Spring 25 - B.P.ofA. Final Review

Question 1

Which of the following anesthetic agents was first documented as being used for surgical anesthesia in 1846?

a) Nitrous oxide
b) Chloroform
c) Ether
d) Halothane

Answer 1

Answer: c) Ether

Rationale: Ether was the first widely used general anesthetic, introduced specifically for surgical anesthesia by William Morton in 1846. Morton was a Dentist from Boston who performed this experiment in a surgical operating room in Massachusetts General Hospital. This documented discovery would go on to revolutionize surgery, showing it was possible to perform surgery without causing pain, and it would birth the field of anesthesia.

Question 2

What is the significance of the critical temperature of a compressed gas?

A. Temperature where gas spontaneously combusts?

B. Temperature at which a compressed gas builds enough pressure to rupture the cylinder?

C. The temperature at which gas becomes a inert?

D. The critical temperature of a gas is a fictional concept.

Answer 2

Answer = A

Rationale: The critical temperature of a compressed gas is the temperature at which the gas cannot be compressed into a liquid if the temperature of the gas is above the critical point regardless of how much pressure is is used.

Question 3

According to the textbook, what color-coding scheme safety standards are used to identify oxygen in North America?

A. Brown

B. Green

C. Yellow

D. Black

Answer 3

Answer: B, Green

Rationale: In North America, the color-coding scheme follows as such: cylinders of oxygen are identified by the color green. Brown is identified as helium, nitrous oxide is identified as blue, yellow denotes air, carbon dioxide signifies gray, and finally nitrogen is identified with the color black. It is important to observe that the color scheme is not a world-wide standard. Therefore, it is essential to be aware of different color schemes. (Butterworth et al., 2022).

Question 4

In what year was the American Association of Nurse Anesthetists founded?

A. 1908.

B. 1931

C. 1946

D. 1953

Answer 4

Correct Answer: B; 1931

Rationale: Agatha Hodgins, a Canadian nurse, traveled to Cleveland to work as an anesthetist for Dr. George Crile at Lakeside Hospital. In 1931, Hodgins founded the AANA primarily to educate physicians and nurses in anesthesia.

Question 5

When should you avoid use of the oxygen flush valve?

a) During expiration

b) During inspiration

c) Between inspiratory and expiratory cycles

d) You should never use the oxygen flush valve

Answer 5

Answer: b; during inspiration

Rationale: During inspiration, the ventilator’s spill valve is closed and the adjustable pressure-limiting (APL) valve is excluded. The flood of oxygen and associated pressure would be delivered to the patient’s lungs at this time.

Question 6

Which statements contrast the Pin (PISS) vs the Diameter (DISS) Index Safety System? Select all that apply:

A) The PISS is used with portable gas cylinders, while the DISS is used with central gas pipelines.
B) The PISS uses unique pin and hole alignments to prevent the misconnection of gas cylinders.
C) The DISS prevents cross-connections by using color-coded fittings for different gases.
D) The DISS uses a noninterchangeable fitting that prevents incorrect hose attachment.
E) The PISS is designed for gas pipeline systems in hospitals.

Answer 6

Correct: A, B, and D

Rationale

“Cylinders attach to the machine via hanger-yoke assemblies, which use a pin index safety system to prevent the accidental connection of the wrong gas cylinder.”

“Gases are delivered from their central Supply source to the operating room through a piping network. The tubing is color-coded and connects to the anesthesia machine through a noninterchangeable diameter-index safety system (DISS) fitting that prevents incorrect hose attachment. Interchangeability is prevented by making the body’s bore diameter and connection nipple specific for each supplied gas”.

Question 7

Question: Select all gases that must pass through safety devices before reaching their flow control valve in an anesthesia machine (select all that apply):

A) Nitrous oxide
B) Air
C) Oxygen
D) Helium

Answer 7

Answer: A. Nitrous oxide, B. Air, and D. Helium

Rationale: Nitrous oxide, air, and other gases like helium must pass through safety devices before reaching their flow control valves. These devices ensure that these gases are only delivered when there is sufficient oxygen pressure, preventing the accidental delivery of a hypoxic gas mixture. Oxygen does not need to pass through these safety devices and goes directly to its flow control valve (Butterworth et al., 2022).

Question 8

In the United States of America, what color is used to represent a cylinder of Nitrous Oxide (N20)?

Black
Green
Blue
Yellow

Answer 8

Answer: C, Blue.

Rationale: In the United States, cylinders of Nitrous Oxide (N2O) are color coded blue. Yellow represents medical air, green represents oxygen, and black represents nitrogen gas (N2) (Butterworth et al., 2022).

Question 9

In the event of the anesthesia machine experiencing a maximum supply pressure of 95-110 psi for a specific gas, what safety mechanisms would alleviate elevated pressures with single-stage pressure regulation?

Proportional reduction in nitrous oxide and other gas pressures
Opening of a high-pressure relief valve for the supplied gas
Closure of shut-off valves, preventing further gas delivery
Presence of a one-way check valve limiting retrograde flow

Answer 9

Correct Answer: B, Opening of a high-pressure relief valve for the supplied gas

Rationale

The correct answer to this question is B because, within a single-stage pressure-regulated system, high-pressure relief valves are utilized for each gas to expel excess gas during elevated supply pressures (Butterworth et al., 2022). Answer choices A and C are incorrect because these are both safety features in response to diminished oxygen supply within a system. Answer choice D is incorrect because one-way check valves are only effective at preventing retrograde flow and not for alleviating excess pressure.

Question 10

What is the purpose of the oxygen supply failure protection device on anesthesia machines?

A) Monitor the patient’s oxygen saturation levels

B) Ensure nitrous oxide and air are delivered directly to the flow control valve

C) Prevent the delivery of a hypoxic gas mixture by sensing oxygen pressure and regulating the flow of other gases

D) Reduce the pipeline pressure of oxygen

Answer 10

Answer: C

Rational: Nitrous oxide, air (in some machines), and other gases pass through safety devices before reaching flow control valves, while oxygen passes directly to its flow control valve. Adequate oxygen pressure is required to allow the flow of other gases. If there is an oxygen supply failure, this safety feature helps prevent the delivery of a hypoxic mixture.

Question 11

Which gas cylinders have a size opening and thread pattern similar to oxygen cylinders, making accidental interchange possible?

A. Nitrous Oxide

B. Carbon Dioxide

C. Medical Air

D. Nitrogen

Answer 11

Correct Answer: B. Carbon Dioxide

Rationale: Understanding the physical and safety features of gas cylinders is essential for preventing potentially life-threatening errors, such as accidental administration of the wrong gas. This topic aligns with the principles of anesthesia covered in the text (Butterworth et al., 2022), emphasizing the importance of the pin index safety system (PISS) designed to prevent gas cylinder interchange. However, instances of equipment failure or improper maintenance can still occur, making it vital for anesthesia providers to be vigilant about the compatibility and markings of gas cylinders.

Question 12

What maximum pressure is an N2O (Nitrous Oxide) E-cylinder pressurized to?

A. 600 psi

B. 838 psi

C. 1900 psi

D. 745 psi

Answer 12

Correct Answer: D

Rationale: At 20˚C, a full E-cylinder of oxygen contains a pressure of 1900 psi, and holds 600 L of volume, while nitrous oxide includes a pressure of 745 psi. 838 psi is incorrect, as this refers to service pressure of carbon dioxide (CO2).

Question 13

Question:

Which of the following gases, commonly seen on anesthesia machines and used in operating rooms, exists in its gaseous form at room temperature inside standard cylinders? Select all that apply.

A. Oxygen

B. Hydrogen

C. Medical Air

D. Nitrous Oxide

Answer 13

Answer: (A and C)

The critical temperature of nitrous oxide is 36.5 Celsius, which is higher than room temperature (20 Celsius). Gases can only be liquified under pressure if they are stored below their critical temperature. Therefore, under pressure inside a cylinder, nitrous oxide will exist as a liquid. The critical temperature of oxygen is -119 Celsius, therefore in a typical cylinder at room temperature, it will exist in its gaseous form. Medical air is a blend of oxygen and nitrogen, and its critical temperature is -140.6 Celsius, therefore it also exists in its gaseous form inside a cylinder at room temperature. Hydrogen gas is not commonly used in the operating room (Butterworth et al., 2022).

Question 14

Question: How much more likely are reported adverse outcomes to be caused by misuse of anesthesia gas delivery systems than by equipment failure or malfunction?

A. 10 times

B. 3 times

C. 5 times

D. 2 times

Answer 14

Correct Answer: B. 3 Times

Rationale: Equipment misuse includes errors in preparation, maintenance, or deployment of devices. Preventable anesthetic mishaps are often linked to an operator’s lack of familiarity with the equipment, failure to verify the machine’s function before use, or both. Many of these incidents could be avoided by conducting an appropriate preanesthetic machine check. However, equipment misuse is 3 times more likely to be associated with an adverse anesthetic event than device malfunction or failure (Butterworth et al., 2022). This number demonstrates the importance of standardized specifications for anesthesia machines and their components as well as the proficiency of those using and working with anesthesia workstations.

Question 15

Question: Which of the following statements regarding the pin index safety system is correct?

