NBCRNA CRNAFree Certified Registered Nurse Anesthetist practice test

Correct answer: A. An approximately 80% elevation in cardiac output

The cardiovascular system undergoes substantial adaptations throughout pregnancy, including benign systolic murmurs and third heart sounds. Central venous pressure remains unchanged throughout a healthy pregnancy despite reductions in systemic vascular resistance. The blood volume expansion during pregnancy prepares the body to tolerate a typical vaginal delivery blood loss of 300–500 mL without adverse effects (a Cesarean delivery loss of 800–1000 mL is also well-tolerated). Immediately after delivery, uterine contractions redistribute roughly 500 mL of blood into the central circulation via autotransfusion, driving an approximately 80% surge in cardiac output.

Correct answer: D. Fentanyl combined with vecuronium

NEC is a surgical emergency occurring most often in infants born before 36 weeks gestation, caused by factors including premature enteral feeding, poor gut colonization, nosocomial infection exposure, and mesenteric ischemia. These critically ill neonates are typically already intubated and receiving vasopressors. The preferred anesthetic regimen combines a narcotic (e.g., fentanyl) with a neuromuscular blocker (e.g., vecuronium). Volatile agents such as isoflurane and sevoflurane are poorly tolerated and should be avoided. Benzodiazepines may supplement opioids, but nitrous oxide is contraindicated because it causes intestinal gas expansion.

Correct answer: D. Stellate ganglion block

Anesthesia providers are increasingly involved in chronic pain management outside the operating suite. Nerve blocks target specific pain generators. The stellate ganglion block is conventionally applied to complex regional pain syndrome of the upper extremity, herpes zoster neuropathy, and post-radiation neuritis, and has shown clinical research success in treating post-traumatic stress disorder. In contrast, occipital nerve blocks address migraines and chronic headaches, celiac plexus blocks manage pancreatic and upper abdominal tumor pain, and lumbar sympathetic blocks treat neuropathic lower extremity pain.

Correct answer: B. Etomidate

Regional anesthesia is preferred for Cesarean delivery under routine circumstances, but in an emergency, general anesthesia is necessary. When the patient is hemodynamically stable and rapid sequence induction is needed, propofol is the preferred agent, though it causes some neonatal depression. For a hemodynamically unstable parturient, ketamine or etomidate is the induction drug of choice. Succinylcholine is typically reserved for situations where rapid intubation is needed without hemodynamic compromise. Sevoflurane carries tocolytic properties raising concern for postpartum hemorrhage. Nitrous oxide is used in some countries as inhaled labor analgesia, not as an induction agent.

Correct answer: D. Inhaled nitric oxide

Pulmonary hypertension remains a major indication for lung transplantation despite expanded pharmacotherapy. Agents used to mitigate induction-associated risks include inhaled nitric oxide, milrinone, epoprostenol, and sildenafil, among others. Inhaled nitric oxide (distinct from nitrous oxide) is the preferred agent because it selectively reduces right ventricular afterload without increasing systemic vascular resistance. Due to its higher cost, epoprostenol is increasingly utilized as an alternative, offering comparable effects on the right ventricle and systemic circulation at lower expense.

Correct answer: B. Prolonged QT interval

Hyperparathyroidism is associated with elevated serum calcium, which shortens (rather than prolongs) the QT interval on the electrocardiogram. Other recognized manifestations include muscle weakness, hypertension, osteoporosis, and hyperchloremic metabolic acidosis. A prolonged QT interval would instead suggest hypocalcemia.

Correct answer: A. Reduced pulmonary compliance and elevated residual volume, increasing the likelihood of hypoxemia during anesthesia

Aging produces significant changes that affect anesthetic management. Pulmonary compliance decreases and residual volume rises in older adults, impairing oxygenation and increasing hypoxemia risk during prolonged procedures. Baroreceptor sensitivity also declines with age, reducing the body's ability to compensate for blood pressure fluctuations and increasing susceptibility to hemodynamic instability. Hepatic and renal blood flows both decline with aging, slowing drug clearance and raising fluid retention risk rather than lowering it. Additionally, pulmonary parenchyma loses elasticity with age, predisposing patients to atelectasis.

Correct answer: D. Aortic stenosis

Spinal and epidural anesthesia should be used with great caution in patients with mild-to-moderate aortic stenosis because the resulting reductions in preload and afterload readily precipitate hypotension. In patients with severe aortic stenosis, neuraxial anesthesia is contraindicated altogether. Mitral valve prolapse, mitral regurgitation, and aortic regurgitation are not contraindications to spinal anesthesia.

Correct answer: B. 2.5 to 3.0 mg/kg

Propofol is the most widely used induction agent in the pediatric population and carries the added benefit of antiemetic properties. Infants require higher induction doses than older children; the standard induction dose for children is 2.0–2.5 mg/kg, whereas infants require 2.5–3.0 mg/kg. Injection pain can be reduced by mixing lidocaine with the propofol prior to administration.

Correct answer: D. Orogastric suctioning, preoxygenation with 100% oxygen, propofol 2.0–2.5 mg/kg induction, succinylcholine, cricoid pressure, and modified rapid-sequence intubation

Pyloric stenosis predominantly affects males (5:1 ratio) and involves hypertrophic pyloric muscle causing gastric outlet obstruction. Infants typically present between 2 and 12 weeks of age with severe dehydration and electrolyte abnormalities requiring correction over up to 72 hours before surgery. Once ready, the provider performs orogastric suctioning (with optional prior irrigation) to minimize aspiration risk. Awake intubation with topical lidocaine was previously standard but is no longer preferred. Volatile agents are avoided for induction. Preoxygenation with 100% oxygen is performed, propofol is the preferred induction agent (barbiturates are acceptable alternatives), followed by succinylcholine, cricoid pressure, and modified rapid-sequence intubation. Opioids are avoided because of apnea risk post-anesthesia.