COMP Exam 1 Flashcards
- Risk factors for deep vein thrombosis include all of the following except
A. a BMI greater than 60
B. obesity hypoventilation syndrome
C. venous stasis
D. Factor VIII deficiency
D. Factor VIII deficiency
A BMI of 60 or more, evidence of venous stasis, central obesity, and obesity hypoventilation syndrome or obstructive sleep apnea are significant risk factors for deep vein thrombosis.
- During the first phase of the injury of a major trauma patient, a core body temperature below 35 degrees Celsius is often associated with: (select two)
A. hypotension
B. coagulopathy
C. alkalosis
D. hypoxia
A. hypotension
B. coagulopathy
A core body temperature below 35 degrees Celsius is often associated with acidosis, hypotension, and coagulopathy during the early phase of injury for the major trauma patient.
- What would constitute a significant change in a somatosensory evoked potential?
A. A 10 percent decrease in amplitude
B. A 10 percent increase in amplitude
C. A 10 percent increase in latency
D. A 10 percent decrease in latency
C. A 10 percent increase in latency
A decrease in amplitude by 50 percent or an increase in latency by 10 percent commonly define a significant change in SSEPs.
- Within the first hour of the neohepatic period, the patient exhibits a decrease in cardiac output and an increase in systemic vascular resistance. What does this change indicate?
A. The patient is rejecting the liver
B. It is likely that the patient is bleeding internally
C. Calcium and fresh frozen plasma should be administered
D. The graft is functioning well
D. The graft is functioning well
A decrease in cardiac output and an increase in the SVR indicates that the graft is functioning correctly and the new liver is beginning to metabolize the vasoactive substances that produce the characteristic low SVR and high cardiac output in patients with end stage liver disease. Other signs that the graft is functioning correctly include: calcium is no longer needed even when large volumes of FFP are infused as the new liver is able to metabolize the citrate preservative and the base deficit normalizes.
- What condition would produce the flow-volume loop shaded in pink?
A. Unilateral vocal cord paralysis
B. Chronic obstructive pulmonary disease
C. Tracheomalacia
D. Tracheal stenosis
D. Tracheal stenosis
A fixed airway obstruction can be caused by a foreign body in the airway, a lesion like tracheal stenosis, or anatomical compression by a tumor or goiter. In a fixed obstruction, the flow-volume loop exhibits decreased flow during both inspiration and expiration. It looks as if the top and bottom of the loop are chopped off.
- A hormone response that initiates signals which amplify the release of the same hormone is referred to as a
A. positive feedback mechanism
B. negative feedback mechanism
C. target-control amplifier
D. circadian rhythm
A. positive feedback mechanism
A positive feedback mechanism is a hormone-regulating system in which the release of a hormone triggers changes which amplify the release of the same hormone.
- Which opioid has the fastest onset?
A. Alfentanil
B. Sufentanil
C. Fentanyl
D. Morphine
A. Alfentanil
Alfentanil has an almost immediate onset when administered. Alfentanil has a small volume of distribution, and 90 percent of the drug is in the nonionized form at physiologic pH, leading to an increased amount of drug being available for binding.
- Why is a single-shot spinal anesthetic not used for primiparous laboring mothers?
A. It produces severe hypotension
B. It results in fetal bradycardia
C. It does not provide a sufficient duration of analgesia
D. The risk of epidural bleeding is too high
C. It does not provide a sufficient duration of analgesia
A single-shot spinal anesthetic will not deliver the duration of analgesia necessary for most laboring patients. In the primiparous patient, multiple injections would be necessary. Even in the multiparous patient, the potential for emergency cesarean section would require a new anesthetic for performance of the procedure.
- According to the AANA code of ethics, which of the following is NOT a requirement in the maintenance of a competent level of practice?
