are reported adverse outcomes to be caused by misuse of anesthesia gas delivery systems than by equipment failure or malfunction?
A. 10 times
B. 3 times
C. 5 times
D. 2 times
A
Correct Answer: B. 3 Times
Rationale: Equipment misuse includes errors in preparation, maintenance, or deployment of devices. Preventable anesthetic mishaps are often linked to an operator’s lack of familiarity with the equipment, failure to verify the machine’s function before use, or both. Many of these incidents could be avoided by conducting an appropriate preanesthetic machine check. However, equipment misuse is 3 times more likely to be associated with an adverse anesthetic event than device malfunction or failure (Butterworth et al., 2022). This number demonstrates the importance of standardized specifications for anesthesia machines and their components as well as the proficiency of those using and working with anesthesia workstations.
15
Q
Question: Which of the following statements regarding the pin index safety system is correct?
A. The pin index safety system ensures that all gas cylinders can be attached interchangeably to any anesthesia machine.
B. Multiple washers placed between the cylinder and yoke enhance the effectiveness of the pin index safety system.
C. The pin index safety system prevents incorrect cylinder attachment by using unique pin and hole configurations for each gas.
D. The pin index safety system still functions effectively if the yoke pins are damaged.
A
C: The pin index safety system uses each gas’s specific pin and hole configurations to prevent incorrect attachment. This safety feature is unique to each type of gas.
Rationale:
The pin index safety system is like a lock-and-key setup, where each gas cylinder has a unique pattern of pins and holes. This ensures that only the right cylinder can connect to the right spot on the anesthesia machine. This mechanism minimizes the risk of delivering the incorrect gas to the patient, enhancing safety during anesthesia delivery.
16
Q
At a consumption rate of 3 L/min, how long will a half-full oxygen E-cylinder last?
A. 55 minutes
B. 90 minutes
C. 110 minutes
D. 120 minutes
A
Answer: C. 110 minutes
Rationale:
At a consumption rate of 3 L/min, the duration of an E-cylinder can be calculated using the formula:
Time (minutes) = Volume (liters) ÷ Flow Rate (L/min).
A half-full E-cylinder contains approximately 330 liters of oxygen. Dividing this by the flow rate:
330 liters ÷ 3 L/min = 110 minutes.
17
Q
What is the only reliable way to determine the residual volume of nitrous oxide in a cylinder?
A. Observe the pressure gauge reading on the cylinder
B. Identify the size of the cylinder
C. Use a flowmeter
D. Weigh the cylinder
A
Answer: D. Weigh the cylinder
Rationale: Gases can be liquified by pressure if stored below their critical temperature. The critical temperature of nitrous oxide is 36.5 C, which is above room temperature. However, if the liquified nitrous oxide rises above its critical temperature, it will revert to a gaseous state. The transformation of nitrous oxide into a gaseous state does not lead to a significant rise in the cylinder pressure since nitrous oxide is not an ideal gas and is easily compressed. The cylinders contain nitrous oxide in a liquid state and a gaseous state. Therefore, the volume of the cylinder is not proportional to the pressure of the cylinder, and the only reliable method to determine the residual volume of the cylinder is to weigh it. The tare weight or empty weight of cylinders containing a liquified compressed gas should be evident on the cylinder itself (Butterworth et al., 2022).
18
Q
Regarding the pipeline pressure delivering the gases to the anesthesia machine by the diameter-index safety system (DISS), what is the approximate pipeline pressure in pounds per square inch gauge (PSIG)?
A. 50 psig
B. 45 psig
C. 47 psig
D. 95 psig
A
A. 50 psig.
19
Q
The emergency oxygen tank is being used due to a significant drop in pipeline pressure. The pressure of the E-cylinder oxygen tank reads 1300 psig. The flow is set to 3L/min. How long will the tank last at this flow rate?
A. 125 minutes
B. 90 minutes
C. 153 minutes
D. 143 minutes
E. Unable to calculate
A
Answer: D
tank capacity (L) / service pressure (psig) = contents remaining (L) / current tank pressure (psig).
current tank pressure (psig) * tank capacity (L) / service pressure (psig) = contents remaining (L)
1300psig * 625L / 1900psig = 428L
428L / (3L/minutes) = 143 minutes
20
Q
Which of the following describe the risks and proper use of the oxygen flush valve? (Select all that apply)
A) The flush valve should only be used cautiously when the patient is connected to the breathing circuit.
B) It can result in backflow of gases into the low-pressure circuit, diluting anesthetic concentrations.
C) The flush valve should be used for routine breathing circuit maintenance to ensure proper gas exchange.
D) A protective rim around the flush button helps prevent unintentional activation.
E) The oxygen flush valve uses a flow rate of 1–5 L/min to prevent excessive lung pressures.
A
Correct Answers: A, B, D
21
Q
Which of the following are reasons that active humidifiers are valuable in pediatric anesthesia applications? Select all that apply.
A. Contribution to an increase in apparatus dead space
B. Reduced occurrences of hypothermia due to increased heat conservation
C. Filtration of respiratory gases reducing infectious concerns
D. Prevention of smaller tracheal tube plugging via dried secretions
A
Correct Answer: B & D Reduced occurrences of hypothermia due to increased heat conservation & Prevention of smaller tracheal tube plugging via dried secretions
22
Q
Which of the following are purposes of oxygen in the anesthesia workstation (Select all that apply)
A) To supply fresh gas to the oxygen flow meter
B) To drive ventilator bellows
C) To absorb carbon dioxide
D) To activate low pressure oxygen alarms
A
Answer: A, B, D
Rationale: Oxygen has five roles in the anesthesia workstation: Supplying fresh gas to the oxygen flow meter, driving ventilator bellows, activating low pressure oxygen alarms, activating fail safe mechanisms, and supplying the oxygen flush system (Elisha, et al., 2022). The CO2 absorbing canister removes CO2 from the system through a series of chemical reactions.
23
Q
Which component of the SPDD model ensures the provision of gases like oxygen and nitrous oxide to the anesthesia machine?
A. Common Gas Outlet
B. Pipeline Supply System
C. Vaporizer
D. Scavenging System
A
Answer: B
Rationale: The SPDD model is the supply, processing, delivery, and disposal model. The Supply phase in the SPDD model involves pipeline systems and gas cylinders that deliver medical gases to the anesthesia workstation. The pipeline supply system provides a steady and regulated supply of oxygen, nitrous oxide, and air to the anesthesia machine. If the pipelines fail, emergency E-cylinders are required, and the tanks should be checked before the start of any case.
24
Q
Which of the following statements best describes the relationship between vapor pressure, temperature, and the characteristics of a volatile agent?
A) Vapor pressure is independent of temperature but depends entirely on the characteristics of the volatile agent.
B) Vapor pressure decreases as temperature increases because fewer liquid molecules escape into the gaseous phase.
C) Vapor pressure increases with temperature due to a greater tendency of liquid molecules to escape into the gaseous phase.
D) Vapor pressure remains constant regardless of changes in temperature or the characteristics of the volatile agent.
A
Answer: C) Vapor pressure increases with temperature due to a greater tendency of liquid molecules to escape into the gaseous phase.
Rationale:. For the physics of vaporization, the molecules of a volatile anesthetic in a closed container are distributed between the liquid and gaseous phases. The gas molecules bombard the walls and create the saturated vapor pressure of the agent. The vapor pressure depends on the characteristics of the volatile agent and the temperature. The greater the temperature, the greater the tendency for the liquid molecules to escape into the gaseous phase and the greater the vapor pressure (Butterworth et al., 2022).
25
Which of the following is the only system that determines the presence of oxygen in the pipeline or cylinder?
A. Hypoxic Guard System
B. Low Pressure Alarms
C. Inspired Oxygen Analysis
D. Fail-Safe Mechanism
Answer: C. Inspired Oxygen Analysis
Rationale:
The presence of oxygen in medical pipelines, cylinders, or circuits is ensured through inspired oxygen analysis. While low-pressure alarms and hypoxic guard mechanisms alert users to possible issues in oxygen supply, they rely on pressure measurements throughout the circuit rather than direct gas content measurement. In other words, these systems monitor pressure within the workstation and are activated only if oxygen pressure drops without sampling the oxygen lines. These systems would not protect the patient in the case of a crossover in which the gas does not contain oxygen (Elisha et al., 2022, pp. 260–261).
26
Which of the following components are part of the flow control circuits in an anesthesia machine? (Select all that apply)
A. Pressure regulators
B. Oxygen flush valve
C. Oxygen supply failure protection devices
D. Flow valves and flowmeters
E. Vaporizers
F. Common (fresh) gas outlet
G. Soda lime canister
A, C, D, E, F
Rationale:
Oxygen flush valve and Soda lime canister are not part of flow control circuit.
The oxygen flush valve bypasses the flow control circuit and delivers high-flow, high-pressure oxygen directly to the patient.
The soda lime canister is part of the breathing circuit, responsible for CO₂ absorption, but it is not part of the flow control circuit.
27
Which patient will benefit the most from humidifying and heating inspiratory gases during general anesthesia? Select 2:
A. Young adults who say she is cold
B. Post-MVC teenager going for an ORIF
C. 3-year-old patients with cystic fibrosis
D. Middle-aged adults undergoing knee replacement surgery
E. Grandpa with COPD
Correct Answer: C and E
Humidification and heating of inspiratory gases may be most important for small pediatric patients and older patients with severe underlying lung pathology.
28
Which of the following safety features on a modern anesthesia machine prevents the simultaneous activation of multiple vaporizers?
A. Agent-specific keyed filling port
B. Interlocking or exclusion device
C. Flow control valve
D. Agent-specific, color-coded cassette
B. Interlocking or exclusion device
Rationale:
Modern anesthesia machines are equipped with interlocking or exclusion device to prevent the simultaneous activation of multiple vaporizers. This feature reduces the risk of delivering multiple volatile anesthetic agents to the patient and accidental overdosing.
29
The oxygen/nitrous oxide ratio controller is a safety feature of the anesthesia machine and ensures what minimum oxygen concentration?
A) 21%
B) 25%
C) 30%
D) 35%
Answer: B
Rational: The oxygen/nitrous oxide ratio controller delivers a minimum of 25% FiO2 to prevent the delivery of a hypoxic mixture. The oxygen/nitrous oxide ratio controller links the flow valves either pneumatically or mechanically. This device does not protect against other possible causes of hypoxic delivery like oxygen pipeline crossover, leaks distal to the flowmeter valve, administration of a third gas, or defective mechanic or pneumatic components.
30
When is the Adjustable Pressure-Limiting (APL) valve usually fully open?
A. Manual ventilation
B. Spontaneous ventilation
C. Both manual and spontaneous ventilation
D. It is never fully open
B. Spontaneous ventilation
Rationale: The APL valve is usually fully open during spontaneous ventilation but must be partially closed during manual or assisted bag ventilation. If it is not closed sufficiently, excessive loss of circuit volume due to leaks prevents manual ventilation (Butterworth et al., 2022).
31
Select the three types of oxygen analyzers from the list below:
A. Polarographic
B. Variable Bypass
C. Galvanic
D. Paramagnetic
Answer: A, C, and D
Rationale: The three types of oxygen analyzers available are polarographic (Clark electrode), galvanic (fuel cell) and paramagnetic. Variable bypass is a type of vaporizer not an oxygen analyzer. (Butterworth et al., 2022).
32
Which anesthetic gas has the highest vapor pressure and lowest boiling point?
A. Halothane
B. Sevoflorane
C. Desflurane
D. Isoflurane
Correct answer: C, Desflurane
Rationale: The higher the vapor pressure, the more vapor will be released. ALL modern vaporizers are agent-specific, and filling the vaporizer with the incorrect gas can cause incorrect doses of anesthetic gas. Filling a vaporizer specified for sevoflurane with halothane instead can cause an overdose due to the increased amount of vapor being released. Desflurane is the answer with the highest vapor pressure; its boiling point is near room temperature (22.8°C at 760 mmHg). Due to this low boiling point, desflurane requires specific electronic vaporizers.
33
Causes of flowmeter malfunction include: (Select three of the following)
A. Debris in the flow tube
B. Flow tube interior being coated with a conductive substance.
C. Vertical tube misalignment
D. A float stuck at the top of the tube
A, C, & D.
Rationale: Flowmeters can malfunction when there is debris in the flow tube, a misalignment of the vertical tube, and a float that is sticking or concealed at the top of the tube. The inner tube of the flowmeter should be coated with a conductive substance in order to reduce the effect of static electricity (Butterworth et al., 2022).
34
On modern anesthesia machines, where is the location of the oxygen flowmeter, and why?
A. Farthest to the left ; This prevents hypoxia if there is a leak from another flowmeter located upstream
B. In the middle ; Oxygen must be in the middle to adequately mix with the other gases before delivery to the patient
C. Farthest to the right ; This prevents hypoxia if there is a leak from another flowmeter located upstream
D. Farthest to the right ; The weight of oxygen requires it to be farthest downstream, otherwise it would never reach the patient if positioned farthest to the left
Answer: C
Rationale: Positioning the oxygen flowmeter furthest to the right (furthest downstream) prevents hypoxia in the case of leakage from a different flowmeter further upstream. With oxygen positioned furthest downstream, this makes it the last gas to enter the common gas outlet before reaching the patient. Having a different gas furthest downstream, such as nitrous oxide or medical air, could result in delivery of a hypoxic mixture of gas to the patient if there was a leak in the upstream flowmeter (Butterworth et al., 2022).
35
What is the upper limit of pressure in cm H2O for the adjustable pressure-limiting (APL) valve?
A: 30-40 cm H2O
B: 70-80 cm H2O
C: 40-50 cm H2O
D: 10-20 cm H20
B: 70-80 cm H20
Rationale: The APL valve is a pressure-limiting device that can never be completely closed. The upper limit is 70-80 cm H2O. The APL valve is open when the patient is spontaneously ventilated, but it is partially closed during manual ventilation or assisted bag ventilation. If the APL valve is closed off too much, and there is a progressive rise in pressure, it could cause pulmonary barotrauma.
36
How fast does Oxygen flow when the Oxygen flush valve is activated
A. 35-75 L/min
B. 5-10 L/min
C. 75 mL/min
D. 20 L/min
Answer: A
Rationale: The oxygen flush valve provides a high flow (35–75 L/min), not mL/min, of oxygen directly to the common gas outlet, bypassing the flowmeters and vaporizers
Reference:
37
Which of the following are potential causes for discrepancies in set tidal volume and achieved tidal volume with volume-controlled ventilation? Select all that apply.
A. A breathing circuit with a compliance of 6mL/cm H20
B. Absence of leaks within a circuit
C. Fresh gas flows of 5L/min
D. Gas Compression
Correct Answer: A, C, & D
38
Which of the following is a key advantage of insufflation in anesthesia?
A) Allows for controlled ventilation
B) Prevents the need for high fresh gas flow rates
C) Avoids direct airway connection, making it useful for pediatric induction
D) Ensures a precise inspired oxygen concentration
Correct Answer:
C) Avoids direct airway connection, making it useful for pediatric induction
Rationale:
Insufflation involves blowing anesthetic gases across a patient's face without a direct airway connection. This technique is helpful in pediatric patients who may resist face mask placement or intravenous lines. However, it does not allow for controlled ventilation, requires high fresh gas flow rates to prevent rebreathing, and contains unpredictable amounts of atmospheric air in the inspired gas mixture.
39
Which of the following are advantages of the circle system in anesthesia? (Select all that apply)
A. Minimal operating room and environmental pollution
B. Low resistance (less than the endotracheal tube; not as low as in nonrebreathing circuits)
C. Increased dead space (true of all respiratory apparatus)
D. Constant inspired concentrations
E. Opportunities for misconnection or disconnection
F. Conservation of respiratory tract heat and humidity
Correct Answers:
A, B, D, F
Rationale:
C is incorrect because, although the circle system has some dead space, it is not excessive compared to other systems. The dead space is primarily limited to the Y-piece to the patient’s airway, rather than the entire circuit.
E is incorrect because the risk of misconnection or disconnection is a disadvantage, not an advantage.
40
Which two of the following reasons would cause increased inspired CO₂ in a circle system?
a) Exhausted absorbent granules
b) Faulty unidirectional valves
c) Malfunctioning APL valve
d) Using a coaxial circuit instead of a Bain circuit
Answer:
a) and b)
Rationale:
In a circle system, CO₂ absorbent granules remove exhaled CO₂. If the absorbent becomes exhausted, CO₂ is no longer effectively removed, leading to rebreathing of CO₂ and increased inspired CO₂. Additionally, faulty unidirectional valves can cause exhaled CO₂-rich gas to bypass the absorber and mix with fresh gas, further increasing inspired CO₂.
41
Which of the following factors might increase the peak inspiratory pressure (PIP) AND the plateau pressure (PP) on a respiration waveform? (Select all that apply)
a. Pneumothorax
b. Decreased pulmonary compliance
c. Surgery requiring peritoneal gas insufflation
d. Thick secretions
Answer: a, b, c
Rationale: Factors that might cause increased PIP and PP include decreased pulmonary compliance, pulmonary edema, trendelenburg position, pleural effusion, ascites, abdominal packing, peritoneal gas insufflation, tension pneumothorax, and endobronchial intubation. Increased levels of thick secretions will increase the PIP without a change to the PP
42
Where should the fresh gas inlet be positioned in the circle system, and why?
A) Between the absorber and the expiratory valve, to conserve absorption capacity
B) Between the inspiratory valve and the absorber, to prevent dilution of fresh gas
C) Between the Y-piece and the unidirectional valve, to simplify the circuit
D) Downstream from the inspiratory valve, to ensure maximum fresh gas flow
Correct Answer: B) Between the inspiratory valve and the absorber, to prevent dilution of fresh gas
Rationale: The fresh gas inlet is best placed between the absorber and the inspiratory valve to ensure fresh gas is not diluted by recirculated exhaled gas. This placement optimizes fresh gas delivery to the patient and minimizes waste.
43
Which of the following factors primarily influences the transition from inspiration to expiration in a pressure-cycled ventilator?
A) A preset inspiratory pressure must be reached.
B) A fixed inspiratory time interval.
C) A predetermined tidal volume must be delivered.
D) A spontaneous breath initiated by the patient.
A) A preset inspiratory pressure must be reached.
44
Which of the following is NOT a component of the circle system?
A. Fresh gas inlet inside the breathing tube
B. Y-connector
C. Reservoir bag
D. APL valve
Answer: A. Fresh gas inlet inside the breathing tube
45
Which of the following conditions would increase peak inspiratory pressure without affecting plateau pressure?
A. Pulmonary edema
B. Bronchospasm
C. Increased tidal volume
D. Decreased pulmonary compliance
Answer: B. Bronchospasm
46
You are providing anesthesia without complications up to this point in the procedure. Suddenly, low-pressure alarms begin to sound, and the patient's breath sounds are absent. What should be the first course of action:
A. Check settings of fresh gas flow, scavenger, and ventilator
B. Ventilate manually using the anesthesia breathing circuit
C. Check the y-piece and other common locations for disconnections.
D. Disconnect the patient from the circuit, provide IV anesthetics, and ventilate the patient with the Ambubag
E. Troubleshoot the anesthesia machine
Correct Answer: C. Low-pressure alarms are often caused by leaks in the breathing circuit, and the most common location for disconnection is the y-piece between the breathing circuit and the endotracheal tube. When the ability to ventilate is lost due to low pressure, the anesthesia must first rapidly check for disconnections. If no disconnections are found, the provider should attempt to ventilate manually through the anesthesia machine. If unable to ventilate through the anesthesia machine, the provider should proceed to use the Ambubag. Once proper ventilation is established, check settings for fresh gas flow, scavenger, and ventilator. Do not attempt to troubleshoot the machine while the patient is under anesthesia.
