NBCRNA NCE Practice – National Board of
Certification and Recertification for Nurse
Anesthetists – 2026/2027 Edition – Questions and
Answers for CRNA Candidates and Professionals
Question 1
In the elderly, the time needed for clinical recovery from neuromuscular blockade is
significantly increased for which agent?
A. Cisatracurium
B. Vecuronium
C. Pipecuronium
D. Mivacurium
Answer: B. Vecuronium
Rationale: Vecuronium's recovery time is prolonged in elderly patients due to age-
related changes in hepatic clearance and increased volume of distribution. In contrast,
cisatracurium and atracurium undergo Hofmann elimination (organ-independent),
making them more predictable in this population.
,Question 2
Considerations for the management of a patient with myotonic dystrophy under general
anesthesia should include which of the following?
A. Anticholinesterase reversal
B. Midazolam premedication
C. Short-acting nondepolarizer
D. Succinylcholine infusion
Answer: C. Short-acting nondepolarizer
Rationale: Myotonic dystrophy patients are at risk for prolonged responses to muscle
relaxants and myotonic reactions to succinylcholine. Short-acting nondepolarizing
agents are preferred, and anticholinesterases should be avoided due to risk of
precipitating myotonia.
Question 3
Which drug would have a normal pharmacokinetic profile in a patient with severe liver
disease?
A. Pancuronium
B. Succinylcholine
C. Mivacurium
D. Atracurium
,Answer: D. Atracurium
Rationale: Atracurium undergoes Hofmann elimination (spontaneous degradation in
plasma) and ester hydrolysis, which are organ-independent. Therefore, its
pharmacokinetics remain relatively normal in patients with severe hepatic dysfunction,
unlike pancuronium, vecuronium, and rocuronium which rely on hepatic clearance.
Question 4
Which neuromuscular blocking agent is a benzylisoquinoline compound?
A. Vecuronium
B. Succinylcholine
C. Pancuronium
D. Mivacurium
Answer: D. Mivacurium
Rationale: Mivacurium is a benzylisoquinoline compound, as are atracurium and
cisatracurium. These agents are characterized by organ-independent metabolism.
Vecuronium and pancuronium are aminosteroids.
Question 5
When providing positive pressure ventilation via a bag-valve-mask device, inspiratory
pressure should be limited to what level?
, A. 15 cm H₂O
B. 25 cm H₂O
C. 40 cm H₂O
D. 50 cm H₂O
Answer: B. 25 cm H₂O
Rationale: Inspiratory pressure should generally be limited to 20-25 cm H₂O during
bag-mask ventilation to minimize the risk of gastric insufflation, which can lead to
regurgitation and aspiration. Higher pressures force air into the stomach rather than the
lungs.
Question 6
What is the first sign of magnesium toxicity when used for seizure prophylaxis in
preeclampsia?
A. Respiratory depression
B. Hypotension
C. Cardiac conduction defects
D. Loss of deep tendon reflexes
Answer: D. Loss of deep tendon reflexes
Certification and Recertification for Nurse
Anesthetists – 2026/2027 Edition – Questions and
Answers for CRNA Candidates and Professionals
Question 1
In the elderly, the time needed for clinical recovery from neuromuscular blockade is
significantly increased for which agent?
A. Cisatracurium
B. Vecuronium
C. Pipecuronium
D. Mivacurium
Answer: B. Vecuronium
Rationale: Vecuronium's recovery time is prolonged in elderly patients due to age-
related changes in hepatic clearance and increased volume of distribution. In contrast,
cisatracurium and atracurium undergo Hofmann elimination (organ-independent),
making them more predictable in this population.
,Question 2
Considerations for the management of a patient with myotonic dystrophy under general
anesthesia should include which of the following?
A. Anticholinesterase reversal
B. Midazolam premedication
C. Short-acting nondepolarizer
D. Succinylcholine infusion
Answer: C. Short-acting nondepolarizer
Rationale: Myotonic dystrophy patients are at risk for prolonged responses to muscle
relaxants and myotonic reactions to succinylcholine. Short-acting nondepolarizing
agents are preferred, and anticholinesterases should be avoided due to risk of
precipitating myotonia.
Question 3
Which drug would have a normal pharmacokinetic profile in a patient with severe liver
disease?
A. Pancuronium
B. Succinylcholine
C. Mivacurium
D. Atracurium
,Answer: D. Atracurium
Rationale: Atracurium undergoes Hofmann elimination (spontaneous degradation in
plasma) and ester hydrolysis, which are organ-independent. Therefore, its
pharmacokinetics remain relatively normal in patients with severe hepatic dysfunction,
unlike pancuronium, vecuronium, and rocuronium which rely on hepatic clearance.
Question 4
Which neuromuscular blocking agent is a benzylisoquinoline compound?
A. Vecuronium
B. Succinylcholine
C. Pancuronium
D. Mivacurium
Answer: D. Mivacurium
Rationale: Mivacurium is a benzylisoquinoline compound, as are atracurium and
cisatracurium. These agents are characterized by organ-independent metabolism.
Vecuronium and pancuronium are aminosteroids.
Question 5
When providing positive pressure ventilation via a bag-valve-mask device, inspiratory
pressure should be limited to what level?
, A. 15 cm H₂O
B. 25 cm H₂O
C. 40 cm H₂O
D. 50 cm H₂O
Answer: B. 25 cm H₂O
Rationale: Inspiratory pressure should generally be limited to 20-25 cm H₂O during
bag-mask ventilation to minimize the risk of gastric insufflation, which can lead to
regurgitation and aspiration. Higher pressures force air into the stomach rather than the
lungs.
Question 6
What is the first sign of magnesium toxicity when used for seizure prophylaxis in
preeclampsia?
A. Respiratory depression
B. Hypotension
C. Cardiac conduction defects
D. Loss of deep tendon reflexes
Answer: D. Loss of deep tendon reflexes
