FREE NBCRNA CPCA Questions and Answers
Which medication produces dissociative anesthesia?
Explanation:
Ketamine is an NMDA-receptor-blocking medication that produces a functional dissociation between the thalamocortical and limbic systems, a state that has been termed dissociative anesthesia. It produces dose-dependent CNS depression characterized by profound analgesia and amnesia by depressing neuronal function in the cerebral cortex and thalamus, while simultaneously activating the limbic system.
Which device is operational to prevent the simultaneous use of more than one anesthetic vaporizer?
Explanation:
Anesthetic machines that contain a mounting system from multiple vaporizers incorporate an interlock system preventing the simultaneous use of more than one vaporizer.
Which muscle relaxant is MOST appropriate in patients with advanced liver disease?
Explanation:
Cisatracurium is metabolized by Hofmann elimination. All other choices have some degree of liver metabolism.
Which drug is MOST appropriate to treat refractory hypotension in a patient who took lisinopril (Prinivil, Zestril) on the day of surgery?
Explanation:
Patients who take ACE inhibitors (lisinopril) can manifest profound hypotension despite boluses of ephedrine and phenylephrine. The best next course of action is to administer a direct-acting catecholamine or vasopressin.
Esmolol (Brevibloc) is metabolized by which mechanism?
Explanation:
Esmolol is the only beta-adrenergic receptor antagonist cleared through plasma hydrolysis.
Which medication should be administered to a patient who is unresponsive and hypoxic after receiving midazolam (Versed) for a 20-minute gastrointestinal procedure?
Explanation:
A benzodiazepine antagonist such as flumazenil can be used to reverse the sedative effects of benzodiazepines such as midazolam. It can be used for excessive sedation but should not be used routinely.
Which drug is metabolized by plasma cholinesterase?
Explanation:
Most aminoester local anesthetics—procaine (Novocain), chloroprocaine (Nesacaine), tetracaine—are hydrolyzed in the plasma by cholinesterase enzymes. The aminoamides—lidocaine, bupivacaine, prilocaine (Citanest), ropivacaine, mepivacaine (Carbocaine)—are metabolized in the liver.
The P wave on an ECG tracing corresponds with:
Explanation:
Atrial depolarization corresponds with the P wave on ECG tracing.
Which drug would carry the HIGHEST risk of an adverse drug reaction with IV contrast dye during a lower limb angiography?
Explanation:
Of the drugs listed, the only medication that carries an adverse drug reaction risk with contrast dye is metformin. When given in conjunction with contrast dye, it is associated with an increased potential for lactic acidosis. The combination of the 2 drugs could expose the patient to significant contrast-induced nephropathy.
A patient with an emergent stroke comes for an embolization procedure. The patient is allergic to morphine and sulfonamides. He has a history of gout, hypertension, gastrointestinal bleeding, and reflux. Which medication should be avoided in the postoperative orders?
Explanation:
Ketorolac is a nonselective inhibitor of prostaglandin synthesis. It is contraindicated in patients with a history of peptic ulcer disease and gastrointestinal bleeding.
During the administration of anesthesia to a patient with sickle cell disease, which action minimizes sickling?
Explanation:
Increased oxygen concentration limits the sickling process. The rest of the choices contribute to sickling. Sickling is increased with lowered oxygen tensions, acidosis, low cardiac output with low-flow states, and hypothermia. Current therapy includes prevention of hypothermia, providing hydration, controlling ventilation to avoid acidosis, and giving supplemental oxygen.