A. The pin index safety system ensures that all gas cylinders can be attached interchangeably to any anesthesia machine.

B. Multiple washers placed between the cylinder and yoke enhance the effectiveness of the pin index safety system.

C. The pin index safety system prevents incorrect cylinder attachment by using unique pin and hole configurations for each gas.

D. The pin index safety system still functions effectively if the yoke pins are damaged.

Answer 15

C: The pin index safety system uses each gas’s specific pin and hole configurations to prevent incorrect attachment. This safety feature is unique to each type of gas.

Rationale:

The pin index safety system is like a lock-and-key setup, where each gas cylinder has a unique pattern of pins and holes. This ensures that only the right cylinder can connect to the right spot on the anesthesia machine. This mechanism minimizes the risk of delivering the incorrect gas to the patient, enhancing safety during anesthesia delivery.

Question 16

At a consumption rate of 3 L/min, how long will a half-full oxygen E-cylinder last?

A. 55 minutes

B. 90 minutes

C. 110 minutes

D. 120 minutes

Answer 16

Answer: C. 110 minutes

Rationale:

At a consumption rate of 3 L/min, the duration of an E-cylinder can be calculated using the formula:

Time (minutes) = Volume (liters) ÷ Flow Rate (L/min).

A half-full E-cylinder contains approximately 330 liters of oxygen. Dividing this by the flow rate:

330 liters ÷ 3 L/min = 110 minutes.

Question 17

What is the only reliable way to determine the residual volume of nitrous oxide in a cylinder?

A. Observe the pressure gauge reading on the cylinder

B. Identify the size of the cylinder

C. Use a flowmeter

D. Weigh the cylinder

Answer 17

Answer: D. Weigh the cylinder

Rationale: Gases can be liquified by pressure if stored below their critical temperature. The critical temperature of nitrous oxide is 36.5 C, which is above room temperature. However, if the liquified nitrous oxide rises above its critical temperature, it will revert to a gaseous state. The transformation of nitrous oxide into a gaseous state does not lead to a significant rise in the cylinder pressure since nitrous oxide is not an ideal gas and is easily compressed. The cylinders contain nitrous oxide in a liquid state and a gaseous state. Therefore, the volume of the cylinder is not proportional to the pressure of the cylinder, and the only reliable method to determine the residual volume of the cylinder is to weigh it. The tare weight or empty weight of cylinders containing a liquified compressed gas should be evident on the cylinder itself (Butterworth et al., 2022).

Question 18

Regarding the pipeline pressure delivering the gases to the anesthesia machine by the diameter-index safety system (DISS), what is the approximate pipeline pressure in pounds per square inch gauge (PSIG)?

A. 50 psig

B. 45 psig

C. 47 psig

D. 95 psig

Answer 18

A. 50 psig.

Question 19

The emergency oxygen tank is being used due to a significant drop in pipeline pressure. The pressure of the E-cylinder oxygen tank reads 1300 psig. The flow is set to 3L/min. How long will the tank last at this flow rate?

A. 125 minutes

B. 90 minutes

C. 153 minutes

D. 143 minutes

E. Unable to calculate

Answer 19

Answer: D

tank capacity (L) / service pressure (psig) = contents remaining (L) / current tank pressure (psig).

current tank pressure (psig) * tank capacity (L) / service pressure (psig) = contents remaining (L)

1300psig * 625L / 1900psig = 428L

428L / (3L/minutes) = 143 minutes

Question 20

Which of the following describe the risks and proper use of the oxygen flush valve? (Select all that apply)

A) The flush valve should only be used cautiously when the patient is connected to the breathing circuit.
B) It can result in backflow of gases into the low-pressure circuit, diluting anesthetic concentrations.
C) The flush valve should be used for routine breathing circuit maintenance to ensure proper gas exchange.
D) A protective rim around the flush button helps prevent unintentional activation.
E) The oxygen flush valve uses a flow rate of 1–5 L/min to prevent excessive lung pressures.

Answer 20

Correct Answers: A, B, D

Question 21

Which of the following are reasons that active humidifiers are valuable in pediatric anesthesia applications? Select all that apply.

A. Contribution to an increase in apparatus dead space
B. Reduced occurrences of hypothermia due to increased heat conservation
C. Filtration of respiratory gases reducing infectious concerns
D. Prevention of smaller tracheal tube plugging via dried secretions

Answer 21

Correct Answer: B & D Reduced occurrences of hypothermia due to increased heat conservation & Prevention of smaller tracheal tube plugging via dried secretions

Question 22

Which of the following are purposes of oxygen in the anesthesia workstation (Select all that apply)

A) To supply fresh gas to the oxygen flow meter

B) To drive ventilator bellows

C) To absorb carbon dioxide

D) To activate low pressure oxygen alarms

Answer 22

Answer: A, B, D

Rationale: Oxygen has five roles in the anesthesia workstation: Supplying fresh gas to the oxygen flow meter, driving ventilator bellows, activating low pressure oxygen alarms, activating fail safe mechanisms, and supplying the oxygen flush system (Elisha, et al., 2022). The CO2 absorbing canister removes CO2 from the system through a series of chemical reactions.

Question 23

Which component of the SPDD model ensures the provision of gases like oxygen and nitrous oxide to the anesthesia machine?

A. Common Gas Outlet

B. Pipeline Supply System

C. Vaporizer

D. Scavenging System

Answer 23

Answer: B

Rationale: The SPDD model is the supply, processing, delivery, and disposal model. The Supply phase in the SPDD model involves pipeline systems and gas cylinders that deliver medical gases to the anesthesia workstation. The pipeline supply system provides a steady and regulated supply of oxygen, nitrous oxide, and air to the anesthesia machine. If the pipelines fail, emergency E-cylinders are required, and the tanks should be checked before the start of any case.

Question 24

Which of the following statements best describes the relationship between vapor pressure, temperature, and the characteristics of a volatile agent?

A) Vapor pressure is independent of temperature but depends entirely on the characteristics of the volatile agent.
B) Vapor pressure decreases as temperature increases because fewer liquid molecules escape into the gaseous phase.
C) Vapor pressure increases with temperature due to a greater tendency of liquid molecules to escape into the gaseous phase.
D) Vapor pressure remains constant regardless of changes in temperature or the characteristics of the volatile agent.

Answer 24

Answer: C) Vapor pressure increases with temperature due to a greater tendency of liquid molecules to escape into the gaseous phase.

Rationale:. For the physics of vaporization, the molecules of a volatile anesthetic in a closed container are distributed between the liquid and gaseous phases. The gas molecules bombard the walls and create the saturated vapor pressure of the agent. The vapor pressure depends on the characteristics of the volatile agent and the temperature. The greater the temperature, the greater the tendency for the liquid molecules to escape into the gaseous phase and the greater the vapor pressure (Butterworth et al., 2022).

Question 25

Which of the following is the only system that determines the presence of oxygen in the pipeline or cylinder? A. Hypoxic Guard System B. Low Pressure Alarms C. Inspired Oxygen Analysis D. Fail-Safe Mechanism

Answer 25

Answer: C. Inspired Oxygen Analysis Rationale: The presence of oxygen in medical pipelines, cylinders, or circuits is ensured through inspired oxygen analysis. While low-pressure alarms and hypoxic guard mechanisms alert users to possible issues in oxygen supply, they rely on pressure measurements throughout the circuit rather than direct gas content measurement. In other words, these systems monitor pressure within the workstation and are activated only if oxygen pressure drops without sampling the oxygen lines. These systems would not protect the patient in the case of a crossover in which the gas does not contain oxygen (Elisha et al., 2022, pp. 260–261).

Question 26

Which of the following components are part of the flow control circuits in an anesthesia machine? (Select all that apply) A. Pressure regulators B. Oxygen flush valve C. Oxygen supply failure protection devices D. Flow valves and flowmeters E. Vaporizers F. Common (fresh) gas outlet G. Soda lime canister

Answer 26

A, C, D, E, F Rationale: Oxygen flush valve and Soda lime canister are not part of flow control circuit. The oxygen flush valve bypasses the flow control circuit and delivers high-flow, high-pressure oxygen directly to the patient. The soda lime canister is part of the breathing circuit, responsible for CO₂ absorption, but it is not part of the flow control circuit.

Question 27

Which patient will benefit the most from humidifying and heating inspiratory gases during general anesthesia? Select 2: A. Young adults who say she is cold B. Post-MVC teenager going for an ORIF C. 3-year-old patients with cystic fibrosis D. Middle-aged adults undergoing knee replacement surgery E. Grandpa with COPD

Answer 27

Correct Answer: C and E Humidification and heating of inspiratory gases may be most important for small pediatric patients and older patients with severe underlying lung pathology.

Question 28

Which of the following safety features on a modern anesthesia machine prevents the simultaneous activation of multiple vaporizers? A. Agent-specific keyed filling port B. Interlocking or exclusion device C. Flow control valve D. Agent-specific, color-coded cassette

Answer 28

B. Interlocking or exclusion device Rationale: Modern anesthesia machines are equipped with interlocking or exclusion device to prevent the simultaneous activation of multiple vaporizers. This feature reduces the risk of delivering multiple volatile anesthetic agents to the patient and accidental overdosing.

