Otterbein/Grant CRNA Basics Final Review
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Questions and Answers
- 1.
Indications for using regional anesthesia include: avoiding general anesthesia, obstetric procedures, urology procedures, orthopedic procedures, patient choice, and pulmonary/cardiac issues.
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
Regional anesthesia is a type of anesthesia that numbs a specific region of the body, allowing the patient to remain awake and conscious during the procedure. It is often used to avoid the risks and side effects associated with general anesthesia. Obstetric, urology, and orthopedic procedures are commonly performed under regional anesthesia. Additionally, regional anesthesia may be preferred by patients who have pulmonary or cardiac issues that make general anesthesia risky. Therefore, the statement that indications for using regional anesthesia include avoiding general anesthesia, obstetric procedures, urology procedures, orthopedic procedures, patient choice, and pulmonary/cardiac issues is true.Rate this question:
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- 2.
All of the following are symptoms of local anesthetic toxicity except:
- A.
Hyperventilation
- B.
Numbness/tingling of lips and tongue, metallic taste, ringing in the ears
- C.
Dizziness, visual disturbances, disorientation
- D.
Tremors, twitching, leading to convulsions
Correct Answer
A. HyperventilationExplanation
Severity is dose related, causes respiratory depressionRate this question:
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- 3.
When added to a local anesthetic, epinephrine causes vasoconstriction which decreases the amount of drug carried away to be metabolized. This may increases the length of time a block is effective by ____.
- A.
50%
- B.
20%
- C.
2x
- D.
0%
Correct Answer
A. 50%Explanation
When epinephrine is added to a local anesthetic, it causes vasoconstriction, which means that the blood vessels in the area constrict or narrow. This narrowing of blood vessels reduces blood flow and decreases the amount of the anesthetic drug that is carried away from the site to be metabolized. As a result, the drug stays in the area for a longer period of time, increasing the length of time that the block is effective. Therefore, the correct answer is 50%, indicating that the addition of epinephrine increases the effectiveness of the block by 50%.Rate this question:
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- 4.
Musculotcutaneous, median, ulnar, radial and ________ nerves are all major terminal branches of the brachial plexus.
Correct Answer
AxillaryExplanation
Most alcoholics must really urinateRate this question:
- 5.
The brachial plexus is divided into ________ trunks, divisions, cords, and branches.
Correct Answer
rootsExplanation
Reach to drink cold beerRate this question:
- 6.
PA catheter indications include all of the following except:
- A.
Pulmonary stenosis
- B.
Impaired cardiac function
- C.
Evaluation of response to fluids/drugs
- D.
Cross clamping of the aorta, suspected/diagnosed pulmonary emboli, ARDS, COPD, pulm. HTN
Correct Answer
A. Pulmonary stenosisExplanation
PA catheter indications include evaluating cardiac function, assessing response to fluids/drugs, and diagnosing conditions such as pulmonary emboli, ARDS, COPD, and pulmonary hypertension. However, it is not indicated for pulmonary stenosis.Rate this question:
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- 7.
Normal SVO2 is 60-80%, all of the following will increase SVO2 except:
- A.
Shivering
- B.
Sepsis
- C.
Cyanid poisoning
- D.
Increased cardiac output
Correct Answer
A. ShiveringExplanation
Shivering is a physiological response to cold temperatures, which causes muscle contractions to generate heat. This increased muscle activity leads to an increase in oxygen consumption and metabolic demand, which in turn increases the oxygen extraction from the blood and decreases the systemic venous oxygen saturation (SVO2). Therefore, shivering would decrease SVO2 rather than increase it.Rate this question:
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- 8.
All of the following will decrease SVO2 except:
- A.
Leftward shift of oxyhemoglobin curve
- B.
Hyperthermia/shivering
- C.
Seizures
- D.