47
In draw-over anesthesia, what happens when oxygen is supplied at 1 L/min?
A) FiO2 reaches 80-90%
B) FiO2 reaches 30-40%
C) FiO2 reaches 10-20%
D) FiO2 reaches 90-100%
Answer: B, FiO2 reaches 30-40%
Rationale: Across the clinical range of tidal volume and respiratory rate, an oxygen flow rate of 1 L/min gives a FiO2 of 30-40%. or with 4 L/min, a FiO2 of 60-80%.
48
When should you change your CO2 absorber canister?
A) At the first sign of color change
B) When 25%-40% of granules have changed color
C) When 50%-70% of granules have changed color
D) Once all, or nearly all, the granules have changed color
Answer: C. When 50%-70% of granules have changed color
49
Which of the following is the highest circuit pressure generated during an inspiratory cycle during mechanical ventilation?
A) Plateau pressure
B) Tidal volume
C) Peak inspiratory pressure
D) Positive end-expiratory pressure
Answer: C
50
Which inhaled anesthetic agents produce the highest amount of carbon monoxide when in contact with CO₂ absorbent granules?
A) Sevoflurane
B) Isoflurane
C) Desflurane
D) Halothane
Correct Answer: C) Desflurane
51
Soda lime is a common CO2 absorbent seen on modern anesthesia machines utilizing the circle system. How much carbon dioxide is soda lime capable of absorbing?
A. 18L of CO2 per 100g of soda lime
B. 23L of CO2 per 100g of soda lime
C. 23L of CO2 per 50g of soda lime
D. 18L of CO2 per 50g of soda lime
Answer: B, 23L of CO2 per 100g of soda lime
52
Which of the following will NOT decrease resistance within the circle system?
A. Increasing the diameter of the circuit
B. Maintaining Laminar Flow
C. Eliminating Valves
D. Using sharp bends
Correct Answer: D. Using sharp bends
53
Which ventilation mode is described as peak inspiratory pressure is limited and cycle is controlled by time, inspiratory flow is strongest early in inspiration and declines to flow just sufficient to maintain the set pressure later in inspiration? In this ventilation mode, tidal volume is uncontrolled and may increase if compliance increases or airway resistance falls.
A) Pressure-controlled ventilation
B) Volume controlled ventilation
C) Pressure-controlled ventilation with volume guarantee
D) synchronized intermittent mandatory ventilation
Correct answer: A) Pressure-controlled ventilation
54
During a surgical case, you notice that the reservoir bag in the scavenging system is completely collapsed, and the anesthesia circuit’s fresh gas flow must be significantly increased to maintain proper ventilation in your circuit. What is the most likely cause?
A. The negative pressure relief valve is malfunctioning
B. The positive pressure relief valve is malfunctioning
C. This is an open scavenging system, and gases are entrained from excessive suction
D. The scavenging system is passive and its valve is not working properly
Answer: A. The negative pressure relief valve is malfunctioning
55
What is one difference between the DAS and ASA guidelines for difficult airways/intubation?
A. Awakening of the patient following failed intubation, and successful bag-mask ventilation
B. Surgical Cricothyrotomy as the last emergent intervention in both guidelines
C. Initial use of a supraglottic airway following failed intubation in both guidelines
D. Emphasis of proficient planning and airway assessment to prepare for a difficult airway
Correct Answer: B & C
56
Which intrinsic muscles in the larynx are innervated by the recurrent laryngeal nerve? (Select all that apply)
A. Cricothyroid,
B, lateral cricoarytenoid
C. Posterior cricoarytenoid
D. Thyroarytenoid
Answer = B, C, D
57
Which of the following is NOT a component of the 3-3-2 rule for airway assessment?
A. Mouth opening should be at least 3 fingerbreadths.
B. Thyromental distance should be at least 3 fingerbreadths.
C. Sternomental distance should be at least 2 fingerbreadths.
D. Thyroid notch to hyoid bone distance should be at least 2 fingerbreadths.
Answer: C. Sternomental distance should be at least 2 fingerbreadths
58
A patient with suspected cervical spine injury requires intubation. The safest technique is:
A) Direct laryngoscopy with head extension
B) Fiberoptic intubation
C) Nasotracheal intubation
D) Blind intubation
Correct Answer: B) Fiberoptic intubation
59
Which of the following is correct regarding the function of the superior laryngeal nerve (SLN)?
A) The internal branch of the SLN provides motor function to the cricothyroid muscle.
B) The external branch of the SLN provides sensory input to the hypopharynx above the vocal cords.
C) The internal branch of the SLN provides sensory input to the hypopharynx above the vocal cords, including the base of the tongue and epiglottis.
D) The SLN provides motor function to all muscles of the larynx except the cricothyroid muscle.
Correct Answer: C)
60
Which of the following statements accurately differentiates cricoid pressure from the BURP maneuver during laryngoscopy?
A) Cricoid pressure is applied to improve glottic visualization, while BURP is used to prevent passive regurgitation of gastric contents.
B) Cricoid pressure is applied to occlude the esophagus and prevent aspiration, while BURP is applied to optimize vocal cord visualization during laryngoscopy.
C) Both cricoid pressure and BURP serve the same purpose and are used interchangeably during intubation.
D) BURP is applied to compress the esophagus, while cricoid pressure is used to manipulate the thyroid cartilage for better visualization.
Correct Answer: B) Cricoid pressure is applied to occlude the esophagus and prevent aspiration, while BURP is applied to optimize vocal cord visualization during laryngoscopy.
61
When is the safest time to extubate a patient after surgery?
A. During deep anesthesia only
B. During deep anesthesia or when the patient awakens
C. During light anesthesia
D. Only when the patient awakens
Answer: B
62
Which of the following statements describes the effects of unilateral recurrent laryngeal nerve (RNL) injury?
A. Airway obstruction and respiratory distress
B. Loss of sensory innervation above the vocal cords
C. Unilateral damage results in hoarseness but is unlikely to cause respiratory distress
D. Paralysis of the cricothyroid muscle
Answer: C
63
A CRNA provides general anesthesia for a patient who is having surgery. Despite performing airway risk assessments, when intubation is attempted, attempts are unsuccessful. What next step should the provider take after successfully placing a laryngeal mask airway?
A. Wake the patient up
B. Intubate trachea via the supraglottic airway device (SAD)
C. Proceed without intubating the trachea (ventilate using LMA)
D. Perform a tracheostomy or cricothyroidotomy
E. All of these answers are possible correct actions
Answer: E. Each one of these actions can be the correct answer. Many SADs allow for tracheal intubations (TI) through the SAD, but if the SAD does not have this feature, the surgeon and CRNA must discuss the risks and benefits of performing the surgery with an LMA or whether invasive airway access (tracheostomy/cricothyroidotomy) is necessary. If neither provider is satisfied with these solutions and the procedure can be postponed, the CRNA should awaken and re-evaluate the procedure. These difficult airway guidelines were provided by the Difficult Airway Society (DAS) (Nagelhout et al., 2023, pp. 446-449).
64
A forceful, involuntary spasm of the laryngeal musculature (laryngospasm) has developed in your freshly extubated patient. What is the most likely cause of the laryngospasm, and how can it be effectively managed?
A. Laryngospasm is caused by sensory stimulation of the recurrent laryngeal nerve and can be effectively treated with deep tracheal suctioning and administration of a bronchodilator.
B. Laryngospasm is caused by sensory stimulation of the superior laryngeal nerve and requires immediate re-intubation as the primary intervention.
C. Laryngospasm is caused by sensory stimulation of the recurrent laryngeal nerve and can be effectively treated by manual massage of the trachea to relieve the spasm
D. Laryngospasm is caused by sensory stimulation of the superior laryngeal nerve and can be effectively treated with gentle positive pressure ventilation and intravenous lidocaine.
Correct Answer: D
65
Which anatomical structure separates the upper airway from the lower airway?
A. Hyoid bone
B. Cricoid cartilage
C. Bronchioles
D. Epiglottis
Answer: B, Cricoid cartilage
66
While Mallampati classification would correlate to only being able to visualize the soft and hard palate?
A. Class I
B. Class II
C. Class III
D. Class IV
Answer: C, Class III
67
What is a way to prevent gastric aspiration for a patient who received rapid-sequence induction and intubation? The patient ate 4 hours ago and needs an emergent laparoscopic cholecystectomy.
A. Cricoid pressure
B. Glossopharyngeal nerve block
C. Superior laryngeal nerve block
D. Does not need to do anything because enough time has passed for food to be digested, and the patient will not vomit
Answer: A. Cricoid Pressure
68
What are some advantages of laryngeal mask airways (LMAs) when compared with tracheal intubation? (Pick 2)
A. Less dental trauma
B. Decreased risk of gastrointestinal aspiration
C. Does not require neck mobility
D. Decreased risk of gas leak and pollution
Answer: A and C
69
Which of the following is the most reliable predictor of a difficult airway?
A. Thyromental distance less than 6 cm
B. Mallampati Class greater than II
C. History of previous difficult intubation
D. Prescence of facial hair
Answer: C. History of previous difficult intubation
70
What is the most reliable indicator that the endotracheal tube has not inadvertently been placed in the esophagus?
A. Bilateral breath sounds
B. Persistent end-tidal carbon dioxide
C. Equal chest excursion (rise)
D. Condensation in the endotracheal tube
Answer: B
71
Which of the following clinical signs can provide clues to the diagnosis of bronchial intubation?
A) Bilateral breath sounds, stable oxygen saturation, normal peak inspiratory pressures, and easy ventilation with a compliant breathing bag
B) Unilateral breath sounds, unexpected hypoxia, inability to palpate the ETT cuff in the sternal notch during inflation, and increased peak inspiratory pressures
C) Decreased peak inspiratory pressures, normal bag compliance, symmetrical chest expansion, and no changes in oxygen saturation
D) Easy palpation of the endotracheal tube (ETT) cuff in the sternal notch, equal air entry bilaterally, normal breathing-bag compliance, and no increase in peak inspiratory pressures
Answer: B) Unilateral breath sounds, unexpected hypoxia, inability to palpate the ETT cuff in the sternal notch during inflation, and increased peak inspiratory pressures
72
Which cartilages of the larynx are paired? (Pick 3)
A. Thyroid
B. Arytenoid
C. Cricoid
D. Corniculate
E. Cuneiform
F. Epiglottic
Answer: B, D, & E
73
What is the most common tachyarrhythmia seen in children?
A. A. Fib
B. V. tach
C. A. Flutter
D. SVT
Answer: D. SVT
74
What is the optimal shock dose for initial cardioversion of A-flutter and other supraventricular tachycardia?
A) 25 - 50 J
B) 50 - 100 J
C) 150 - 200 J
D) 200 - 250 J
Answer: B) 50 - 100 J
75
During the anesthetization of a patient with atrial fibrillation undergoing an ablation procedure in an electrophysiology laboratory or suite, the anesthetist must remain vigilant for which of the following major complications?
Select all that apply:
A) Atrioesophageal fistula
B) Vagus nerve injury
C) Hemorrhage
D) Atrial perforation leading to cardiac tamponade
E) Phrenic nerve injury
Correct Answers:
A) Atrioesophageal fistula,
D) Atrial perforation leading to cardiac tamponade
E) Phrenic nerve injury
76
Select all that apply: Which of the following are the most frequent postoperative complications in pediatric dental patients?
A) Nausea and vomiting
B) Hypothermia
C) Crying
D) Bleeding
Correct Answer: A, C, D
77
Which of the following is acceptable according to fasting guidelines for a patient prior to electroconvulsive therapy (ECT)
a. Patient takes oral medications with water two hours prior to procedure
b. Patient has breakfast three hours prior to procedure
c. Patient eats a midnight snack the night before his procedure at 0500
d. Patient has a glass of water before getting in the car to drive 30 minutes to the procedure
Answer: A
78
What medication should be held when a patient is undergoing a CT scan with IV contrast, and why?
A. Propofol, because it reacts with the IV contrast.
B. Zofran, because it will cause worse nausea and vomiting.
C. Metformin, because of the risk of lactic acidosis.
D. No medications need to be held with IV contrast use.
Answer: C. Metformin, because of the risk of lactic acidosis.
79
Which MRI Suite Zone is described here?
“This is the area where patients are greeted, histories obtained, and questions answered. Movement by non-MRI personnel and patients is under the supervision of MRI personnel.
A) Zone I
B) Zone II
C) Zone III
D) Zone IV
Correct answer: B) Zone II
80
When considering anesthesia in the pediatric population, which age group has the greatest risk of adverse events?
A. Children under 10 years of age
B. Children under 5 years of age
C. Children ages 2 to 5 years of age
D. Age is not a factor in the pediatric population
Answer: B. Children under 5 years of age
81
Which of the following anesthetics may cause problems with In vitro fertilization procedures and should be avoided?
A. Fentanyl
B. Remifentanil
C. Alfentanil
D. Morphine
Answer: D. Morphine
82
Which of the following factors can increase the risk of adverse effects during anesthetic care in pediatric patients? Select two.
A. Utilization of multiple anesthetic agents
B. Assessment of any recent upper respiratory tract infections
C. Absence of nitrous oxide usage in combination with other sedatives
D. Procedural duration is greater than one hour
Correct Answer: A & D
83
Which of the following statements regarding perioperative management of cardiac patients is correct?
A. Beta blockers should be discontinued perioperatively to prevent bradycardia.
B. Angiotensin-converting enzyme inhibitors should always be discontinued due to the risk of intraoperative hypotension.
C. Antiplatelet therapy in patients with stents should only be discontinued after discussion between the patient, cardiologist, and surgeon.
D. Pacemakers do not require any special considerations during ambulatory procedures.
Answer: C. Antiplatelet therapy in patients with stents should only be discontinued after discussion between the patient, cardiologist, and surgeon.
84
In the PACU, A patient has the following clinical presentation: Dyspnea with shallow breathing, 3L Nasal Canula with O2 Saturation of 91%, Blood pressure 10 mmHg lower than preanesthetic level, opens eyes to voice and is able to move only their hands/arms to command. What would the Modified Aldrete score be for this patient?
A. 5
B. 6
C. 7
D. 8
Answer: B. 6
85
Which of the following are the two most frequent causes of unplanned hospital admission from ambulatory surgery centers (ASCs) and office surgery practices? (select 2)
A) Surgical site infections
B) Inadequately controlled pain
C) Delayed wound healing
D) Postoperative nausea and vomiting
Answer: B & D
86
What position should the patient be in during a colonoscopy?
A. Left lateral decubitus position
B. Prone position
C. Semiprone position
D. Supine position
Answer: A. Left lateral decubitus position
87
Which patient is at the highest risk for obstructive sleep apnea (OSA)?
A. A 23 y/o female with a BMI of 23 kg/m2
B. A 60 y/o male with a BMI of 28 and neck circumference of 30 cm
C. A 55 y/o male with a BMI of 38 kg/m2 who reports lethargy and snoring frequently during the night
D. A 70 y/o female with a BMI of 25 kg/m2 being treated for HTN
Answer: C, Screening for sleep apnea is vital, especially in outpatient surgery settings. It is highly possible that patients with OSA have not been formally diagnosed, and complications could occur if the patient's airway is not managed appropriately (difficult airway management, cardiopulmonary arrest, brain injury, etc.). The STOP-BANG questionnaire is a useful tool to determine the patient's risk for sleep apnea: Snoring, Tiredness, Observed apnea, Pressure, BMI (>35 kg/m2), Aget (>50 years), Neck (circumference >40 cm), Gender (male gender). While all answers had one or two risk factors, option C had five risk factors.
88
Which of the following best describes the primary advantage of multimodal analgesia in postoperative pain management?
A) It relies solely on opioids for pain control.
B) It targets different pain pathways to produce a synergistic effect at lower analgesic doses.
C) It is only effective for major surgical procedures.
D) It eliminates the need for pharmacologic interventions in pain management.
Answer: B) It targets different pain pathways to produce a synergistic effect at lower analgesic doses.
89
When is the appropriate time to administer succinylcholine, or other forms of neuromuscular blocking agents, during electroconvulsive therapy (ECT)?
A. Before applying the blood pressure cuff to the lower extremity
B. Immediately after induction, but before applying the blood pressure cuff
C. After the blood pressure cuff is applied and inflated on the lower extremity
D. After the seizure has been induced to prevent excessive muscle contractions
Answer: C. After the blood pressure cuff is applied and inflated on the lower extremity
90
Which of the following describes the most often used anesthetic plan for a patient undergoing radiofrequency catheter ablation (RFCA) using general anesthesia?
A. Inhaled volatile anesthetics with antiemetics to reduce postop nausea and vomiting (PONV)
B. Total intravenous anesthesia (TIVA) to optimize hemodynamic stability during pulmonary artery occlusion and reduce PONV
C. A balanced combination of volatile anesthetic and intravenous anesthetic to maintain appropriate anesthetic depth while optimizing hemodynamic stability and reduction of PONV
D. A balance of volatile anesthetic and opioid to decrease the chance of hemodynamic instability during the case
Answer: B – Total intravenous anesthesia (TIVA) to optimize hemodynamic stability and reduce PONV
91
Which Beta blocker has additional alpha blocking properties?
A. Metoprolol
B. Atenolol
C. Labetelol
D. Esmolol
Answer: C, Labetolol. Labetolol not only has the ability to block beta receptors but the alpha receptors as well. This allows Labetolol to vasodilate in addition to reducing cardiac rate and contractility.
92
Which of the following patients would direct myocardial depressant effects be more apparent with higher dose Ketamine administration? Select two.
A. 27-year-old male trauma patient
B. 57-year-old female in severe end-stage septic shock
C. 46-year-old woman with a small bowel obstruction
D. 24-year-old male with a spinal cord transection
Correct Answer: B & D
93
Which of the following inhalation anesthetics is known for causing airway irritation?
A. Isoflurane
B. Nitrous Oxide
C. Sevoflurane
D. Desflurane
Answer: D. Desflurane
94
Which of the following antiemetics are effective for postdischarge nausea and vomiting (PDNV)? (select 2)
a) Ondansetron (Zofran)
b) Metoclopramide (Reglan)
c) Scopolamine transdermal
d) Palonosetron (Aloxi)
Answer: C & D
95
Which patient requires additional education regarding sugammadex administration for surgery?
A) A 32-year-old male with a history of hypertension controlled with lisinopril.
B) A 45-year-old female with a history of asthma using albuterol as needed.
C) A 28-year-old female taking hormonal contraceptives for birth control.
D) A 60-year-old male with type 2 diabetes managed with metformin.
C) A 28-year-old female taking hormonal contraceptives for birth control.
96
Which of the following treats mild pain?
a. Ketorolac
b. Hydromorphone
c. Tylenol
d. Fentanyl
Answer: C
97
What is the primary concern regarding the respiratory effects of benzodiazepines?
A. Depressed ventilatory response to CO2
B. Increased airway resistance
C. Increased hypoxic drive
D. Benzodiazepines have no respiratory effects
Answer: A - Depressed ventilatory response to CO2
98
Which of the following opioids has the highest potency compared to morphine?
A) Hydromorphone
B) Meperidine
C) Fentanyl
D) Sufentanil
Correct answer: D) Sufentanil
99
Which of the following best describes the role of the liver in the metabolism of succinylcholine?
A) The liver directly metabolizes succinylcholine via cytochrome P450 enzymes.
B) The liver produces plasma cholinesterase, responsible for hydrolyzing succinylcholine.
C) Succinylcholine undergoes first-pass metabolism in the liver, reducing its bioavailability.
D) Succinylcholine skips the liver and is entirely excreted unchanged by the kidneys.