Question 29

The oxygen/nitrous oxide ratio controller is a safety feature of the anesthesia machine and ensures what minimum oxygen concentration? A) 21% B) 25% C) 30% D) 35%

Answer 29

Answer: B Rational: The oxygen/nitrous oxide ratio controller delivers a minimum of 25% FiO2 to prevent the delivery of a hypoxic mixture. The oxygen/nitrous oxide ratio controller links the flow valves either pneumatically or mechanically. This device does not protect against other possible causes of hypoxic delivery like oxygen pipeline crossover, leaks distal to the flowmeter valve, administration of a third gas, or defective mechanic or pneumatic components.

Question 30

When is the Adjustable Pressure-Limiting (APL) valve usually fully open? A. Manual ventilation B. Spontaneous ventilation C. Both manual and spontaneous ventilation D. It is never fully open

Answer 30

B. Spontaneous ventilation Rationale: The APL valve is usually fully open during spontaneous ventilation but must be partially closed during manual or assisted bag ventilation. If it is not closed sufficiently, excessive loss of circuit volume due to leaks prevents manual ventilation (Butterworth et al., 2022).

Question 31

Select the three types of oxygen analyzers from the list below: A. Polarographic B. Variable Bypass C. Galvanic D. Paramagnetic

Answer 31

Answer: A, C, and D Rationale: The three types of oxygen analyzers available are polarographic (Clark electrode), galvanic (fuel cell) and paramagnetic. Variable bypass is a type of vaporizer not an oxygen analyzer. (Butterworth et al., 2022).

Question 32

Which anesthetic gas has the highest vapor pressure and lowest boiling point? A. Halothane B. Sevoflorane C. Desflurane D. Isoflurane

Answer 32

Correct answer: C, Desflurane Rationale: The higher the vapor pressure, the more vapor will be released. ALL modern vaporizers are agent-specific, and filling the vaporizer with the incorrect gas can cause incorrect doses of anesthetic gas. Filling a vaporizer specified for sevoflurane with halothane instead can cause an overdose due to the increased amount of vapor being released. Desflurane is the answer with the highest vapor pressure; its boiling point is near room temperature (22.8°C at 760 mmHg). Due to this low boiling point, desflurane requires specific electronic vaporizers.

Question 33

Causes of flowmeter malfunction include: (Select three of the following) A. Debris in the flow tube B. Flow tube interior being coated with a conductive substance. C. Vertical tube misalignment D. A float stuck at the top of the tube

Answer 33

A, C, & D. Rationale: Flowmeters can malfunction when there is debris in the flow tube, a misalignment of the vertical tube, and a float that is sticking or concealed at the top of the tube. The inner tube of the flowmeter should be coated with a conductive substance in order to reduce the effect of static electricity (Butterworth et al., 2022).

Question 34

On modern anesthesia machines, where is the location of the oxygen flowmeter, and why? A. Farthest to the left ; This prevents hypoxia if there is a leak from another flowmeter located upstream B. In the middle ; Oxygen must be in the middle to adequately mix with the other gases before delivery to the patient C. Farthest to the right ; This prevents hypoxia if there is a leak from another flowmeter located upstream D. Farthest to the right ; The weight of oxygen requires it to be farthest downstream, otherwise it would never reach the patient if positioned farthest to the left

Answer 34

Answer: C Rationale: Positioning the oxygen flowmeter furthest to the right (furthest downstream) prevents hypoxia in the case of leakage from a different flowmeter further upstream. With oxygen positioned furthest downstream, this makes it the last gas to enter the common gas outlet before reaching the patient. Having a different gas furthest downstream, such as nitrous oxide or medical air, could result in delivery of a hypoxic mixture of gas to the patient if there was a leak in the upstream flowmeter (Butterworth et al., 2022).

Question 35

What is the upper limit of pressure in cm H2O for the adjustable pressure-limiting (APL) valve? A: 30-40 cm H2O B: 70-80 cm H2O C: 40-50 cm H2O D: 10-20 cm H20

Answer 35

B: 70-80 cm H20 Rationale: The APL valve is a pressure-limiting device that can never be completely closed. The upper limit is 70-80 cm H2O. The APL valve is open when the patient is spontaneously ventilated, but it is partially closed during manual ventilation or assisted bag ventilation. If the APL valve is closed off too much, and there is a progressive rise in pressure, it could cause pulmonary barotrauma.

Question 36

How fast does Oxygen flow when the Oxygen flush valve is activated A. 35-75 L/min B. 5-10 L/min C. 75 mL/min D. 20 L/min

Answer 36

Answer: A Rationale: The oxygen flush valve provides a high flow (35–75 L/min), not mL/min, of oxygen directly to the common gas outlet, bypassing the flowmeters and vaporizers Reference:

Question 37

Which of the following are potential causes for discrepancies in set tidal volume and achieved tidal volume with volume-controlled ventilation? Select all that apply. A. A breathing circuit with a compliance of 6mL/cm H20 B. Absence of leaks within a circuit C. Fresh gas flows of 5L/min D. Gas Compression

Answer 37

Correct Answer: A, C, & D

Question 38

Which of the following is a key advantage of insufflation in anesthesia? A) Allows for controlled ventilation B) Prevents the need for high fresh gas flow rates C) Avoids direct airway connection, making it useful for pediatric induction D) Ensures a precise inspired oxygen concentration

Answer 38

Correct Answer: C) Avoids direct airway connection, making it useful for pediatric induction Rationale: Insufflation involves blowing anesthetic gases across a patient's face without a direct airway connection. This technique is helpful in pediatric patients who may resist face mask placement or intravenous lines. However, it does not allow for controlled ventilation, requires high fresh gas flow rates to prevent rebreathing, and contains unpredictable amounts of atmospheric air in the inspired gas mixture.

Question 39

Which of the following are advantages of the circle system in anesthesia? (Select all that apply) A. Minimal operating room and environmental pollution B. Low resistance (less than the endotracheal tube; not as low as in nonrebreathing circuits) C. Increased dead space (true of all respiratory apparatus) D. Constant inspired concentrations E. Opportunities for misconnection or disconnection F. Conservation of respiratory tract heat and humidity

Answer 39

Correct Answers: A, B, D, F Rationale: C is incorrect because, although the circle system has some dead space, it is not excessive compared to other systems. The dead space is primarily limited to the Y-piece to the patient’s airway, rather than the entire circuit. E is incorrect because the risk of misconnection or disconnection is a disadvantage, not an advantage.

Question 40

Which two of the following reasons would cause increased inspired CO₂ in a circle system? a) Exhausted absorbent granules b) Faulty unidirectional valves c) Malfunctioning APL valve d) Using a coaxial circuit instead of a Bain circuit

Answer 40

Answer: a) and b) Rationale: In a circle system, CO₂ absorbent granules remove exhaled CO₂. If the absorbent becomes exhausted, CO₂ is no longer effectively removed, leading to rebreathing of CO₂ and increased inspired CO₂. Additionally, faulty unidirectional valves can cause exhaled CO₂-rich gas to bypass the absorber and mix with fresh gas, further increasing inspired CO₂.

Question 41

Which of the following factors might increase the peak inspiratory pressure (PIP) AND the plateau pressure (PP) on a respiration waveform? (Select all that apply) a. Pneumothorax b. Decreased pulmonary compliance c. Surgery requiring peritoneal gas insufflation d. Thick secretions

Answer 41

Answer: a, b, c Rationale: Factors that might cause increased PIP and PP include decreased pulmonary compliance, pulmonary edema, trendelenburg position, pleural effusion, ascites, abdominal packing, peritoneal gas insufflation, tension pneumothorax, and endobronchial intubation. Increased levels of thick secretions will increase the PIP without a change to the PP

Question 42

Where should the fresh gas inlet be positioned in the circle system, and why? A) Between the absorber and the expiratory valve, to conserve absorption capacity B) Between the inspiratory valve and the absorber, to prevent dilution of fresh gas C) Between the Y-piece and the unidirectional valve, to simplify the circuit D) Downstream from the inspiratory valve, to ensure maximum fresh gas flow

Answer 42

Correct Answer: B) Between the inspiratory valve and the absorber, to prevent dilution of fresh gas Rationale: The fresh gas inlet is best placed between the absorber and the inspiratory valve to ensure fresh gas is not diluted by recirculated exhaled gas. This placement optimizes fresh gas delivery to the patient and minimizes waste.

Question 43

Which of the following factors primarily influences the transition from inspiration to expiration in a pressure-cycled ventilator? A) A preset inspiratory pressure must be reached. B) A fixed inspiratory time interval. C) A predetermined tidal volume must be delivered. D) A spontaneous breath initiated by the patient.

Answer 43

A) A preset inspiratory pressure must be reached.