A. Achieving and maintaining a doctoral degree
B. Engaging in continuous quality improvement activities
C. Maintaining registered nursing licensure
D. Fulfilling all advanced practice requirements
A. Achieving and maintaining a doctoral degree
According to the AANA code of ethics, a CRNA has a duty to maintain practice competency by engaging in continuous quality improvement activities, engaging in lifelong educational activities related to the profession, maintaining a state nursing licensure, and fulfilling any and all advanced practice requirements.
- You suspect that a colleague about to induce anesthesia on a patient is chemically impaired. Which initial intervention would be appropriate?
A. Delay the case until another CRNA is available
B. Allow the case to proceed but notify administration
C. Allow the case to proceed but notify the AANA
D. Perform the first 5-10 minutes of the case with the CRNA
A. Delay the case until another CRNA is available
According to the AANA code of ethics, the CRNA has a duty to take appropriate action to protect patients from healthcare providers who may subject the patient to situations that may cause harm, whether due to incompetence, impairment, illegality, or unethical practices. In this case, the CRNA should not allow the case to proceed until another anesthesia provider is available. Then, actions can be initiated to determine the nature of the impairment.
- A nurse anesthetist administered a drug by physician’s order that was found to be an erroneous dose that caused harm to the patient. Which of the following would relieve the anesthetist of the burden of ethical responsibility?
A. the physician’s order was erroneous
B. the institution had no policy indicating the dose was too large
C. the patient did not have an allergy to the drug
D. none of these relieve the burden of responsibility
D. none of these relieve the burden of responsibility
According to the AANA code of ethics, the CRNA is responsible and accountable for decisions and actions made in the course of his or her professional practice. Physician orders and institutional policies do not relieve the burden of responsibility of the CRNA.
- Which demographic is most likely to experience a type I hypersensitivity reaction under anesthesia?
A. Adult female
B. Adult male
C. Adolescent female
D. Adolescent male
A. Adult female
Adult females are three times more likely to experience a type I hypersensitivity reaction. There is no gender difference in adolescence, which suggests that sex hormones may play a role in the incidence of reactions.
- When should chest compressions be initiated in the neonate?
A. Heart rate < 60 bpm
B. Heart rate < 100 bpm
C. If apnea is present
D. If gasping is present
A. Heart rate < 60 bpm
After ventilation with oxygen for 30 seconds, chest compressions should be initiated in the neonate when the heart rate is less than 60 bpm.
- Alfentanil has a faster clearance in children because of their _____.
A. increased pulmonary uptake
B. smaller volume of distribution
C. increased hepatic blood flow
D. faster renal elimination
B. smaller volume of distribution
Alfentanil has a faster clearance in children because of their smaller volume of distribution for the drug.
- A patient with chronic renal failure exhibits life-threatening hyperkalemia and dialysis is not immediately available. Select two agents administered together to treat hyperkalemia.
A. Hypoventilation
B. Glucose administration
C. Insulin administration
D. Heparin administration
B. Glucose administration
C. Insulin administration
Although dialysis would be the definitive treatment for this patient, other treatments include: glucose, insulin, bicarbonate, and hyperventilation.
- A patient with a Bivona tracheostomy tube is about to undergo an MRI. You know that
A. you should replace the Bivona tube with a Shiley tube
B. the Bivona tube is MRI-safe
C. the presence of a tracheostomy is a contraindication to an MRI
D. vibrations from the MRI will often dislodge the Bivona tube
A. you should replace the Bivona tube with a Shiley tube
Although it is not mentioned in the product packaging, a Bivona tracheostomy tube contains ferrous material and should be replaced with a Shiley tube before the scan.
What are the most common anatomical sites for invasive arterial monitoring line placement? (select two)
A. radial
B. brachial
C. femoral
D. dorsalis pedis
A. radial
C. femoral
Although many arterial sites can be used (including brachial, axillary, and dorsalis pedis), the most commonly used are the radial and femoral sites.
