Certification Review for Nurse Anesthesia

289 Pages·2016·18.54 MB·English

by  Burns Shari M.

Ce rt ifica t io n Re vie w
fo r Nu rse An e st h e sia
Shari M. Burns, CRNA, Ed.D. Shaun Mendel, CRNA, MS
Program Director/Professor Assistant Director/Assistant Professor
Nurse Anesthesia Program Nurse Anesthesia Program
Midwestern University, Midwestern University
Glendale, Arizona Glendale, Arizona
With Contributors Michael MacKinnon, CRNA, MSN
MacKinnon Anesthesia PLLC
Jacob D. Hantla, CRNA, MS
Phoenix, Arizona
Arizona Heart Anesthesia
Phoenix, Arizona
Christol Williams, CRNA, DNAP
Assistant Professor
F. Scott Imus, CRNA, MS
Nurse Anesthesia Program
Assistant Professor
Midwestern University
Nurse Anesthesia Program
Glendale, Arizona
Midwestern University
Glendale, Arizona
New York Chicago San Francisco Athens London Madrid Mexico City
Milan New Delhi Singapore Sydney Totonto
Copyright © 2015 by McGraw-Hill Education. All rights reserved. Except as permitted under the United States Copyright Act of 1976, no part of this
publication may be reproduced or distributed in any form or by any means, or stored in a database or retrieval system, without the prior written permission of
the publisher.
ISBN: 978-0-07-182767-6
MHID: 0-07-182767-6
The material in this eBook also appears in the print version of this title: ISBN: 978-0-07-182766-9,
MHID: 0-07-182766-8.
eBook conversion by codeMantra
Version 1.0
All trademarks are trademarks of their respective owners. Rather than put a trademark symbol after every occurrence of a trademarked name, we use names in
an editorial fashion only, and to the bene t of the trademark owner, with no intention of infringement of the trademark. Where such designations appear in this
book, they have been printed with initial caps.
McGraw-Hill Education eBooks are available at special quantity discounts to use as premiums and sales promotions or for use in corporate training programs.
To contact a representative, please visit the Contact Us page at www.mhprofessional.com.
Notice
Medicine is an ever-changing science. As new research and clinical experience broaden our knowledge, changes in treatment and drug therapy are required. The
authors and the publisher of this work have checked with sources believed to be reliable in their efforts to provide information that is complete and generally
in accord with the standards accepted at the time of publication. However, in view of the possibility of human error or changes in medical sciences, neither the
authors nor the publisher nor any other party who has been involved in the preparation or publication of this work warrants that the information contained
herein is in every respect accurate or complete, and they disclaim all responsibility for any errors or omissions or for the results obtained from use of the
information contained in this work. Readers are encouraged to con rm the information contained herein with other sources. For example and in particular,
readers are advised to check the product information sheet included in the package of each drug they plan to administer to be certain that the information
contained in this work is accurate and that changes have not been made in the recommended dose or in the contraindications for administration. This
recommendation is of particular importance in connection with new or infrequently used drugs.
TERMS OF USE
This is a copyrighted work and McGraw-Hill Education and its licensors reserve all rights in and to the work. Use of this work is subject to these terms.
Except as permitted under the Copyright Act of 1976 and the right to store and retrieve one copy of the work, you may not decompile, disassemble, reverse
engineer, reproduce, modify, create derivative works based upon, transmit, distribute, disseminate, sell, publish or sublicense the work or any part of it without
McGraw-Hill Education’s prior consent. You may use the work for your own noncommercial and personal use; any other use of the work is strictly prohibited.
Your right to use the work may be terminated if you fail to comply with these terms.
THE WORK IS PROVIDED “AS IS.” McGRAW-HILL EDUCATION AND ITS LICENSORS MAKE NO GUARANTEES OR WARRANTIES AS
TO THE ACCURACY, ADEQUACY OR COMPLETENESS OF OR RESULTS TO BE OBTAINED FROM USING THE WORK, INCLUDING ANY
INFORMATION THAT CAN BE ACCESSED THROUGH THE WORK VIA HYPERLINK OR OTHERWISE, AND EXPRESSLY DISCLAIM ANY
WARRANTY, EXPRESS OR IMPLIED, INCLUDING BUT NOT LIMITED TO IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR
A PARTICULAR PURPOSE. McGraw-Hill Education and its licensors do not warrant or guarantee that the functions contained in the work will meet your
requirements or that its operation will be uninterrupted or error free. Neither McGraw-Hill Education nor its licensors shall be liable to you or anyone else for
any inaccuracy, error or omission, regardless of cause, in the work or for any damages resulting therefrom. McGraw-Hill Education has no responsibility for
the content of any information accessed through the work. Under no circumstances shall McGraw-Hill Education and/or its licensors be liable for any indirect,
incidental, special, punitive, consequential or similar damages that result from the use of or inability to use the work, even if any of them has been advised of
the possibility of such damages. This limitation of liability shall apply to any claim or cause whatsoever whether such claim or cause arises in contract, tort or
otherwise.
