CRNA Board Questions With Complete Solutions

CRNA Board Questions With Complete Solutions

Positive end expiratory pressure (PEEP):

• decreases dead space

2.increases venous return to the heart

• decreases intrapulmonary shunting
• decreases extravascular lung water Correct Ans - Positive end

expiratory pressure (PEEP): decreases intrapulmonary shunting

The major effect of PEEP is to increase FRC and tidal ventilation above the closing capacity. This results in a decrease in intrapulmonary shunting.Neither PEEP nor CPAP decrease extravascular lung water. By increasing intrathoracic pressure, PEEP decreases venous return to the heart.

The essential component of cardioplegia solutions is:

• mannitol 2. magnesium 3. potassium 4. corticosteroid Correct Ans -

The essential component of cardioplegia solutions is: potassium

High concentrations of potassium (20 - 30 mEq/L) are used in cardioplegia solutions. These solutions result in an increase in extracellular potassium and reduce transmembrane potential. This progressively interferes with the normal sodium currents of depolarization and eventually the sodium channels are completely inactivated.pg. 1092Barash, PG, Cullen, BF, Stoelting, RK, Cahalan, MK, Stock, MC, Ortega,

R.,Sharar, SR, and Holt, NF. Clinical Anesthesia. Philadelphia: Lippincott

Williams & Wilkins, 2017.Forms of mechanical ventilation that produce tidal volumes at or below

anatomic dead space include: (Select 2)

• high-frequency oscillation

2. inverse I:E ratio ventilation

• airway pressure release ventilation
• differential lung ventilation
• high-frequency positive-pressure ventilation
• pressure support ventilation Correct Ans - Forms of mechanical

ventilation that produce tidal volumes at or below anatomic dead space

include: high-frequency oscillation, high-frequency positive-pressure

ventilation High-frequency oscillation (HFO) creates a to-and-fro gas movement in the airway at rates of 400 - 2400 times/min. High frequency positive-pressure 1 / 4

ventilation is delivered at a rate of 60 - 120 breaths/min. Tidal volume is at or below anatomic dead space. High-frequency ventilation techniques may be useful in cases of bronchopleural and tracheoesophageal fistulas.pg. 1062Barash, PG, Cullen, BF, Stoelting, RK, Cahalan, MK, Stock, MC, Ortega,

R.,Sharar, SR, and Holt, NF. Clinical Anesthesia. Philadelphia: Lippincott

Williams & Wilkins, 2017.During rapid-sequence induction, cricoid pressure is applied to reduce the incidence of regurgitation. After loss of consciousness, the recommended

amount of downward force applied to the cricoid cartilage is:(Enter numerical

answer.) Correct Ans - 3.0 - 4.4 kg Using cricoid yolk studies, the optimum force necessary to effectively occlude the esophagus without obstruction of the trachea is between 30 and 44 Newtons (3.0 - 4.4 kg). It is recommended that 2 kg of force be applied prior to loss of consciousness and that pressure be increased to 4 kg of force after loss of consciousness.

pg. 420Nagelhout, JJ, Elisha, S. Nurse Anesthesia. St. Louis: Elsevier, 2018.

Changes found in banked blood include: (Select 2)

• increased levels of 2,3-DPG
• a left shift of the hemoglobin dissociation curve
• decreased levels of potassium
• formation of microaggregates
• alkalosis secondary to the presence of citrate
• increased intracellular ATP stores
• thrombocytosis Correct Ans - Changes found in banked blood

include: (Select 2) a left shift of the hemoglobin dissociation curve, formation of microaggregates

Changes occurring in banked blood include:

Depletion of 2,3-DPG Depletion of intracellular ATP Oxidative damage Increased adhesion to vascular endothelium Altered cell morphology Accumulation of microaggregates Hyperkalemia (as high as 17.2 mEq/L) Absence of platelets (after 2 days of storage) 2 / 4

Hemolysis Accumulation of proinflammatory products

Pulmonary changes associated with Duchenne's muscular dystrophy include:

• a restrictive ventilatory defect
• an obstructive ventilatory defect 3. decreased pulmonary artery pressures
• increased residual volume Correct Ans - Pulmonary changes

associated with Duchenne's muscular dystrophy include: a restrictive

ventilatory defect The combination of marked kyphoscoliosis and degeneration of the respiratory muscles produces a severe restrictive ventilatory defect in patients with Duchenne's muscular dystrophy. Pulmonary hypertension is also commonly seen.Download CoreNotes

http://www.ccanesthesiareview.com/QF/Muscular_Dystrophy.pdf

pg. 753Butterworth, JF, Mackey, DC, and Wasnick, JD. Morgan & Mikhail's

Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical

Publishing Division, 2013.

Key elements in the AANA's definition of wellness include: (Select 3)

• effective adaptation 2. resilience 3. professionalism 4. competence 5. coping

mechanisms 6. compassion 7. fortitude 8. perseverance Correct Ans -

Key elements in the AANA's definition of wellness include: (Select 3) effective

adaptation, resilience, coping mechanisms The AANA defines wellness as a positive state of the mind, body, and spirit reflecting a balance of effective adaptation, resilience, and coping mechanisms in personal and professional environments that enhance quality of life."About Health and Wellness" URL: https://www.aana.com/practice/health- and-wellness-peer-assistance/about-health-wellness

An increase in intraocular pressure has been associated with: (select 3)

• nitrous oxide administration 2. succinylcholine administration 3. opioid

administration 4. hyperventilation 5. laryngoscopy 6. hypoxemia 7.sevoflurane administration Correct Ans - An increase in intraocular

pressure has been associated: succinylcholine administration, hypoxemia,

laryngoscopy 3 / 4

Succinylcholine increases intraocular pressure by 5 - 10 mm Hg for 5 - 10 minutes after administration. This increase is primarily the result of prolonged contracture of the extraocular muscles from the depolarizing effects of succinylcholine. Nitrous oxide, volatile anesthetic agents and opioids have been associated with a reduction in intraocular pressure. Hypoxemia, hypercarbia, hypertension, hypervolemia, laryngoscopy and intubation have all been shown to increase IOP.pp. 760-761Butterworth, JF, Mackey, DC, and Wasnick, JD. Morgan & Mikhail's

Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical

Publishing Division, 2013.

In the pressure-volume loop below, cardiac work is best represented by:

• the area of the curve 2. the slope of the line from points C to D 3. the

distance of the line from points C to D 4. the slope of a line from points A to D Correct Ans - In the pressure-volume loop below, stroke work is best

represented by: the area of the curve

Stroke work is the product of pressure and volume and is linearly related to myocardial oxygen consumption. Stroke work is best represented by the area of the curve of a pressure-volume loop.pg. 288Barash, PG, Cullen, BF, Stoelting, RK, Cahalan, MK, Stock, MC, Ortega,

R.,Sharar, SR, and Holt, NF. Clinical Anesthesia. Philadelphia: Lippincott

Williams & Wilkins, 2017.According to the Modified Glasgow Coma Scale, a moderate head injury is

associated with a score of:

13 - 15

9 - 12

• - 9

less than 6 Correct Ans - According to the Modified Glasgow Coma

Scale, a moderate head injury is associated with a score of: 9 - 12

According to the Modified Glasgow Coma scale, mild head injury is associated with a score of 13 - 15, moderate head injury is associated with a score of 9 - 12, and severe head injury is associated with a score of less than 8.

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