Question 44

Which of the following is NOT a component of the circle system? A. Fresh gas inlet inside the breathing tube B. Y-connector C. Reservoir bag D. APL valve

Answer 44

Answer: A. Fresh gas inlet inside the breathing tube

Question 45

Which of the following conditions would increase peak inspiratory pressure without affecting plateau pressure? A. Pulmonary edema B. Bronchospasm C. Increased tidal volume D. Decreased pulmonary compliance

Answer 45

Answer: B. Bronchospasm

Question 46

You are providing anesthesia without complications up to this point in the procedure. Suddenly, low-pressure alarms begin to sound, and the patient's breath sounds are absent. What should be the first course of action: A. Check settings of fresh gas flow, scavenger, and ventilator B. Ventilate manually using the anesthesia breathing circuit C. Check the y-piece and other common locations for disconnections. D. Disconnect the patient from the circuit, provide IV anesthetics, and ventilate the patient with the Ambubag E. Troubleshoot the anesthesia machine

Answer 46

Correct Answer: C. Low-pressure alarms are often caused by leaks in the breathing circuit, and the most common location for disconnection is the y-piece between the breathing circuit and the endotracheal tube. When the ability to ventilate is lost due to low pressure, the anesthesia must first rapidly check for disconnections. If no disconnections are found, the provider should attempt to ventilate manually through the anesthesia machine. If unable to ventilate through the anesthesia machine, the provider should proceed to use the Ambubag. Once proper ventilation is established, check settings for fresh gas flow, scavenger, and ventilator. Do not attempt to troubleshoot the machine while the patient is under anesthesia.

Question 47

In draw-over anesthesia, what happens when oxygen is supplied at 1 L/min? A) FiO2 reaches 80-90% B) FiO2 reaches 30-40% C) FiO2 reaches 10-20% D) FiO2 reaches 90-100%

Answer 47

Answer: B, FiO2 reaches 30-40% Rationale: Across the clinical range of tidal volume and respiratory rate, an oxygen flow rate of 1 L/min gives a FiO2 of 30-40%. or with 4 L/min, a FiO2 of 60-80%.

Question 48

When should you change your CO2 absorber canister? A) At the first sign of color change B) When 25%-40% of granules have changed color C) When 50%-70% of granules have changed color D) Once all, or nearly all, the granules have changed color

Answer 48

Answer: C. When 50%-70% of granules have changed color

Question 49

Which of the following is the highest circuit pressure generated during an inspiratory cycle during mechanical ventilation? A) Plateau pressure B) Tidal volume C) Peak inspiratory pressure D) Positive end-expiratory pressure

Answer 49

Answer: C

Question 50

Which inhaled anesthetic agents produce the highest amount of carbon monoxide when in contact with CO₂ absorbent granules? A) Sevoflurane B) Isoflurane C) Desflurane D) Halothane

Answer 50

Correct Answer: C) Desflurane

Question 51

Soda lime is a common CO2 absorbent seen on modern anesthesia machines utilizing the circle system. How much carbon dioxide is soda lime capable of absorbing? A. 18L of CO2 per 100g of soda lime B. 23L of CO2 per 100g of soda lime C. 23L of CO2 per 50g of soda lime D. 18L of CO2 per 50g of soda lime

Answer 51

Answer: B, 23L of CO2 per 100g of soda lime

Question 52

Which of the following will NOT decrease resistance within the circle system? A. Increasing the diameter of the circuit B. Maintaining Laminar Flow C. Eliminating Valves D. Using sharp bends

Answer 52

Correct Answer: D. Using sharp bends

Question 53

Which ventilation mode is described as peak inspiratory pressure is limited and cycle is controlled by time, inspiratory flow is strongest early in inspiration and declines to flow just sufficient to maintain the set pressure later in inspiration? In this ventilation mode, tidal volume is uncontrolled and may increase if compliance increases or airway resistance falls. A) Pressure-controlled ventilation B) Volume controlled ventilation C) Pressure-controlled ventilation with volume guarantee D) synchronized intermittent mandatory ventilation

Answer 53

Correct answer: A) Pressure-controlled ventilation

Question 54

During a surgical case, you notice that the reservoir bag in the scavenging system is completely collapsed, and the anesthesia circuit’s fresh gas flow must be significantly increased to maintain proper ventilation in your circuit. What is the most likely cause? A. The negative pressure relief valve is malfunctioning B. The positive pressure relief valve is malfunctioning C. This is an open scavenging system, and gases are entrained from excessive suction D. The scavenging system is passive and its valve is not working properly

Answer 54

Answer: A. The negative pressure relief valve is malfunctioning

Question 55

What is one difference between the DAS and ASA guidelines for difficult airways/intubation? A. Awakening of the patient following failed intubation, and successful bag-mask ventilation B. Surgical Cricothyrotomy as the last emergent intervention in both guidelines C. Initial use of a supraglottic airway following failed intubation in both guidelines D. Emphasis of proficient planning and airway assessment to prepare for a difficult airway

Answer 55

Correct Answer: B & C

Question 56

Which intrinsic muscles in the larynx are innervated by the recurrent laryngeal nerve? (Select all that apply) A. Cricothyroid, B, lateral cricoarytenoid C. Posterior cricoarytenoid D. Thyroarytenoid

Answer 56

Answer = B, C, D

Question 57

Which of the following is NOT a component of the 3-3-2 rule for airway assessment? A. Mouth opening should be at least 3 fingerbreadths. B. Thyromental distance should be at least 3 fingerbreadths. C. Sternomental distance should be at least 2 fingerbreadths. D. Thyroid notch to hyoid bone distance should be at least 2 fingerbreadths.

Answer 57

Answer: C. Sternomental distance should be at least 2 fingerbreadths

Question 58

A patient with suspected cervical spine injury requires intubation. The safest technique is: A) Direct laryngoscopy with head extension B) Fiberoptic intubation C) Nasotracheal intubation D) Blind intubation

Answer 58

Correct Answer: B) Fiberoptic intubation

Question 59

Which of the following is correct regarding the function of the superior laryngeal nerve (SLN)? A) The internal branch of the SLN provides motor function to the cricothyroid muscle. B) The external branch of the SLN provides sensory input to the hypopharynx above the vocal cords. C) The internal branch of the SLN provides sensory input to the hypopharynx above the vocal cords, including the base of the tongue and epiglottis. D) The SLN provides motor function to all muscles of the larynx except the cricothyroid muscle.

Answer 59

Correct Answer: C)

Question 60

Which of the following statements accurately differentiates cricoid pressure from the BURP maneuver during laryngoscopy? A) Cricoid pressure is applied to improve glottic visualization, while BURP is used to prevent passive regurgitation of gastric contents. B) Cricoid pressure is applied to occlude the esophagus and prevent aspiration, while BURP is applied to optimize vocal cord visualization during laryngoscopy. C) Both cricoid pressure and BURP serve the same purpose and are used interchangeably during intubation. D) BURP is applied to compress the esophagus, while cricoid pressure is used to manipulate the thyroid cartilage for better visualization.

Answer 60

Correct Answer: B) Cricoid pressure is applied to occlude the esophagus and prevent aspiration, while BURP is applied to optimize vocal cord visualization during laryngoscopy.

Question 61

When is the safest time to extubate a patient after surgery? A. During deep anesthesia only B. During deep anesthesia or when the patient awakens C. During light anesthesia D. Only when the patient awakens

Answer 61

Answer: B

Question 62

Which of the following statements describes the effects of unilateral recurrent laryngeal nerve (RNL) injury? A. Airway obstruction and respiratory distress B. Loss of sensory innervation above the vocal cords C. Unilateral damage results in hoarseness but is unlikely to cause respiratory distress D. Paralysis of the cricothyroid muscle

Answer 62

Answer: C

Question 63

A CRNA provides general anesthesia for a patient who is having surgery. Despite performing airway risk assessments, when intubation is attempted, attempts are unsuccessful. What next step should the provider take after successfully placing a laryngeal mask airway? A. Wake the patient up B. Intubate trachea via the supraglottic airway device (SAD) C. Proceed without intubating the trachea (ventilate using LMA) D. Perform a tracheostomy or cricothyroidotomy E. All of these answers are possible correct actions

Answer 63

Answer: E. Each one of these actions can be the correct answer. Many SADs allow for tracheal intubations (TI) through the SAD, but if the SAD does not have this feature, the surgeon and CRNA must discuss the risks and benefits of performing the surgery with an LMA or whether invasive airway access (tracheostomy/cricothyroidotomy) is necessary. If neither provider is satisfied with these solutions and the procedure can be postponed, the CRNA should awaken and re-evaluate the procedure. These difficult airway guidelines were provided by the Difficult Airway Society (DAS) (Nagelhout et al., 2023, pp. 446-449).

Question 64

A forceful, involuntary spasm of the laryngeal musculature (laryngospasm) has developed in your freshly extubated patient. What is the most likely cause of the laryngospasm, and how can it be effectively managed? A. Laryngospasm is caused by sensory stimulation of the recurrent laryngeal nerve and can be effectively treated with deep tracheal suctioning and administration of a bronchodilator. B. Laryngospasm is caused by sensory stimulation of the superior laryngeal nerve and requires immediate re-intubation as the primary intervention. C. Laryngospasm is caused by sensory stimulation of the recurrent laryngeal nerve and can be effectively treated by manual massage of the trachea to relieve the spasm D. Laryngospasm is caused by sensory stimulation of the superior laryngeal nerve and can be effectively treated with gentle positive pressure ventilation and intravenous lidocaine.