Co nte nts
Preface ........................................................................................................................................................ v
Acknowledgements .................................................................................................................................... vi
1. Basic Sciences
Questions .....................................................................................................................................................01
Answers and Explanations . ......................................................................................................................... 35
2. Equipment, Instrumentation, and Technology
Questions .................................................................................................................................................. 111
Answers and Explanations . ....................................................................................................................... 120
3. Basic Principles
Questions .................................................................................................................................................. 143
Answers and Explanations . ....................................................................................................................... 162
4. Advanced Principles
Questions .................................................................................................................................................. 213
Answers and Explanations . ....................................................................................................................... 233
Index ....................................................................................................................................................... 275
iii
This page intentionally left blank
Pre ace
Building a solid oundation o knowledge is pivotal or to promote patient sa ety is laudable. he review questions
practice as a Certi ied Registered Nurse Anesthetist (CRNA). oster knowledge acquisition providing a oundation or sa e
Continuous changes in science, pharmacology, and technol- anesthetic practice. Basic Science; Equipment, Instrumen-
ogy necessitate the need to consistently strive to build upon tation, and echnology; and Basic and Advanced Principles
material learned through classroom, simulation, and clinical serve as the ocus or each chapter. he intent o the
rotations. Even with years o practice, seasoned CRNAs content-based questions provides you with the ability to
strive to consistently update knowledge to improve anes- identi y strengths and gaps in your knowledge base. Ratio-
thetic care. he purpose o this book is two old: (1) to pro- nale or the correct responses is provided along with current
vide a strong resource or graduating student nurse anesthe- anesthesia re erences including the newest edition o
tists that assists in preparation or the National Certi ication Morgan and Mikhail’s Clinical Anesthesiology (5th ed.). New
Examination (NCE) and (2) to o er current, comprehen- York, NY: Lange Medical Books McGraw-Hill. Question
sive review material or seasoned CRNAs. ormats include multiple choice, multiple response, and calcu-
he review book is based upon the content areas tested lation. he questions are intentionally not grouped according
by the National Board o Certi ication and Recerti ication to speci ic topics in order to provide a review that mirrors a real
o Nurse Anesthetists (NBCRNA). he NBCRNA’s quest test environment. Enjoy the review!
v
Ackno wle dg me nts
Many thanks to nurse anesthesia colleagues, aculty, and University Nurse Anesthesia Program aculty or unwaver-
students who reviewed items contained in this review book. ing support and encouragement and to Alanna Connelly,
Contributions by clinical and academic aculty ostered a Program Coordinator, or countless hours o ormatting
comprehensive review or students and practicing nurse and editing. his work is dedicated to the nurse anesthesia
anesthetists. pro ession and today’s students who aspire to continue the
Special thanks to Jacqueline Smith, Ph.D., Dean, Col- tradition o providing sa e anesthetic care. Finally, I thank
lege o Health Sciences, Glendale, and the Midwestern my dear amily.
vi
CHAPTER 1
Basic Scie nce s
Questions
1. What results when alpha-1 receptors are activated? 6. What is the blood to gas partition coef cient o halo-
thane?
(A) Presynaptic nerve terminals are stimulated.
(A) 0.47
(B) Adenylate cyclase activity is inhibited.
(B) 0.65
(C) Negative eedback loop inhibits norepineph-
rine release. (C) 1.4
(D) Intracellular calcium ion concentration (D) 2.4
increases.
7. Which inhalational agent is a halogenated alkane?
2. Which initial intervention is correct i pulmonary
(A) Halothane
embolism is suspected?
(B) Nitrous oxide
(A) Discontinue intravenous luids
(C) Des lurane
(B) Increase FiO
(D) Sevo lurane
2
(C) Extubate the patient
8. How would you classi y a patient with repeated blood
(D) Discontinue inotropic support
pressure measurements ranging rom 160/100 to
179/109?
3. Which anticholinergic increases heart rate the most?
(A) High normal
(A) Scopolamine
(B) Stage 1 hypertension
(B) Glycopyrrolate
(C) Stage 2 hypertension
(C) Atropine
(D) Stage 3 hypertension
(D) Pyridostigmine
9. Which condition is NO associated with precipitat-
4. What is the normal V/Q ratio?
ing unstable angina?
(A) 1
(A) Polycythemia
(B) 0.8
(B) Anemia
(C) 2
(C) hyrotoxicosis
(D) 0.5
(D) Emotional stress
5. What is the underlying pathology o cor pulmonale?
10. Which neuromuscular blocking drug is contraindi-
(A) Pulmonary hypertension
cated during the care o a patient with Guillain-Barré
(B) Decreased pulmonary vascular resistance syndrome?
(C) Systemic hypertension
(A) Succinylcholine
(D) Orthostatic hypotension
(B) Rocuronium
(C) Atracurium
(D) Pancuronium
1
2 1: Basic Sciences
11. Which two lung pathologies are orms o chronic 17. A patient with mitral stenosis is asymptomatic with
obstructive pulmonary disease (COPD)? occasional mild symptoms with exertion. Which
mitral valve area is associated with these symptoms?
