NBCRNA National Certification Examination (NCE) — Questions and Answers

Question 1: The Venturi effect in anesthesia equipment is used primarily in which device?

Circle breathing system CO2 absorber
Venturi oxygen mask to entrain room air (Correct answer)
Scavenging system interface
Variable bypass vaporizer

Correct answer: Venturi oxygen mask to entrain room air

Venturi (air-entrainment) oxygen masks use the Bernoulli/Venturi principle to entrain precise amounts of room air, delivering accurate fixed FiO2 concentrations.

Question 2: The treatment of choice for severe LAST with cardiovascular collapse is:

Sodium bicarbonate bolus
Defibrillation as primary intervention
High-dose epinephrine infusion
Lipid emulsion therapy (Intralipid 20%) (Correct answer)

Correct answer: Lipid emulsion therapy (Intralipid 20%)

Lipid emulsion therapy acts as a 'lipid sink,' sequestering the highly lipophilic local anesthetic from cardiac sodium channels and reversing cardiovascular toxicity.

Question 3: The Mallampati classification is used preoperatively to predict what?

Likelihood of post-operative sore throat
Depth of anesthesia required
Aspiration risk
Difficulty of laryngoscopy and intubation (Correct answer)

Correct answer: Difficulty of laryngoscopy and intubation

The Mallampati score assesses oropharyngeal structures visible with mouth open and tongue protruded; higher scores (III–IV) correlate with restricted laryngoscopic view and difficult intubation.

Question 4: Femoral nerve block at the inguinal ligament provides analgesia for which surgical procedure?

Foot and ankle procedures
Posterior knee and calf surgery
Shoulder arthroplasty
Hip fracture and anterior thigh surgery (Correct answer)

Correct answer: Hip fracture and anterior thigh surgery

The femoral nerve (L2–L4) provides sensory innervation to the anterior thigh, medial leg, and knee joint, making femoral nerve block effective for hip fracture pain and anterior thigh/knee procedures.

Question 5: Which is the first sign of magnesium toxicity when used for seizure prophylaxis in preeclampsia?

Cardiac conduction defects
Respiratory depression
Hypotension
Loss of deep tendon reflexes (Correct answer)

Correct answer: Loss of deep tendon reflexes

Explanation: <br> Loss of deep tendon reflexes is typically the first sign of magnesium toxicity when used for seizure prophylaxis in preeclampsia. Magnesium can accumulate in the body, leading to neuromuscular effects such as diminished reflexes before more severe symptoms like respiratory depression, hypotension, or cardiac conduction defects occur.

Question 6: The epiglottis is lifted indirectly when the laryngoscope blade tip is placed in the vallecula during which technique?

Curved (Macintosh) blade laryngoscopy (Correct answer)
Fiberoptic nasotracheal intubation
Video laryngoscopy with hyperangulated blade
Straight (Miller) blade laryngoscopy

Correct answer: Curved (Macintosh) blade laryngoscopy

The Macintosh curved blade is placed in the vallecula (between the base of tongue and epiglottis); advancement stretches the hyoepiglottic ligament, indirectly elevating the epiglottis.

Question 7: Intraoperative hypotension most commonly defined as MAP <65 mmHg is most rapidly treated with which initial intervention?

Dopamine infusion
Increasing volatile anesthetic concentration
IV fluid bolus and phenylephrine or ephedrine based on heart rate (Correct answer)
Initiating norepinephrine infusion as first line

Correct answer: IV fluid bolus and phenylephrine or ephedrine based on heart rate

A fluid bolus addresses hypovolemia while a vasopressor (phenylephrine for tachycardia, ephedrine for bradycardia) corrects vasodilation or reduced SVR; the choice depends on the underlying cause.

Question 8: Intraoperative anaphylaxis most commonly presents with which cardiovascular sign?