Hemorrhage/Decreased CO
Correct Answer
A. Leftward shift of oxyhemoglobin curveExplanation
A leftward shift of the oxyhemoglobin curve indicates an increased affinity of hemoglobin for oxygen, meaning that hemoglobin will bind to oxygen more strongly. This would result in increased oxygen saturation in the blood, leading to an increase in SVO2. Therefore, a leftward shift of the oxyhemoglobin curve would not decrease SVO2.Rate this question:
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- 9.
When interpreting a CVP waveform, the C wave represents:
- A.
Ventricular contraction
- B.
RA contraction
- C.
Atrial filling
- D.
Tricuspid valve opening
Correct Answer
A. Ventricular contractionExplanation
The CVP waveform is a measurement of the pressure in the central venous system. The C wave in the waveform represents a slight increase in pressure caused by the contraction of the ventricles. This occurs when the tricuspid valve closes after ventricular systole, causing a small backflow of blood into the right atrium. Therefore, the C wave in the CVP waveform represents ventricular contraction.Rate this question:
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- 10.
You're performing an Allen's test, you release the ulnar artery and expect color to return to the hand within how many seconds?
Correct Answer
5
fiveExplanation
During an Allen's test, the ulnar artery is temporarily occluded to assess the collateral circulation in the hand. After releasing the pressure on the ulnar artery, the color should return to the hand within 5 seconds. The prompt also provides the word "five" as an alternative way of expressing the number 5.Rate this question:
- 11.
The dicrotic notch occurs when ventricular pressure becomes less than that of the aortic root, closing the aortic valve, and is associated with the onset of:
- A.
Diastole
- B.
Systole
Correct Answer
A. DiastoleExplanation
The dicrotic notch occurs during diastole. Diastole is the phase of the cardiac cycle when the heart muscle relaxes and fills with blood. During diastole, the ventricles are relaxed and the aortic valve closes, causing the dicrotic notch to occur. This notch represents a brief increase in aortic pressure as the aortic valve closes and prevents blood from flowing back into the left ventricle. Therefore, the dicrotic notch is associated with the onset of diastole.Rate this question:
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- 12.
Respiratory variation in arterial waveforms > 10 mmHg indicates ________ intravascular volume.
- A.
Decreased
- B.
Increased
- C.
Option 3
- D.
Option 4
Correct Answer
A. DecreasedExplanation
Respiratory variation in arterial waveforms refers to the changes in arterial pressure that occur during the respiratory cycle. A respiratory variation in arterial waveforms greater than 10 mmHg indicates decreased intravascular volume. This means that there is not enough fluid within the blood vessels, leading to reduced blood volume and potentially decreased perfusion to organs and tissues. This can be caused by factors such as dehydration, bleeding, or fluid loss.Rate this question:
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- 13.
Left IJ CVP insertion is associated with __________ duct injury.
Correct Answer
thoracicExplanation
Left IJ CVP insertion is associated with thoracic duct injury. The thoracic duct is the largest lymphatic vessel in the body and is responsible for draining lymph fluid from the lower half of the body, left upper limb, and left side of the head and neck. During left IJ CVP insertion, there is a risk of accidentally puncturing or injuring the thoracic duct, which can lead to leakage of lymph fluid. This can result in complications such as chylothorax, a condition characterized by the accumulation of lymphatic fluid in the pleural space.Rate this question:
- 14.
What is the most common mechanism of nerve injury in the OR?
- A.
Compression
- B.
Stretch
- C.
Transection
- D.
Kinking
Correct Answer
A. CompressionExplanation
Compression is the most common mechanism of nerve injury in the operating room. This occurs when a nerve is subjected to excessive pressure or compression, leading to damage or dysfunction. Compression can occur due to various factors such as improper positioning of the patient, incorrect placement of surgical instruments, or prolonged pressure on a specific nerve during surgery. This can result in symptoms such as numbness, tingling, weakness, or loss of sensation in the affected area. Prompt identification and management of nerve compression are crucial to prevent long-term complications and promote optimal patient outcomes.Rate this question:
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- 15.
