NBCRNA Pharmacology for Nurse Anesthetists 1 — Questions and Answers
Question 1: Which inhalation anesthetic has the lowest blood-gas partition coefficient, resulting in the fastest induction and emergence?
- Desflurane (Correct answer)
- Sevoflurane
- Isoflurane
- Halothane
Correct answer: Desflurane
Desflurane has the lowest blood-gas partition coefficient (0.42) among currently used volatile agents, enabling the most rapid alveolar equilibration.
Question 2: What is the primary mechanism of action of propofol?
- GABA-A receptor potentiation (Correct answer)
- NMDA receptor antagonism
- Opioid receptor agonism
- Sodium channel blockade
Correct answer: GABA-A receptor potentiation
Propofol produces hypnosis primarily by enhancing GABA-mediated inhibitory neurotransmission at GABA-A receptors.
Question 3: Which neuromuscular blocking agent is reversed specifically by sugammadex?
- Rocuronium (Correct answer)
- Succinylcholine
- Cisatracurium
- Pancuronium
Correct answer: Rocuronium
Sugammadex is a modified gamma-cyclodextrin that encapsulates rocuronium (and vecuronium) to reverse neuromuscular blockade.
Question 4: The MAC of an inhalation anesthetic is defined as the minimum alveolar concentration that prevents movement in what percentage of patients exposed to a surgical skin incision?
- 50% (Correct answer)
- 95%
- 75%
- 99%
Correct answer: 50%
MAC is the median effective dose (ED50), representing the alveolar concentration at which 50% of patients do not move in response to a surgical skin incision.
Question 5: Which opioid has the fastest onset due to its high lipid solubility and is most commonly used for intraoperative analgesia infusions?
- Remifentanil (Correct answer)
- Morphine
- Meperidine
- Hydromorphone
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 6: Ketamine produces dissociative anesthesia primarily through which receptor mechanism?
- NMDA receptor antagonism (Correct answer)
- GABA-A receptor agonism
- Mu-opioid receptor agonism
- Alpha-2 adrenergic agonism
Correct answer: NMDA receptor antagonism
Ketamine blocks NMDA (N-methyl-D-aspartate) glutamate receptors, producing dissociative anesthesia, analgesia, and amnesia.
NBCRNA Pharmacology for Nurse Anesthetists 1
Which inhalation anesthetic has the lowest blood-gas partition coefficient, resulting in the fastest induction and emergence?