CRNA Practice Questions with Answers &
Rationales WITH ANATOMY, PHYSIOLOGY, AND
PATHOPHYSIOLOGY COVERED ALREADY
GRADED A+
The following questions are designed to reflect the depth and breadth of the NBCRNA NCE.
These questions test application-level knowledge—the ability to apply facts to clinical
scenarios—which is the focus of the actual certification exam.
DOMAIN 1:
1. A patient with severe mitral stenosis is scheduled for a non-cardiac surgery. Which
hemodynamic parameter is most important to monitor during induction of anesthesia?
A. Heart rate
B. Systemic vascular resistance (SVR)
C. Pulmonary artery wedge pressure (PAWP)
D. Central venous pressure (CVP)
Answer: A
Rationale: In mitral stenosis, left ventricular filling is dependent on adequate diastolic filling
time. Tachycardia reduces diastolic filling time, decreases left ventricular preload, and can
precipitate pulmonary edema. Maintaining a normal or slightly slow heart rate is critical. While
SVR (B), PAWP (C), and CVP (D) are important, heart rate is the most critical parameter to
control in mitral stenosis.
2. A patient with a history of COPD is undergoing general anesthesia. Which ventilator setting
is most appropriate to prevent dynamic hyperinflation (auto-PEEP)?
A. High respiratory rate with low tidal volume
B. Low respiratory rate with adequate expiratory time
1
, C. High inspiratory flow rate with short inspiratory time
D. Low tidal volume with high PEEP
Answer: B
Rationale: Patients with COPD have prolonged expiratory time constants due to airway
obstruction. To prevent dynamic hyperinflation (auto-PEEP), the ventilator should be set with
a low respiratory rate and adequate expiratory time to allow complete exhalation. High
respiratory rates (A) shorten expiratory time and worsen air trapping.
3. A patient with chronic heart failure (HFrEF) is undergoing surgery. Which intravenous
induction agent is MOST contraindicated due to its negative inotropic effects?
A. Etomidate
B. Ketamine
C. Propofol
D. Thiopental
Answer: D
Rationale: Thiopental is a barbiturate with significant negative inotropic and vasodilatory
effects, which can cause severe hypotension in patients with heart failure. Etomidate (A) is the
preferred agent in heart failure due to its hemodynamic stability. Ketamine (B) has
sympathomimetic effects. Propofol (C) has negative inotropic effects but is less pronounced
than thiopental.
4. A patient with a history of malignant hyperthermia (MH) is scheduled for surgery. Which of
the following is the safest anesthetic plan?
A. Use of sevoflurane and succinylcholine
B. Use of propofol and nondepolarizing muscle relaxants
C. Use of halothane and succinylcholine
D. Use of ketamine and desflurane
Answer: B
Rationale: Malignant hyperthermia is triggered by volatile anesthetics (sevoflurane, halothane,
desflurane) and succinylcholine. The safest plan for an MH-susceptible patient is a total
intravenous anesthesia (TIVA) technique using propofol and nondepolarizing muscle relaxants.
Option A, C, and D all use volatile anesthetics or succinylcholine.
2
, 5. A patient with liver cirrhosis is undergoing surgery. Which of the following is a concern
regarding neuromuscular blockade in this patient?
A. Prolonged duration of action of succinylcholine
B. Prolonged duration of action of rocuronium
C. Increased sensitivity to neostigmine
D. Decreased sensitivity to atracurium
Answer: B
Rationale: Rocuronium (and other nondepolarizing muscle relaxants) are primarily metabolized
by the liver. In cirrhosis, hepatic clearance is reduced, leading to prolonged duration of action.
Succinylcholine (A) is metabolized by plasma cholinesterase, which may be decreased in liver
disease but is less predictable. Atracurium (D) is degraded by Hofmann elimination and is a
preferred agent in liver disease.
6. A patient with renal failure is undergoing surgery. Which of the following is a concern
regarding the use of ketamine?
A. Prolonged emergence
B. Hypertension and tachycardia
C. Nephrotoxicity
D. Prolonged neuromuscular blockade
Answer: B
Rationale: Ketamine increases heart rate and blood pressure due to sympathomimetic effects.
In patients with renal failure who may already have hypertension, this can be problematic.