The lung zones shift from vertical to horizontal when going from standing to a supine position.
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
When a person is standing, the lung zones are primarily vertical, with the upper lobes located superiorly and the lower lobes located inferiorly. However, when a person changes to a supine position (lying flat on their back), the lung zones shift to a more horizontal orientation. This is because the gravitational forces acting on the lungs change when the body position changes. In the supine position, the lungs expand more evenly, allowing for a more uniform distribution of ventilation throughout the lung fields. Therefore, the statement is true.Rate this question:
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- 16.
Which of the following ligaments creates the popping sensation when placing an epidural?
- A.
Ligamentum flavum
- B.
Interspinous
- C.
Supraspinous
Correct Answer
A. Ligamentum flavumExplanation
The ligamentum flavum is a ligament located in the spinal column. When placing an epidural, the ligamentum flavum is pierced by the needle, creating a popping sensation. This ligament is known for its elastic properties, which allow it to stretch and then return to its original shape.Rate this question:
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- 17.
When performing a spinal anesthetic using the midline approach, the layers of anatomy that are traversed (from posterior to anterior) are skin, subcutaneous fat, supraspinous ligament, interspinous ligament, ligamentum flavum, dura mater, subdural space, arachnoid mater, and finally the subarachnoid space.
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
The explanation for the given correct answer is that when performing a spinal anesthetic using the midline approach, the layers of anatomy that are traversed from posterior to anterior are indeed skin, subcutaneous fat, supraspinous ligament, interspinous ligament, ligamentum flavum, dura mater, subdural space, arachnoid mater, and finally the subarachnoid space. This is the correct sequence of layers that need to be penetrated in order to reach the desired subarachnoid space for the administration of the spinal anesthetic.Rate this question:
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- 18.
Systemic absorption of LA is greatest at which of the following?
- A.
Tracheal
- B.
Caudal
- C.
Epidural
- D.
Subcutaneous
Correct Answer
A. TrachealExplanation
IV>tracheal>intrapleural, intercostal>Caudal>paracervical>epidural>brachial plexus>subarachnoid,sciatic,femoral>subcutaneous
In Time I Can Please Everyone But Susie & SallyRate this question:
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- 19.
Regarding local anesthetics, ________ lipid solubility correlates with increased protein binding, potency, duration of action, and a higher tendency for severe toxicity, especially cardiotoxicity.
- A.
Increased
- B.
Decreased
Correct Answer
A. IncreasedExplanation
Local anesthetics with increased lipid solubility have a stronger affinity for proteins, leading to increased protein binding. This results in higher potency, longer duration of action, and an increased likelihood of severe toxicity, particularly cardiotoxicity.Rate this question:
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- 20.
The addition of epinephrine to bupivacaine, ropivacaine, or etidocaine will prolong their duration of action.
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
Their DOA is already 180-600 min, will not be effected by epiRate this question:
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- 21.
Muscle cramps, tingling, numbness, hyperactive deep tendon reflees, Trousseau's sign (carpopedal spasm), Chvostek's sign (masster spasm), laryngeal spasms, convulsions, AND prolonged QT/ST segments are all associated with:
- A.
Hypocalcemia
- B.
Hypercalcemia
Correct Answer
A. HypocalcemiaExplanation
The symptoms mentioned in the question, such as muscle cramps, tingling, numbness, hyperactive deep tendon reflexes, Trousseau's sign (carpopedal spasm), Chvostek's sign (masseter spasm), laryngeal spasms, convulsions, and prolonged QT/ST segments, are all indicative of hypocalcemia. Hypocalcemia refers to low levels of calcium in the blood, which can lead to these symptoms. Hypercalcemia, on the other hand, refers to high levels of calcium in the blood and is not associated with the mentioned symptoms.Rate this question:
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- 22.
What would be the maintenance fluid requirement for a 85 kg person?
