NBCRNA EXAM AND STUDY GUIDE LATEST 2026/2027 TEST
BANK COMPLETE REAL EXAM QUESTIONS AND CORRECT
DETAILED ANSWERS (VERIFIED ANSWERS WITH
RATIONALES) GRADED A+ |NBCRNA EXAM PREP (LATEST
UPDATE!!)
1. What is the most reliable indicator of proper endotracheal tube
placement?
A) Bilateral breath sounds
B) Chest rise and fall
C) End-tidal CO₂ detection (capnography)
D) Oxygen saturation
Answer C: End-tidal CO₂ detection
Rationale: Capnography provides immediate confirmation of tracheal placement
and is considered the gold standard. Breath sounds and chest rise can be falsely
reassuring in esophageal intubation .
2. During a laparoscopic cholecystectomy, end-tidal CO₂ rises to 55 mmHg
despite unchanged minute ventilation. Which physiologic change most likely
explains this?
A) Decreased cardiac output with increased dead space ventilation
B) Increased metabolic rate due to surgical stress response
C) Absorption of CO₂ from the peritoneal cavity
,D) Bronchospasm causing ventilation-perfusion mismatch
Answer C: Absorption of CO₂ from the peritoneal cavity
Rationale: Insufflation of CO₂ during laparoscopy leads to transperitoneal
absorption, increasing ETCO₂. This requires adjustments in minute ventilation .
3. The Mallampati classification is used to predict:
A) Difficult mask ventilation
B) Difficult intubation
C) Aspiration risk
D) Hemodynamic response to laryngoscopy
Answer B: Difficult intubation
Rationale: Mallampati classification assesses visibility of the base of the tongue,
soft palate, uvula, and tonsillar pillars. Class III or IV predicts difficult intubation .
4. What is the most common cause of upper airway obstruction in an
unconscious patient?
A) Laryngospasm
B) Foreign body
C) Tongue obstruction
D) Bronchospasm
Answer C: Tongue obstruction
Rationale: In an unconscious patient, the tongue falls back against the posterior
pharyngeal wall. This is managed with a jaw thrust, chin lift, or airway device .
,5. Which neuromuscular blocking agent is most appropriate for a patient
with end-stage renal disease (ESRD)?
A) Atracurium
B) Rocuronium
C) Vecuronium
D) Pancuronium
Answer A: Atracurium
Rationale: Atracurium undergoes Hofmann elimination and ester hydrolysis,
independent of renal function. Rocuronium, vecuronium, and pancuronium rely on
renal excretion .
6. Which of the following is the most reliable indicator of adequate
preoxygenation in a healthy adult?
A) End-tidal oxygen concentration > 90%
B) Oxygen saturation measured by pulse oximetry of 100%
C) End-tidal nitrogen concentration < 5%
D) Arterial partial pressure of oxygen > 400 mmHg
Answer C: End-tidal nitrogen concentration < 5%
Rationale: Preoxygenation aims to denitrogenate the functional residual capacity.
End-tidal nitrogen < 5% confirms adequate denitrogenation .
, 7. Which of the following intravenous induction agents is most likely to cause
a significant decrease in systemic vascular resistance?
A) Etomidate
B) Ketamine
C) Propofol
D) Thiopental
Answer C: Propofol
Rationale: Propofol causes dose-dependent hypotension primarily through
decreased systemic vascular resistance and some myocardial depression.
8. A patient undergoing craniotomy for tumor resection develops sudden
hypotension, increased end-tidal CO₂, and decreased oxygen saturation. The
most likely cause is:
A) Venous air embolism (VAE)
B) Pulmonary embolism
C) Myocardial ischemia
D) Anaphylactic reaction
Answer A: Venous air embolism (VAE)
Rationale: VAE is a risk during craniotomy in sitting or semi-sitting position.
Classic signs include hypotension, increased ETCO₂ initially, then decreased ETCO₂,
and hypoxia .
BANK COMPLETE REAL EXAM QUESTIONS AND CORRECT
DETAILED ANSWERS (VERIFIED ANSWERS WITH
RATIONALES) GRADED A+ |NBCRNA EXAM PREP (LATEST
UPDATE!!)
1. What is the most reliable indicator of proper endotracheal tube
placement?
A) Bilateral breath sounds
B) Chest rise and fall
C) End-tidal CO₂ detection (capnography)
D) Oxygen saturation
Answer C: End-tidal CO₂ detection
Rationale: Capnography provides immediate confirmation of tracheal placement
and is considered the gold standard. Breath sounds and chest rise can be falsely
reassuring in esophageal intubation .
2. During a laparoscopic cholecystectomy, end-tidal CO₂ rises to 55 mmHg
despite unchanged minute ventilation. Which physiologic change most likely
explains this?
A) Decreased cardiac output with increased dead space ventilation
B) Increased metabolic rate due to surgical stress response
C) Absorption of CO₂ from the peritoneal cavity
,D) Bronchospasm causing ventilation-perfusion mismatch
Answer C: Absorption of CO₂ from the peritoneal cavity
Rationale: Insufflation of CO₂ during laparoscopy leads to transperitoneal
absorption, increasing ETCO₂. This requires adjustments in minute ventilation .
3. The Mallampati classification is used to predict:
A) Difficult mask ventilation
B) Difficult intubation
C) Aspiration risk
D) Hemodynamic response to laryngoscopy
Answer B: Difficult intubation
Rationale: Mallampati classification assesses visibility of the base of the tongue,
soft palate, uvula, and tonsillar pillars. Class III or IV predicts difficult intubation .
4. What is the most common cause of upper airway obstruction in an
unconscious patient?
A) Laryngospasm
B) Foreign body
C) Tongue obstruction
D) Bronchospasm
Answer C: Tongue obstruction
Rationale: In an unconscious patient, the tongue falls back against the posterior
pharyngeal wall. This is managed with a jaw thrust, chin lift, or airway device .
,5. Which neuromuscular blocking agent is most appropriate for a patient
with end-stage renal disease (ESRD)?
A) Atracurium
B) Rocuronium
C) Vecuronium
D) Pancuronium
Answer A: Atracurium
Rationale: Atracurium undergoes Hofmann elimination and ester hydrolysis,
independent of renal function. Rocuronium, vecuronium, and pancuronium rely on
renal excretion .
6. Which of the following is the most reliable indicator of adequate
preoxygenation in a healthy adult?
A) End-tidal oxygen concentration > 90%
B) Oxygen saturation measured by pulse oximetry of 100%
C) End-tidal nitrogen concentration < 5%
D) Arterial partial pressure of oxygen > 400 mmHg
Answer C: End-tidal nitrogen concentration < 5%
Rationale: Preoxygenation aims to denitrogenate the functional residual capacity.
End-tidal nitrogen < 5% confirms adequate denitrogenation .
, 7. Which of the following intravenous induction agents is most likely to cause
a significant decrease in systemic vascular resistance?
A) Etomidate
B) Ketamine
C) Propofol
D) Thiopental
Answer C: Propofol
Rationale: Propofol causes dose-dependent hypotension primarily through
decreased systemic vascular resistance and some myocardial depression.
8. A patient undergoing craniotomy for tumor resection develops sudden
hypotension, increased end-tidal CO₂, and decreased oxygen saturation. The
most likely cause is:
A) Venous air embolism (VAE)
B) Pulmonary embolism
C) Myocardial ischemia
D) Anaphylactic reaction
Answer A: Venous air embolism (VAE)
Rationale: VAE is a risk during craniotomy in sitting or semi-sitting position.
Classic signs include hypotension, increased ETCO₂ initially, then decreased ETCO₂,
and hypoxia .