Select (2) two
(A) 0.2-0.5 cm2
(A) Asthma
(B) 0.5-1.0 cm2
(B) Chronic bronchitis
(C) 1.5-2.0 cm2
(C) Aspiration pneumonitis
(D) 2.0-2.5 cm2
(D) Emphysema
18. Which term describes ull drug activation o a
12. Which is a normal unctional residual capacity?
receptor?
(A) 500 mL
(A) Antagonist
(B) 1,200 mL
(B) Partial agonist
(C) 2,300 mL
(C) Agonist
(D) 1,100 mL
(D) Noncompetitive antagonist
13. What are the three most common used pharmaco-
19. A 60-year-old emale with mitral stenosis has the ol-
logical agents or treating ischemic heart disease?
lowing post-induction vital signs: HR 125, BP 70/45
(A) Nitrates, alpha blockers, and ACE-inhibitors
ollowed by sudden supraventricular tachycardia
(B) Nitrates, beta-blockers, and calcium channel
(SV ). What will you do rst?
blockers
(A) Cardioversion
(C) Beta-blockers, calcium channel blockers, and
(B) Ephedrine
ACE-inhibitors
(C) Phenylephrine
(D) Calcium channel blockers, nitrates, and ARBs
(D) Vasopressin
14. Which narcotic does not cause histamine release?
20. Which adrenergic agonist a ects the heart rate the
(A) Fentanyl
greatest?
(B) Morphine
(A) Norepinephrine
(C) Hydromorphone
(B) Dobutamine
(D) Meperidine
(C) Ephedrine
(D) Isoproterenol
15. Which o the ollowing occurs ollowing administra-
tion o morphine?
21. What is the onset o analgesia ollowing administra-
(A) Increased hypoxic drive
tion o epidural morphine 5 mg?
(B) Decreased apneic threshold
(A) 30-60 minutes
(C) Decreased hypoxic drive
(B) 15-30 minutes
(D) Decreased PaCO
2
(C) 5-15 minutes
(D) > 60 minutes
16. T e patient is shivering in the post–anesthesia care
unit. Which intravenous medication will you use?
22. Which o the ollowing local anesthetics and dosages
(A) Meperidine (10 to 25 mg)
are used or cesarean section with spinal anesthesia?
(B) Fentanyl (25 µg)
(A) Lidocaine (100 mg)
(C) Morphine (5 mg)
(B) etracaine (14 mg)
(D) Hyromorphone (5 mg)
(C) Bupivacaine (12 mg)
(D) Mepivacaine (16 mg)
Questions: 11–33 3
23. Which anticholinergic is classi ed as a quaternary 29. What classic triad o symptoms is associated with aor-
amine? tic stenosis with a valve area < 1 cm2?
(A) Scopolamine (A) Hypotension, dyspnea on exertion, and pul-
monary congestion
(B) Atropine
(B) Hoarseness, chest pain, and pulmonary emboli
(C) Neostigmine
(C) Chest pains, arrhythmias, and embolic events
(D) Glycopyrrolate
(D) Dyspnea on exertion, angina, and exertional
24. Which anticholinergic cannot cross the blood-brain syncope
barrier?
30. How does the elimination hal -time o remi entanil
(A) Glycopyrrolate
di er rom al entanil?
(B) Atropine
(A) Elimination hal -time is longer or
(C) Scopolamine
remi entanil.
(D) Scopolamine and atropine
(B) Elimination hal -time is shorter or al entanil.
(C) Elimination hal -time is similar or al entanil
25. Which variable increases minimum alveolar concen-
and remi entanyl.
tration (MAC)?
(D) Elimination hal -time is shorter or remi entanil.
(A) Hypernatremia
(B) Hyperthermia
31. One goal during a general anesthetic is to decrease the
(C) Acute intoxication
neuroendocrine stress response to surgical stimula-
(D) Ketamine tion. Which medication will be help ul?
(A) Vecuronium
26. Which actors will exacerbate mitral regurgitation?
(B) Midazolam
(A) achycardia and acute increases in a terload.
(C) Lidocaine
(B) achycardia and acute decreases in a terload.
(D) Fentanyl
(C) Bradycardia and acute increases in a terload.
(D) Bradycardia and acute decreases in a terload. 32. You administered meperidine IV. Immediately
ollowing administration the patient developed pro-
27. Which volumes are included in vital capacity? ound hypotension, hyperpyrexia, and respiratory
arrest. What drug interaction do you suspect?
(A) idal volume and residual volume
(B) Residual volume and expiratory reserve volume (A) Interaction with monoamine oxidase inhibitors
(MAOs)
(C) Expiratory reserve volume and inspiratory
capacity volume (B) Interaction with erythromycin
(D) Inspiratory capacity volume and residual (C) Interaction with sodium pentothal
volume (D) Interaction with etomidate
28. Your patient’s hemodynamic pro le is as ollows: 33. What is the normal aortic valve area?
HR = 100 beats/minute, cardiac output (CO) = 5.0
(A) 0.5-1.0 cm2
L/min, end-diastolic volume (EDV) = 100 mL.
(B) 1.0-1.5 cm2
Calculate the ejection fraction and write the answer
(C) 1.5-2.5 cm2
in the box below:
(D) 2.5-3.5 cm2
%