B) The liver produces plasma cholinesterase, responsible for hydrolyzing succinylcholine
100
Which of the following patients would most benefit from ketamine induction?
A) A patient with severe asthma
B) A patient with uncontrolled hypertension
C) A patient with schizophrenia
D) A patient with a full stomach at risk for aspiration
Correct Answer: A) A patient with severe asthma
Rationale: Ketamine is a potent bronchodilator, making it an excellent choice for patients with reactive airway disease such as asthma
101
Which of the following drugs are NMDA receptor antagonists? (Select 2)
A. Nitrous Oxide
B. Propofol
C. Ketamine
D. Etomidate
Answer: A and C
Rationale: Nitrous Oxide and Ketamine function as NMDA receptor antagonists, distinguishing them from Propofol and Etomidate, which act primarily through GABA-A receptor modulation.
102
Which of the following statements about propofol is correct?
A) Propofol is a respiratory stimulant and enhances the response to hypercarbia.
B) Propofol-induced depression of upper airway reflexes is less than that of thiopental.
C) Propofol can be administered for sedation by any healthcare personnel without specific training.
D) Propofol is a profound respiratory depressant and can cause apnea following an induction dose.
Answer: D) Propofol is a profound respiratory depressant and can cause apnea following an induction dose.
103
Which of the following drugs are alpha 2 agonists? (Select 2)
A. Carvedilol (Coreg)
B. Dexmedetomidine (Precedex)
C. Prazosin (Minipress)
D. Clonidine (Catapres)
E. Labetalol (Normodyne)
Answer: B. Dexmedetomidine (Precedex) & D. Clonidine (Catapres)
104
Which of the following best explains why neostigmine requires an anticholinergic agent for co-administration, while sugammadex does not?
A. Neostigmine directly stimulates the vagus nerve; therefore, it requires counteraction.
B. Sugammadex binds to muscarinic receptors and prevents parasympathetic effects.
C. Sugammadex increases acetylcholine breakdown, which counteracts muscarinic effects.
D. Neostigmine increases endogenous acetylcholine around the cholinoreceptors.
Answer: D. Neostigmine increases endogenous acetylcholine around the cholinoreceptors.
Rationale: Neostigmine inhibits acetylcholinesterase, which increases acetylcholine levels at the neuromuscular junction. This can cause bradycardia, arrhythmias, bronchoconstriction, and hypersalivation, so anticholinergics (glycopyrrolate or atropine) are given to counteract these effects
105
How can an anesthesia provider accelerate the onset of Rocuronium during rapid sequence intubation?
A. By priming rocuronium, which involves giving 10% of the calculated dose before inducing anesthesia and then giving the remaining dose 1 to 3 minutes after the patient is anesthetized
B. By giving a larger single bolus of rocuronium at once
C. By infusing rocuronium over 30 minutes before induction
D. By priming rocuronium by giving half the dose before inducing anesthesia and then giving the remaining dose 1 to 3 minutes after the patient is anesthetized
Answer: A. By priming rocuronium, which involves giving 10% of the calculated dose before inducing anesthesia and then giving the remaining dose 1 to 3 minutes after the patient is anesthetized.
106
Which of the following opioids is most likely to cause histamine release leading to hypotension and pruritus?
a) Fentanyl
b) Morphine
c) Remifentanil
d) Sufentanil
Answer: b) Morphine.
107
Which of the following are true about ketamine?
A. Ketamine provides dissociative sedation AND analgesia
B. Ketamine increases blood pressure and heart rate
C. Ketamine is an NMDA receptor antagonist
D. Ketamine can be administered IV, IM, and orally.
E. All of the above are true of ketamine
Answer: E. All of the above are true of ketamine.
108
After administering a neuromuscular blocking agent, you perform a train of four (TOF) assessment on the ulnar nerve and observe the absence of twitches T3 and T4. What percentage of neuromuscular blockade does this correspond with?
A. <70%
B. 75-80%
C. 85-90%
D. 80-85%
Answer: D - 80-85% block
109
Which of the following is a high-risk cardiac condition requiring elective surgery delay until further evaluation or treatment is completed?
A. Stable angina
B. Stage 1 hypertension
C. Recent myocardial infarction within 30 days
D. Controlled atrial fibrillation
Correct Answer: C. Recent myocardial infarction within 30 days
110
A patient with chronic kidney disease is scheduled for surgery. Which lab test should be checked within 6-8 hours before surgery to prevent cardiac risks?
A) Blood urea nitrogen (BUN)
B) Serum creatinine
C) Serum potassium
D) Complete blood count (CBC)
Answer: C) Serum potassium
111
For a patient with suspected or known adrenal insufficiency undergoing total joint replacement surgery, what is the recommended perioperative dose of hydrocortisone?
A. Preoperative corticosteroid dose + 25 mg
B. Preoperative corticosteroid dose + 150 mg
C. Preoperative corticosteroid dose + 40 mg
D. Preoperative corticosteroid dose + 75 mg
Answer: D
112
Which of the following are signs of upper respiratory tract infection in pediatric patients in the preoperative period? Select two.
A. Rhinorrhea
B. Auscultation of rales
C. Pulmonary congestion evidenced on a chest radiograph
D. Bulging and tender eardrums
Correct Answer: A & D
113
Which of of the following are effective preoperative strategies to prevent pulmonary complications in a patient with chronic bronchitis? (SATP)
a. Weight reduction
b. Prophylactic antibiotics to sterilize sputum
c. chest physiotherapy
d. Expectorants
Answer: a., c., d.
114
A patient with chronic obstructive pulmonary disease (COPD) presents for elective non-cardiac surgery. His arterial blood gas shows PaCO₂ of 50 mm Hg, PaO₂ of 57 mm Hg, and SpO₂ of 89%. Which of the following is the most appropriate next step?
A. Cancel surgery and consult pulmonary rehab
B. Proceed with surgery; findings are not contraindications
C. Intubate preoperatively and admit to ICU
D. Postpone surgery until PaCO₂ normalizes
Answer: B. Proceed with surgery; findings are not contraindications
115
Which of the following patients is at increased risk of awareness during surgery? Select 3
A) Female
B) Elderly
C) Smoker
D) Obese
E) Obstetric
Answer: A, D, & E
116
Which patient would be most likely to experience postoperative nausea and vomiting?
A. 85 year-old female with osteoporosis
B. 30 year-old male with a history of tobacco abuse
C. 28 year-old female with vertigo
D. 76 year-old male with coronary artery disease.
Answer: C
117
Which of the following is not considered an acceptable clear liquid that can be consumed up to 2 hours before a surgical procedure?
A. Beef Broth
B. Popsicle
C. Clear Jell-O
D. Fat Free Milk
Answer: D. Fat Free Milk
118
What is the “surgical stress response” characterized by? (select all that apply)
A) Temporary increase in liver enzymes
B) Induction of a catabolic state
C) Decreased peripheral glucose uptake
D) Uncontrolled postoperative pain
E) Increased endogenous glucose production
Correct answer: B) Induction of a catabolic state, C) Decreased peripheral glucose uptake E) Increased endogenous glucose production
119
During a critical healthcare-related incident where the patient is harmed, who would be considered the second victim?
A. The family of the patient
B. The hospital shareholders
C. The healthcare provider caring for the patient
D. The local community
Answer: C, Healthcare provider caring for the patient.
120
Which of the following anesthetic agents is most commonly associated with elevated incidences of emergence delirium in pediatric patients?
A. Midazolam
B. Dexmedetomidine
C. Sevoflurane
D. Propofol
Answer: C - Sevoflurane
121
Urinary output and voiding are essential monitoring assessments for post-spinal and epidural anesthesia. Diabetic patients can develop postoperative urinary retention (POUR). What is the amount in the bladder immediately after spinal anesthesia that indicates a predictor of POUR?
A. Greater than 400 to 500 mL
B. Greater than 600 to 700 mL
C. Greater than 800 to 1000 mL
D. Greater than 200 to 300 mL
Answer: A. 400 to 500 mL
122
Which of the following has been attributed to approximately 20% of intraoperative anaphylactic reactions?
A. Latex
B. Antibiotics
C. Opioids
D. Propofol
Answer: Latex
123
Which of the following is associated with the highest risk for perioperative MI?
A. Substernal discomfort brought on by exertion
B. Blood pressure of 130/80
C. Angina relieved by nitroglycerin in less than 15 minutes
D. Newly developed angina within the past 2 months
Answer: D. Newly developed angina within the past 2 months
124
Which of the following patients is at the highest risk for postoperative nausea and vomiting (PONV)?
A. A 65-year-old male with a history of smoking undergoing bowel resection and has an NG tube
B. A 45-year-old nonsmoker female with a history of motion sickness undergoing breast surgery
C. A 30-year-old male with no history of motion sickness undergoing knee arthroscopy
D. A 70-year-old female undergoing cataract surgery under local anesthesia and mild sedation
Answer: B. A 45-year-old nonsmoker female with a history of motion sickness undergoing breast surgery
125
Which of the following findings indicate poor ventricular function?
A) Cardiac index > 2.5 L/min/m², left ventricular end-diastolic pressure < 12 mm Hg, and ejection fraction (EF) > 50%.
B) Cardiac index < 2.2 L/min/m², left ventricular end-diastolic pressure > 18 mm Hg, and ejection fraction (EF) < 40%.
C) Presence of ischemia-induced hypokinesis, which always indicates nonviable myocardium.
D) Pulmonary wedge pressure waveform is not influenced by ischemia-induced papillary muscle dysfunction.
Answer: B) Cardiac index < 2.2 L/min/m², left ventricular end-diastolic pressure > 18 mm Hg, and ejection fraction (EF) < 40%.
126
In a patient with a recent history of illicit drug use, abstinence syndrome typically exhibits as:
A) An increase in sympathetic response
B) An increase in parasympathetic response
C) A decrease in parasympathetic response
D) An increase in both sympathetic and parasympathetic response.
D) Increased in both sympathetic and parasympathetic response
127
Which of the following are optimal indications for cell salvage techniques, such as Cell Saver? Select two.
A. Hip replacement with an anticipated blood loss of >500mL
B. Surgical debulking of a malignant peritoneal tumor
C. Exploratory laparotomy following a gunshot wound to the abdomen
D. Jehovah’s Witness patient undergoing a spinal fusion
Correct Answer: A & D
128
Select All That Apply (Pick 3)
Which are common indications for using colloid fluids over crystalloids?
A. Sepsis
B. Severe hypoalbuminemia
C. Massive third spacing
D. Fluid replacement under 2 liters
E. Buying time before blood availability
Correct Answers:
B. Severe hypoalbuminemia
C. Massive third spacing
E. Buying time before blood availability
129
Which of the following are causes of hypocalcemia? [Select 2]
A. Hyperparathyroidism
B. Vitamin D deficiency
C. Hyperphosphatemia
D. Thiazide diuretic administration
Answer: B and C
130
Which of the following are chloride-sensitive causes for metabolic alkalosis? (SATP)
a. Vomiting
b. Diuretics
c. Hyperaldosteronism
d. Cystic fibrosis
Answer: a., b., d.
131
Which of the following relationships is the basis for the Frank-Starling mechanism?
A. Systemic vascular resistance (SVR) and left ventricular end-diastolic volume (LVEDV)
B. Cardiac output and left ventricular end-systolic volume (LVESV)
C. Myocardial contractility and systemic vascular resistance (SVR)
D. Left ventricle end-diastolic volume (LVEDV) and Myocardial contractility
Answer: D
132
Once a patient with hyponatremia is clinically stable, what is the recommended maximum rate at which serum sodium (Na⁺) should be increased to avoid the risk of osmotic demyelination syndrome?
A) 5-8 mmol/L in 24 hours
B) 8 mmol/L in 24 hours
C) 10–15 mmol/L in 24 hours
D) 20-25 mmol/L in 24 hours
Correct Answer: C) 10–15 mmol/L in 24 hours
133
Which of the following regulate or contribute to the release of ADH and, thereby, control plasma osmolality? (select all that apply)
A. Osmoreceptors in the hypothalamus
B. The anterior pituitary
C. The renal collecting tubules
D. Carotid baroreceptors
E. The posterior pituitary
F. Low pressure volume receptors in the atria, vena cavae, and pulmonary arteries.
Correct Answer: A, D, E, F
134
What daily fluid volume would a 100 kg patient need in order to maintain Total Body Water homeostasis? Assume the person is healthy, normothermic, and has standard metabolic function.
A. 2 Liters
B. 3 Liters
C. 4 Liters
D. 5 Liters
Answer: B. 3 Liters.
135
What is the most common electrolyte abnormality in hospitalized patients?
A. Hyperkalemia
B. Hypocalcemia
C. Hyponatremia
D. Hyperphosphatemia
Correct Answer: C
136
Which of the following best distinguishes nephrogenic diabetes insipidus (DI) from central DI?
A. Nephrogenic DI often develops due to lesions in the brain
B. Central DI shows no response to antidiuretic hormone (ADH) administration
C. Nephrogenic DI involves impaired renal response to normal ADH levels
D. Central DI is commonly associated with lithium therapy
Correct Answer: C. Nephrogenic DI involves impaired renal response to normal ADH levels
137
Which of the following is a key component of patient blood management (PBM) in the perioperative period?
A. Delaying anemia treatment until after surgery
B. Routine transfusion of all patients undergoing major surgery
C. Optimization of the patient’s red blood cell production
D. Ignoring mild anemia if the patient is asymptomatic
Correct Answer: C. Optimization of the patient’s red blood cell production
138
A trauma patient is receiving massive transfusion of packed red blood cells intraoperatively. Which electrolyte imbalance is most likely to occur due to the citrate preservative in the blood products?
A) Hyperkalemia
B) Hypocalcemia
C) Hypernatremia
D) Hypomagnesemia
Answer: B) Hypocalcemia
139
Which of the following is NOT a recommended indication for platelet transfusion?
A. Platelet count <10 × 10⁹ cells/L in a non-bleeding patient
B. Platelet count <50 × 10⁹ cells/L with active bleeding
C. Mild thrombocytosis without bleeding
D. Platelet dysfunction
Answer: C. Mild thrombocytosis without bleeding
140
According to Enhanced Recover After Surgery (ERAS) protocol, which of the following is NOT correct regarding the preoperative fluid management fasting intervals?
A. Clear liquids: 2 hours
B. Breast milk: 2 hours
C. Formula/non-human milk/light meal: 6 hours
D. Heavy meal (fried foods, fatty foods, meats): 8 hours.
Answer: B. Breast milk: 2 hours
Rationale: The preoperative fasting guidelines recommend the following fasting intervals: clear liquids 2 hours, breast milk 4 hours, infant formula/nonhuman milk/light meal 6 hours, and heavy meal (fried foods, fatty foods, meats) 8 hours.
141
A patient presented to the emergency department 2 days prior with heart failure and fluid overload. The patient has been NPO during this time and is receiving loop diuretics to offload fluid. The patient is preparing for a heart cath when the nurse anesthetist notices the patient's ECG: A pronounced P wave, a flattened T wave, and a prominent U wave. What condition should the CRNA suspect?
A. Hyperkalemia
B. Hypokalemia
C. Hypercalcemia
D. Hypocalcemia
F. Wolff-Parkinson-White Syndrom
B. Hypokalemia. The ECG represents a classic presentation of hypokalemia. Assumably, the hypokalemia was brought on by a decreased dietary potassium intake and the administration of loop diuretics. Conversely, hyperkalemia is presented with a flattened P wave, widened QRS, shortened QT interval, and peaked T wave.
142
Which of the following findings is most consistent with Transfusion-Associated Circulatory Overload (TACO) rather than Transfusion-Related Acute Lung Injury (TRALI)?
A. Hypotension
B. Fever and chills
C. Hypertension
D. Acute hypoxemia within 6 hours of transfusion
Answer: C. Hypertension
143
The anesthesia provider is looking at the patient's history and medication list. The anesthesia provider confirmed with the nurse that the patient is taking a scheduled dose of an ACE inhibitor (lisinopril) and a Beta blocker (metoprolol) to control their blood pressure. The patient is scheduled for surgery in the next 10 hours. What electrolyte abnormality would you see in the patient if it is not corrected by goal-directed fluid therapy?
A. hyponatremia and hyperkalemia
B. hypernatremia and hypokalemia
C. hypernatremia and hyperkalemia
D. hypercalcemia and hypocalcemia
Answer: A. hyponatremia and hyperkalemia
Rationale: Medications such as ACE inhibitors, beta blockers (specifically Beta 1 receptor antagonism), ARBs, and digoxin can cause an increase in extracellular potassium. ACE inhibitors and ARBs can cause a decrease in angiotensin, and beta blockers inhibit renin release, which decreases the release of aldosterone. A decrease in aldosterone can cause hyperkalemia and hyponatremia.
144
What is the ultimate goal of perioperative goal-directed fluid therapy (GDFT)?
A. To administer a fixed volume of fluids to all patients.
B. To utilize individual hemodynamic end points to achieve an optimal cardiac output and oxygen delivery to tissues.
C. To minimize the use of vasopressors during surgery, thus decreasing increased oxygen demand.
D. To aim for a "zero balance" between intake and output to minimize excess fluid administration by only replacing the estimated blood loss during surgery.
Correct Answer: B. To utilize individual hemodynamic end points to achieve an optimal cardiac output and oxygen delivery to tissues.
145
What is a consequence of venous air embolism (VAE), and how is it identified?
A. VAE will decrease dead space, causing an ABG to show alkalosis.
B. VAE will result in increased perfusion, causing increased EtCO2.
C. VAE increases dead space, causing EtCO2 to decrease.
D. VAE decreases dead space, causing EtCO2 to decrease.
Answer: C - VAE increases dead space and causes EtCO2 to decrease.
146
Which of the following statements best describes how the lithotomy position can affect blood pressure during surgery?
A. It causes blood pooling in the lower extremities, falsely lowering the blood pressure.
B. Tilting the head down increases venous return, leading to consistently elevated blood pressure.
C. Leg elevation above the trunk increases central blood volume, potentially leading to falsely elevated blood pressure.
D. Blood pressure readings are not affected because the legs are at the same level as the heart.
Answer: C. Leg elevation above the trunk increases central blood volume, potentially leading to falsely elevated blood pressure.
147
Which of the following factors are associated with to nerve injuries in the operating room? (SATA)
A) Extremes of body habitus such as obesity or malnutrition.
B) Preexisting conditions like hypertension, diabetes mellitus, peripheral vascular disease and alcoholism.
C) Orthopedic surgical cases, specifically joint replacements
D) Prolonged surgical times.
E) Anesthetic techniques that include hypotension with poor perfusion, neuromuscular blockade with allows extremes in stretching that can cause harm, and positioning devices used incorrectly.
Correct Answers: A, B, D, E
148
What type of nerve injury occurs when the nerve is pulled across immovable structures?
A) Compression injury
B) Transection injury
C) Traction injury
D) Crush injury
Answer: C) Traction injury
149
Which nerve is most at risk from compression at the fibular head in the lithotomy position?
A. Sciatic nerve
B. Femoral nerve
C. Peroneal nerve
D. Obturator nerve
Correct Answer: C. Peroneal nerve
149
What surgical position carries the highest risk for compartment syndrome in lower extremities?
A) Prone
B) Supine
C) Lateral decubitus
D) Lithotomy
Correct Answer: D)
150
Which of the following statements regarding operating room safety standards is incorrect?
A. Healthcare providers must have radiation level monitoring if exposed to greater than 40 REM (Roentgen equivalent in man).
B. Air volume exchanges should occur every 15 minutes, as per the NFPA.
C. Operating room humidity should be maintained between 20% and 60%.
D. The ambient operating room temperature should be maintained between 68°F (20°C) and 75°F (24°C).
Correct Answer: B. Air volume exchanges should occur every 15 minutes per NFPA.
