CRNA BOARD COMPREHENSIVE EXAM
QUESTIONS AND CORRECT ANSWERS
Positive end expiratory pressure (PEEP):
1. decreases dead space
2.increases venous return to the heart
3. decreases intrapulmonary shunting
4. decreases extravascular lung water -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:
1. mannitol 2. magnesium 3. potassium 4. corticosteroid -
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.
Forms of mechanical ventilation that produce tidal volumes at or below anatomic dead
space include: (Select 2)
1. high-frequency oscillation
2. inverse I:E ratio ventilation
3. airway pressure release ventilation
4. differential lung ventilation
5. high-frequency positive-pressure ventilation
6. pressure support ventilation -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 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.
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.) -
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.
Changes found in banked blood include: (Select 2)
1. increased levels of 2,3-DPG
2. a left shift of the hemoglobin dissociation curve
3. decreased levels of potassium
4. formation of microaggregates
5. alkalosis secondary to the presence of citrate
6. increased intracellular ATP stores
7. thrombocytosis -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)
Hemolysis
Accumulation of proinflammatory products
Pulmonary changes associated with Duchenne's muscular dystrophy include:
1. a restrictive ventilatory defect
2. an obstructive ventilatory defect 3. decreased pulmonary artery pressures 4. increased
residual volume -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.
Key elements in the AANA's definition of wellness include: (Select 3)
1. effective adaptation 2. resilience 3. professionalism 4. competence 5. coping
mechanisms 6. compassion 7. fortitude 8. perseverance -
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.
An increase in intraocular pressure has been associated with: (select 3)
,1. nitrous oxide administration 2. succinylcholine administration 3. opioid
administration 4. hyperventilation 5. laryngoscopy 6. hypoxemia 7. sevoflurane
administration -ANS__________________________ An increase in intraocular
pressure has been associated: succinylcholine administration, hypoxemia, laryngoscopy
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.
In the pressure-volume loop below, cardiac work is best represented by:
1. 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 -
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.
According to the Modified Glasgow Coma Scale, a moderate head injury is associated
with a score of:
13 - 15
9 - 12
6-9
less than 6 -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.
The addition of bicarbonate to a local anesthetic solution:
1. delays the onset of blockade
2. increases the concentration of the nonionic form of the local anesthetic
3. causes a fall in the pH of the solution
4. should only be done when using bupivacaine -
ANS__________________________ The addition of bicarbonate to a local
anesthetic solution: increases the concentration of the nonionic form of the local
anesthetic
The onset of neural blockade depends on the penetration of the nerve cell membrane by
the nonionic form of the anesthetic. Increasing the pH of the anesthetic solution
increases the concentration of the nonionic form and thereby hastens the onset of the
, block. Bicarbonate is usually not added to bupivacaine, since it can cause precipitation if
the pH is raised above 6.8.
Factors increasing the affinity of hemoglobin for oxygen include: (Select 2)
1. increased carbon dioxide levels 2. increased 2,3-DPG levels 3. increased pH 4. the
presence of fetal hemoglobin 5. increased body temperature 6. the presence of
hemoglobin-S -ANS__________________________ Factors increasing the affinity
of hemoglobin for oxygen include: increased pH, presence of fetal hemoglobin
Factors that increase the affinity of hemoglobin for oxygen would cause a leftward shift
of the hemoglobin dissociation curve and a decrease in the P50. These factors include
alkalosis, decreased CO2 levels, and decreased 2,3-DPG levels. Hemoglobin-S, found in
patients with sickle cell disease, has a decreased affinity for oxygen. Fetal hemoglobin,
however, has an increased affinity for oxygen to help in oxygen transfer from the mother
to the fetus.
In the figure below, inspiratory capacity is best represented by:
1. A
2. A + tidal volume
3. B
4. B + tidal volume -ANS__________________________ In the figure below,
inspiratory capacity is best represented by: A + tidal volume
Inspiratory capacity is the sum of the inspiratory reserve volume (A) and the tidal
volume. B represents the expiratory reserve volume, C represents the FRC, D represents
the residual volume, E represents the vital capacity and F represents the total lung
volume.
Laminar flow in the airway occurs in the: (Select 2)
1. trachea main stem bronchi
2. terminal bronchiole
3. 3rd generation bronchus
4. respiratory bronchiole -ANS__________________________ Laminar flow in
the airway occurs mostly in the: terminal bronchiole, respiratory bronchiole
Flow in the larger airways is mostly turbulent. Laminar flow normally occurs only distal
to small bronchioles (< 1mm). The Reynolds number is used to predict the type of
airway flow; a low Reynolds number (< 1000) is associated with laminar flow, whereas a
high value (> 1500) is associated with turbulent flow.