Hypertension and bradycardia
Atrial fibrillation
Severe hypotension and tachycardia (Correct answer)
Bradycardia with normal blood pressure

Correct answer: Severe hypotension and tachycardia

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

Question 9: The intubating laryngeal mask airway (ILMA/Fastrach) differs from a standard LMA in that it is designed to:

Be used in awake patients without sedation
Provide a tighter seal for positive pressure ventilation
Allow blind or fiberoptic-guided endotracheal tube placement through the LMA (Correct answer)
Replace surgical airway access in CICO emergencies

Correct answer: Allow blind or fiberoptic-guided endotracheal tube placement through the LMA

The ILMA has a rigid curved shaft, epiglottic elevating bar, and detachable airway tube designed to guide a specially designed endotracheal tube through the LMA into the trachea.

Question 10: In the lateral position, blood flow to the dependent lung of the anesthetized patient MOST represents which zone of flow?

Zone: 3 (Correct answer)
Zone: 5
Zone: 7
Zone: 1

Correct answer: Zone: 3

Explanation: <br> Zone 3 occurs in dependent lung regions where alveolar pressure exceeds arterial and venous pressures. This positioning allows for optimal gas exchange in these areas, which are crucial for maintaining adequate ventilation and perfusion balance during anesthesia.

Question 11: Which induction agent is contraindicated in patients with porphyria?

Thiopental (Correct answer)
Ketamine
Propofol
Etomidate

Correct answer: Thiopental

Barbiturates such as thiopental induce delta-aminolevulinic acid (ALA) synthase, precipitating acute porphyric crises in susceptible patients.

Question 12: What dermatome level of sensory blockade is required for adequate spinal anesthesia during cesarean delivery?

T6
T10
T2
T4 (Correct answer)

Correct answer: T4

A sensory block to T4 (nipple line) is required for cesarean delivery to cover peritoneal manipulation and uterine exteriorization.

Question 13: What does a sustained upslope (shark fin appearance) in the capnography waveform indicate?

Esophageal intubation
Hyperventilation
Pulmonary embolism
Obstructive airway disease or bronchospasm (Correct answer)

Correct answer: Obstructive airway disease or bronchospasm

A prolonged, slanted upslope on capnography (shark fin) reflects uneven CO2 elimination from lung units with different time constants, characteristic of obstructive disease.

Question 14: Etomidate is preferred for induction in hemodynamically unstable patients primarily because it does what?

Blocks sympathetic nervous system
Provides profound analgesia
Causes bronchodilation
Minimally affects cardiovascular function (Correct answer)

Correct answer: Minimally affects cardiovascular function

Etomidate provides reliable hypnosis with minimal cardiovascular depression, making it the induction agent of choice for patients with cardiovascular compromise.

Question 15: What is the reversal agent for benzodiazepine-induced sedation?

Naloxone
Flumazenil (Correct answer)
Neostigmine
Physostigmine

Correct answer: Flumazenil

Flumazenil is a competitive benzodiazepine receptor antagonist that reverses sedation, amnesia, and respiratory depression caused by benzodiazepines.

Question 16: A patient's preoperative HbA1c of 10.5% suggests what and has what implication for elective surgery?

Poorly controlled diabetes associated with increased risk of surgical site infection and cardiovascular complications; consider optimizing glycemic control (Correct answer)
Requires insulin pump adjustment only
Excellent glycemic control; proceed without modification
No anesthetic implications if fasting glucose is <200 mg/dL

Correct answer: Poorly controlled diabetes associated with increased risk of surgical site infection and cardiovascular complications; consider optimizing glycemic control

HbA1c >8% reflects chronic hyperglycemia and is associated with impaired wound healing, infection, and perioperative cardiovascular events; HbA1c >9–10% often warrants preoperative optimization for elective cases.

Question 17: The cognitive aid (crisis checklist) most recommended for managing intraoperative crises is designed to do what?

Replace clinical judgment with algorithmic decision-making
Serve as a documentation tool for medicolegal defense
Assign tasks automatically to operating room team members
Reduce cognitive load during high-stress events by providing stepwise protocols that prevent critical steps from being missed (Correct answer)

Correct answer: Reduce cognitive load during high-stress events by providing stepwise protocols that prevent critical steps from being missed

Cognitive aids (like the Stanford Emergency Manual) address the well-documented human tendency to experience cognitive overload during emergencies, where critical steps are forgotten; the checklist externalizes the protocol so the team can focus on execution.