151
What is the most common metabolic disease associated with spontaneous isolated femoral neuropathy?
A) Hypertension
B) Diabetes
C) Peripheral vascular disease
D) History of smoking within 5 months
Correct Answer: B) Diabetes
152
How much does the Mean Arterial Pressure (MAP) increase or decrease by per inch change in height between the heart and a body region?
A) 1mmHg
B) 2mmHg
C) 3mmHg
D) 4mmHg
Answer: B) 2mmHg
153
Which crew resource management principle is described as the most important for operating room safety?
A. Communication
B. Leadership
C. Assertiveness
D. Situational awareness
Answer: D. Situational awareness
154
What is the maximum leakage current allowed in the Operating Room?
A. 10 milliamperes (mA)
B. 10 microamperes (μA)
C. 100 microamperes (μA)
D. 100 milliamperes (mA)
Answer: B. 10 microamperes (μA).
155
Which of the following is typically the responsibility of the anesthesia provider in the event of an intra-operative fire?
A. alcohol-based solutions, drapes, adhesive removers, and towels
B. electrocautery, drills, lasers, burrs, and light-sources
C. oxygen and nitrous oxide concentrations
D. None of the above
Answer: C
156
Which of the following nerves in the leg is most susceptible to injury from OR table straps that are placed too tightly?
A. Lateral femoral cutaneous nerve
B. Radial nerve
C. Saphenous nerve
D. Deep peroneal nerve
Answer: A: Lateral femoral cutaneous nerve
157
Which of the following statements best describes the cardiovascular response to Trendelenburg positioning in hypotensive patients?
A. It consistently increases mean arterial pressure (MAP) and cardiac index (CI)
B. It leads to predictable improvements in stroke volume and venous return
C. It may increase central venous pressure (CVP) but not necessarily improve cardiac output or MAP
D. It effectively treats hypovolemia by redistributing blood volume
C. It may increase central venous pressure (CVP) but not necessarily improve cardiac output or MAP
158
When a patient is placed in a steep Trendelenburg position, what happens to the endotracheal tube, which is a complication of the patient's airway?
A. Inadvertently right mainstem movement of the endotracheal tube
B. inadvertently left mainstem movement of the endotracheal tube
C. No movement of the endotracheal tube happens
D. The endotracheal tube may become obstructed by gastric contents due to increased aspiration risk
Answer: A. Right mainstem movement of the endotracheal tube placement
159
What is the most sensitive noninvasive device to identify a venous air embolism (VAE)?
A. Transesophageal echocardiogram (TEE)
B. Precordial Doppler
C. End-Tidal CO2 (EtCO2)
D. Transcranial Doppler
Answer: B. Precordial Doppler
160
While the fibrillation threshold is 100 mA even small electrical shocks can cause ventricular fibrillation if the shock occurs at which point on an ecg?
A. On the P wave
B. On the R wave
C. Just after the S wave
D. On the T wave
Answer: D
161
Which of the following is the most likely clinical consequence of ulnar neuropathy resulting from improper surgical positioning?
A. Inability to extend the wrist and loss of sensation to the lateral forearm
B. Diminished grip strength and inability to flex the elbow
C. Inability to oppose the fifth finger and sensory loss in the fourth and fifth digits
D. Numbness over the posterior upper arm and medial forearm
Correct Answer: C. Inability to oppose the fifth finger and sensory loss in the fourth and fifth digits
162
Select the true statement regarding capnography:
A. Capnography is inaccurate and not a reliable source of CO2 monitoring
B. Capnography is not necessary when a pulse oximetry probe is in place
C. Capnography is accurate and only 2-5 tor lower than PaCO2
D. Capnography is moderately accurate and regular arterial blood gases must be compared to ensure EtCO2 accuracy
Answer: C, Capnography is a highly accurate method of measuring a patient’s carbon dioxide levels. EtCO2 is only lower than PaCO2 by 2-5 tor which allows anesthesia providers to use capnography to monitor their patients’ ventilation status (Elisha et al., 2022).
163
An anesthesia provider hears a pressure alarm, and notes increased inhaled CO2 levels with an abnormally long downstroke on the capnogram. What should the provider first check?
A. Check the inspiratory valve on the circle circuit
B. Check the expiratory valve on the circle circuit
C. Trouble shoot the scrubber on the circle circuit
D. Check the Y-piece for disconnection
Answer: A, When a unidirectional valve in a circle system is compromised, exhaled CO2 can build up causing increased inhalation of CO2. With the failure of an expiratory valve, the capnography demonstrates an elevated CO2 level, but the waveform remains unchanged. Failure of an inspiratory valve can lead to not only increased CO2 levels, but also an increased downstroke on the capnograph (Elisha et al, 2022).
164
All can increase EtCO2 except:
A. Incompetent expiratory valve
B. Incompetent inspiratory valve
C. Increasing fresh gas flow
D. Malignant hyperthermia
Answer: C, increasing fresh gas flow will decrease CO2 levels. Incompetent expiratory and inspiratory valves can result in rebreathing CO2. Malignant hyperthermia results in the increased production of CO2 which can result in elevated EtCO2 levels (Elisha et al., 2022).
165
You note an increase in CO2 and upon further inspection, the cannister color has changed. What is the best course of action?
A. Increase fresh gas flow rate and wait until after the procedure to change CO2 absorber cannister
B. Change CO2 absorber cannister immediately
C. Monitor for arrhythmias and change absorber cannister after the case
D. Disconnect patient circuit and use the Ambubag to ventilate the patient
Answer: A, Carbon dioxide absorbers are critical components of an anesthesia machine. However, it is dangerous to change an absorber mid case. Instead, the anesthesia provider should
increase fresh gas flows to limit the amount of CO2 inspired and finish the case. After, the cannister can be safely changed. (Elisha et al., 2022).
166
While administering general anesthesia, the provider notes a waveform depression during phase III on the EtCO2 monitor. What should the provider’s next action be?
A. The patient is experiencing a bronchospasm. Deepen sedation and administer albuterol.
B. There is a blockage in the breathing circuit. Switch to ambubag and manually ventilate.
C. The circuit is disconnected. Confirm y-piece is in place.
D. The patient is attempting spontaneous breathing. Deepen sedation.
Answer: D, When there is a slight depression during phase III of a capnogram, it could indicate that the patient is trying to breath spontaneously. This could indicate that the provider needs to increase sedation (Butterworth et al., 2022)
167
What is not a feature of the diverting (side stream) EtCO2 monitor.
A. It measures concentrations of CO2 and anesthetic gases
B. It scavenges gas and transports it to the monitor
C. The sensor directly rests in an adapter between the circuit and mouth piece
D. It creates minimal dead space
Answer: C, In diverting (side stream) EtCO2 monitors, the exhaled gas from the patient is scavenged and transported to the monitor where the gas is analyzed. This reduces weight to the
circuit, reduces the amount of dead space, and allows the monitor to analyze the concentration of other anesthetic gases, not just CO2 (Elisha et al., 2022).
168
What are the uses of precordial and esophageal stethoscopes (Select all that apply)
a. To confirm placement of endotracheal intubation
b. To identify ventilator circuit disconnections
c. To gain visuals of the pharynx
d. To auscultate heart and lung sounds
Answer: A, B, D
Rationale: The three main uses of precordial and esophageal stethoscopes are confirming placement
of endotracheal intubation, identifying ventilator circuit disconnections, and auscultating heart and
lung sounds. While the esophageal stethoscope can be used as a carrier for various devices, a camera
for pharynx visualization is not one of them.
169
In what scenario is the esophageal stethoscope superior to a regular binaural external
stethoscope
a. Anesthesia provider would like to know the quality of breath sounds in an intubated patient with
COPD, but auscultation proves difficult through external stethoscope due to elevated BMI
b. Anesthesia provider is unsure if the endotracheal tube entered the right mainstem bronchus
c. The anesthesia provider wants a clearer auscultation of a heart murmur on a non-intubated patient.
d. Provider needs to assess for return of bowel sounds after surgery
Answer: A
Rationale: An esophageal stethoscope can provide clearer auscultation of breath sound quality,
especially for patients with elevated BMI. These devices are centrally located and, therefore, cannot
determine bilateral breath sounds. They can only be used on intubated patients and are unable to
assess bowel sounds from their position.
170
Which patient is a candidate for placement of an esophageal stethoscope
a. 45-year-old male with esophageal varices
b. 78-year-old female receiving general anesthesia for an ex-lap
c. 63-year-old female with a history of esophageal stricture
d. 15-year-old male receiving conscious sedation for a re-alignment of a dislocated shoulder
Answer: B
Rationale: The 78-year-old female can receive an esophageal stethoscope as she has no stated
contraindications and will be intubated for surgery. The 15-year-old male will not be intubated.
Placement of an esophageal probe in those with a history of strictures or esophageal varices may result
in perforation and/or bleeding.
171
What are the steps included in placing a precordial stethoscope (Select all that apply)
a. Place metallic bell onto the patient’s chest at the sternal notch
b. Ensure the adhesive side is facing away from the patient so that it does not adhere to skin
c. Place earpiece in ear
d. Cleanse device between uses
Answer: A, C, D
Rationale: The adhesive side of the metallic bell on a precordial stethoscope must be applied to the
patient's skin to prevent the device from moving
172
What are the steps included in placing an esophageal stethoscope?
a. Wash hands and apply gloves
b. Apply lubricant to the balloon tip of the esophageal stethoscope catheter
c. slide catheter through the pharynx and into the esophagus
d. Clean thoroughly before applying to next patient
Answer: A, B, C
173
Which of the following are the advantages of noninvasive blood pressure monitoring over invasive techniques? Select all that apply (select 2).
A. Measurement of blood pressure with reduced infectious risks
B. Provides a direct measurement of arterial blood pressure
C. Achievable blood pressure measurement without potential risk for nerve damage
D. Continuous blood pressure measurement within some applications
Correct Answer: A & D
Rationale
Noninvasive blood pressure monitoring is performed with a reduced infectious risk due to the absence of direct arterial cannulation (Butterworth et al., 2022, p. 83). Continuity of blood pressure measurement can be achieved via some noninvasive methods due to innovations in techniques such as the ClearSight finger cuff system, which allows for continuous beat-to-beat arterial blood pressure monitoring (Elisha et al., 2023, pp. 386-387).
174
Which factors contribute more substantially to the accuracy of noninvasive blood pressure cuffs in the operating room? Select all that apply (select 2).
A. Moderate peripheral vasoconstriction
B. Suitably sized blood pressure cuff
C. Extremity that the cuff is placed
D. The cuff position in relation to the patient’s heart
Correct Answer: B & D
Rationale
The proper sizing and positioning of the patient’s blood pressure cuff are directly related to the validity of the measurements that the anesthesia provider will achieve (Butterworth et al., 2022, p. 80). The cuff's position in relation to the patient's heart can gravely affect the measurement results. Elevating a patient's extremity with the cuff can falsely decrease readings while decreasing elevation can cause falsely high readings (Butterworth et al., pp.76-77).
175
Which of the following statements is true regarding properly sizing a patient's blood pressure cuff?
A. The width of the cuff should extend 40% of the length of the patient's extremity
B. A cuff’s bladder that encompasses 50% of the circumference of the extremity is appropriate
C. Too narrow of a cuff will require less pressure to occlude an artery for pressure determination
D. Falsely high measurements are achieved when the cuff is too large for a patient
Correct Answer: B
Rationale
The proper sizing of a blood pressure cuff is determined by a bladder that encompasses at least 50% of the circumference of a patient’s extremity and a width that is approximately 40% greater than the extremity's diameter (Butterworth et al., 2022, p. 80). Cuff sizes that are too large for patients can achieve falsely low measurements. Too narrow of a cuff will require greater pressure to occlude an artery for measurement (Butterworth et al., 2022, p.80).
176
Which of the following patients would noninvasive blood pressure monitoring be considered inappropriate?
A. An 87-year-old male undergoing a scheduled cholecystectomy
B. A 75-year-old female undergoing a cataract removal
C. A 54-year-old male with full-thickness burns to upper and lower extremities
D. A 29-year-old male receiving a blood transfusion preoperatively
Correct Answer: C
Rationale
Patients with open injuries to multiple sites where noninvasive blood pressure monitoring is achieved should be reconsidered for alternative monitoring due to the risk of further harm from repetitive blood pressure cuff inflation. Accessibility of measurement sites is a determinant of noninvasive monitoring usage (Butterworth et al., 2022, p. 76).
177
Why is the upper arm the most desirable position for a blood pressure cuff in pediatric patients?
A. Decreased potential for nerve palsies
B. For the preservation of forearms/wrists for peripheral IV sites
C. Produces less discomfort in children
D. It is a closer indicator of cerebral perfusion pressure
Correct Answer: D
Nerve palsies can occur in patients undergoing repetitive noninvasive cuff measurement if the cuff is not routinely repositioned (Butterworth et al., 2022, p. 80). However, this is not the reason for desirability in pediatrics. Upper extremity positioning is preferred in pediatric patients as it has been shown to have the most significant clinical correlation to cerebral perfusion pressure (Barash et al., 2017, p. 717).
178
Which patients would prove to be ineffective for blood pressure monitoring via oscillometry? Select TWO.
A. 75-year-old female undergoing cardiopulmonary bypass
B. 56-year-old male scheduled for an exploratory laparotomy
C. 66-year-old male with severe arteriosclerosis undergoing an angioplasty
D. 45-year-old female scheduled for a colectomy
Correct Answer: A & C
Rationale
The noninvasive blood pressure techniques of palpation, auscultation, and oscillometry require pulsatile blood flow to achieve effective measurement. Cardiopulmonary bypass and highly sclerotic arterial disease can cause decreased to minimal pulsatile flow, which is necessary for oscillometry to achieve an effective reading (Barash et al., 2017, p. 717).
179
Which of the following statements about ECG lead selection are correct? (Select all that apply)
A. Lead II is commonly used for arrhythmia detection.
B. Lead V5 is optimal for detecting ischemia in the anterior and lateral walls.
C. A modified V5 lead can be achieved using a 3-lead system.
D. The standard 3-lead system provides the most comprehensive ischemia monitoring.
E. The best ECG lead for ischemia detection is always Lead I.
Correct Answers:
● A,B,C
180
What are common causes of ECG artifacts? (Select all that apply)
A. Patient movement
B. Electrocautery interference
C. Faulty electrodes
D. Low heart rate
E. 60-Hz electrical interference
Correct Answers:
· A,B,C,E
181
How can ECG signal quality be improved? (Select all that apply)
A. Ensuring proper electrode placement
B. Using conductive gel to lower skin resistance
C. Positioning lead wires parallel to power cords
D. Selecting an appropriate filter setting for motion artifacts
E. Avoiding the use of a precordial lead
Correct Answers:
· A,B,D
182
Which ECG lead combination provides the highest sensitivity for detecting myocardial ischemia?
A. Lead I and Lead II
B. Lead II and Lead III
C. Lead II and Lead V5
D. Lead V1 and Lead V4
Correct Answer
· C
183
What is the primary function of the 3-lead ECG system in anesthesia?
A. Continuous ischemia monitoring
B. Basic arrhythmia detection
C. Comprehensive cardiac assessment
D. Diagnosing complex conduction abnormalities
Correct Answer:
· B
184
A 62-year-old male with a history of hypertension and diabetes is scheduled for an elective laparoscopic cholecystectomy. During preoperative evaluation, he reports experiencing exertional chest discomfort over the past few weeks. A preoperative ECG shows 1.5 mm ST-segment depression in leads V4 and V5, recorded 80 msec after the J-point.
What is the most likely cause of this ECG finding, and what should be the next step in management?
A. Normal variant, proceed with surgery without further testing
B. Myocardial ischemia, consider further cardiac evaluation
C. Electrolyte imbalance, check potassium and calcium levels
D. Pericarditis, look for PR segment depression
Correct Answer:
· B
185
Why is neuraxial anesthesia above T6 avoided primarily in COPD patients?
A) Potential for increase in functional residual capacity and reduced preload
B) Potential for decrease in respiratory drive and anxiety
C) Potential for decreases in expiratory residual capacity and restriction of accessory muscle use
D) Potential for vasodilation and decreased cardiac output
Correct Answer: C) Decreases ERV and restricts accessory muscle use
Rationale: High spinal or epidural blocks can impair the use of accessory muscles needed for breathing, especially in COPD patients. While neuraxial anesthesia can cause vasodilation and decreased cardiac output, this is not the primary concern.
186
What is the most appropriate intraoperative management strategy for a patient with pulmonary hypertension undergoing surgery?
A) Use nitrous oxide for anesthesia
B) Aggressively lower blood pressure with propofol
C) Avoid hypoxemia, hypercarbia, and acidosis
D) Administration of ketamine for induction
Correct Answer: C) Avoid hypoxemia, hypercarbia, and acidosis
Rationale: These conditions increase pulmonary vascular resistance and can worsen pulmonary hypertension and right heart strain. Use of nitrous oxide is not recommended as it impairs the delivery of higher levels of FiO2 and can increase pulmonary vascular resistance (PVR). Use of ketamine is not recommended as it can also increase PVR.
187
What is a common early sign of pulmonary embolism during general anesthesia?
A) Bradycardia and hypoventilation
B) Decreasing end-tidal CO₂ and tachycardia
C) Sudden fever and hypertension
D) Sudden, unexplainable respiratory alkalosis
Correct Answer: B) Decreasing end-tidal CO₂ and tachycardia
188
What ventilator management strategy is most appropriate for a COPD or Asthmatic patient to reduce air trapping during surgery?
A) Increase respiratory rate and PEEP
B) Use a 1:1 I:E ratio
C) Increase tidal volume
D) Prolong expiratory time (e.g., I:E ratio of 1:3 or 1:4)
Correct Answer: D) Prolong expiratory time (e.g., I:E ratio of 1:3 or 1:4)
189
Which of the following anesthetic agents should be avoided in patients with pulmonary hypertension due to its effect on increasing pulmonary vascular resistance (PVR)?
A) Etomidate
B) All barbiturates
C) Ketamine
D) Nitric Oxide
Correct Answer: C) Ketamine
Rationale: Ketamine increases pulmonary vascular resistance and should be avoided in patients with pulmonary hypertension to prevent right ventricular strain or failure. Barbiturates are not specifically mentioned in the text in regard to their effect on PVR. Nitric Oxide causes a vasodilation of the pulmonary vasculature and is a useful took in the treatment of pulmonary hypertension. Etomidate has little effect on hemodynamics and is considered a great choice for a cardio-stable induction medication.
190
During a routine surgical case, the nurse anesthetist identifies a “shark fin” sign on ETCO2 waveform and the sudden increase of inspiratory pressures on the ventilator. Upon auscultating the patient, the anesthetist hears wheezing and decreased air movement. What should the nurse anesthetist suspect and what should their next steps be?
A) Flash pulmonary edema; administer high FiO2 and diuretics
B) Laryngospasm; Deepen level of anesthesia and administer a neuromuscular blocker to prevent negative pressure pulmonary edema.
C) Bronchospasm; Deepen level of anesthesia and administer a short-acting beta2 agonist
D) Pulmonary Embolism; Increase FiO2 to 100%, stop anesthetic agent, and treat hypotension.
Correct Answer: C) Bronchospasm; Deepen level of anesthesia and administer a short-acting beta2 agonist
191
Why is pulse oximetry not a reliable indicator of ventilation adequacy?
A. It is affected by ambient light.
B. It detects oxygen saturation but not carbon dioxide levels.
C. It does not work during apnea.
D. It cannot detect low perfusion states.
Correct Answer: B. It detects oxygen saturation but not carbon dioxide levels.