Correct Answer
125Explanation
The maintenance fluid requirement for a person is determined based on their weight. In this case, the person weighs 85 kg. The answer given, 125, is likely the amount of maintenance fluid required for this individual. However, without additional context or information, it is difficult to provide a more detailed explanation.Rate this question:
- 23.
An 85 kg person has been NPO for 6 hours, what is their NPO deficit?
Correct Answer
750Explanation
The NPO deficit refers to the amount of fluid that a person needs to replace after being restricted from taking anything orally. In this case, the person has been NPO (nothing by mouth) for 6 hours. To calculate the NPO deficit, we multiply the number of hours by the hourly fluid requirement. The average hourly fluid requirement is 125 mL per hour. Therefore, the NPO deficit would be 6 hours multiplied by 125 mL, resulting in a deficit of 750 mL.Rate this question:
- 24.
And 85 kg person who has been NPO for 6 hours is having a bowel resection, how many mL's of fluid do you anticipate administering in the 1st hour of surgery?
Correct Answer
1180Explanation
During surgery, it is important to maintain fluid balance and prevent dehydration. The amount of fluid to be administered depends on various factors such as the patient's weight and the duration of fasting. In this case, the patient weighs 85 kg and has been NPO (nothing by mouth) for 6 hours, indicating a need for fluid replacement. The answer of 1180 mL suggests that this is the anticipated amount of fluid to be administered in the first hour of surgery to ensure proper hydration and maintain the patient's fluid balance.Rate this question:
- 25.
Which West zone should a PA catheter tip be placed?
- A.
III
- B.
II
- C.
I
- D.
IV
Correct Answer
A. IIIExplanation
The correct answer is III because the PA catheter tip should be placed in the pulmonary artery, which is located in the right side of the heart. In the given options, zone III is the only one that corresponds to the correct placement of the catheter tip. Zones I, II, and IV are not accurate locations for the PA catheter tip placement.Rate this question:
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- 26.
Your patient is in the sitting position for a craniotomy when you notice an increase in end tidal nitrogen, arrhythmias, and auscultate a mill wheel murmur. After you consider shanking the surgeon, you know that you should treat the venous air embolus by aspirating through a multiorifice central venous catheter.
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
The given correct answer is true. When a patient in a sitting position for a craniotomy experiences an increase in end tidal nitrogen, arrhythmias, and a mill wheel murmur, it indicates the presence of a venous air embolus. To treat this condition, the recommended approach is to aspirate the air through a multiorifice central venous catheter. This procedure helps remove the air from the venous system and prevents further complications.Rate this question:
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- 27.
In order for a case to truly be considering monitored anesthesia care, the patient must maintain spontaneous ventilation.
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
Monitored anesthesia care refers to the administration of anesthesia while the patient remains conscious and able to respond to verbal commands. In this context, maintaining spontaneous ventilation means that the patient is able to breathe on their own without the need for mechanical assistance. This is important because it ensures that the patient's airway remains open and they can continue to oxygenate their body adequately during the procedure. Therefore, the statement "In order for a case to truly be considering monitored anesthesia care, the patient must maintain spontaneous ventilation" is true.Rate this question:
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- 28.
Contraindication for performing a MAC case include patient discomfort, patient positioning such as prone, the surgeon being unable to operate safely with the patient being non-paralyzed, and being unable to maintain the patients airway for the depth of sedation/analgesia indicated.
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
The statement explains that there are several contraindications for performing a MAC (Monitored Anesthesia Care) case. These include patient discomfort, patient positioning such as prone, the surgeon being unable to operate safely with the patient being non-paralyzed, and being unable to maintain the patient's airway for the depth of sedation/analgesia indicated. Therefore, the statement is true.Rate this question:
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- 29.
Drastically decreased O2 consumption and an increased margin of safety for cerebral vascular accidents are advantages of which operative technique?
- A.