Question 18: Which volatile anesthetic is contraindicated in patients at risk for malignant hyperthermia?

Ketamine
Nitrous oxide only
All potent volatile agents (Correct answer)
Propofol

Correct answer: All potent volatile agents

All potent volatile anesthetic agents (halothane, isoflurane, desflurane, sevoflurane) are known triggers for malignant hyperthermia in susceptible individuals.

Question 19: The Wright respirometer is used intraoperatively to measure what?

End-tidal CO2
Inspiratory oxygen fraction
Airway resistance
Exhaled tidal volume (Correct answer)

Correct answer: Exhaled tidal volume

The Wright respirometer is a mechanical device that measures exhaled tidal and minute volumes by counting rotations of a vane turned by gas flow.

Question 20: Interscalene brachial plexus block provides the best anesthesia for surgery on which area?

Hand and digits
Shoulder and proximal humerus (Correct answer)
Forearm and elbow only
Axilla and chest wall

Correct answer: Shoulder and proximal humerus

The interscalene approach targets the brachial plexus at the C5–C7 roots, providing excellent coverage of the shoulder, clavicle, and proximal humerus while often missing the ulnar nerve (C8–T1).

Question 21: What is the most serious complication specific to interscalene brachial plexus block?

Horner syndrome
Postoperative shoulder pain rebound
Ulnar nerve sparing requiring supplemental block
Ipsilateral phrenic nerve palsy causing hemidiaphragm paralysis (Correct answer)

Correct answer: Ipsilateral phrenic nerve palsy causing hemidiaphragm paralysis

Ipsilateral phrenic nerve block occurs in nearly 100% of interscalene blocks, reducing pulmonary function by about 25%, which is contraindicated in patients with severe respiratory disease.

Question 22: According to the ASA Difficult Airway Algorithm, after a failed intubation attempt in a 'cannot intubate, cannot oxygenate' (CICO) scenario, what is the definitive rescue technique?

Blind nasal intubation
Retrograde wire intubation
Emergency front-of-neck airway (cricothyrotomy) (Correct answer)
Repeated direct laryngoscopy attempts

Correct answer: Emergency front-of-neck airway (cricothyrotomy)

In a CICO emergency, emergency front-of-neck airway access (surgical or needle cricothyrotomy) is the definitive rescue step to restore oxygenation and prevent death.

Question 23: Saddle block is a form of spinal anesthesia providing perineal anesthesia; it is achieved by using which technique?

Continuous spinal with catheter at L5–S1
Hyperbaric solution injected with patient sitting upright for 5–10 minutes (Correct answer)
Bilateral pudendal nerve blocks
Isobaric solution with patient in lithotomy position

Correct answer: Hyperbaric solution injected with patient sitting upright for 5–10 minutes

A saddle block uses a small volume of hyperbaric local anesthetic with the patient sitting; gravity restricts spread to the sacral nerve roots (S2–S5), anesthetizing the perineal 'saddle' area.

Question 24: The addition of epinephrine to local anesthetic solutions for peripheral nerve blocks primarily serves what purpose?

Enhances nerve membrane penetration
Reduces systemic toxicity by increasing absorption
Prevents allergic reactions to the local anesthetic
Prolongs duration of block by causing vasoconstriction (Correct answer)

Correct answer: Prolongs duration of block by causing vasoconstriction

Epinephrine causes local vasoconstriction, reducing vascular absorption of the local anesthetic and thereby prolonging the duration of the nerve block.

Question 25: During cardiac arrest under general anesthesia, which drug is given with caution (or avoided) when epinephrine is being used to treat LAST?

Beta-blockers
Amiodarone
High-dose vasopressin and calcium channel blockers (Correct answer)
Lidocaine

Correct answer: High-dose vasopressin and calcium channel blockers

High-dose vasopressin can worsen lipid emulsion therapy outcomes; beta-blockers can exacerbate the myocardial depression; ASRA recommends smaller epinephrine doses (<1 mcg/kg) rather than standard ACLS doses during LAST resuscitation.

