Free NBCRNA CPCA Questions and Answers — Questions and Answers
Question 1: Esmolol (Brevibloc) is metabolized by which mechanism?
- First-pass hepatic elimination
- Plasma hydrolysis (Correct answer)
- Protein binding
- Renal excretion
Correct answer: Plasma hydrolysis
Explanation: <br> Esmolol is the only beta-adrenergic receptor antagonist cleared through plasma hydrolysis.
Question 2: Which medication produces dissociative anesthesia?
- Fentanyl (Sublimaze)
- Ketamine (Ketalar) (Correct answer)
- Lidocaine (Xylocaine)
- Propofol (Diprivan)
Correct answer: Ketamine (Ketalar)
Explanation: <br> 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.
Question 3: Which medication should be administered to a patient who is unresponsive and hypoxic after receiving midazolam (Versed) for a 20-minute gastrointestinal procedure?
- Atropine
- Flumazenil (Romazicon) (Correct answer)
- Naloxone (Narcan)
- Neostigmine (Prostigmin)
Correct answer: Flumazenil (Romazicon)
Explanation: <br> 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.
Question 4: The P wave on an ECG tracing corresponds with:
- atrial repolarization.
- atrial depolarization. (Correct answer)
- ventricular repolarization.
- ventricular depolarization.
Correct answer: atrial depolarization.
Explanation: <br> Atrial depolarization corresponds with the P wave on ECG tracing.
Question 5: Which drug would carry the HIGHEST risk of an adverse drug reaction with IV contrast dye during a lower limb angiography?
- Citalopram (Celexa)
- Metformin (Glucophage) (Correct answer)
- Metoprolol (Toprol)
- Omeprazole (Prilosec)
Correct answer: Metformin (Glucophage)
Explanation: <br> 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.
Question 6: Which drug is metabolized by plasma cholinesterase?
- Bupivacaine (Marcaine)
- Lidocaine (Xylocaine)
- Ropivacaine (Naropin)
- Tetracaine (Correct answer)
Correct answer: Tetracaine
Explanation: <br> 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.
Question 7: Which device is operational to prevent the simultaneous use of more than one anesthetic vaporizer?
- Agent-limiting
- Interlock (Correct answer)
- Quick connect
- Variable bypass
Correct answer: Interlock
Explanation: <br> Anesthetic machines that contain a mounting system from multiple vaporizers incorporate an interlock system preventing the simultaneous use of more than one vaporizer.
Question 8: Which muscle relaxant is MOST appropriate in patients with advanced liver disease?
- Cisatracurium (Nimbex) (Correct answer)
- Pancuronium (Pavulon)
- Rocuronium (Zemuron)
- Vecuronium (Norcuron)
Correct answer: Cisatracurium (Nimbex)
Explanation: <br> Cisatracurium is metabolized by Hofmann elimination. All other choices have some degree of liver metabolism.
Question 9: Which drug is MOST appropriate to treat refractory hypotension in a patient who took lisinopril (Prinivil, Zestril) on the day of surgery?
- Atropine
- Glucagon
- Isoproterenol (Isuprel)
- Vasopressin (Correct answer)
Correct answer: Vasopressin
Explanation: <br> 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.
Question 10: During the administration of anesthesia to a patient with sickle cell disease, which action minimizes sickling?
- Administration of 100% oxygen (Correct answer)
- Avoidance of hyperthermia
- Continued hypoventilation
- Restriction of fluids
Correct answer: Administration of 100% oxygen
Explanation: <br> 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.
Question 11: 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?
- Acetaminophen
- Fentanyl (Sublimaze)
- Hydromorphone (Dilaudid)
- Ketorolac (Toradol) (Correct answer)
Correct answer: Ketorolac (Toradol)
Explanation: <br> Ketorolac is a nonselective inhibitor of prostaglandin synthesis. It is contraindicated in patients with a history of peptic ulcer disease and gastrointestinal bleeding.
Free NBCRNA CPCA Questions and Answers
Esmolol (Brevibloc) is metabolized by which mechanism?