NBCRNA Anesthetic Complications and Crisis Management 1

Question 1

Intraoperative anaphylaxis most commonly presents with which cardiovascular sign?

Accepted Answer

Severe hypotension and tachycardia

Answer

Anaphylaxis causes massive histamine release leading to vasodilation, increased capillary permeability, and reduced venous return, producing severe distributive hypotension with compensatory tachycardia.

Question 2

The first-line treatment for intraoperative anaphylaxis is:

Accepted Answer

Epinephrine 0.01 mg/kg IV (10–100 mcg) titrated to response

Answer

Epinephrine is the only first-line treatment for anaphylaxis; it counteracts vasodilation (alpha-1), supports heart rate and contractility (beta-1), and reverses bronchospasm (beta-2).

Question 3

Intraoperative bronchospasm during general anesthesia is most commonly caused by what?

Accepted Answer

Airway manipulation (intubation, suctioning) in an inadequately anesthetized patient

Answer

Stimulation of the reactive airway by endotracheal tube placement or suctioning when the depth of anesthesia is inadequate triggers reflex bronchospasm through vagal airway reflexes.

Question 4

Which intraoperative sign is the earliest indicator of malignant hyperthermia (MH)?

Accepted Answer

Unexplained increase in end-tidal CO2

Answer

Increased metabolic rate from uncontrolled skeletal muscle calcium release produces excess CO2 before core temperature rises significantly, making elevated ETCO2 the most sensitive early MH sign.

Question 5

The immediate management of an accidental intravenous injection of local anesthetic (LAST) begins with:

Accepted Answer

Stop injection, call for help, secure airway, and prepare lipid emulsion

Answer

The ASRA LAST management protocol prioritizes stopping the injection, calling for help, maintaining oxygenation and airway, controlling seizures with benzodiazepines, and preparing lipid emulsion for cardiovascular collapse.

NBCRNA - National Board of Certification and Recertification for Nurse Anesthetists Practice Test

NBCRNA - National Board of Certification and Recertification for Nurse Anesthetists Practice Test

NBCRNA Anesthetic Complications and Crisis Management 1