Answer 64

Correct Answer: D

Question 65

Which anatomical structure separates the upper airway from the lower airway? A. Hyoid bone B. Cricoid cartilage C. Bronchioles D. Epiglottis

Answer 65

Answer: B, Cricoid cartilage

Question 66

While Mallampati classification would correlate to only being able to visualize the soft and hard palate? A. Class I B. Class II C. Class III D. Class IV

Answer 66

Answer: C, Class III

Question 67

What is a way to prevent gastric aspiration for a patient who received rapid-sequence induction and intubation? The patient ate 4 hours ago and needs an emergent laparoscopic cholecystectomy. A. Cricoid pressure B. Glossopharyngeal nerve block C. Superior laryngeal nerve block D. Does not need to do anything because enough time has passed for food to be digested, and the patient will not vomit

Answer 67

Answer: A. Cricoid Pressure

Question 68

What are some advantages of laryngeal mask airways (LMAs) when compared with tracheal intubation? (Pick 2) A. Less dental trauma B. Decreased risk of gastrointestinal aspiration C. Does not require neck mobility D. Decreased risk of gas leak and pollution

Answer 68

Answer: A and C

Question 69

Which of the following is the most reliable predictor of a difficult airway? A. Thyromental distance less than 6 cm B. Mallampati Class greater than II C. History of previous difficult intubation D. Prescence of facial hair

Answer 69

Answer: C. History of previous difficult intubation

Question 70

What is the most reliable indicator that the endotracheal tube has not inadvertently been placed in the esophagus? A. Bilateral breath sounds B. Persistent end-tidal carbon dioxide C. Equal chest excursion (rise) D. Condensation in the endotracheal tube

Answer 70

Answer: B

Question 71

Which of the following clinical signs can provide clues to the diagnosis of bronchial intubation? A) Bilateral breath sounds, stable oxygen saturation, normal peak inspiratory pressures, and easy ventilation with a compliant breathing bag B) Unilateral breath sounds, unexpected hypoxia, inability to palpate the ETT cuff in the sternal notch during inflation, and increased peak inspiratory pressures C) Decreased peak inspiratory pressures, normal bag compliance, symmetrical chest expansion, and no changes in oxygen saturation D) Easy palpation of the endotracheal tube (ETT) cuff in the sternal notch, equal air entry bilaterally, normal breathing-bag compliance, and no increase in peak inspiratory pressures

Answer 71

Answer: B) Unilateral breath sounds, unexpected hypoxia, inability to palpate the ETT cuff in the sternal notch during inflation, and increased peak inspiratory pressures

Question 72

Which cartilages of the larynx are paired? (Pick 3) A. Thyroid B. Arytenoid C. Cricoid D. Corniculate E. Cuneiform F. Epiglottic

Answer 72

Answer: B, D, & E

Question 73

What is the most common tachyarrhythmia seen in children? A. A. Fib B. V. tach C. A. Flutter D. SVT

Answer 73

Answer: D. SVT

Question 74

What is the optimal shock dose for initial cardioversion of A-flutter and other supraventricular tachycardia? A) 25 - 50 J B) 50 - 100 J C) 150 - 200 J D) 200 - 250 J

Answer 74

Answer: B) 50 - 100 J

Question 75

During the anesthetization of a patient with atrial fibrillation undergoing an ablation procedure in an electrophysiology laboratory or suite, the anesthetist must remain vigilant for which of the following major complications? Select all that apply: A) Atrioesophageal fistula B) Vagus nerve injury C) Hemorrhage D) Atrial perforation leading to cardiac tamponade E) Phrenic nerve injury

Answer 75

Correct Answers: A) Atrioesophageal fistula, D) Atrial perforation leading to cardiac tamponade E) Phrenic nerve injury

Question 76

Select all that apply: Which of the following are the most frequent postoperative complications in pediatric dental patients? A) Nausea and vomiting B) Hypothermia C) Crying D) Bleeding

Answer 76

Correct Answer: A, C, D

Question 77

Which of the following is acceptable according to fasting guidelines for a patient prior to electroconvulsive therapy (ECT) a. Patient takes oral medications with water two hours prior to procedure b. Patient has breakfast three hours prior to procedure c. Patient eats a midnight snack the night before his procedure at 0500 d. Patient has a glass of water before getting in the car to drive 30 minutes to the procedure

Answer 77

Answer: A

Question 78

What medication should be held when a patient is undergoing a CT scan with IV contrast, and why? A. Propofol, because it reacts with the IV contrast. B. Zofran, because it will cause worse nausea and vomiting. C. Metformin, because of the risk of lactic acidosis. D. No medications need to be held with IV contrast use.

Answer 78

Answer: C. Metformin, because of the risk of lactic acidosis.

Question 79

Which MRI Suite Zone is described here? “This is the area where patients are greeted, histories obtained, and questions answered. Movement by non-MRI personnel and patients is under the supervision of MRI personnel. A) Zone I B) Zone II C) Zone III D) Zone IV

Answer 79

Correct answer: B) Zone II

Question 80

When considering anesthesia in the pediatric population, which age group has the greatest risk of adverse events? A. Children under 10 years of age B. Children under 5 years of age C. Children ages 2 to 5 years of age D. Age is not a factor in the pediatric population

Answer 80

Answer: B. Children under 5 years of age

Question 81

Which of the following anesthetics may cause problems with In vitro fertilization procedures and should be avoided? A. Fentanyl B. Remifentanil C. Alfentanil D. Morphine

Answer 81

Answer: D. Morphine

Question 82

Which of the following factors can increase the risk of adverse effects during anesthetic care in pediatric patients? Select two. A. Utilization of multiple anesthetic agents B. Assessment of any recent upper respiratory tract infections C. Absence of nitrous oxide usage in combination with other sedatives D. Procedural duration is greater than one hour

Answer 82

Correct Answer: A & D

Question 83

Which of the following statements regarding perioperative management of cardiac patients is correct? A. Beta blockers should be discontinued perioperatively to prevent bradycardia. B. Angiotensin-converting enzyme inhibitors should always be discontinued due to the risk of intraoperative hypotension. C. Antiplatelet therapy in patients with stents should only be discontinued after discussion between the patient, cardiologist, and surgeon. D. Pacemakers do not require any special considerations during ambulatory procedures.

Answer 83

Answer: C. Antiplatelet therapy in patients with stents should only be discontinued after discussion between the patient, cardiologist, and surgeon.

Question 84

In the PACU, A patient has the following clinical presentation: Dyspnea with shallow breathing, 3L Nasal Canula with O2 Saturation of 91%, Blood pressure 10 mmHg lower than preanesthetic level, opens eyes to voice and is able to move only their hands/arms to command. What would the Modified Aldrete score be for this patient? A. 5 B. 6 C. 7 D. 8

Answer 84

Answer: B. 6

Question 85

Which of the following are the two most frequent causes of unplanned hospital admission from ambulatory surgery centers (ASCs) and office surgery practices? (select 2) A) Surgical site infections B) Inadequately controlled pain C) Delayed wound healing D) Postoperative nausea and vomiting

Answer 85

Answer: B & D

Question 86

What position should the patient be in during a colonoscopy? A. Left lateral decubitus position B. Prone position C. Semiprone position D. Supine position

Answer 86

Answer: A. Left lateral decubitus position

Question 87

Which patient is at the highest risk for obstructive sleep apnea (OSA)? A. A 23 y/o female with a BMI of 23 kg/m2 B. A 60 y/o male with a BMI of 28 and neck circumference of 30 cm C. A 55 y/o male with a BMI of 38 kg/m2 who reports lethargy and snoring frequently during the night D. A 70 y/o female with a BMI of 25 kg/m2 being treated for HTN

Answer 87

Answer: C, Screening for sleep apnea is vital, especially in outpatient surgery settings. It is highly possible that patients with OSA have not been formally diagnosed, and complications could occur if the patient's airway is not managed appropriately (difficult airway management, cardiopulmonary arrest, brain injury, etc.). The STOP-BANG questionnaire is a useful tool to determine the patient's risk for sleep apnea: Snoring, Tiredness, Observed apnea, Pressure, BMI (>35 kg/m2), Aget (>50 years), Neck (circumference >40 cm), Gender (male gender). While all answers had one or two risk factors, option C had five risk factors.

Question 88

Which of the following best describes the primary advantage of multimodal analgesia in postoperative pain management? A) It relies solely on opioids for pain control. B) It targets different pain pathways to produce a synergistic effect at lower analgesic doses. C) It is only effective for major surgical procedures. D) It eliminates the need for pharmacologic interventions in pain management.

Answer 88

Answer: B) It targets different pain pathways to produce a synergistic effect at lower analgesic doses.

