Otterbein/Grant CRNA Basics Final Review

Indications for using regional anesthesia include: avoiding general anesthesia, obstetric procedures, urology procedures, orthopedic procedures, patient choice, and pulmonary/cardiac issues.

• True

• False

All of the following are symptoms of local anesthetic toxicity except:

• Hyperventilation

• Numbness/tingling of lips and tongue, metallic taste, ringing in the ears

• Dizziness, visual disturbances, disorientation

• Tremors, twitching, leading to convulsions

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 ____. 

• 50%

• 20%

• 2x

• 0%

Musculotcutaneous, median, ulnar, radial and ________ nerves are all major terminal branches of the brachial plexus.

The brachial plexus is divided into ________ trunks, divisions, cords, and branches.

PA catheter indications include all of the following except:

• Pulmonary stenosis

• Impaired cardiac function

• Evaluation of response to fluids/drugs

• Cross clamping of the aorta, suspected/diagnosed pulmonary emboli, ARDS, COPD, pulm. HTN

Normal SVO2 is 60-80%, all of the following will increase SVO2 except:

• Shivering

• Sepsis

• Cyanid poisoning

• Increased cardiac output

All of the following will decrease SVO2 except:

• Leftward shift of oxyhemoglobin curve

• Hyperthermia/shivering

• Seizures

• Hemorrhage/Decreased CO

When interpreting a CVP waveform, the C wave represents:

• Ventricular contraction

• RA contraction

• Atrial filling

• Tricuspid valve opening

You're performing an Allen's test, you release the ulnar artery and expect color to return to the hand within how many seconds?

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:

• Diastole

• Systole

Respiratory variation in arterial waveforms > 10 mmHg indicates ________ intravascular volume.

• Decreased

• Increased

• Option 3

• Option 4

Left IJ CVP insertion is associated with __________ duct injury.

What is the most common mechanism of nerve injury in the OR?

• Compression

• Stretch

• Transection

• Kinking

The lung zones shift from vertical to horizontal when going from standing to a supine position.

• True

• False

Which of the following ligaments creates the popping sensation when placing an epidural? 

• Ligamentum flavum

• Interspinous

• Supraspinous

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.

• True

• False

Systemic absorption of LA is greatest at which of the following?

• Tracheal

• Caudal

• Epidural

• Subcutaneous

Regarding local anesthetics, ________ lipid solubility correlates with increased protein binding, potency, duration of action, and a higher tendency for severe toxicity, especially cardiotoxicity.

• Increased

• Decreased

The addition of epinephrine to bupivacaine, ropivacaine, or etidocaine will prolong their duration of action.

• True

• False

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:

• Hypocalcemia

• Hypercalcemia

What would be the maintenance fluid requirement for a 85 kg person?

An 85 kg person has been NPO for 6 hours, what is their NPO deficit?

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?

Which West zone should a PA catheter tip be placed?

• III

• II

• I

• IV

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.

• True

• False

In order for a case to truly be considering monitored anesthesia care, the patient must maintain spontaneous ventilation.

• True

• False

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.

• True

• False

Drastically decreased O2 consumption and an increased margin of safety for cerebral vascular accidents are advantages of which operative technique?

• Hypothermic

• Hypovolemic

• MAC

• Regional

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?

All of the following are primary purposes of PACU except:

• Performing surgeries

• Critical assessment

• Stabilization

• Prevention and detection of post-op complications

A patient should be hemodynamically stable, with adequate ventilation/oxygenation via a stable, patent airway before leaving the OR for the PACU.

• True

• False

All of the following are risk factors for PONV except...

• A male, smoker

• A female, nonsmoker, with a history of motion sickness

• The use of inhaled agents and opioids

• A patient with a history of PONV

Rapid cooling of a patient when utilizing hypothermic technique results in:

• V-fib

• A-fib

• NSR

• Junctional rhythm

°C  x  9/5 + 32 = °F(°F  -  32)  x  5/9 = °C

• True

• False

When performing hypotensive anesthesia, blood loss is related to:

• MAP

• Cardiac output

• Central venous pressure

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. 

• True

• False

__________ toxicity can occur with massive blood transfusions, causing significant hypocalcemia resulting in myocardial depression, hypotension, and a narrow pulse pressure.

MAP = (SBP + 2DBP)/3  orMAP = DBP + 1/3(SBP - DBP)

• True

• False

The movement of the mediastinum toward the head is most likely to cause right mainstem intubation in which patient position?

• Trendelenburg

• Reverse trendelenburg

• Lateral

• Lithotomy

Which position is associated with a better matching of V/Q causing improvement in oxygenation?

• Prone

• Supine

• Lateral

• Lithotomy

Which position allows for the best ventilation?

• Sitting

• Supine

• Lateral

• Lithotomy

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.

• Sympathetic

• Parasympathetic

The perception of pain occurs in the cerebral cortex.

• True

• False