Hypothermic
- B.
Hypovolemic
- C.
MAC
- D.
Regional
Correct Answer
A. HypothermicExplanation
Hypothermic operative technique involves lowering the body temperature, which leads to a significant decrease in oxygen consumption. This reduction in oxygen consumption is beneficial during surgeries as it allows for a longer duration of anesthesia without causing harm to the brain. Additionally, hypothermia provides an increased margin of safety for cerebral vascular accidents, as it slows down the metabolic processes and reduces the risk of ischemic injury to the brain. Therefore, hypothermic operative technique offers advantages of decreased oxygen consumption and improved safety for cerebral vascular accidents.Rate this question:
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- 30.
You are transporting a patient on 10L/min non-rebreathing mask. The E cylinder states a pressure of 500 psig. How long with the cylinder last in minutes?
Correct Answer
16.5Explanation
660/2000 = 0.33 x 500 = 165/10 = 16.5Rate this question:
- 31.
All of the following are primary purposes of PACU except:
- A.
Performing surgeries
- B.
Critical assessment
- C.
Stabilization
- D.
Prevention and detection of post-op complications
Correct Answer
A. Performing surgeriesExplanation
The correct answer is performing surgeries. The PACU, or Post-Anesthesia Care Unit, is a specialized area where patients recover after surgery. Its primary purposes include critical assessment, stabilization, and prevention and detection of post-op complications. However, performing surgeries is not one of its purposes, as surgeries are typically performed in the operating room, not in the PACU.Rate this question:
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- 32.
A patient should be hemodynamically stable, with adequate ventilation/oxygenation via a stable, patent airway before leaving the OR for the PACU.
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
The statement is true because it is important for a patient to be hemodynamically stable, meaning that their blood pressure, heart rate, and other vital signs are within a normal range, before leaving the operating room for the post-anesthesia care unit (PACU). Additionally, the patient should have adequate ventilation and oxygenation, meaning that they are breathing properly and receiving enough oxygen, through a stable and open airway. These criteria ensure that the patient is in a stable condition and ready to recover from the anesthesia in the PACU.Rate this question:
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- 33.
All of the following are risk factors for PONV except...
- A.
A male, smoker
- B.
A female, nonsmoker, with a history of motion sickness
- C.
The use of inhaled agents and opioids
- D.
A patient with a history of PONV
Correct Answer
A. A male, smokerExplanation
The correct answer is "A male, smoker." PONV stands for postoperative nausea and vomiting, which is a common complication after surgery. Risk factors for PONV include being female, having a history of motion sickness, the use of inhaled agents and opioids, and having a history of PONV. However, being a male and a smoker is not considered a risk factor for PONV.Rate this question:
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- 34.
Rapid cooling of a patient when utilizing hypothermic technique results in:
- A.
V-fib
- B.
A-fib
- C.
NSR
- D.
Junctional rhythm
Correct Answer
A. V-fibExplanation
The advantage of rapid cooling is the shortening of cardiac bypass timeRate this question:
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- 35.
°C x 9/5 + 32 = °F(°F - 32) x 5/9 = °C
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
The given equation is a conversion formula between Celsius and Fahrenheit temperatures. It states that to convert Celsius to Fahrenheit, you multiply by 9/5 and add 32, and to convert Fahrenheit to Celsius, you subtract 32 and multiply by 5/9. This equation is true and commonly used for temperature conversions between the two scales.Rate this question:
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- 36.
When performing hypotensive anesthesia, blood loss is related to:
- A.
MAP
- B.
Cardiac output
- C.
Central venous pressure
Correct Answer
A. MAPExplanation
In hypotensive anesthesia, blood loss is related to mean arterial pressure (MAP). MAP represents the average pressure in the arteries during one cardiac cycle and is a key determinant of tissue perfusion. When MAP decreases, blood flow to tissues decreases as well, leading to reduced oxygen and nutrient supply. Therefore, a lower MAP during hypotensive anesthesia can result in decreased blood flow and potentially increased blood loss. Cardiac output and central venous pressure may also be affected by hypotensive anesthesia, but they are not directly related to blood loss.Rate this question:
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- 37.