Question 89

When is the appropriate time to administer succinylcholine, or other forms of neuromuscular blocking agents, during electroconvulsive therapy (ECT)? A. Before applying the blood pressure cuff to the lower extremity B. Immediately after induction, but before applying the blood pressure cuff C. After the blood pressure cuff is applied and inflated on the lower extremity D. After the seizure has been induced to prevent excessive muscle contractions

Answer 89

Answer: C. After the blood pressure cuff is applied and inflated on the lower extremity

Question 90

Which of the following describes the most often used anesthetic plan for a patient undergoing radiofrequency catheter ablation (RFCA) using general anesthesia? A. Inhaled volatile anesthetics with antiemetics to reduce postop nausea and vomiting (PONV) B. Total intravenous anesthesia (TIVA) to optimize hemodynamic stability during pulmonary artery occlusion and reduce PONV C. A balanced combination of volatile anesthetic and intravenous anesthetic to maintain appropriate anesthetic depth while optimizing hemodynamic stability and reduction of PONV D. A balance of volatile anesthetic and opioid to decrease the chance of hemodynamic instability during the case

Answer 90

Answer: B – Total intravenous anesthesia (TIVA) to optimize hemodynamic stability and reduce PONV

Question 91

Which Beta blocker has additional alpha blocking properties? A. Metoprolol B. Atenolol C. Labetelol D. Esmolol

Answer 91

Answer: C, Labetolol. Labetolol not only has the ability to block beta receptors but the alpha receptors as well. This allows Labetolol to vasodilate in addition to reducing cardiac rate and contractility.

Question 92

Which of the following patients would direct myocardial depressant effects be more apparent with higher dose Ketamine administration? Select two. A. 27-year-old male trauma patient B. 57-year-old female in severe end-stage septic shock C. 46-year-old woman with a small bowel obstruction D. 24-year-old male with a spinal cord transection

Answer 92

Correct Answer: B & D

Question 93

Which of the following inhalation anesthetics is known for causing airway irritation? A. Isoflurane B. Nitrous Oxide C. Sevoflurane D. Desflurane

Answer 93

Answer: D. Desflurane

Question 94

Which of the following antiemetics are effective for postdischarge nausea and vomiting (PDNV)? (select 2) a) Ondansetron (Zofran) b) Metoclopramide (Reglan) c) Scopolamine transdermal d) Palonosetron (Aloxi)

Answer 94

Answer: C & D

Question 95

Which patient requires additional education regarding sugammadex administration for surgery? A) A 32-year-old male with a history of hypertension controlled with lisinopril. B) A 45-year-old female with a history of asthma using albuterol as needed. C) A 28-year-old female taking hormonal contraceptives for birth control. D) A 60-year-old male with type 2 diabetes managed with metformin.

Answer 95

C) A 28-year-old female taking hormonal contraceptives for birth control.

Question 96

Which of the following treats mild pain? a. Ketorolac b. Hydromorphone c. Tylenol d. Fentanyl

Answer 96

Answer: C

Question 97

What is the primary concern regarding the respiratory effects of benzodiazepines? A. Depressed ventilatory response to CO2 B. Increased airway resistance C. Increased hypoxic drive D. Benzodiazepines have no respiratory effects

Answer 97

Answer: A - Depressed ventilatory response to CO2

Question 98

Which of the following opioids has the highest potency compared to morphine? A) Hydromorphone B) Meperidine C) Fentanyl D) Sufentanil

Answer 98

Correct answer: D) Sufentanil

Question 99

Which of the following best describes the role of the liver in the metabolism of succinylcholine? A) The liver directly metabolizes succinylcholine via cytochrome P450 enzymes. B) The liver produces plasma cholinesterase, responsible for hydrolyzing succinylcholine. C) Succinylcholine undergoes first-pass metabolism in the liver, reducing its bioavailability. D) Succinylcholine skips the liver and is entirely excreted unchanged by the kidneys.

Answer 99

B) The liver produces plasma cholinesterase, responsible for hydrolyzing succinylcholine

Question 100

Which of the following patients would most benefit from ketamine induction? A) A patient with severe asthma B) A patient with uncontrolled hypertension C) A patient with schizophrenia D) A patient with a full stomach at risk for aspiration

Answer 100

Correct Answer: A) A patient with severe asthma Rationale: Ketamine is a potent bronchodilator, making it an excellent choice for patients with reactive airway disease such as asthma

Question 101

Which of the following drugs are NMDA receptor antagonists? (Select 2) A. Nitrous Oxide B. Propofol C. Ketamine D. Etomidate

Answer 101

Answer: A and C Rationale: Nitrous Oxide and Ketamine function as NMDA receptor antagonists, distinguishing them from Propofol and Etomidate, which act primarily through GABA-A receptor modulation.

Question 102

Which of the following statements about propofol is correct? A) Propofol is a respiratory stimulant and enhances the response to hypercarbia. B) Propofol-induced depression of upper airway reflexes is less than that of thiopental. C) Propofol can be administered for sedation by any healthcare personnel without specific training. D) Propofol is a profound respiratory depressant and can cause apnea following an induction dose.

Answer 102

Answer: D) Propofol is a profound respiratory depressant and can cause apnea following an induction dose.

Question 103

Which of the following drugs are alpha 2 agonists? (Select 2) A. Carvedilol (Coreg) B. Dexmedetomidine (Precedex) C. Prazosin (Minipress) D. Clonidine (Catapres) E. Labetalol (Normodyne)

Answer 103

Answer: B. Dexmedetomidine (Precedex) & D. Clonidine (Catapres)

Question 104

Which of the following best explains why neostigmine requires an anticholinergic agent for co-administration, while sugammadex does not? A. Neostigmine directly stimulates the vagus nerve; therefore, it requires counteraction. B. Sugammadex binds to muscarinic receptors and prevents parasympathetic effects. C. Sugammadex increases acetylcholine breakdown, which counteracts muscarinic effects. D. Neostigmine increases endogenous acetylcholine around the cholinoreceptors.

Answer 104

Answer: D. Neostigmine increases endogenous acetylcholine around the cholinoreceptors. Rationale: Neostigmine inhibits acetylcholinesterase, which increases acetylcholine levels at the neuromuscular junction. This can cause bradycardia, arrhythmias, bronchoconstriction, and hypersalivation, so anticholinergics (glycopyrrolate or atropine) are given to counteract these effects

Question 105

How can an anesthesia provider accelerate the onset of Rocuronium during rapid sequence intubation? A. By priming rocuronium, which involves giving 10% of the calculated dose before inducing anesthesia and then giving the remaining dose 1 to 3 minutes after the patient is anesthetized B. By giving a larger single bolus of rocuronium at once C. By infusing rocuronium over 30 minutes before induction D. By priming rocuronium by giving half the dose before inducing anesthesia and then giving the remaining dose 1 to 3 minutes after the patient is anesthetized

Answer 105

Answer: A. By priming rocuronium, which involves giving 10% of the calculated dose before inducing anesthesia and then giving the remaining dose 1 to 3 minutes after the patient is anesthetized.

Question 106

Which of the following opioids is most likely to cause histamine release leading to hypotension and pruritus? a) Fentanyl b) Morphine c) Remifentanil d) Sufentanil

Answer 106

Answer: b) Morphine.

Question 107

Which of the following are true about ketamine? A. Ketamine provides dissociative sedation AND analgesia B. Ketamine increases blood pressure and heart rate C. Ketamine is an NMDA receptor antagonist D. Ketamine can be administered IV, IM, and orally. E. All of the above are true of ketamine

Answer 107

Answer: E. All of the above are true of ketamine.

Question 108

After administering a neuromuscular blocking agent, you perform a train of four (TOF) assessment on the ulnar nerve and observe the absence of twitches T3 and T4. What percentage of neuromuscular blockade does this correspond with? A. <70% B. 75-80% C. 85-90% D. 80-85%

Answer 108

Answer: D - 80-85% block

Question 109

Which of the following is a high-risk cardiac condition requiring elective surgery delay until further evaluation or treatment is completed? A. Stable angina B. Stage 1 hypertension C. Recent myocardial infarction within 30 days D. Controlled atrial fibrillation

Answer 109

Correct Answer: C. Recent myocardial infarction within 30 days

Question 110

A patient with chronic kidney disease is scheduled for surgery. Which lab test should be checked within 6-8 hours before surgery to prevent cardiac risks? A) Blood urea nitrogen (BUN) B) Serum creatinine C) Serum potassium D) Complete blood count (CBC)

Answer 110

Answer: C) Serum potassium

Question 111

For a patient with suspected or known adrenal insufficiency undergoing total joint replacement surgery, what is the recommended perioperative dose of hydrocortisone? A. Preoperative corticosteroid dose + 25 mg B. Preoperative corticosteroid dose + 150 mg C. Preoperative corticosteroid dose + 40 mg D. Preoperative corticosteroid dose + 75 mg

Answer 111

Answer: D

Question 112

Which of the following are signs of upper respiratory tract infection in pediatric patients in the preoperative period? Select two. A. Rhinorrhea B. Auscultation of rales C. Pulmonary congestion evidenced on a chest radiograph D. Bulging and tender eardrums

Answer 112

Correct Answer: A & D

Question 113

Which of of the following are effective preoperative strategies to prevent pulmonary complications in a patient with chronic bronchitis? (SATP) a. Weight reduction b. Prophylactic antibiotics to sterilize sputum c. chest physiotherapy d. Expectorants

Answer 113

Answer: a., c., d.