Question 26: A patient taking clopidogrel for a coronary stent placed 4 months ago requires urgent hip fracture surgery. The recommended management is:

Hold clopidogrel 5–7 days before proceeding with neuraxial anesthesia
Continue clopidogrel and use general anesthesia with neuraxial anesthesia contraindicated
Cancel surgery until the stent is at least 12 months old
Proceed with surgery; withholding antiplatelet therapy risks in-stent thrombosis (Correct answer)

Correct answer: Proceed with surgery; withholding antiplatelet therapy risks in-stent thrombosis

For urgent surgery, the risk of delaying outweighs the bleeding risk; proceeding is recommended, and neuraxial anesthesia would be contraindicated per ASRA guidelines if clopidogrel was recently taken.

Question 27: The adductor canal block (subsartorial block) provides primarily what type of analgesia for knee surgery?

Sensory analgesia with preserved quadriceps strength (Correct answer)
Complete motor and sensory block of the lower leg
Motor block facilitating early physical therapy
Analgesia equivalent to femoral nerve block

Correct answer: Sensory analgesia with preserved quadriceps strength

The adductor canal contains the saphenous nerve and articular branches; blocking here provides medial knee and anterior thigh analgesia while largely preserving quadriceps motor function for early mobilization.

Question 28: Considerations for the management of a patient with myotonic dystrophy under general anesthesia should include a/an:

succinylcholine infusion.
midazolam premedication.
anticholinesterase reversal.
short-acting nondepolarizer. (Correct answer)

Correct answer: short-acting nondepolarizer.

Explanation: <br> Myotonic dystrophy is a genetic disorder affecting muscle function, and patients may be sensitive to depolarizing muscle relaxants like succinylcholine. Therefore, using a short-acting nondepolarizing muscle relaxant is preferred to avoid complications associated with prolonged neuromuscular blockade in these patients.

Question 29: Obstructive sleep apnea (OSA) increases perioperative risk primarily due to increased sensitivity to what?

Regional anesthetics causing excessive sympatholysis
Opioids and sedatives causing upper airway obstruction and hypoxia (Correct answer)
Neuromuscular blocking agents requiring higher doses
Volatile anesthetics causing bronchospasm

Correct answer: Opioids and sedatives causing upper airway obstruction and hypoxia

OSA patients have baseline hypoxemia risk and exaggerated sensitivity to opioids and sedatives, which further depress pharyngeal muscle tone and respiratory drive, increasing postoperative airway obstruction risk.

Question 30: Which opioid has the fastest onset due to its high lipid solubility and is most commonly used for intraoperative analgesia infusions?

Meperidine
Remifentanil (Correct answer)
Hydromorphone
Morphine

Correct answer: Remifentanil

Remifentanil is an ultra-short-acting opioid with rapid onset and offset due to ester hydrolysis metabolism, making it ideal for continuous intraoperative infusions.

Question 31: The epidural blood patch (EBP) treats post-dural puncture headache by:

Sealing the dural hole with autologous blood clot to stop CSF leakage (Correct answer)
Increasing intracranial pressure with blood volume
Providing anti-inflammatory treatment to the meninges
Diluting inflammatory mediators in the intrathecal space

Correct answer: Sealing the dural hole with autologous blood clot to stop CSF leakage

Injection of 15–20 mL of autologous blood into the epidural space forms a clot that seals the dural puncture, restoring normal CSF dynamics and relieving the headache.

NBCRNA National Certification Examination (NCE)

The NCE is the entry-level certification exam for nurse anesthesia graduates, testing the knowledge, skills, and abilities required for safe and effective anesthesia practice across four content domains.

170

Questions

180 min

Time Limit

70%

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These practice questions were written with AI tools. They are not real exam questions. Exam facts are checked against the official sources listed below. Not reviewed by a subject-matter expert. Editorial policy

Sources & references

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nbcrna.com — Passing score, eligibility, exam format, registration deadline, test dates, test delivery, time limit, renewal, score validity, retake policy · verified Oct 2026
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