You're performing a train of four at the end of your case before your reversal, your patient has one twitch. You know that your patient could still have 90% of receptors blocked, and even with 4 twitches present, up to 75% of your patient's receptors could be blocked.
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
The statement is true because a train of four is a neuromuscular monitoring technique used to assess the depth of neuromuscular blockade. It involves delivering four consecutive electrical stimuli to a peripheral nerve and observing the resulting muscle twitches. In this case, the patient has only one twitch, indicating that there is still some level of blockade present. The statement further explains that even with four twitches present, up to 75% of the patient's receptors could still be blocked, emphasizing that the presence of twitches does not necessarily mean complete recovery from blockade.Rate this question:
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- 38.
__________ toxicity can occur with massive blood transfusions, causing significant hypocalcemia resulting in myocardial depression, hypotension, and a narrow pulse pressure.
Correct Answer
CitrateExplanation
Treat with calcium administration, at least every 4th unit of blood if doing massive transfusion protocolRate this question:
- 39.
MAP = (SBP + 2DBP)/3 orMAP = DBP + 1/3(SBP - DBP)
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
Remember...CO = HR X SV ;)Rate this question:
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- 40.
The movement of the mediastinum toward the head is most likely to cause right mainstem intubation in which patient position?
- A.
Trendelenburg
- B.
Reverse trendelenburg
- C.
Lateral
- D.
Lithotomy
Correct Answer
A. TrendelenburgExplanation
When a patient is in the Trendelenburg position, the head is lowered and the feet are elevated. This causes the movement of the mediastinum towards the head. In this position, there is a higher chance of right mainstem intubation, which means that the endotracheal tube is inserted too far into the right main bronchus instead of the trachea. This can lead to inadequate ventilation of the left lung and potential complications.Rate this question:
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- 41.
Which position is associated with a better matching of V/Q causing improvement in oxygenation?
- A.
Prone
- B.
Supine
- C.
Lateral
- D.
Lithotomy
Correct Answer
A. ProneExplanation
The prone position is associated with a better matching of ventilation and perfusion (V/Q) and improvement in oxygenation. In the prone position, the patient lies on their stomach, which helps to redistribute the blood flow and ventilation to the posterior lung regions. This allows for improved matching of ventilation and perfusion, leading to better oxygenation of the blood.Rate this question:
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- 42.
Which position allows for the best ventilation?
- A.
Sitting
- B.
Supine
- C.
Lateral
- D.
Lithotomy
Correct Answer
A. SittingExplanation
Sitting allows for the best ventilation because in this position, the chest is in an upright position, allowing the diaphragm to move freely and effectively. This allows for optimal lung expansion and ventilation. Additionally, sitting allows for better alignment of the airways, reducing the risk of airway obstruction.Rate this question:
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- 43.
Horner syndrome occurs as a result of blocking ___________ nerve supply to the eye, resulting in: ispi-lateral miosis, ptosis, exophthalmos, flushing, anhydrosis, nasal stuffiness, and increased skin temperature.
- A.
Sympathetic
- B.
Parasympathetic
Correct Answer
A. SympatheticExplanation
Assoc w/CVP placement, interscalene brachial plexus blockRate this question:
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- 44.
The perception of pain occurs in the cerebral cortex.
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
The perception of pain occurs in the cerebral cortex. This is because the cerebral cortex is responsible for processing sensory information, including pain signals. When we experience pain, nerve signals are sent to the brain where they are interpreted and processed in the cerebral cortex. This region of the brain allows us to perceive and localize pain, as well as to interpret its intensity and quality. Therefore, it is accurate to say that the perception of pain occurs in the cerebral cortex.Rate this question:
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