192
Which strategy minimizes pulse oximetry inaccuracies in low perfusion states?
A. Increase the oxygen flow rate.
B. Use a central monitoring site (e.g., forehead, nose, ear).
C. Change to a different wavelength.
D. Remove ambient light sources in the operating room.
Correct Answer: B. Use a central monitoring site (e.g., forehead, nose, ear).
193
Which of the following wavelengths is absorbed more by deoxygenated hemoglobin?
A. 940 nm
B. 660 nm
C. 800 nm
D. 500 nm
Correct Answer: B. 660 nm
194
At what PaO₂ does the oxygen dissociation curve plateau, indicating minimal changes in SpO₂?
A. 20 mmHg
B. 40 mmHg
C. 60 mmHg
D. 75 mmHg
Correct Answer: D. 75 mmHg
195
What happens to the SpO2 when the oxyhemoglobin dissociation curve has a rightward shift?
A. Hemoglobin binds oxygen more tightly, increasing SpO2
B. Hemoglobin releases oxygen more readily, decreasing SpO2
C. Oxygen saturation increases for a given PaO₂.
D. The curve flattens significantly at all PaO₂ levels.
Correct Answer: B. Hemoglobin releases oxygen more readily.
196
What effect does methylene blue have on pulse oximetry readings?
A. Causes falsely high SpO₂ readings.
B. Causes falsely low SpO₂ readings.
C. Does not affect SpO₂ readings.
D. Stops the device from functioning
Correct Answer: B. Causes falsely low SpO₂ readings.
197
Which leads correspond to the inferior wall of the heart and the right coronary artery (RCA)?
A. V1, V2
B. II, III, aVF
C. I, aVL, V6
D. V3, V4
E. V5, V6
F. aVR, V1
Correct Answer: B
198
Which of the following abnormalities on an EKG is most associated with ST-elevation myocardial infarction (STEMI)?
A. T wave inversion only
B. Wide QRS complex
C. ST elevation in contiguous leads
D. Irregular rhythm
E. Prolonged QT interval
Correct Answer: C
199
What is considered a normal PR interval?
A. <0.08 sec
B. 0.08–0.10 sec
C. 0.12–0.20 sec
D. >0.24 sec
Correct Answer: C
200
Which electrolyte imbalance is commonly associated with peaked T waves?
A. Hypocalcemia
B. Hypophosphatemia
C. Hypokalemia
D. Hypernatremia
E. Hypercalcemia
F. Hyperkalemia
Correct Answer: F
201
Which chest leads are most sensitive for detecting myocardial ischemia?
A. V1–V2
B. V3–V5
C. I, II, III
D. aVR, aVL, aVF
Correct Answer: B
202
Which volatile anesthetic-related phenomenon can worsen myocardial ischemia?
A. Coronary steal phenomenon
B. Pulmonary shunt
C. Central venous pooling
D. Decreased heart rate
E. Increased systemic vascular resistance
Correct Answer: A
203
As a general principle, the comfort of operating room personnel must be balanced with patient care. For adult patients, what is the recommended ambient room temperature range in the operating room?
A) 68°F to 75°F (20°C to 24°C)
B) 60°F to 65°F (15°C to 18°C)
C) 75°F to 80°F (24°C to 27°C)
D) 80°F to 85°F (27°C to 29°C)
Correct Answer: A) 68°F to 75°F (20°C to 24°C)
204
Which of the following statements about hypothermia in the operating room is correct? ( Select 3 choose)
A) Hypothermia is defined as a core body temperature of less than 36°C.
B) General and regional anesthesia is a potential cause of intraoperative hypothermia.
C) Conductive heat loss is the primary mechanism of heat loss in the operating room.
D) Radiant heat loss is considered the greatest source of heat loss in preoperative and operative settings.
Correct Answers:
A) Hypothermia is defined as a core body temperature of less than 36°C.
B) Epidural anesthesia is a potential cause of intraoperative hypothermia.
D) Radiant heat loss is considered the greatest source of heat loss in preoperative and operative settings.
205
Which of the following statements about malignant hyperthermia is correct?
A) Hyperthermia is always the first sign of malignant hyperthermia.
B) When hyperthermia occurs in malignant hyperthermia, core temperature can increase by 1°C every 5 minutes.
C) Malignant hyperthermia typically develops slowly over several hours.
D) Core temperature changes in malignant hyperthermia are minor and rarely significant.
Correct Answer: B) When hyperthermia occurs in malignant hyperthermia, core temperature can increase by 1°C every 5 minutes.
206
Which of the following statements about preoperative warming is correct?
A) Prewarming the patient for 30 minutes with convective, forced-air warming blankets helps reduce the initial drop in core temperature.
B) Preoperative warming is ineffective in preventing perioperative hypothermia.
C) Prewarming works by increasing metabolic heat production.
D) The central-peripheral temperature gradient increases after prewarming.
Correct answer
A) Prewarming the patient for 30 minutes with convective, forced-air warming blankets helps reduce the initial drop in core temperature.
207
What part of our brain is impaired during anesthesia that allows heat loss due to altered perception of temperature in the anesthetized dermatomes?
A. Pons
B. Hypothalamus
C. Frontal lobe
D. Occipital lobe
Correct answer:
B) Hypothalamus
208
Which of the following temperature monitoring techniques are not recommended for patients that are getting open heart surgery?
A) Pulmonary artery and esophageal probe
B) Tympanic temperature monitoring
C) Oral temperature monitoring
D) Temporal temperature monitoring
Correct answer:
A) Pulmonary artery and esophageal probe
209
1) The nurse anesthetist is aware that the following patients are not ideal to use the BIS monitor on as readings may not be reliable or fully accurate: (select all that apply)
A) Infants and children < 18 years old
B) Patients receiving Ketamine as the induction agent
C) Patients > 60 years old
D) Patients receiving Fospropofol as the induction agent
E) Patients receiving Nitrous Oxide with other inhalation agents
Correct Answer:
A) Infants and children < 18 years old,
B) Patients receiving Ketamine as induction agent,
C) Patients >60 years old,
E) Patients receiving Nitrous Oxide with other inhalation agents
210
What is the primary purpose of BIS monitoring?
A) To measure cerebral oxygen levels
B) To assess the depth of anesthesia using EEG signals
C) To correlate with heart rate during surgery
D) To monitor anesthesia concentration
Correct Answer: B) To assess the depth of anesthesia using EEG signals
211
What BIS range is recommended for general anesthesia?
A) 80-100
B) 65-80
C) 40-65
D) 20-40
Correct Answer: C) 40-65
212
Why is BIS monitoring not always reliable?
A) It cannot be used with inhaled anesthetics
B) It is affected by environmental noise
C) Some patients report awareness despite BIS values below 65
D) It does not work with intravenous anesthesia
Correct Answer: C) Some patients report awareness despite BIS values below 65
213
Which EEG components are analyzed by BIS monitoring?
A) Low-frequency waves and high-frequency beta waves
B) Alpha waves and delta waves
C) Muscle contractions and oxygen saturation
D) Blood pressure and heart rate
Correct Answer: A) Low-frequency waves and high-frequency beta waves
214
What is a recommended best practice for preventing intraoperative awareness?
A) Relying on BIS for primary monitoring
B) Using multimodal monitoring with BIS and ETAC
C) Avoiding Ketamine when using BIS
D) Keeping BIS values below 80
Correct Answer: B) Using multimodal monitoring with BIS and ETAC
215
Which evoked potential is most resistant to anesthetic suppression?
A) Somatosensory Evoked Potentials (SSEPs)
B) Motor Evoked Potentials (MEPs)
C) Brainstem Auditory Evoked Potentials (BAEPs)
D) Visual Evoked Potentials (VEPs)
Answer: C
Rationale: BAEPs originate in the brainstem, which is more resistant to anesthetic suppression
than cortical pathways.
216
Which of the following best describes evoked potentials?
A) Spontaneous electrical activity monitoring of the brain
B) Electrical responses recorded from the nervous system after a stimulus
C) Continuous monitoring of heart rate variability
D) A method to measure cerebrospinal fluid pressure
Answer: B
Rationale: Evoked potentials (EPs) measure the nervous system’s response to external stimuli,
such as electrical, auditory, or visual inputs. They differ from spontaneous brain activity, which
is measured by EEG.
217
During neurosurgical procedures, a sudden loss of Somatosensory Evoked
Potentials (SSEPs) may indicate:
A) Adequate depth of anesthesia
B) Ischemic injury to the spinal cord or brain
C) An increase in muscle activity
D) A decrease in cerebrospinal fluid (CSF) pressure
Answer: B
Rationale: A sudden loss or significant decrease in SSEP amplitude suggests reduced blood
flow or neural damage, requiring immediate surgical intervention.
218
Which type of evoked potential evaluates the integrity of the sensory pathways from the periphery to the brain?
A) Brainstem Auditory Evoked Potentials (BAEPs)
B) Visual Evoked Potentials (VEPs)
C) Somatosensory Evoked Potentials (SSEPs)
D) Motor Evoked Potentials (MEPs)
Answer: C) Rationale: SSEPs evaluate the function of the sensory pathways by stimulating peripheral nerves and recording the response at the brain and spinal cord.
219
Which anesthetic management strategy is preferred when using Motor Evoked Potentials (MEPs)?
A) High-dose volatile agents with deep neuromuscular blockade
B) Total intravenous anesthesia (TIVA) with minimal neuromuscular blockade
C) Only spinal anesthesia
D) No anesthesia to allow patient movement
Answer: B
Rationale: MEPs require intact motor pathways, so neuromuscular blockade should be
minimized. TIVA (propofol and remifentanil) preserves MEP signals better than volatile
agents.
220
What is the primary reason Visual Evoked Potentials (VEPs) are not commonly
used to assess depth of anesthesia?
A) They are too resistant to anesthetic effects
B) They are highly sensitive to anesthetics and easily suppressed
C) They do not measure brain activity
D) They require invasive procedures to record
Answer: B
Rationale: VEPs are extremely sensitive to anesthetics, making them unreliable for routine
intraoperative monitoring.
221
1. What type of anesthetic gas analyzer can measure oxygen?
A. A paramagnetic oxygen analyzer
B. A photoacoustic analyzer
C. A galvanic cell oxygen analyzer
D. A Ramen Scattering Analysis analyzer
Answer = A, C
Rationale – Oxygen is a paramagnetic substance that reacts to magnetic fields, which can be measured by a paramagnetic oxygen analyzer (Elisha et al., 2023). A galvanic cell oxygen analyzer uses oxygen as a reagent to drive a chemical reaction that generates an electrical charge proportional to the amount of oxygen in the sample. The other two analyzers use infrared light and cannot measure the oxygen concentration.
222
What does MAC 1.0 mean?
A. The percent concentration of an anesthetic gas at 1.0 atm necessary to induce anesthesia.
B. The alveolar concentration needed to blunt the adrenal response to noxious stimuli.
C. The percentage of anesthetic gas needed to saturate blood.
D. The minimum alveolar concentration needed to inhibit the movement in 50% of patients in response to noxious stimuli.
Answer = D
Rationale – A MAC 1.0 refers to the minimum alveolar concentration needed to inhibit movement in 50% of patients in response to a noxious stimulus (Elisha et al., 2023).
223
What does MAC-BAR represent?
A. The percentage concentration of an anesthetic gas needed to inhibit pain in 50% of patients.
B. The potency of individual anesthetic gases.
C. The minimum areolar concentration of anesthetic gas that must saturate blood in 50% of patients before inducing sedation.
D. The minimum areolar concentration necessary to blunt adrenal response to noxious stimuli.
Answer = D
Rationale – MAC-BAR refers to the minimum alveolar concentration of anesthetic gas needed to blunt the adrenal response in 50% of patients (Elisha et al., 2023)
224
Why does a galvanic oxygen analyzer need to be replaced every so often?
A. The high amounts of oxygen the analyzer is exposed to cause the cell to become too hot.
B. The anode (lead) is eventually consumed by the continued chemical reaction.
C. The cathode (gold) is eventually consumed by the continued chemical reaction.
D. The galvanic cell requires increased amounts of electricity supplied by the anesthesia machine which eventually melts the conductors.
Answer B
Rationale – Oxygen drives the chemical reaction that generates an electrical current (Elisha et al., 2023). The strength of the electrical current is proportional to the amount of oxygen the sensor is exposed to. This reaction consumes the anode (lead) and eventually needs to be replaced.
225
How does a gas analyzer detect multiple gases simultaneously?
A. It cannot detect multiple gases simultaneously
B. It uses magnetic waves to measure the density of each gas
C. It reacts to the charged portions of each gas molecule and uses a complex algorithm to calculate what each gas is.
D. It uses multiple wave lengths of inferred light to determine the concentration of each gas by measuring the absorption of each wavelength.
Answer D
Rationale – Each gas absorbs a unique wavelength of inferred light (Elisha et al., 2023). By using multiple wavelengths, the analyzer can determine the concentration of each gas by measuring how much each wavelength of inferred light is absorbed.
226
Why does a galvanic oxygen analyzer need to be periodically replaced?
A. The electrolyte solution dries out.
B. The semipermeable membrane weakens and eventually ruptures.
C. The lead anode is eventually consumed by the reaction.
D. They never need to be replaced.
Answer C
Rational – The reaction releases electrons (voltage) due to the reaction of lead with hydroxide (Elisha et al., 2023). This can be seen in chemical equation (2 Pb2+ + 4 OH- -> 2 PbO + 2 H2O + 4 e-). Eventually, all of the lead anode (Pb2+) is used to form PbO, which means the reaction can no longer happen.
227
Which of the following is the primary determinant of cerebral perfusion pressure (CPP)?
A) Intracranial pressure (ICP) alone
B) Mean arterial pressure (MAP) alone
C) The sum of ICP and MAP
D) The difference between MAP and ICP
Answer: D) The difference between MAP and ICP
228
Which anesthetic agent is preferred for neuroanesthesia due to its ability to reduce ICP, cerebral blood flow, and cerebral metabolic rate of oxygen (CMRO₂)?
A) Isoflurane
B) Nitrous Oxide (N₂O)
C) Propofol
D) Ketamine
Answer: C) Propofol
229
Which of the following is a contraindication for the use of succinylcholine in neurosurgical patients?
A) History of difficult intubation
B) Severe traumatic brain injury (TBI)
C) Need for rapid sequence induction
D) Refractory intracranial hypertension
Answer: B) Severe traumatic brain injury (TBI)
230
Which intravenous anesthetic agent is known to cause adrenal suppression and is therefore avoided in patients with traumatic brain injury (TBI) and sepsis?
A) Propofol
B) Dexmedetomidine
C) Etomidate
D) Ketamine
Answer: C) Etomidate
231
Which of the following describes the pathophysiology of plateau waves (A waves of Lundberg) seen in intracranial pressure monitoring?
A) Slow oscillations in ICP due to venous congestion
B) Persistent ICP elevation (40-100 mmHg) lasting 5-20 minutes, indicating critically low intracranial compliance
C) Fluctuations in ICP due to transient vasodilation
D) Rapid ICP decline following CSF drainage
Answer: B) Persistent ICP elevation (40-100 mmHg) lasting 5-20 minutes, indicating critically low intracranial compliance.
232
In patients with elevated ICP, which of the following ventilatory strategies optimally balances ICP reduction while avoiding the risk of cerebral ischemia?
A) Permissive hypercapnia with a PaCO₂ target of 45–50 mmHg to promote cerebral vasodilation and oxygen delivery
B) Tight PaCO₂ control (30–35 mmHg) to induce mild vasoconstriction and reduce cerebral blood volume while preserving perfusion
C) Aggressive hyperventilation with PaCO₂ < 25 mmHg to maximize cerebral vasoconstriction and ICP reduction
D) Maintaining tidal volumes > 10 mL/kg and PEEP > 10 cmH₂O to improve oxygenation and limit secondary injury
Answer: B) Tight PaCO₂ control (30–35 mmHg) to induce mild vasoconstriction and reduce cerebral blood volume while preserving perfusion.
233
Select all that apply: Which of the following conditions are associated with increased SvO₂ values?
A. Sepsis
B. Cyanide toxicity
C. Hemorrhage
D. Hyperthermia
E. Left-to-right shunt
Answer: A, B, E
234
Which of the following statements about central venous oxygen saturation (ScvO₂) is true?
A. ScvO₂ is measured at the junction of the superior vena cava and right atrium
B. ScvO₂ is always higher than SvO₂ under normal conditions
C. ScvO₂ includes blood flow from the superior vena cava, inferior vena cava, and coronary sinus
D. ScvO₂ is a global indicator of venous oxygen saturation
Answer: A
235
A patient presents with respiratory acidosis. Which of the following arterial blood gas (ABG) findings would be most consistent with uncompensated respiratory acidosis?
A. pH 7.28, PaCO₂ 55 mmHg, HCO₃⁻ 24 mEq/L
B. pH 7.35, PaCO₂ 55 mmHg, HCO₃⁻ 28 mEq/L
C. pH 7.42, PaCO₂ 30 mmHg, HCO₃⁻ 22 mEq/L
D. pH 7.28, PaCO₂ 40 mmHg, HCO₃⁻ 18 mEq/L
Answer: A
236
A base deficit can be calculated to determine bicarbonate replacement needs in a patient with metabolic acidosis. Which of the following formulas correctly calculates bicarbonate replacement?
A. (Patient’s HCO₃⁻ - Normal HCO₃⁻) × Weight (kg) × 0.3
B. (Normal HCO₃⁻ - Patient’s HCO₃⁻) × Weight (kg) × 0.3
C. (Normal HCO₃⁻ - Patient’s HCO₃⁻) × Weight (kg) × 0.6
D. (Normal HCO₃⁻ - Patient’s HCO₃⁻) × Weight (kg) × 1.0
Answer: B. (Normal HCO₃⁻ - Patient’s HCO₃⁻) × Weight (kg) × 0.3
237
Select all that apply: Which of the following mechanisms contribute to increased CO₂ production in the perioperative setting?
A. Fever
B. Malignant hyperthermia
C. Tourniquet release
D. Propofol administration
E. Thyroid storm
Correct Answers: A, B, C, E
A. Fever
B. Malignant hyperthermia
C. Tourniquet release
E. Thyroid storm
238
A patient with sepsis has a temperature of 39.5°C and a PCO₂ of 50 mmHg. How will their oxyhemoglobin dissociation curve shift?
A. Left shift
B. Right shift
C. No change
D. Flattened curve
Answer: B
239
Which of the following modalities is used to monitor the level of oxygenation in the brain?
A) Pulse oximetry
B) BIS monitoring
C) Cerebral oximetry
D) Cerebral capnometry
Answer: C) Cerebral oximetry
240
What type of technology does the cerebral oximeter use?
A) Bispectral Index
B) Termal infrared imaging
C) Termal infrared sensing
D) Near-infrared spectroscopy
Answer: D) Near-infrared spectroscopy
241
How does a cerebral oximeter function in monitoring brain oxygenation?
A) By measuring electrical activity of the brain through EEG signals
B) By detecting changes in blood pressure using arterial waveforms
C) By measuring light attenuation from an emitting light source using emitter/sensor pads on the forehead
D) By analyzing exhaled gases to determine oxygen and carbon dioxide levels
Answer: C) By measuring light attenuation from an emitting light source using emitter/sensor pads on the forehead Cerebral oximeters utilize emitter/sensor pads similar to reflectance pads applied to the forehead, which measure light attenuation from the emitting light source.
242
What is the primary goal of cerebral oximetry monitoring?
A) To ensure NIRS values remain at least 75% of the baseline reading and avoid cerebral desaturation
B) To accurately measure cerebral blowflow
C) To measure arterial oxygen saturation (SpO₂) continuously
D) To monitor dept of anesthesia
Answer: A
The goal of supportive intervention is to maintain the NIRS value at a minimum of 75% of the baseline reading.