- The most common congenital abnormality that can result in aortic dissection is
A. Marfan syndrome
B. Bicuspid aortic valve
C. Ehlers-Danlos syndrome
D. Takayasu’s arteritis
B. Bicuspid aortic valve
Although Marfan syndrome and Ehlers-Danlos syndrome are associated with an increased risk for aortic aneurysm and dissection, bicuspid aortic valve is far more common, occurring in 1% of the population. Takayasu’s arteritis is associated with peripheral vascular disease.
- You are consulted by the emergency department for a patient exhibiting inspiratory stridor, drooling, sore throat, dysphagia, tachycardia, fever, and prefers a sitting, sniffing position to breathe easier. You suspect that this patient suffers from
A. Inflammation of the subglottic airway structures
B. Inflammation of the epiglottis
C. Inflammation of the supraglottic airway structures
D. Unilateral vocal cord paralysis
C. Inflammation of the supraglottic airway structures
Although this patient exhibits symptoms associated with epiglottitis, the diagnosis is a misnomer. The patient with epiglottitis actually suffers from generalized irritation and severe edema of all of the supraglottic structures. Some academics have even suggested renaming the condition supraglottitis to more accurately reflect the pathology.
- A patient has a pH of 7.3. You administer three acidic drugs to this patient that have three different pKa values. Match the degree of ionization you would expect to see in this patient with the pKa value of the drug.
pKa = 8.1 < 50% ionized pKa = 4.5 > 50% ionized pKa = 7.3 50% ionized
pKa = 8.1 > 50% ionized pKa = 4.5 50% ionized pKa = 7.3 <50% ionized
An acidic drug with a pKa of 4.5 will be more than 50% ionized in a pH of 7.3. An acidic drug with a pKa of 7.3 will be exactly 50% ionized at a pH of 7.3. An acidic drug with a pKa of 8.1 will be less than 50% ionized at a pH of 7.3. Refer to the pKa workbook and video in this program for a detailed explanation of how to discern this information quickly.
- Which hormone is produced in the hypothalamus, released from the neurohyphosis, and targets the collecting ducts in the distal nephron?
A. Aldosterone
B. Antidiuretic hormone
C. Angiotensin
D. Atrial natriuretic factor
B. Antidiuretic hormone
Antidiuretic hormone (ADH) is a hormone produced in the hypothalamus, released from the neurohypophysis (posterior pituitary) and targets the distal nephron. ADH increases tubular permeability causing the reabsorption of water. In the absence of ADH, the collecting ducts and distal tubule are almost impermeable to water.
- Which anti-epileptic drug is least likely to produce aplastic anemia?
A. Valproate
B. Gabapentin
C. Phenytoin
D. Carbamazepine
B. Gabapentin
Antiepileptic drugs are associated with anemias. The symptoms are typically mild, but can occasionally produce aplastic anemia. They are most commonly seen with valproate, carbamazepine, and phenytoin.
- Factors that decrease the amount of prolapse in patients with mitral valve prolapse include (select four)
A. Drug-induced myocardial depression B. Pulmonary hypertension C. Increased preload D. Hypertension E. Decreased systemic vascular resistance F. Tachycardia G. Atrial fibrillation H. Vasoconstriction
A. Drug-induced myocardial depression
C. Increased preload
D. Hypertension
H. Vasoconstriction
Any factor that maintains a larger ventricular volume will decrease the degree of prolapse. Hypertension, vasoconstriction, drug-induced myocardial depression, and increased preload will decrease the degree of prolapse.
- An attempt to touch a person without their consent, even if no harm is caused, is referred to as
A. wrongful contact
B. battery
C. felony touching
D. assault
D. assault
Assault is the attempt to touch another person. Battery is the actual touching of a person without their consent. Harm does not have to be caused in cases of assault or battery.
- What determines the duration of action of an irreversible antagonist?
A. Hepatic blood flow
B. Receptor regeneration
C. Renal clearance of the drug
D. The ED50 of the drug
B. Receptor regeneration
Because the drug binds irreversibly with the receptor, the duration of action of the drug is not as closely related to its metabolism as it is to the speed at which new receptors can be produced.