Ketamine does not cause nephrotoxicity (C) and does not significantly prolong emergence (A) or
neuromuscular blockade (D).
7. A patient with a pheochromocytoma is undergoing resection. Which of the following is the
MOST important preoperative intervention?
A. Initiation of beta-blockers alone
B. Initiation of alpha-blockers (e.g., phenoxybenzamine)
C. Initiation of calcium channel blockers
D. Initiation of ACE inhibitors
Answer: B
Rationale: Preoperative management of pheochromocytoma requires alpha-blockade to
3
, prevent life-threatening hypertensive crises during tumor manipulation. Beta-blockers (A)
should not be given without prior alpha-blockade, as unopposed beta-blockade can cause
hypertensive crisis. Calcium channel blockers (C) and ACE inhibitors (D) are not the primary
treatment.
8. A patient with a history of myasthenia gravis is undergoing surgery. Which of the following
is a concern regarding neuromuscular blockade?
A. Resistance to nondepolarizing muscle relaxants
B. Prolonged duration of action of nondepolarizing muscle relaxants
C. Resistance to succinylcholine
D. Prolonged duration of action of succinylcholine
Answer: B
Rationale: Patients with myasthenia gravis have decreased numbers of acetylcholine receptors
and are highly sensitive to nondepolarizing muscle relaxants, resulting in prolonged duration of
action. They are relatively resistant to succinylcholine (C) due to increased plasma
cholinesterase activity or receptor changes. Option A is incorrect; they are sensitive, not
resistant.
9. A patient with a history of asthma is undergoing surgery. Which of the following is the
preferred intravenous induction agent to minimize bronchospasm?
A. Thiopental
B. Propofol
C. Ketamine
D. Etomidate
Answer: C
Rationale: Ketamine is the preferred induction agent in patients with reactive airway disease
because it has bronchodilatory properties. Propofol (B) can be used but may cause some
bronchospasm. Thiopental (A) and etomidate (D) do not have bronchodilatory effects and may
trigger bronchospasm.
10. A patient with a history of coronary artery disease is undergoing surgery. Which of the
following is the MOST important goal during induction?
4
Rationales WITH ANATOMY, PHYSIOLOGY, AND
PATHOPHYSIOLOGY COVERED ALREADY
GRADED A+
The following questions are designed to reflect the depth and breadth of the NBCRNA NCE.
These questions test application-level knowledge—the ability to apply facts to clinical
scenarios—which is the focus of the actual certification exam.
DOMAIN 1:
1. A patient with severe mitral stenosis is scheduled for a non-cardiac surgery. Which
hemodynamic parameter is most important to monitor during induction of anesthesia?
A. Heart rate
B. Systemic vascular resistance (SVR)
C. Pulmonary artery wedge pressure (PAWP)
D. Central venous pressure (CVP)
Answer: A
Rationale: In mitral stenosis, left ventricular filling is dependent on adequate diastolic filling
time. Tachycardia reduces diastolic filling time, decreases left ventricular preload, and can
precipitate pulmonary edema. Maintaining a normal or slightly slow heart rate is critical. While
SVR (B), PAWP (C), and CVP (D) are important, heart rate is the most critical parameter to
control in mitral stenosis.
2. A patient with a history of COPD is undergoing general anesthesia. Which ventilator setting
is most appropriate to prevent dynamic hyperinflation (auto-PEEP)?
A. High respiratory rate with low tidal volume
B. Low respiratory rate with adequate expiratory time
1
, C. High inspiratory flow rate with short inspiratory time
D. Low tidal volume with high PEEP
Answer: B
Rationale: Patients with COPD have prolonged expiratory time constants due to airway
obstruction. To prevent dynamic hyperinflation (auto-PEEP), the ventilator should be set with
a low respiratory rate and adequate expiratory time to allow complete exhalation. High
respiratory rates (A) shorten expiratory time and worsen air trapping.
3. A patient with chronic heart failure (HFrEF) is undergoing surgery. Which intravenous
induction agent is MOST contraindicated due to its negative inotropic effects?