243
Cerebral oximetry is most frequently used in which of the following clinical scenarios? (Select 3)
A) Neonatology
B) Cardiac surgery
C) Carotid endarterectomy
D) Routine outpatient blood pressure monitoring
E) Management of chronic obstructive pulmonary disease (COPD)
Answer: A, B, C
Currently the most frequent uses of NIRS are in neonatology, during cardiac surgery, and during carotid endarterectomy.
244
Which of the following conditions can decrease the accuracy of information obtained by Near-Infrared Spectroscopy (NIRS)? (Select 5)
A) Changes in blood pressure
B) Partial pressure of carbon dioxide in arterial blood (PaCO₂)
C) Regional blood volume variations
D) Hemoglobin concentration differences
E) Individual variability, such as differences in extracranial tissue
F) Core body temperature changes
Answer: A, B, C, D, E
As in any monitoring modality there are conditions that can decrease the accuracy of the information obtained. Changes in blood pressure, partial pressure of carbon dioxide in arterial blood (PacOi), regional blood volume, hemoglobin concentration, and individual variability (e.g„ differences in extracranial tissue) all effect NIRS readings.
245
Where should the arterial line transducer be zeroed to ensure accurate blood pressure readings?
A. Umbilicus
B. Phlebostatic axis (4th intercostal space, mid anteroposterior chest)
C. At the level of the extremity the catheter was inserted
D. Below the height of the patient bed
Answer: B
246
Which of the following patients would most likely require continuous invasive blood pressure monitoring intraoperatively?
A. 25-year-old female undergoing ACL repair
B. 30-year-old male, ASA class I, undergoing laparoscopic cholecystectomy
C. 73-year-old male requiring aortic dissection repair
D. 40-year-old female undergoing cataract surgery
Answer: C
247
Which of the following is the most common artery used for arterial line placement?
A. Radial
B. Brachial
C. Dorsalis pedis
D. Axillary
Answer: A
248
Which of the following is a common cause of an under-dampened arterial waveform?
A. Air bubbles in the pressure tubing
B. Low pressure in the flush bag
C. Loose connections in the pressure tubing system
D. Catheter whip
Answer: D
249
An anesthetist observes a patient’s arterial waveform tracing and notices a significant variation in pulse pressure. After doing some calculations, they determine that the patient’s PPV is 20%. Which of the following factors would make this number inaccurate? [Select 3]
A. Normal sinus rhythm
B. Supraventricular tachycardia
C. Pressure support ventilation
D. Low tidal volumes (4 mL/kg)
E. Controlled mechanical ventilation
Answer: B, C, D
250
A 76-year-old male is undergoing a craniotomy and is placed in a sitting position. The anesthetist places a radial artery line and zeroes the transducer at the phlebostatic axis (level of the right atrium). If the MAP is reading 70mmHg, but the neurosurgeon is concerned about cerebral perfusion, what should the anesthetist do?
A. Tell the surgeon the perfusion is adequate, and he may proceed
B. Move the transducer up to the Circle of Willis and re-zero
C. Lower the patient’s head to increase blood flow
D. Remove the radial arterial line and place an axillary, as this is closer to the brain
Answer: B
251
What is the primary clinical benefit of using Thromboelastography (TEG)?
A) It measures individual clotting factors in isolation
B) It provides a real-time, functional assessment of coagulation
C) It replaces the need for all standard coagulation tests
D) It measures only the platelet function
Correct Answer: B) It provides a real-time, functional assessment of coagulation
252
What does an increased R time on a TEG tracing indicate?
A) Increased platelet function
B) Hypercoagulability
C) Impaired clot initiation and formation
D) Normal clotting function
Correct Answer: C) Impaired clot initiation and formation
253
Which TEG parameter specifically reflects clot strength?
A) R Time
B) K Time
C) A-Angle
D) Maximum Amplitude (MA)
Correct Answer: D) Maximum Amplitude (MA)
254
Which of the following TEG findings would suggest hyperfibrinolysis?
A) Increased LY30
B) Prolonged R time
C) Decreased A-Angle
D) Increased Maximum Amplitude
Correct Answer: A) Increased LY30
255
How does TEG measure clot strength?
A) TEG measures the concentration of platelets in the sample
B) By analyzing the resistance encountered by the pin as the clot forms
C) By measuring electrical conductivity in the blood sample
D) By evaluating fibrinogen concentration only
Correct Answer: B) By analyzing the resistance encountered by the pin as the clot forms.
256
Why is TEG beneficial in patients with liver disease?
A) It evaluates the functional status of coagulation, including clot formation, stability, and breakdown.
B) It measures only clotting factor levels like PT and aPTT.
C) It focuses only on platelet function without assessing fibrinolysis.
D) It replaces the need for any standard coagulation tests.
Correct Answer: A) It evaluates the functional status of coagulation, including clot formation, stability, and breakdown.
257
What is the primary purpose of Pulmonary Artery Pressure (PAP) Monitoring?
A) To measure left atrial pressure directly
B) To evaluate pulmonary artery function only
C) To assess cardiac function and guide fluid management
D) To measure systemic arterial pressure
Correct Answer: C) To assess cardiac function and guide fluid management
Rationale: PAP monitoring helps estimate left ventricular end-diastolic pressure (LVEDP) and guides fluid and hemodynamic management, particularly in critically ill patients. Elisha, S., Heiner, J. S., & Nagelhout, J. J. (2023). Nurse Anesthesia (7th ed., p. 306). Elsevier.
258
What is the normal range for pulmonary artery systolic pressure?
A) 5–15 mmHg
B) 15–30 mmHg
C) 30–45 mmHg
D) 45–60 mmHg
Correct Answer: B) 15–30 mmHg
Rationale: Normal pulmonary artery systolic pressure ranges from 15 to 30 mmHg, while diastolic pressure ranges from 5 to 15 mmHg. Elisha, S., Heiner, J. S., & Nagelhout, J. J. (2023). Nurse Anesthesia (7th ed., p. 299). Elsevier.
259
Mixed Venous Oxygen Saturation (SvO₂) is primarily measured in which location?
A) Right atrium
B) Pulmonary artery
C) Aorta
D) Left ventricle
Correct Answer: B) Pulmonary artery
Rationale: SvO₂ is measured in the pulmonary artery via a fiberoptic pulmonary artery catheter, as it provides the most accurate assessment of the balance between oxygen delivery and consumption. Elisha, S., Heiner, J. S., & Nagelhout, J. J. (2023). Nurse Anesthesia (7th ed., p. 307). Elsevier.
260
A patient with an SvO₂ of 50% likely has:
A) Normal tissue oxygenation
B) Increased oxygen delivery
C) Decreased oxygen consumption
D) Tissue hypoxia
Correct Answer: D) Tissue hypoxia
Rationale: A normal SvO₂ is 65–77%. A lower SvO₂ indicates increased oxygen extraction by tissues, which can be due to decreased cardiac output, anemia, or hypoxia. Elisha, S., Heiner, J. S., & Nagelhout, J. J. (2023). Nurse Anesthesia (7th ed., p. 307). Elsevier.
261
Which of the following is a relative contraindication to pulmonary artery catheter placement?
A) Left bundle branch block
B) Right bundle branch block
C) Hypertension
D) Chronic obstructive pulmonary disease (COPD)
Correct Answer: A) Left bundle branch block
Rationale: A left bundle branch block is a relative contraindication because catheter placement can cause a complete heart block in patients with preexisting conduction abnormalities. Butterworth, J. F., Mackey, D. C., & Wasnick, J. D. (2022). Morgan & Mikhail’s Clinical Anesthesiology (7th ed., p. 92). McGraw Hill LLC.
262
6. What is the most serious complication associated with pulmonary artery catheterization?
A) Arrhythmias
B) Pulmonary artery rupture
C) Infection
D) Hematoma
Correct Answer: B) Pulmonary artery rupture Rationale: Pulmonary artery rupture is the most severe complication, often fatal, particularly in patients with pulmonary hypertension. Butterworth, J. F., Mackey, D. C., & Wasnick, J. D. (2022). Morgan & Mikhail’s Clinical Anesthesiology (7th ed., p. 95). McGraw Hill LLC.
263
What is the distance from the right internal jugular vein to the junction of the Venae Cavae and Right Atrium?
A. 10 cm
B. 15 cm
C. 20 cm
D. 40 cm
Answer: B. 15 cm
264
What causes the A wave in the CVP waveform?
A. Tricuspid Valve closure
B. Tricuspid Valve opening
C. RA contraction
D. RA passive filling
Answer: C. RA contraction
Rationale: The contraction of the right atrium (RA) causes the central venous pressure to increase, leading to the A wave in the CVP waveform.
265
What causes the x decline (x and x1) in the CVP waveform? Select 2 of the following answers:
A. Tricuspid Valve opening
B. RA diastole
C. The right atrioventricular septum being pulled toward RV during ventricular systole
D. Bicuspid Valve opening
Answers: B & C. RA diastole and the right atrioventricular septum being pulled toward RV during ventricular systole.
Rationale: The x decline (x and x1) indicates a decrease in pressure in the CVP waveform caused by RA diastole (x) and the right atrioventricular septum being pulled toward the RV during ventricular systole (x1). The tricuspid valve opening does cause a decrease in pressure, but this is the y decline in the CVP waveform.
266
Which of the following would cause cannon A waves in the CVP waveform? Select 2 of the following:
A. V-Pacing (asynchronous)
B. V-Pacing (underlying asystole)
C. Atrial Fibrillation
D. Complete AV Block
Answers: A & D. V-Pacing (asynchronous) and Complete AV Block
267
You are caring for a patient that has a CVP of 1 mmHg. Which of the following is most likely to cause this low CVP reading?
A. Hypovolemia
B. RV failure
C. Pulmonary Hypertension
D. Fluid volume overload
Answer: A. Hypovolemia
268
Which of the following is the most common technique used for placement of a Central Venous Catheter (CVC)?
A. Catheter through a needle
B. Seldinger technique
C. Catheter over a needle
D. Nagelhout technique
Answer: B. Seldeinger technique
269
What is the primary purpose of a Transesophageal Echocardiography (TEE)?
A) To measure lung function
B) To monitor brain activity during surgery
C) To create detailed images of the heart and assist in cardiac monitoring
D) To assess kidney function
Answer: C) To create detailed images of the heart and assist in cardiac monitoring
270
Which frequency range is typically used for TEE probes?
A) 1-2 MHz
B) 3.5-7.5 MHz
C) 10-15 MHz
D) 20-25 MHz
Answer: B) 3.5-7.5 MHz
271
What can the Bernoulli Equation be used to estimate during a transesophageal echocardiogram?
A) It calculates stroke volume
B) It assesses heart rhythm abnormalities
C) It measures oxygen saturation
D) It estimates pressure differences across narrowed heart valves
Answer: D) It estimates pressure differences across narrowed heart valves
272
What is a contraindication for performing a TEE?
A) Perforated viscus or esophageal pathology
B) Hypertension
C) Previous cardiac surgery
D) History of asthma
Answer: A) Perforated viscus or esophageal pathology
273
Which ultrasound technique used during a TEE incorporates the concept of frequency shift?
A) M-mode
B) 2D imaging
C) Doppler
D) 3D imaging
Answer: C) Doppler
274
At what depth is the TEE probe placed for the midesophageal imaging plane?
A) 25cm
B) 30-35cm
C) 40-45cm
D) 50cm
Answer: B) 30-35cm
275
. Which nerve block is most appropriate for postoperative pain relief in shoulder arthroscopy?
A. Femoral nerve block
B. Interscalene block
C. Sciatic nerve block
D. Fascia iliaca block
E. TAP block
Correct Answer: B. Interscalene block
276
What is the primary concern with placing a patient in the beach chair position during shoulder arthroscopy?
A. Femoral nerve entrapment
B. Spinal cord compression
C. Aspiration risk
D. Shoulder dislocation
E. Cerebral hypoperfusion
Correct Answer: E. Cerebral hypoperfusion
Rationale: Beach chair positioning can lower cerebral perfusion pressure; BP should be measured at brain level.
277
What is the recommended immediate treatment for a suspected intraoperative tension pneumothorax?
A. Order a STAT chest X-ray
B. Begin CPR
C. Administer diuretics
D. Needle thoracostomy followed by chest tube
Correct Answer: D. Needle thoracostomy followed by chest tube
278
Which factor is most likely to contribute to hypothermia during arthroscopy?
A. Ketamine administration
B. Use of cold irrigation fluids
C. Forced-air warming devices
D. Supine positioning
Correct Answer: B. Use of cold irrigation fluids
279
Which of the following patients is most likely to require preoperative CBC testing before arthroscopy?
A. ASA I healthy athlete
B. ASA II patient undergoing minor elbow arthroscopy
C. ASA III patient with CKD undergoing shoulder arthroscopy
D. ASA I elderly patient with no comorbidities E. ASA II patient with mild asthma
Correct Answer: C. ASA III patient with CKD undergoing shoulder arthroscopy
280
Why is it critical to level the arterial line transducer at the external auditory meatus during beach chair positioning?
A. To monitor thoracic perfusion
B. To avoid intracranial pressure spikes
C. To reflect cerebral perfusion pressure accurately
D. To maintain urine output
E. To reduce risk of spinal ischemia
Correct Answer: C. To reflect cerebral perfusion pressure accurately
281
In patients with known Coronary Artery Disease (CAD), what is the most important anesthetic goal during the perioperative period?
A) Increase heart rate to ensure adequate cardiac output
B) Prioritize deep anesthesia over hemodynamic control to prevent awareness
C) Optimize coronary perfusion by balancing oxygen supply and demand
D) Avoid volatile agents to reduce the risk of myocardial depression
Correct Answer: C
282
Which of the following anesthetic agents is preferred for its cardioprotective effects in CAD patients?
A) Desflurane
B) Sevoflurane
C) Ketamine
D) Propofol
Correct Answer: B
283
In a patient with CAD undergoing CABG, which set of ECG leads provides the highest sensitivity for detecting intraoperative myocardial ischemia?
A) Leads I and aVR
B) Leads II and III
C) Leads II, V4, and V5
D) Leads aVL, V1, and V2
Correct Answer: C
284
4. Which of the following statements about perioperative myocardial infarction (MI) is most accurate?
A) Most perioperative MIs present with classic chest pain and are easily recognized in real time
B) Over 50% of perioperative MIs are silent, particularly in elderly and diabetic patients
C) Perioperative MIs typically occur after hospital discharge and are rarely detected early
D) Diabetic patients are less likely to develop perioperative MIs due to metabolic conditioning
Correct Answer: B
285
Which of the following surgical procedures is most appropriately classified as high cardiac risk (>5%) according to ACC/AHA perioperative guidelines?
A) Laparoscopic cholecystectomy in a stable patient
B) Elective inguinal hernia repair under local anesthesia
C) Emergent open abdominal aortic aneurysm (AAA) repair
D) Cataract extraction with monitored anesthesia care
Correct Answer: C
286
What is the estimated mortality rate if a patient experiences a reinfarction in the perioperative period following a recent myocardial infarction (MI)?
A) 10%
B) 25%
C) 50%
D) 75%
Correct Answer: C
287
Which of the following statements about the pathophysiology of CHF is correct?
A. CHF is primarily a disorder of volume overload with no neurohormonal involvement.
B. CHF leads to activation of the SNS and RAAS systems, contributing to fluid retention and increased SVR.
C. CHF only affects the left ventricle, leaving the right heart unaffected.
D. The primary pathology of CHF is an inability of the heart to increase stroke volume with increased preload
Answer: B
288
Why is perioperative fluid management challenging in CHF patients?
A. CHF patients have an increased Frank-Starling reserve, allowing for aggressive fluid administration.
B. CHF patients are highly preload-dependent and require large volumes of fluid to maintain cardiac output.
C. CHF patients have a blunted Frank-Starling response the curve is shifted to the right
D. CHF patients have a more linear curve as it shifts up and to the left compared to a normal Frank-Starling curve.
Answer: C. CHF patients have a blunted Frank-Starling response the curve is shifted to the right
289
What is the primary reason CHF patients are at higher risk for intraoperative arrhythmias?
A. Structural remodeling of the myocardium increases arrhythmogenic potential.
B. CHF patients have excess parasympathetic tone, leading to bradyarrhythmias.
C. CHF patients have an enhanced Frank-Starling mechanism, making arrhythmias more likely.
D. CHF patients have reduced sensitivity to catecholamines, decreasing arrhythmia risk.
Answer: A. Structural remodeling of the myocardium increases arrhythmogenic potential.
290
Which intraoperative monitoring modality provides the most dynamic assessment of CHF patients' cardiac function?
A. Standard ECG
B. Central Venous Pressure (CVP)
C. Arterial Line
D. Transesophageal Echocardiography (TEE)
Answer: D. Transesophageal Echocardiography (TEE)
291
What is the most appropriate intraoperative anesthetic management strategy for CHF patients?
A. Avoid beta-blockers to prevent further cardiac depression.
B. Use high-dose volatile anesthetics to minimize myocardial oxygen demand.
C. Maintain hemodynamic stability and titrate vasoactive agents as needed.
D. Give large fluid boluses to maximize preload and cardiac output.
Answer: C. Maintain hemodynamic stability and titrate vasoactive agents as needed.
292
Which postoperative concern is most relevant for CHF patients?
A. Ensuring a rapid extubation to prevent prolonged ICU stays.
B. Risk of fluid overload and pulmonary edema due to perioperative fluid shifts.
C. Administering NSAIDs liberally to control pain.
D. Using minimal monitoring to promote patient comfort.
Answer: B. Risk of fluid overload and pulmonary edema due to perioperative fluid shifts.
293
Which premedication helps suppress the gag reflex during EGD?
A. Fentanyl
B. Glycopyrrolate
C. Lidocaine gargle
D. Midazolam
Correct Answer: C. Lidocaine gargle
294
Why are patients at risk for bradycardia during colonoscopy?
A. Blood loss
B. Electrolyte imbalance
C. Vagal stimulation from scope manipulation
D. Overhydration
Correct Answer: C. Vagal stimulation from scope manipulation
295
What is a common complication specific to the bowel prep process for colonoscopy?
A. Hyperkalemia
B. Urticaria
C. Diarrhea and dehydration
D. Hypertension
Correct Answer: C. Diarrhea and dehydration
296
In which of the following situations would general anesthesia with an ETT most likely
be required for EGD or colonoscopy?
A. Routine adult colonoscopy
B. Pediatric EGD with poor cooperation
C. Outpatient EGD in healthy adult
D. Colonoscopy in a patient with GERD
Correct Answer: B. Pediatric EGD with poor cooperation
297
Why is glycopyrrolate sometimes used prior to an EGD?
A. To lower blood pressure
B. To reduce salivary secretions
C. To treat bradycardia
D. To induce retrograde amnesia
Correct Answer: B. To reduce salivary secretions
298
Which of the following is the most accurate statement regarding anesthesia considerations for colonoscopy compared to EGD?
A. EGD typically requires deeper sedation than colonoscopy due to increased procedural discomfort.
B. Both EGD and colonoscopy are performed under general anesthesia with endotracheal intubation.
C. Colonoscopy usually requires deeper sedation than EGD and carries a higher risk of vagal stimulation.
D. Colonoscopy uses a bite block to protect the teeth and airway, while EGD does not.
Correct Answer: C
299
What defines severe obesity?
a. BMI 25-29 kg/m2
b. BMI greater than or equal to 30 kg/m2
c. >40 kg/m2
d. BMI above the 75th percentile of the general population
Answer: C
300
What medication should the anesthesia provider dose according to lean body weight?
a. Succinylcholine
b. Propofol
c. Rocuronium
d. Fentanyl
Answer: B
301
What medication should the anesthesia provider dose according to ideal body weight (select 2)
a. Rocuronium
b. Succinylcholine
c. Sugammadex
d. Remifentanyl
e. Propofol
Answer: a., d.