- Which lung function test involves the inhalation of a gas mixture containing carbon monoxide?
A. Diffusion capacity
B. Body plethysmography
C. Inhalation challenge test
D. FEF 25-75
A. Diffusion capacity
Because the oxygen level in the pulmonary capillaries varies as it moves through the lungs, oxygen cannot be used to measure the ability of gas to diffuse across the alveolar capillary membrane. Instead, a gas mixture containing carbon monoxide is used to determine diffusion capacity because carbon monoxide has a negligent partial pressure in the blood and binds to hemoglobin over 200 times more powerfully than oxygen.
- The pharmacokinetics of which neuromuscular blocking agent would be least affected by liver failure?
A. Cisatracurium
B. Pancuronium
C. Rocuronium
D. Vecuronium
A. Cisatracurium
Because they rely on Hofmann elimination, the duration of action of atracurium and cisatracurium is not affected by hepatic disease. Repeat doses or continuous infusions of agents that rely on hepatic metabolism such as vecuronium, rocuronium, and pancuronium, however, are another story. As these drugs accumulate, the decreased ability of the liver to metabolize the drug can result in a prolonged duration of action. They also have active metabolites which contribute to the prolonged duration of action.
- Which statement helps explain why the duration of action of midazolam is prolonged in patients with renal disease?
A. Midazolam is not a highly protein bound drug
B. Renal insufficiency increases the plasma clearance of midazolam
C. A large portion of midazolam is excreted as active metabolites
D. The termination of midazolam’s effect is primarily due to redistribution
C. A large portion of midazolam is excreted as active metabolites
Benzodiazepines are extensively protein bound. The reduced protein binding in patients with renal disease results in an increased free fraction of the drug. Also, 60-80% of midazolam is excreted as an active metabolite. In renal disease, this metabolite accumulates and can result in prolonged sedation.
- Beta-adrenergic blockers administered to a parturient
A. do not cross the placenta
B. can produce reflex tachycardia in the newborn
C. can result in hypoglycemia in the newborn
D. are associated with fetal respiratory depression
C. can result in hypoglycemia in the newborn
Beta-adrenergic blockers administered to a parturient cross the placenta and can produce bradycardia, hypoglycemia, and hypotension in the newborn. Beta-blockers are also likely to pass into breast milk.
- Bradycardia is associated with repeat doses of _____ in pediatric patients.
A. glycopyrrolate
B. ketamine
C. propofol
D. succinylcholine
D. succinylcholine
Bradycardia and potentially asystole are potential side effects of succinylcholine re-administration, particular in children.
- Following a carotid endarterectomy, a patient in the recovery area exhibits significant headache and slurred speech followed by the onset of seizures. This would be consistent with
A. myocardial infarction
B. cerebellar dysfunction
C. cerebral hyperperfusion syndrome
D. ruptured abdominal aortic aneurysm
C. cerebral hyperperfusion syndrome
Cerebral hyperperfusion syndrome can occur following a carotid endarterectomy and produce symptoms such as headache, seizures, cerebral edema, and intracerebral hemorrhage. It occurs due to the sudden relief of a high-grade stenosis combined with impaired cerebral autoregulation. It can be devastating, but complete recovery is possible if recognized and treated early. The primary goals are the treatment of hypertension and control of cerebral perfusion.
- Compared to standard video-assisted thoracoscopic surgery (VATS), robotic video-assisted thoracic surgery (RVATS) is associated with
A. Decreased risk of chylothorax
B. Increased risk of recurrent laryngeal nerve injury
C. Decreased risk of perioperative morbidity
D. Longer duration of hospital stay
B. Increased risk of recurrent laryngeal nerve injury
Compared to a VATS, the RVATS procedure has similar lengths of hospital stay and risk of perioperative morbidity. The risks of chylothorax and recurrent laryngeal nerve injury are actually increased with an RVATS.