Question 114

A patient with chronic obstructive pulmonary disease (COPD) presents for elective non-cardiac surgery. His arterial blood gas shows PaCO₂ of 50 mm Hg, PaO₂ of 57 mm Hg, and SpO₂ of 89%. Which of the following is the most appropriate next step? A. Cancel surgery and consult pulmonary rehab B. Proceed with surgery; findings are not contraindications C. Intubate preoperatively and admit to ICU D. Postpone surgery until PaCO₂ normalizes

Answer 114

Answer: B. Proceed with surgery; findings are not contraindications

Question 115

Which of the following patients is at increased risk of awareness during surgery? Select 3 A) Female B) Elderly C) Smoker D) Obese E) Obstetric

Answer 115

Answer: A, D, & E

Question 116

Which patient would be most likely to experience postoperative nausea and vomiting? A. 85 year-old female with osteoporosis B. 30 year-old male with a history of tobacco abuse C. 28 year-old female with vertigo D. 76 year-old male with coronary artery disease.

Answer 116

Answer: C

Question 117

Which of the following is not considered an acceptable clear liquid that can be consumed up to 2 hours before a surgical procedure? A. Beef Broth B. Popsicle C. Clear Jell-O D. Fat Free Milk

Answer 117

Answer: D. Fat Free Milk

Question 118

What is the “surgical stress response” characterized by? (select all that apply) A) Temporary increase in liver enzymes B) Induction of a catabolic state C) Decreased peripheral glucose uptake D) Uncontrolled postoperative pain E) Increased endogenous glucose production

Answer 118

Correct answer: B) Induction of a catabolic state, C) Decreased peripheral glucose uptake E) Increased endogenous glucose production

Question 119

During a critical healthcare-related incident where the patient is harmed, who would be considered the second victim? A. The family of the patient B. The hospital shareholders C. The healthcare provider caring for the patient D. The local community

Answer 119

Answer: C, Healthcare provider caring for the patient.

Question 120

Which of the following anesthetic agents is most commonly associated with elevated incidences of emergence delirium in pediatric patients? A. Midazolam B. Dexmedetomidine C. Sevoflurane D. Propofol

Answer 120

Answer: C - Sevoflurane

Question 121

Urinary output and voiding are essential monitoring assessments for post-spinal and epidural anesthesia. Diabetic patients can develop postoperative urinary retention (POUR). What is the amount in the bladder immediately after spinal anesthesia that indicates a predictor of POUR? A. Greater than 400 to 500 mL B. Greater than 600 to 700 mL C. Greater than 800 to 1000 mL D. Greater than 200 to 300 mL

Answer 121

Answer: A. 400 to 500 mL

Question 122

Which of the following has been attributed to approximately 20% of intraoperative anaphylactic reactions? A. Latex B. Antibiotics C. Opioids D. Propofol

Answer 122

Answer: Latex

Question 123

Which of the following is associated with the highest risk for perioperative MI? A. Substernal discomfort brought on by exertion B. Blood pressure of 130/80 C. Angina relieved by nitroglycerin in less than 15 minutes D. Newly developed angina within the past 2 months

Answer 123

Answer: D. Newly developed angina within the past 2 months

Question 124

Which of the following patients is at the highest risk for postoperative nausea and vomiting (PONV)? A. A 65-year-old male with a history of smoking undergoing bowel resection and has an NG tube B. A 45-year-old nonsmoker female with a history of motion sickness undergoing breast surgery C. A 30-year-old male with no history of motion sickness undergoing knee arthroscopy D. A 70-year-old female undergoing cataract surgery under local anesthesia and mild sedation

Answer 124

Answer: B. A 45-year-old nonsmoker female with a history of motion sickness undergoing breast surgery

Question 125

Which of the following findings indicate poor ventricular function? A) Cardiac index > 2.5 L/min/m², left ventricular end-diastolic pressure < 12 mm Hg, and ejection fraction (EF) > 50%. B) Cardiac index < 2.2 L/min/m², left ventricular end-diastolic pressure > 18 mm Hg, and ejection fraction (EF) < 40%. C) Presence of ischemia-induced hypokinesis, which always indicates nonviable myocardium. D) Pulmonary wedge pressure waveform is not influenced by ischemia-induced papillary muscle dysfunction.

Answer 125

Answer: B) Cardiac index < 2.2 L/min/m², left ventricular end-diastolic pressure > 18 mm Hg, and ejection fraction (EF) < 40%.

Question 126

In a patient with a recent history of illicit drug use, abstinence syndrome typically exhibits as: A) An increase in sympathetic response B) An increase in parasympathetic response C) A decrease in parasympathetic response D) An increase in both sympathetic and parasympathetic response.

Answer 126

D) Increased in both sympathetic and parasympathetic response

Question 127

Which of the following are optimal indications for cell salvage techniques, such as Cell Saver? Select two. A. Hip replacement with an anticipated blood loss of >500mL B. Surgical debulking of a malignant peritoneal tumor C. Exploratory laparotomy following a gunshot wound to the abdomen D. Jehovah’s Witness patient undergoing a spinal fusion

Answer 127

Correct Answer: A & D

Question 128

Select All That Apply (Pick 3) Which are common indications for using colloid fluids over crystalloids? A. Sepsis B. Severe hypoalbuminemia C. Massive third spacing D. Fluid replacement under 2 liters E. Buying time before blood availability

Answer 128

Correct Answers: B. Severe hypoalbuminemia C. Massive third spacing E. Buying time before blood availability

Question 129

Which of the following are causes of hypocalcemia? [Select 2] A. Hyperparathyroidism B. Vitamin D deficiency C. Hyperphosphatemia D. Thiazide diuretic administration

Answer 129

Answer: B and C

Question 130

Which of the following are chloride-sensitive causes for metabolic alkalosis? (SATP) a. Vomiting b. Diuretics c. Hyperaldosteronism d. Cystic fibrosis

Answer 130

Answer: a., b., d.

Question 131

Which of the following relationships is the basis for the Frank-Starling mechanism? A. Systemic vascular resistance (SVR) and left ventricular end-diastolic volume (LVEDV) B. Cardiac output and left ventricular end-systolic volume (LVESV) C. Myocardial contractility and systemic vascular resistance (SVR) D. Left ventricle end-diastolic volume (LVEDV) and Myocardial contractility

Answer 131

Answer: D

Question 132

Once a patient with hyponatremia is clinically stable, what is the recommended maximum rate at which serum sodium (Na⁺) should be increased to avoid the risk of osmotic demyelination syndrome? A) 5-8 mmol/L in 24 hours B) 8 mmol/L in 24 hours C) 10–15 mmol/L in 24 hours D) 20-25 mmol/L in 24 hours

Answer 132

Correct Answer: C) 10–15 mmol/L in 24 hours

Question 133

Which of the following regulate or contribute to the release of ADH and, thereby, control plasma osmolality? (select all that apply) A. Osmoreceptors in the hypothalamus B. The anterior pituitary C. The renal collecting tubules D. Carotid baroreceptors E. The posterior pituitary F. Low pressure volume receptors in the atria, vena cavae, and pulmonary arteries.

Answer 133

Correct Answer: A, D, E, F

Question 134

What daily fluid volume would a 100 kg patient need in order to maintain Total Body Water homeostasis? Assume the person is healthy, normothermic, and has standard metabolic function. A. 2 Liters B. 3 Liters C. 4 Liters D. 5 Liters

Answer 134

Answer: B. 3 Liters.

Question 135

What is the most common electrolyte abnormality in hospitalized patients? A. Hyperkalemia B. Hypocalcemia C. Hyponatremia D. Hyperphosphatemia

Answer 135

Correct Answer: C

Question 136

Which of the following best distinguishes nephrogenic diabetes insipidus (DI) from central DI? A. Nephrogenic DI often develops due to lesions in the brain B. Central DI shows no response to antidiuretic hormone (ADH) administration C. Nephrogenic DI involves impaired renal response to normal ADH levels D. Central DI is commonly associated with lithium therapy

Answer 136

Correct Answer: C. Nephrogenic DI involves impaired renal response to normal ADH levels

Question 137

Which of the following is a key component of patient blood management (PBM) in the perioperative period? A. Delaying anemia treatment until after surgery B. Routine transfusion of all patients undergoing major surgery C. Optimization of the patient’s red blood cell production D. Ignoring mild anemia if the patient is asymptomatic

Answer 137

Correct Answer: C. Optimization of the patient’s red blood cell production

Question 138

A trauma patient is receiving massive transfusion of packed red blood cells intraoperatively. Which electrolyte imbalance is most likely to occur due to the citrate preservative in the blood products? A) Hyperkalemia B) Hypocalcemia C) Hypernatremia D) Hypomagnesemia

Answer 138

Answer: B) Hypocalcemia

Question 139

Which of the following is NOT a recommended indication for platelet transfusion? A. Platelet count <10 × 10⁹ cells/L in a non-bleeding patient B. Platelet count <50 × 10⁹ cells/L with active bleeding C. Mild thrombocytosis without bleeding D. Platelet dysfunction

Answer 139

Answer: C. Mild thrombocytosis without bleeding

Question 140

According to Enhanced Recover After Surgery (ERAS) protocol, which of the following is NOT correct regarding the preoperative fluid management fasting intervals? A. Clear liquids: 2 hours B. Breast milk: 2 hours C. Formula/non-human milk/light meal: 6 hours D. Heavy meal (fried foods, fatty foods, meats): 8 hours.