Sickle hemoglobin: (Select 2)
1. has a lower P50 than hemoglobin A
2. releases oxygen less readily than hemoglobin A
3. is present in about 30% of African Americans
4. readily polymerizes and precipitates in the red cell
5. results from a single amino acid substitution on the α-chain
QUESTIONS AND CORRECT ANSWERS
Positive end expiratory pressure (PEEP):
1. decreases dead space
2.increases venous return to the heart
3. decreases intrapulmonary shunting
4. decreases extravascular lung water -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:
1. mannitol 2. magnesium 3. potassium 4. corticosteroid -
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.
Forms of mechanical ventilation that produce tidal volumes at or below anatomic dead
space include: (Select 2)
1. high-frequency oscillation
2. inverse I:E ratio ventilation
3. airway pressure release ventilation
4. differential lung ventilation
5. high-frequency positive-pressure ventilation
6. pressure support ventilation -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 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.
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.) -
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.
Changes found in banked blood include: (Select 2)
1. increased levels of 2,3-DPG
2. a left shift of the hemoglobin dissociation curve
3. decreased levels of potassium
4. formation of microaggregates
5. alkalosis secondary to the presence of citrate
6. increased intracellular ATP stores
7. thrombocytosis -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)
Hemolysis
Accumulation of proinflammatory products
Pulmonary changes associated with Duchenne's muscular dystrophy include:
1. a restrictive ventilatory defect
2. an obstructive ventilatory defect 3. decreased pulmonary artery pressures 4. increased
residual volume -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.
Key elements in the AANA's definition of wellness include: (Select 3)
1. effective adaptation 2. resilience 3. professionalism 4. competence 5. coping
mechanisms 6. compassion 7. fortitude 8. perseverance -
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.
An increase in intraocular pressure has been associated with: (select 3)
,1. nitrous oxide administration 2. succinylcholine administration 3. opioid
administration 4. hyperventilation 5. laryngoscopy 6. hypoxemia 7. sevoflurane
administration -ANS__________________________ An increase in intraocular
pressure has been associated: succinylcholine administration, hypoxemia, laryngoscopy
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.
In the pressure-volume loop below, cardiac work is best represented by:
1. 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 -
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.
According to the Modified Glasgow Coma Scale, a moderate head injury is associated
with a score of:
13 - 15
9 - 12
6-9
less than 6 -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.
The addition of bicarbonate to a local anesthetic solution:
1. delays the onset of blockade
2. increases the concentration of the nonionic form of the local anesthetic
3. causes a fall in the pH of the solution
4. should only be done when using bupivacaine -
ANS__________________________ The addition of bicarbonate to a local
anesthetic solution: increases the concentration of the nonionic form of the local
anesthetic
The onset of neural blockade depends on the penetration of the nerve cell membrane by
the nonionic form of the anesthetic. Increasing the pH of the anesthetic solution
increases the concentration of the nonionic form and thereby hastens the onset of the
, block. Bicarbonate is usually not added to bupivacaine, since it can cause precipitation if
the pH is raised above 6.8.
Factors increasing the affinity of hemoglobin for oxygen include: (Select 2)
1. increased carbon dioxide levels 2. increased 2,3-DPG levels 3. increased pH 4. the
presence of fetal hemoglobin 5. increased body temperature 6. the presence of
hemoglobin-S -ANS__________________________ Factors increasing the affinity
of hemoglobin for oxygen include: increased pH, presence of fetal hemoglobin
Factors that increase the affinity of hemoglobin for oxygen would cause a leftward shift
of the hemoglobin dissociation curve and a decrease in the P50. These factors include
alkalosis, decreased CO2 levels, and decreased 2,3-DPG levels. Hemoglobin-S, found in
patients with sickle cell disease, has a decreased affinity for oxygen. Fetal hemoglobin,
however, has an increased affinity for oxygen to help in oxygen transfer from the mother
to the fetus.
In the figure below, inspiratory capacity is best represented by:
1. A
2. A + tidal volume
3. B
4. B + tidal volume -ANS__________________________ In the figure below,
inspiratory capacity is best represented by: A + tidal volume
Inspiratory capacity is the sum of the inspiratory reserve volume (A) and the tidal
volume. B represents the expiratory reserve volume, C represents the FRC, D represents
the residual volume, E represents the vital capacity and F represents the total lung
volume.
Laminar flow in the airway occurs in the: (Select 2)
1. trachea main stem bronchi
2. terminal bronchiole
3. 3rd generation bronchus
4. respiratory bronchiole -ANS__________________________ Laminar flow in
the airway occurs mostly in the: terminal bronchiole, respiratory bronchiole
Flow in the larger airways is mostly turbulent. Laminar flow normally occurs only distal
to small bronchioles (< 1mm). The Reynolds number is used to predict the type of
airway flow; a low Reynolds number (< 1000) is associated with laminar flow, whereas a
high value (> 1500) is associated with turbulent flow.
Sickle hemoglobin: (Select 2)
1. has a lower P50 than hemoglobin A
2. releases oxygen less readily than hemoglobin A
3. is present in about 30% of African Americans
4. readily polymerizes and precipitates in the red cell
5. results from a single amino acid substitution on the α-chain