A. Etomidate
B. Ketamine
C. Propofol
D. Thiopental
Answer: D
Rationale: Thiopental is a barbiturate with significant negative inotropic and vasodilatory
effects, which can cause severe hypotension in patients with heart failure. Etomidate (A) is the
preferred agent in heart failure due to its hemodynamic stability. Ketamine (B) has
sympathomimetic effects. Propofol (C) has negative inotropic effects but is less pronounced
than thiopental.
4. A patient with a history of malignant hyperthermia (MH) is scheduled for surgery. Which of
the following is the safest anesthetic plan?
A. Use of sevoflurane and succinylcholine
B. Use of propofol and nondepolarizing muscle relaxants
C. Use of halothane and succinylcholine
D. Use of ketamine and desflurane
Answer: B
Rationale: Malignant hyperthermia is triggered by volatile anesthetics (sevoflurane, halothane,
desflurane) and succinylcholine. The safest plan for an MH-susceptible patient is a total
intravenous anesthesia (TIVA) technique using propofol and nondepolarizing muscle relaxants.
Option A, C, and D all use volatile anesthetics or succinylcholine.
2
, 5. A patient with liver cirrhosis is undergoing surgery. Which of the following is a concern
regarding neuromuscular blockade in this patient?
A. Prolonged duration of action of succinylcholine
B. Prolonged duration of action of rocuronium
C. Increased sensitivity to neostigmine
D. Decreased sensitivity to atracurium
Answer: B
Rationale: Rocuronium (and other nondepolarizing muscle relaxants) are primarily metabolized
by the liver. In cirrhosis, hepatic clearance is reduced, leading to prolonged duration of action.
Succinylcholine (A) is metabolized by plasma cholinesterase, which may be decreased in liver
disease but is less predictable. Atracurium (D) is degraded by Hofmann elimination and is a
preferred agent in liver disease.
6. A patient with renal failure is undergoing surgery. Which of the following is a concern
regarding the use of ketamine?
A. Prolonged emergence
B. Hypertension and tachycardia
C. Nephrotoxicity
D. Prolonged neuromuscular blockade
Answer: B
Rationale: Ketamine increases heart rate and blood pressure due to sympathomimetic effects.
In patients with renal failure who may already have hypertension, this can be problematic.
Ketamine does not cause nephrotoxicity (C) and does not significantly prolong emergence (A) or
neuromuscular blockade (D).
7. A patient with a pheochromocytoma is undergoing resection. Which of the following is the
MOST important preoperative intervention?
A. Initiation of beta-blockers alone
B. Initiation of alpha-blockers (e.g., phenoxybenzamine)
C. Initiation of calcium channel blockers
D. Initiation of ACE inhibitors
Answer: B
Rationale: Preoperative management of pheochromocytoma requires alpha-blockade to
3
, prevent life-threatening hypertensive crises during tumor manipulation. Beta-blockers (A)
should not be given without prior alpha-blockade, as unopposed beta-blockade can cause
hypertensive crisis. Calcium channel blockers (C) and ACE inhibitors (D) are not the primary
treatment.
8. A patient with a history of myasthenia gravis is undergoing surgery. Which of the following
is a concern regarding neuromuscular blockade?
A. Resistance to nondepolarizing muscle relaxants
B. Prolonged duration of action of nondepolarizing muscle relaxants
C. Resistance to succinylcholine
D. Prolonged duration of action of succinylcholine
Answer: B
Rationale: Patients with myasthenia gravis have decreased numbers of acetylcholine receptors
and are highly sensitive to nondepolarizing muscle relaxants, resulting in prolonged duration of
action. They are relatively resistant to succinylcholine (C) due to increased plasma
cholinesterase activity or receptor changes. Option A is incorrect; they are sensitive, not
resistant.
9. A patient with a history of asthma is undergoing surgery. Which of the following is the
preferred intravenous induction agent to minimize bronchospasm?
A. Thiopental
B. Propofol
C. Ketamine
D. Etomidate
Answer: C
Rationale: Ketamine is the preferred induction agent in patients with reactive airway disease
because it has bronchodilatory properties. Propofol (B) can be used but may cause some
bronchospasm. Thiopental (A) and etomidate (D) do not have bronchodilatory effects and may
trigger bronchospasm.
10. A patient with a history of coronary artery disease is undergoing surgery. Which of the
following is the MOST important goal during induction?
4