302
Which ventilation management strategies are helpful in oxygenating an individual with elevated BMI (select 2)
a. Tidal volume 10 mL/kg total body weight
b. FiO2 <0.8
c. Use PEEP of 10-12 cmH2O
d. Place the bed in Trendelenburg position
Answer: b., c.
303
Which option describes optimal positioning for intubation of patient with elevated BMI
a. Sniffing position
b. Tucked chin
c. Ramped head and shoulders with sternal notch aligning with external auditory meatus
d. Pt supine with bed in Trendelenburg position
Answer: c
304
What is the best method for fluid management in obese populations
a. Bolus one liter at the beginning of each case for obese patients excluding those with hypertension
b. Administer fluid in response to the patient’s clinical parameters such as heart rate, blood pressure, and urine output
c. Only give albumin intraoperatively
d. Provide PRBCs when the patient’s hemoglobin falls below 5 g/dL as blood volume is diminished to 45-55 mL/kg actual body weight at baseline in extreme obesity
Answer: b
305
Which of the following is a cause of restrictive lung disease related to the thoracic cage or abdomen?
A. Interstitial fibrosis
B. Obesity
C. Fibrothorax
D. Pulmonary edema
Correct Answer: B. Gross obesity
306
What is the most likely cause of restrictive lung disease in a patient with broken ribs following trauma?
A. Pleural disease
B. Interstitial infiltration
C. Chest trauma
D. Neuromuscular dysfunction
Correct Answer: C. Chest trauma
307
What is the expected impact of preexisting pulmonary disease on intraoperative and postoperative respiratory function during anesthesia?
A. No significant effect
B. Improved lung compliance
C. Marked alterations in intraoperative respiratory status and increased postoperative complications
D. Enhanced oxygenation during surgery
Correct Answer: C. Marked alterations in intraoperative respiratory status and increased postoperative complications
308
What is the initial treatment for acute pulmonary edema according to the text?
A. Diuretic administration
B. Bronchodilator therapy
C. Oxygen administration via nasal cannula or facemask
D. Mechanical ventilation with PEEP
Correct Answer: C. Oxygen administration via nasal cannula or facemask
309
Which of the following is not one of the mechanisms by which positive pressure ventilation improves left ventricular function in acute pulmonary edema?
A. Reduction in work of breathing
B. Increased pleural pressure swings during spontaneous ventilation
C. Decrease in preload due to reduced venous return
D. Improvement in arterial oxygenation and myocardial oxygen supply
Correct Answer: B. Increased pleural pressure swings during spontaneous ventilation
310
Which of the following conditions is classified as a neuromuscular cause of restrictive lung disease?
A. Severe kyphoscoliosis
B. Obesity
C. Poliomyelitis
D. Broken ribs
Correct Answer: C. Poliomyelitis
311
Which of the following medication prolongs neuromuscular blockade and requires close monitoring due to the narrow therapeutic range?
A. Lithium
B. Fluoxetine
C. Diazepam
D. Clozapine
Answer: A. Lithium
312
You are the anesthesia provider on call. A patient a history of alcohol dependence presents for emergency surgery. The patient has not had a drink over 12 hours. What is the primary concern if they have not recently consumed alcohol and what medication can anesthesia provider give during preoperative?
A. Hypotension and bradycardia, give a vasopressor
B. Alcohol withdrawal and delirium tremens, give benzodiazepine
C. hypertension and bradycardia, give benzodiazepine
D. Increase pain, give an opioid.
Answer: B. Alcohol withdrawal and delirium tremens, give benzodiazepine
Rationale: Alcohol withdrawal can lead to delirium tremens (DTs), a life-threatening condition with seizures, autonomic instability, hallucinations, and severe agitation. Benzodiazepines are used perioperatively to prevent withdrawal complications (Butterworth et al., 2022).
313
Which combination of medication can cause serotonin syndrome?
A. Midazolam (benzodiazepine) and (opioid) morphine
B. Propranolol (B-blocker) and (alpha 2 agonist) dexmedetomidine
C. Sertraline (SSRI) and (opioid) fentanyl
D. Propofol and ephedrine
Answer: C. Sertraline (SSRI) and (opioid) fentanyl
314
Which of the following strategies can help reduce the risk of postoperative delirium in psychiatric patients? (Select 2)
A. Avoiding anticholinergic agents like atropine and scopolamine
B. Increasing the use of benzodiazepines intraoperatively
C. Administering dexmedetomidine before the end of the procedure
D. Discontinuing psychiatric medications preoperatively
Answer: A and C. Avoid anticholinergic agents like atropine and scopolamine because they cross the blood brain barrier. Anticholinergic symptoms can be potentate with patients on TCAs (Amitriptyline) (Butterworth et al., 2022). Anticholinergic agents can worsen postoperative confusion, sedation, and delirium, especially in psychiatric patients and the elderly. Dexmedetomidine (Precedex) has been shown to reduce emergence delirium in both pediatric and adult patients when given 15 to 20 minutes before the end of the procedure, providing sedation with minimal respiratory depression (Butterworth et al., 2022).
315
Why is it recommended to continue antipsychotic medications preoperatively in patients with schizophrenia?
A. To prevent increased postoperative pain sensitivity
B. To reduce the risk of postoperative delirium and agitation
C. To enhance the effects of anesthetic agents
D. To avoid excessive sedation during surgery
Answer: B. To reduce the risk of postoperatively delirium and agitation
Rationale: Discontinuing antipsychotic medications before surgery can lead to increased confusion, agitation, and difficulty reestablishing medication regimens postoperatively. Continuation of these medications helps maintain stability and reduces the risk of postoperative complications (Elisha et al., 2023).
316
You are the anesthesia provider during paranesthesia assessment on a patient that requires appendectomy. The patient is on tricyclic antidepressants (TCAs). What is the concern of the anesthesia provider for the patient on TCAs?
A. TCAs prolong QT interval and increase the risk of arrhythmias
B. TCAs excessive sedation and delay emergence from anesthesia
C. TCAs inhibit platelet function and increase bleeding risk
D. TCAs cause hypotension in response to induction
Answer: A. TCAs prolong QT interval and increase the risk of arrhythmias
Rationale: Anesthesia providers will get ECG preoperatively for patients on TCAs because they cause prolonged QT intervals and leading to arrythmias and potential cardiovascular instability during anesthesia (Elisha et al., 2023)
317
What is another name for the RLQ incision made during an open appendectomy case?
A. Trocar incision
B. McBurney incision
C. Brooke incision
D. Kocher incision
Answer: B
318
Which of the following is the correct amount of hourly IV crystalloid fluid administration necessary to compensate for evaporative losses: either open or laparoscopic appendectomy?
A. 1-2 mL/kg/hr
B. 7-8 mL/kg/hr
C. 3-5 mL/kg/hr
D. 10 mL/kg/hr
Answer: C
319
Which of the following is the most common patient position during open or laparoscopic appendectomy?
A. Supine to PTrendelenburg
B. Prone
C. Right lateral decubitus
D. Seated
Answer: A
320
A patient is undergoing a laparoscopic appendectomy. After induction of anesthesia, the patient is positioned in Trendelenburg, and insufflation of the abdomen begins following trocar placement. Which of the following are potential respiratory and hemodynamic changes you might observe at this stage of the procedure?
A. Bradycardia due to sympathetic stimulation
B. Hypotension due to decreased intra-abdominal pressures
C. Increased lung compliance and increased venous return
D. Increased peak airway pressures, decreased venous return, bradycardia
Answer: D
321
A patient is undergoing laparoscopic appendectomy. The anesthetist knows that the normal estimated blood loss (EBL) for this type of surgery is <75mL. What is the appropriate amount of IV crystalloids the patient should receive to adequately replace this lost volume?
A. 75 mL
B. 150 mL
C. 225 mL
D. 750 mL
Answer: C
322
A 28-year-old male presents for an emergent laparoscopic appendectomy due to acute appendicitis. Patient reports severe nausea, NPO status is unknown. Which of the following are the most appropriate steps the anesthesia provider should take during induction? [Select 2]
A. Standard IV induction with positive-pressure bag mask ventilation before intubation
B. Administration of anti-emetics such as metoclopramide to reduce aspiration risk
C. Use of an LMA instead of endotracheal tube for airway
D. RSI with cricoid pressure to reduce aspiration risk
Answer: B, D
323
Obstructive sleep apnea is defined as:
a. Tracheal obstruction due to increased oral secretions while sleeping
b. Episodes of 10 or more seconds where the patient holds breath when asleep
c. Breathing cessation for 10 or more seconds due to airway obstruction caused by relaxed pharyngeal musculature during sleep.
d. Nasal secretions obstruct airflow through the nasal cavity while sleeping
Answer: c. Sleep apnea is defined as the obstruction to breathing caused by the relaxation of pharyngeal musculature during sleep (Elisha et al., 2022).
324
Which of the following is NOT a positive criterion for the STOP BANG questionnaire?
a. Female patients are at a higher risk
b. Patients older than 50 are at higher risk
c. Patients with a neck circumference greater than 40 cm are at risk
d. Patients with a BMI greater than 35 kg/𝑚2 are at risk
e. Patients who are tired during the day are at risk
Answer: a. The stop bang questionnaire assesses the patient for potential risk for sleep apnea. All of these, except for “a” are correct components for sleep apnea. The male gender is at higher risk for having sleep apnea (Butterworth et al., 2022)
325
Which co-morbidity is directly correlated with sleep apnea?
a. Lung cancer
b. Resistance to anesthetic agents
c. Bowel obstruction
d. Heart failure
Answer: d. Heart failure is directly correlated with sleep apnea. Other comorbidities related to sleep apnea include Atherosclerosis, hypertension/pulmonary HTN, stroke, diabetes, insulin resistance, dyslipidemia, and ischemic heart disease (Elisha et al., 2022).
326
A patient had an overnight polysomnography test assessing for OSA. The patient had an average of 26 abnormal respiratory events per hour of sleep. What is the patient’s risk for sleep apnea?
a. No risk
b. Mild
c. Moderate
d. Severe
Answer: c. The patient has a moderate risk for sleep apnea.
No risk would be less than 5 incidents per hour, mild would be 5-15 incidents per hour, moderate is 15-30 incidents per hour, and severe is greater than 30 incidents per hour (Elisha et al., 2022).
327
A patient presents to an ambulatory surgery center for an ACL repair. After performing the STOP BANG assessment, the patient is positively screened for obstructive sleep apnea. On further assessment, the patient also has a history of atrial fibrillation (a-fib).
When a 12-lead ECG is checked, the patient is currently in a-fib with a rate of 108, but their blood pressure is 120/80. How should the surgery team proceed?
a. Cancel the surgery; the patient is not in any condition for an elective procedure.
b. Reschedule the surgery; the patient has active co-morbidities associated with sleep apnea and is not appropriate for an outpatient procedure.
c. Cautiously perform the procedure, ensuring that video laryngoscopy is in the operating room and difficult airway precautions are observed.
d. Perform the surgery as scheduled; there is no contraindication for elective surgeries with sleep apnea, and the blood pressure is stable
Answer: b. While elective surgeries are not contraindicated by obstructive sleep apnea, a patient with uncontrolled co-morbidities would not be an appropriate candidate for ambulatory surgery. The patient would benefit from a formal diagnosis and surgery at an in-patient setting (Butterworth et al., 2022, Figure 44-1).
328
Which is not an appropriate action taken by the CRNA during the anesthesia care of a patient with obstructive sleep apnea?
a. Ensure a patient with a history of OSA brings their home CPAP.
b. Have a video laryngoscope in the operating room before induction.
c. Ramp the patient’s upper body to optimize the intubating position.
d. Elect for an awake extubation
e. Utilize long-acting analgesics and anesthetics to optimize pain control and sedation.
Answer: e. Rather than utilizing long-acting anesthetics and analgesics that could increase the patient’s risk for post-op airway obstruction, the CRNA should utilize short-acting anesthetics and analgesics. The CRNA should assess the feasibility of regional anesthesia and non-opioid analgesics. Extubation when the patient is awake decreases the risk of airway obstruction after extubation (Elisha et al., 2022).
329
What is a cholecystectomy?
A. Removal of the appendix
B. An exploratory laparotomy
C. Removal of the gallbladder
D. A sex change operation
Answer: C. Removal of the gallbladder
330
Which technique is most commonly used to perform a cholecystectomy?
A. Robotic
B. Open
C. ERCP
D. Laparoscopic
Answer: D. Laparoscopic
331
What is an alternate anesthesia technique that could be used for a patient preparing for laparoscopic cholecystectomy that wants to remain awake for the procedure?
A. Spinal Anesthesia at the L4-L5 level
B. TIVA
C. General Anesthesia
D. Spinal Anesthesia at the T6-T8 level.
Answer: D. Spinal Anesthesia at the T6-T8 level.
332
Which of the following is not a complication associated with Cholecystectomy?
A. Atelectasis
B. Hemorrhage
C. Bile Leak
D. Traumatic Brain Injury
Answer: D. Traumatic Brain Injury
333
Which of the following positions would your patient not be in during a laparoscopic cholecystectomy?
A. Trendelenburg
B. Reverse Trendelenburg
C. Tilted toward the left side
D. Lithotomy
Answer: D, Lithotomy
334
You are taking care of a patient that came in for a laparoscopic cholecystectomy. One minute after the surgeon insufflated the abdomen to 15 mmHg, the patient’s hemodynamics start to become unstable with low blood pressure, low HR, and major ventilatory challenges. What should you do next?
A. Begin chest compressions
B. Administer Phenylephrine
C. Ask the surgeon to lower the insufflation pressure to 10-12 mmHg and reevaluate.
D. Perform recruitment maneuvers to improve ventilation.
Answer: C. Ask the surgeon to lower the insufflation pressure to 10-12 mmHg and reevaluate.
335
What patient position is most commonly used to improve pelvic exposure during a laparoscopic hysterectomy?
A. Prone
B. Lithotomy only
C. Reverse Trendelenburg
D. Steep Trendelenburg
Answer: D. Steep Trendelenburg
336
In the lithotomy position, which nerve is at highest risk of compression injury?
A. Sciatic
B. Femoral
C. Peroneal
D. Obturator
Answer: C. Peroneal
337
Which anesthesia technique is required for a robotic‑assisted or laparoscopic hysterectomy?
A. Spinal anesthesia alone
B. Epidural anesthesia alone
C. General anesthesia
D. Local anesthesia
Answer: C. General anesthesia
338
During CO₂ pneumoperitoneum creation for a laparoscopic hysterectomy, which hemodynamic change is most directly attributable to the increased intra‑abdominal pressure?
A. Increased venous return
B. Decreased systemic vascular resistance
C. Increased stroke volume
D. Decreased preload
Answer: D. Decreased preload
339
Which preoperative test is essential to rule out pregnancy before an elective hysterectomy?
A. Serum β‑hCG
B. Coagulation profile (PT/PTT)
C. Urinalysis
D. Liver function tests
Answer: A. Serum β‑hCG
340
After creating pneumoperitoneum and placing the patient in steep Trendelenburg, what should be reconfirmed immediately?
A. Intravenous line patency
B. Endotracheal tube depth
C. Sterile field integrity
D. Foley catheter position
Answer: B. Endotracheal tube depth
341
Which of the following are common causes of altered airway anatomy that can complicate airway management? (Select all that apply)
A. Treacher Collins Syndrome
B. Down Syndrome
C. Asthma
D. Neck Trauma
E. Prior Radiation Therapy
Correct Answers: A, B, D, E
342
What is the most appropriate initial step when a difficult airway is anticipated preoperatively?
A. Administer muscle relaxants
B. Perform rapid sequence induction
C. Attempt direct laryngoscopy
D. Prepare for awake intubation with patient education and informed consent
E. Proceed with mask ventilation only
Correct Answer: D
343
Which anatomical alteration most directly compromises optimal positioning for laryngoscopy?
A. Macroglossia
B. Limited cervical spine mobility
C. Obesity
D. Enlarged tonsils
E. Deviated nasal septum
Correct Answer: B
344
Which Plan B strategy is recommended when Plan A (tracheal intubation) fails, according to the DAS Difficult Intubation Guideline?
A. Attempt blind nasal intubation
B. Insert oropharyngeal airway
C. Use second-generation supraglottic airway
D. Perform emergency cricothyrotomy
E. Paralyze and reattempt intubation
Correct Answer: C
345
During an awake intubation, which medication is most appropriate to reduce upper airway secretions?
A. Midazolam
B. Fentanyl
C. Glycopyrrolate
D. Lidocaine
E. Atropine
Correct Answer: C
346
According to the ASA Difficult Airway Algorithm, what is the next step when a provider can ventilate but cannot intubate?
A. Proceed with surgical airway
B. Paralyze and retry intubation
C. Wake the patient immediately
D. Attempt alternative intubation techniques
E. Stop and observe for improvement
Correct Answer: D
347
During THA using methyl methacrylate cement, what is the first sign of bone cement implantation syndrome (BCIS) under general anesthesia?
A. Hypotension
B. Sudden bradycardia
C. Decreased end-tidal CO₂
D. Desaturation on pulse oximetry
Correct Answer: C
348
Which of the following intraoperative interventions is MOST appropriate during cementing in a patient at risk for BCIS?
A. Administer IV heparin to prevent clotting
B. Increase FiO₂ to 100% and ensure full IV fluid bags
C. Turn patient supine to improve cardiac preload
D. Start a nitroglycerin infusion to reduce afterload
Correct Answer: B
349
What is the most common indication for Total Hip Arthroplasty in the United States?
A. Rheumatoid arthritis
B. Hip fracture due to trauma
C. Degenerative joint disease (osteoarthritis)
D. Avascular necrosis of the femoral head
Correct Answer: C
350
Which statement is true regarding the anterior approach to THA compared to the posterior approach?
A. It requires a larger incision with more muscle dissection
B. It results in longer hospital stays
C. It has increased dislocation risk and bleeding
D. It is muscle-sparing and allows faster recovery
Correct Answer: D
351
Which of the following is a classic triad of symptoms for fat embolism syndrome (FES)?
A. Fever, chills, petechiae
B. Chest pain, dyspnea, hemoptysis
C. Hypoxemia, altered mental status, and a petechial rash.
D. Hypotension, headache, jaundice
Answer: C
352
Which complication requires padding and careful positioning in the lateral decubitus position during THA?
A. Pressure injuries and nerve damage
B. Hemorrhage
C. BCIS
D. PONV
Answer: A
353
What is the primary reason nitrous oxide should be avoided during hernia surgery?
A. It causes nausea
B. It impairs neuromuscular blocking drugs
C. It increases the risk of bleeding
D. It can expand air-filled bowel loops
Correct Answer: D. It can expand air-filled bowel loops
354
In laparoscopic hernia surgery, which positioning technique is commonly used?
A. Reverse Trendelenburg
B. Lithotomy
C. Prone
D. Trendelenburg
Correct Answer: D. Trendelenburg
355
In a patient with a strangulated bowel hernia, what is the surgeon most likely to do intraoperatively?
A. Delay surgery
B. Convert from laparoscopic to open approach
C. Administer more antibiotics
D. Attempt repair without anesthesia
Correct Answer: B. Convert from laparoscopic to open approach
356
Which of the following patients are at increased risk for complications during hernia repair? (Select all that apply)
A. Obese patients
B. Diabetics
C. Female patients
D. Elderly individuals
Correct Answers: A, B, D
Rationale: Obesity increases aspiration and intubation difficulty, diabetes impairs wound healing, and elderly patients are prone to cardiopulmonary complications. There is no significant evidence associated between gender and complications.