Answer 140

Answer: B. Breast milk: 2 hours Rationale: The preoperative fasting guidelines recommend the following fasting intervals: clear liquids 2 hours, breast milk 4 hours, infant formula/nonhuman milk/light meal 6 hours, and heavy meal (fried foods, fatty foods, meats) 8 hours.

Question 141

A patient presented to the emergency department 2 days prior with heart failure and fluid overload. The patient has been NPO during this time and is receiving loop diuretics to offload fluid. The patient is preparing for a heart cath when the nurse anesthetist notices the patient's ECG: A pronounced P wave, a flattened T wave, and a prominent U wave. What condition should the CRNA suspect? A. Hyperkalemia B. Hypokalemia C. Hypercalcemia D. Hypocalcemia F. Wolff-Parkinson-White Syndrom

Answer 141

B. Hypokalemia. The ECG represents a classic presentation of hypokalemia. Assumably, the hypokalemia was brought on by a decreased dietary potassium intake and the administration of loop diuretics. Conversely, hyperkalemia is presented with a flattened P wave, widened QRS, shortened QT interval, and peaked T wave.

Question 142

Which of the following findings is most consistent with Transfusion-Associated Circulatory Overload (TACO) rather than Transfusion-Related Acute Lung Injury (TRALI)? A. Hypotension B. Fever and chills C. Hypertension D. Acute hypoxemia within 6 hours of transfusion

Answer 142

Answer: C. Hypertension

Question 143

The anesthesia provider is looking at the patient's history and medication list. The anesthesia provider confirmed with the nurse that the patient is taking a scheduled dose of an ACE inhibitor (lisinopril) and a Beta blocker (metoprolol) to control their blood pressure. The patient is scheduled for surgery in the next 10 hours. What electrolyte abnormality would you see in the patient if it is not corrected by goal-directed fluid therapy? A. hyponatremia and hyperkalemia B. hypernatremia and hypokalemia C. hypernatremia and hyperkalemia D. hypercalcemia and hypocalcemia

Answer 143

Answer: A. hyponatremia and hyperkalemia Rationale: Medications such as ACE inhibitors, beta blockers (specifically Beta 1 receptor antagonism), ARBs, and digoxin can cause an increase in extracellular potassium. ACE inhibitors and ARBs can cause a decrease in angiotensin, and beta blockers inhibit renin release, which decreases the release of aldosterone. A decrease in aldosterone can cause hyperkalemia and hyponatremia.

Question 144

What is the ultimate goal of perioperative goal-directed fluid therapy (GDFT)? A. To administer a fixed volume of fluids to all patients. B. To utilize individual hemodynamic end points to achieve an optimal cardiac output and oxygen delivery to tissues. C. To minimize the use of vasopressors during surgery, thus decreasing increased oxygen demand. D. To aim for a "zero balance" between intake and output to minimize excess fluid administration by only replacing the estimated blood loss during surgery.

Answer 144

Correct Answer: B. To utilize individual hemodynamic end points to achieve an optimal cardiac output and oxygen delivery to tissues.

Question 145

What is a consequence of venous air embolism (VAE), and how is it identified? A. VAE will decrease dead space, causing an ABG to show alkalosis. B. VAE will result in increased perfusion, causing increased EtCO2. C. VAE increases dead space, causing EtCO2 to decrease. D. VAE decreases dead space, causing EtCO2 to decrease.

Answer 145

Answer: C - VAE increases dead space and causes EtCO2 to decrease.

Question 146

Which of the following statements best describes how the lithotomy position can affect blood pressure during surgery? A. It causes blood pooling in the lower extremities, falsely lowering the blood pressure. B. Tilting the head down increases venous return, leading to consistently elevated blood pressure. C. Leg elevation above the trunk increases central blood volume, potentially leading to falsely elevated blood pressure. D. Blood pressure readings are not affected because the legs are at the same level as the heart.

Answer 146

Answer: C. Leg elevation above the trunk increases central blood volume, potentially leading to falsely elevated blood pressure.

Question 147

Which of the following factors are associated with to nerve injuries in the operating room? (SATA) A) Extremes of body habitus such as obesity or malnutrition. B) Preexisting conditions like hypertension, diabetes mellitus, peripheral vascular disease and alcoholism. C) Orthopedic surgical cases, specifically joint replacements D) Prolonged surgical times. E) Anesthetic techniques that include hypotension with poor perfusion, neuromuscular blockade with allows extremes in stretching that can cause harm, and positioning devices used incorrectly.

Answer 147

Correct Answers: A, B, D, E

Question 148

What type of nerve injury occurs when the nerve is pulled across immovable structures? A) Compression injury B) Transection injury C) Traction injury D) Crush injury

Answer 148

Answer: C) Traction injury

Question 149

Which nerve is most at risk from compression at the fibular head in the lithotomy position? A. Sciatic nerve B. Femoral nerve C. Peroneal nerve D. Obturator nerve

Answer 149

Correct Answer: C. Peroneal nerve

Question 149

What surgical position carries the highest risk for compartment syndrome in lower extremities? A) Prone B) Supine C) Lateral decubitus D) Lithotomy

Answer 149

Correct Answer: D)

Question 150

Which of the following statements regarding operating room safety standards is incorrect? A. Healthcare providers must have radiation level monitoring if exposed to greater than 40 REM (Roentgen equivalent in man). B. Air volume exchanges should occur every 15 minutes, as per the NFPA. C. Operating room humidity should be maintained between 20% and 60%. D. The ambient operating room temperature should be maintained between 68°F (20°C) and 75°F (24°C).

Answer 150

Correct Answer: B. Air volume exchanges should occur every 15 minutes per NFPA.

Question 151

What is the most common metabolic disease associated with spontaneous isolated femoral neuropathy? A) Hypertension B) Diabetes C) Peripheral vascular disease D) History of smoking within 5 months

Answer 151

Correct Answer: B) Diabetes

Question 152

How much does the Mean Arterial Pressure (MAP) increase or decrease by per inch change in height between the heart and a body region? A) 1mmHg B) 2mmHg C) 3mmHg D) 4mmHg

Answer 152

Answer: B) 2mmHg

Question 153

Which crew resource management principle is described as the most important for operating room safety? A. Communication B. Leadership C. Assertiveness D. Situational awareness

Answer 153

Answer: D. Situational awareness

Question 154

What is the maximum leakage current allowed in the Operating Room? A. 10 milliamperes (mA) B. 10 microamperes (μA) C. 100 microamperes (μA) D. 100 milliamperes (mA)

Answer 154

Answer: B. 10 microamperes (μA).

Question 155

Which of the following is typically the responsibility of the anesthesia provider in the event of an intra-operative fire? A. alcohol-based solutions, drapes, adhesive removers, and towels B. electrocautery, drills, lasers, burrs, and light-sources C. oxygen and nitrous oxide concentrations D. None of the above

Answer 155

Answer: C

Question 156

Which of the following nerves in the leg is most susceptible to injury from OR table straps that are placed too tightly? A. Lateral femoral cutaneous nerve B. Radial nerve C. Saphenous nerve D. Deep peroneal nerve

Answer 156

Answer: A: Lateral femoral cutaneous nerve

Question 157

Which of the following statements best describes the cardiovascular response to Trendelenburg positioning in hypotensive patients? A. It consistently increases mean arterial pressure (MAP) and cardiac index (CI) B. It leads to predictable improvements in stroke volume and venous return C. It may increase central venous pressure (CVP) but not necessarily improve cardiac output or MAP D. It effectively treats hypovolemia by redistributing blood volume

Answer 157

C. It may increase central venous pressure (CVP) but not necessarily improve cardiac output or MAP

Question 158

When a patient is placed in a steep Trendelenburg position, what happens to the endotracheal tube, which is a complication of the patient's airway? A. Inadvertently right mainstem movement of the endotracheal tube B. inadvertently left mainstem movement of the endotracheal tube C. No movement of the endotracheal tube happens D. The endotracheal tube may become obstructed by gastric contents due to increased aspiration risk

Answer 158

Answer: A. Right mainstem movement of the endotracheal tube placement

Question 159

What is the most sensitive noninvasive device to identify a venous air embolism (VAE)? A. Transesophageal echocardiogram (TEE) B. Precordial Doppler C. End-Tidal CO2 (EtCO2) D. Transcranial Doppler

Answer 159

Answer: B. Precordial Doppler

Question 160

While the fibrillation threshold is 100 mA even small electrical shocks can cause ventricular fibrillation if the shock occurs at which point on an ecg? A. On the P wave B. On the R wave C. Just after the S wave D. On the T wave

Answer 160

Answer: D

Question 161

Which of the following is the most likely clinical consequence of ulnar neuropathy resulting from improper surgical positioning? A. Inability to extend the wrist and loss of sensation to the lateral forearm B. Diminished grip strength and inability to flex the elbow C. Inability to oppose the fifth finger and sensory loss in the fourth and fifth digits D. Numbness over the posterior upper arm and medial forearm

Answer 161

Correct Answer: C. Inability to oppose the fifth finger and sensory loss in the fourth and fifth digits