- Which of the following agents produces irreversible inhibition of platelet function by preventing the synthesis of thromboxane A2?
A. Phosphodiesterase inhibitors
B. ADP receptor antagonists
C. Acetylsalicylic acid
D. Glycoprotein Iib/IIIa receptor antagonists
C. Acetylsalicylic acid
Cyclooxygenase inhibitors such as aspirin cause irreversible inhibition of platelet cyclooxygenase which prevents synthesis of thromboxane A2. ADP receptor antagonists such as ticlopidine and clopidogrel block the ADP receptor non-competitively and irreversibly inhibit IIb/IIIa platelet aggregation. Phosphodiesterase inhibitors such as dipyridamole act by inhibiting phosphodiesterase which results in an increase in cyclic AMP which is an inhibitor of platelet aggregation. Glycoprotein Iib/IIIa receptor antagonists such as abciximab reversibly block the Iib/IIIa site by which fibrinogen crosslinks platelets together.
- Which gas law states that the total pressure of a system is the additive pressure of each individual gas in a mixture?
A. Boyle’s
B. Charles’
C. Dalton’s
D. Gay-Lussac’s
C. Dalton’s
Dalton’s law states that the total pressure of a mixture of gases is equal to the sum of the pressures each individual gas in the mixture exerts.
- Which of the following is not a potential side effect of dexmedetomidine?
A. delayed recovery
B. hypotension
C. bradycardia
D. respiratory depression
D. respiratory depression
Dexmedetomidine does not produce significant respiratory depression. Hypotension, bradycardia, oversedation, and delayed recovery are potential side effects of the drug.
- During the initial recovery period, which agent has been associated with a high incidence of altered short-term memory and cognition, hallucinations, and nightmares?
A. Propofol
B. Midazolam
C. Ketamine
D. Diazepam
C. Ketamine
During the initial recovery period, ketamine has been associated with a high incidence of psychomimetic reactions. These include altered short-term memory and cognition, hallucinations, and nightmares.
- Which type of visual evoked potential is performed on an awake patient?
A. Patterned VEPs
B. Unpatterned VEPs
C. Stochastic VEPs
D. Constant simulus VEPs
A. Patterned VEPs
During Visual Evoked Potentials (VEPs), the patient is presented a visual stimulus for a select number of times, then the cerebral responses are dispayed after being amplified and averaged on a computer. There are two types of VEPs: patterned and unpatterned. Patterned tests are used on awake patients.
- Which of the following statements regarding metabolic function in the elderly is true?
A. Maximal oxygen consumption increases with age
B. Circulating catecholamine levels decrease with age
C. Insulin resistance decreases with age
D. Elderly patients have a decreased response to beta-adrenergic agents
D. Elderly patients have a decreased response to beta-adrenergic agents
Elderly patients have a decreased response to beta-adrenergic agents and an increase in circulating catecholamine levels. Maximal oxygen consumption decreases with age and insulin resistance increases, resulting in a decreased ability to handle glucose loads.
- What is the pH indicator added to soda lime to help assess the functional integrity of the absorbent?
A. Ethyl violet
B. Water
C. Potassium hydroxide
D. Sodium hydroxide
A. Ethyl violet
Ethyl violet is a pH indicator that is added to soda lime to help determine when the absorbent is exhausted. When the pH of the absorbent decreases, the ethyl violet changes from colorless to purple.
- Heat that is lost as body moisture converts from the liquid phase to gas phase is referred to as
A. radiant heat loss
B. convective heat loss
C. conductive heat loss
D. evaporative heat loss
D. evaporative heat loss
Evaporative heat loss occurs when moisture from the skin, exposed organs, and the respiratory tract turns from the liquid to gas phase. This process requires energy and the majority of the energy comes from our bodies. As a result of the loss of energy, our body loses heat as well.