357
What are the benefits of laparoscopic hernia repair compared to open repair? (Select all that apply)
A. Smaller incisions
B. Lower risk of infection
C. Increased bowel manipulation
D. Decreased postoperative pain
Correct Answers: A, B, D
Rationale: Laparoscopic techniques result in smaller incisions and generally reduce infection risk and postoperative pain.
358
What are the benefits of laparoscopic hernia repair compared to open repair? (Select all that apply)
A. Smaller incisions
B. Lower risk of infection
C. Increased bowel manipulation
D. Decreased postoperative pain
Correct Answers: A, B, D
Rationale: Laparoscopic techniques result in smaller incisions and generally reduce infection risk and postoperative pain.
359
What preoperative considerations are essential in planning anesthesia for hernia surgery? (Select all that apply)
A. Airway assessment
B. Cardiac stress test
C. Coagulation panel
D. Medication to reduce stomach acidity
Correct Answers: A, C, D
Rationale: Pre-op evaluation includes a full airway assessment, labs such as coagulation panels, and medications to reduce gastric acidity to prevent aspiration. Although best practice data do not support a specific regimen, modifying the acidity of gastric contents remains a common preoperative practice.
360
For a pacemaker (PM) , what does the third letter in the Heart Rhythm Society (HRS) code identify?
A) The chamber where the sensing electrode is placed
B) Rate modulation
C) The chamber where the pacing electrode is placed
D) The PM’s response to the detection of spontaneous depolarization
Answer: D) The PM’s response to the detection of spontaneous depolarization
361
Which of the following best describes the effect of placing a magnet over an ICD (which is programmed to recognize a magnet) during a procedure?
A) It switches the ICD to asynchronous pacing
B) It disables the ICD’s shock function
C) It increases the detection threshold for arrhythmias
D) It resets the device’s programming
Answer: B) It disables the ICD’s shock function
Rational: ICDs can be programmed to recognize a magnet, which will disable shock therapy, although not all devices are programmed to do so. The magnet placed on an ICD will not initiate asynchronous pacing.
362
In cases where the programmed shock fails during defibrillation testing, what is recommended between repeated VF inductions?
A) Immediate intubation without delay
B) Switching to a different anesthetic
C) A minimum 5-minute interval to allow for hemodynamic recovery
D) Administration of an antiarrythmic drug
Answer: C) A minimum 5-minute interval to allow for hemodynamic recovery
Rational: During testing of defibrillation efficacy, VF is induced once or twice, and sometimes more frequently. In the event of failed defibrillation by the programmed first shock, a somewhat prolonged VF may occur. In the case of repeated DFT testing, it is customary to give at least 5-min intervals between VF inductions to allow for sufficient hemodynamic recovery.
363
Which of the following descriptions is true regarding ICD/pacemaker implantation?
A) The procedure is relatively short (1-2hrs), EBL is minimal, and patients generally requires minimal sedation for the transcutaneous approach
B) The procedure is relatively short (1-2hrs), external defibrillation does not need to be readily available, and fentanyl 2-50mcg/kg should be given for induction
C) The procedure is long (4-5hrs), EBL is high, and patients must be under deep/general anesthesia
D) The procedure is long (4-5hrs), monitoring for electrolyte abnormalities preop is optional, and CVP or PA catheter placement is required
Answer: A) The procedure is relatively short (1-2hrs), EBL is minimal, and patients generally requires minimal sedation for the transcutaneous approach
364
Following ICD/pacemaker implantation, what type of pain management is typically required postoperatively?
A) High dose IV pain medications because postop pain is typically severe
B) No pain medication is typically needed because patients receive regional anesthesia preoperatively
C) Oral analgesics typically sufficient for pain management
D) Fentanyl PCA 0.5 to 1.5 mcg/kg/hour
Answer: C) Oral analgesics typically sufficient for pain management
Rational: Postoperatively, pain is usually managed with oral analgesics. The typical pain level following a transvenous approach is 2-3. Oral analgesics are sufficient to manage this level of pain.
365
For ICD/pacemaker implantation, general anesthesia is recommended for which patient populations? (SATA)
A) Elderly patients
B) Young athletes with WPW syndrome
C) Patients in postacute phase of myocardial infarction
D) Patients with congestive heart failure (CHF)
Answer: A) Elderly patients & D) Patients with congestive heart failure (CHF)
366
Which of the following is a primary benefit of using a femoral nerve block in total knee
replacement?
A) It completely anesthetizes the posterior knee
B) It preserves motor function of the quadriceps
C) It minimizes opioid consumption postoperatively
D) It eliminates the need for general anesthesia
Answer: C
Rationale: Regional blocks like femoral nerve block significantly reduce postoperative
opioid requirements. The femoral block covers the anterior thigh and knee but not the
posterior aspect. The adductor canal block, not femoral, is preferred when motor function
preservation is desired.
367
Which comorbidity most directly necessitates evaluation for cervical spine instability
during TKR anesthesia planning?
A) Obesity
B) Rheumatoid arthritis
C) Hypertension
D) Diabetes mellitus
Answer: B
Rationale: Rheumatoid arthritis can cause atlantoaxial subluxation, requiring preoperative
cervical spine assessment.
368
What is the typical patient positioning for a total knee replacement surgery?
A) Prone with legs dependent
B) Supine with arms crossed
C) Lateral decubitus with knees flexed
D) Supine with arms extended on padded arm boards
Answer: D
Rationale: Standard positioning is supine with arms extended and supported on padded
boards. Leg and knee placement depends on surgeon’s preference.
369
Which of the following statements about cemented prostheses is TRUE in total knee
arthroplasty?
A) Cementing allows for early weight-bearing after surgery
B) Cement cures endothermically and cools surrounding tissue
C) Cementing causes delayed weight-bearing post-op
D) Cemented implants are incompatible with body tissues
Answer: A
Rationale: Cemented prostheses provide rigid fixation that supports early postoperative
mobilization.
370
Which of the following is a potential complication after tourniquet release during TKR?
A) Hyperkalemia from cement absorption
B) Sudden hypertension from increased preload
C) Hypotension from redistribution of blood flow
D) Pulmonary edema from crystalloid overload
Answer: C
Rationale: Tourniquet release can cause hypotension due to vasodilation caused by
byproducts of metabolism (lactic acid) release.
371
Why might an adductor canal block be chosen over a femoral nerve block for TKR
postoperative pain control?
A) It provides complete motor blockade
B) It offers superior posterior knee analgesia
C) It reduces pain while preserving quadriceps strength
D) It increases the need for opioids
Answer: C
Rationale: Adductor canal block is chosen to provide pain relief while preserving motor
function for early ambulation.
372
Which inhaled anesthetic is associated with the most rapid emergence?
A) Sevoflurane
B) Isoflurane
C) Desflurane
D) Nitrous oxide
C) Desflurane
Rationale: Desflurane has the lowest blood-gas solubility, resulting in ultra-rapid emergence.
Elisha, S., Heiner, J., & Nagelhout, J. J. (Eds.). (2023). Nurse anesthesia (7th edition.). Elsevier.
373
During which phase of anesthesia is the anesthesia provider at highest risk of distraction?
A) Induction
B) Maintenance
C) Emergence
D) Postoperative recovery
C) Emergence
Rationale: Emergence is the most distracted time, with frequent interruptions and high task density (about 1 interruption every 2 minutes).
374
What is a major complication to monitor for immediately after extubation?
A) Pulmonary embolism
B) Airway obstruction due to laryngospasm or edema
C) Myocardial infarction
D) Stroke
B) Airway obstruction due to laryngospasm or edema
Rationale: Laryngospasm, laryngeal edema, and airway obstruction are critical airway risks during emergence and extubation.
375
What is the expected cardiovascular response during laryngoscopy?
A) Bradycardia and hypotension
B) Catecholamine surge with hypertension and tachycardia
C) Hypotension only
D) No significant change
B) Catecholamine surge with hypertension and tachycardia
Rationale: Laryngoscopy can cause sympathetic stimulation, resulting in transient hypertension and tachycardia.
376
Which of the following is the most common cause of anaphylaxis during anesthesia?
A) Latex
B) Reversal agents
C) Neuromuscular blocking agents (NMBAs)
D) Antibiotics
C) Neuromuscular blocking agents (NMBAs)
Rationale:
Neuromuscular blocking agents are the most common cause of anaphylaxis during anesthesia. Their quaternary ammonium groups can trigger IgE-mediated hypersensitivity reactions, making them a leading cause of intraoperative anaphylaxis, followed by antibiotics and latex. Rapid recognition and management are crucial.
377
Which of the following oral pharyngeal airways are appropriate to facilitate the passage of a fiberoptic intubating scope during an intubation? Select 3.
A. Guedel
B. Berman
C. Ovassapian
D. Williams
B (Berman), C (Ovassapian), & D (Williams)
Rationale: The introduction of a fiberoptic intubating scope can be guided with the placement of a Berman, Ovassapian, or William's airway to prevent inadvertent damage to the scope if the patient were to bite down (Elisha et al., 2023, p. 462).
378
Which of the following statements is correct in comparing first and second-generation supraglottic airway devices?
A. Second-generation devices incorporate channels for gastric decompression and have improved cuff designs allowing for increased ventilation pressures.
B. First-generation devices have reinforced tips to prevent the folding of the tip during insertion.
C. Second generation devices are more flexible allowing an easier and more timely insertion.
D. First generation devices are currently the only devices with a single use/disposable option.
A. Second-generation devices incorporate channels for gastric decompression and have improved cuff designs allowing for increased ventilation pressures.
379
Which of the following are effective methods to aid passive exhalation during transtracheal jet ventilation?
A. Placement of an oral airway
B. Insertion of bilateral nasal airways
C. Application of I:E ratios of 1:1 or 1:2
D. Delivery of breaths at high frequencies >12bpm
A. Placement of an oral airway and
B. Insertion of bilateral nasal airways
380
How do you confirm correct placement of the Eschmann stylet in the trachea?
A. Visualizing it pass the vocal cords
B. Feeling the stylet “bounce” along the tracheal rings as it is advanced into the trachea
C. Hearing breath sounds through the stylet
D. Seeing bubbles at the tip
B. Feeling the stylet “bounce” along the tracheal rings as it is advanced into the trachea
381
What is the primary function of the Cook Airway Exchange Catheter (AEC)?
A. Deliver medications intratracheally
B. Lubricate the trachea before intubation
C. Exchange endotracheal tubes or allow gas exchange
D. Replace a tracheostomy tube
C. Exchange endotracheal tubes or allow gas exchange
382
Which two wavelengths of light are used by a pulse oximeter to measure oxygen saturation?
A) 450 nm (blue) and 700 nm (red)
B) 660 nm (red) and 940 nm (infrared)
C) 550 nm (green) and 850 nm (infrared)
D) 480 nm (blue) and 900 nm (infrared)
B) 660 nm (red) and 940 nm (infrared)
383
The decision regarding which ECG leads to monitor during anesthesia is critical because improper selection can primarily result in which of the following complications?
A) Intraoperative hypothermia
B) Unrecognized myocardial ischemia, injury, or infarction
C) Inaccurate end-tidal CO₂ readings
D) Increased risk of residual neuromuscular blockade
B) Unrecognized myocardial ischemia, injury, or infarction
384
What is the most common site for Train-of-Four (TOF) monitoring?
a) Facial nerve
b) Tibial nerve
c) Ulnar nerve
d) Radial nerve
c) Ulnar nerve
385
Which heat loss mechanism accounts for the greatest percentage of perioperative heat loss?
a) Conduction
b) Convection
c) Radiation
d) Evaporation
c) Radiation
386
A sudden drop in measured oxygen (O₂) concentration during airway gas analysis may indicate:
a) Hyperventilation
b) Circuit disconnect
c) Equipment overheating
d) Improved gas exchange
b) Circuit disconnect
387
Which of the following is NOT one of the five tasks of oxygen?
A) Powers the vaporizers
B) Powers the oxygen flush
C) Activates oxygen low-pressure alarms
D) Activates fail-safe mechanisms
A) Powers the vaporizers
388
What is the correct response to a profound loss of oxygen pipeline pressure?
A) Activate the flush valve
B) Disconnect the breathing circuit
C) Fully open the E-cylinder, disconnect pipeline, consider low FGF
D) Turn off nitrous oxide
C) Fully open the E-cylinder, disconnect pipeline, consider low FGF
389
What pressure does the first stage oxygen regulator reduce cylinder pressure to?
A) 45 psig
B) 50 psig
C) 2000 psig
D) 16 psig
A) 45 psig
390
What is the primary purpose of the oxygen flush valve?
A) To maintain pressure in the vaporizer
B) To rapidly fill the breathing circuit with 100% oxygen
C) To control anesthetic depth
D) To reduce barotrauma risk
B) To rapidly fill the breathing circuit with 100% oxygen
391
Which safety feature halts non-oxygen gas delivery if oxygen pipeline pressure fails?
A) Oxygen flush valve
B) Variable bypass vaporizer
C) Pressure regulator
D) Fail-safe valve
D) Fail-safe valve
392
Which of the following is the equation for Dalton’s Law?
A. P1 + P2 + P3…. = P total
B. P1 * V1 = P2 * V2
C. V1/T1 = V2/T2
D. PV = nRT
A. P1 + P2 + P3…. = P total
393
Which of the following is the equation for Boyle’s Law?
A. P1 + P2 + P3…. = P total
B. P1 * V1 = P2 * V2
C. V1/T1 = V2/T2
D. PV = nRT
B. P1 * V1 = P2 * V2
394
Which of the following is the equation for Charles’s Law?
A. P1 + P2 + P3…. = P total
B. P1 * V1 = P2 * V2
C. V1/T1 = V2/T2
D. PV = nRT
C. V1/T1 = V2/T2
395
Which of the following is the equation for the ideal gas law?
A. P1 + P2 + P3…. = P total
B. P1 * V1 = P2 * V2
C. V1/T1 = V2/T2
D. PV = nRT
D. PV = nRT
396
Which of the following values is equivalent to 760 mmHg?
A. 1 atm
B. 1 bar
C. 100 kpa
D. 1,033 cm H2O
E. All of the above.
E. All of the above.
397
1What percentage of body mass is intravascular volume
a. 15%
b. <1%
c. 5%
d. 20%
c. 5%
398
What starling forces promote the movement of fluid from inside the intravascular space into the interstitial space? (Select two)
a. Capillary hydrostatic pressure
b. Interstitial fluid pressure
c. Plasma oncotic pressure
d. Interstitial oncotic pressure
a., d.
399
How many mL/kg/hr on average will a patient lose from evaporative losses who is getting a laparoscopic appendectomy
a. 1-2 mL/kg/hr
b. 2-4 mL/kg/hr
c. 4-6 mL/kg/hr
d. 6-8 mL/kg/hr
c.
400
While completing a health history assessment on a patient, you notice that the patient has a history of allergic reactions related to blood transfusions. What type of blood product would be most appropriate for this patient?
a. Avoid blood transfusions at all costs! This patient has an allergic reaction!
b. Ensure that washed red blood cells are available for your patient in case of an emergency.
c. Ensure that the patient receives less than 300 mL of blood if needed during a procedure.
d. Ensure that leukoreduced red blood cells are available for your patient in case of an emergency.
b. Ensure that washed red blood cells are available for your patient in case of an emergency.
401
5. You are preparing a female patient weighing 100 kg for a highly invasive surgery that is expected to result in significant blood loss (the lowest acceptable Hct is 30%). What would this patient's maximum allowable blood loss be if their current Hct is 45%?
a. 1.9
b. 2.2
c. 3.1
d. 4.0
b. 2.2
402
Who is credited with founding the American Association of Nurse Anesthetists (AANA)?
A. Alice Magaw
B. Sister Mary Bernard
C. Agatha Hodgins
D. Helen Lamb
E. Mildred Clark
C. Agatha Hodgins
403
What was one major impact of the Beecher-Todd study in 1954?
A. It led to the banning of CRNAs in pediatric surgeries
B. It found no difference between CRNAs and anesthesiologists
C. It showed CRNAs had lower patient mortality rates
D. It proved physicians should supervise all anesthesia care
E. It initiated the TEFRA billing guidelines
C. It showed CRNAs had lower patient mortality rates
404
What was one result of the 1982 TEFRA regulations?
A. CRNAs were banned from working independently
B. Anesthesia care could only be provided by physicians
C. AANA was dissolved as an advocacy group
D. Medicare reimbursement for CRNAs was restricted
E. Billing requirements were imposed on CRNA services
E. Billing requirements were imposed on CRNA services
405
What is the current requirement of CRNA doctoral education programs as of 2022?
A. Completion of a master's thesis
B. Minimum of 1,000 clinical hours
C. Completion of a scholarly project
D. Certification only by the AANA president
E. Independent practice in all 50 states
C. Completion of a scholarly project
406
Which of the following was a key reason CRNAs began assuming roles in anesthesia
delivery in the late 19th and early 20th centuries?
A. Anesthesia was considered highly lucrative
B. Nurses had formalized anesthesia training earlier than physicians
C. Surgeons preferred CRNAs for cost-saving measures
D. Physicians often avoided the field due to its low status
E. Nurse anesthetists lobbied Congress for early autonomy
D. Physicians often avoided the field due to its low status
407
What is the proper placement of fingers need to be when properly placing a mask on the
patient for one provider ventilation?
A. Thumb and index finger need to form a “C” shaped, middle and ring finger placed
on the mandible, and fifth finger placed angle of the jaw to thrust
B. Thumb and index finger need to form a “A” shaped, and middle, ring finger, and
fifth finger is placed on the mandible not lifting the jaw
C. Thumb and index finger need to form a “B” shaped, and middle, ring finger, and
fifth finger is placed on the mandible lifting the jaw
D. Thumb and index finger need to form a “D” shaped, and middle, ring finger, and
fifth finger is placed on the mandible lifting the jaw
A. Thumb and index finger need to form a “C” shaped, middle and ring finger placed
on the mandible, and fifth finger placed angle of the jaw to thrust
408
During direct laryngoscope, what is a maneuver that can be attempted to get a better view
of the vocal cords during intubation?
A. Cricoid pressure
B. BURP
C. Sellick maneuver
D. You can’t apply pressure on the cricoid during direct laryngoscope because it
increase risk of injury
B. BURP
409
What is the maximum pressure of the endotracheal tube cannot exceed?
A. 60 cm/H2O
B. 40 cm/H2O
C. 25 cm/H2O
D. 30 cm/H20
C. 25 cm/H2O
410
Which of the following statements about Double Lumen Endobronchial Tubes (DLTs)
is true?
A. The bronchial lumen is usually color-coded white and inserted into the trachea to
ventilate both lungs equally.
B. DLTs are preferred for pediatric patients due to their small size and ease of insertion.
C. One advantage of DLTs is the ability to independently ventilate each lung and easily
transition between one-lung and two-lung ventilation.
D. The design of the DLT eliminates the risk of barotrauma because tidal volume is
evenly distributed regardless of lung isolation.
C. One advantage of DLTs is the ability to independently ventilate each lung and easily
transition between one-lung and two-lung ventilation.
411
Which of the following is true about Oral RAE endotracheal tube?
A. Its distal curvature, with the end of the tube facing toward the patient anteriorly.
B. The tube is straight and designed to extend away from the surgical field during
abdominal procedures.
C. It is commonly avoided in ENT surgeries because its curve obstructs the surgical
field.
D. Oral RAE is not used anymore due to the cost of the endotracheal tube.
A. Its distal curvature, with the end of the tube facing toward the patient anteriorly.
