NBCRNA NATIONAL CERTIFICATION EXAMINATION (NCE)
COMPLETE PRACTICE EXAM 200 QUESTIONS WITH VERIFIED
ANSWERS & RATIONALES LATEST UPDATE | COMPREHENSIVE
EXAM PREPARATION
EXAM STRUCTURE:
Domain 1: Airway Management ............................. 68 Questions (34%)
Domain 2: Applied Clinical Pharmacology ................. 48 Questions (24%)
Domain 3: Applied Physiology & Pathophysiology .......... 48 Questions (24%)
Domain 4: Anesthesia Equipment, Technology & Safety ..... 36 Questions (18%)
DOMAIN 1: AIRWAY MANAGEMENT (Questions 1-68)
Question 1:
A 45-year-old patient with a BMI of 38 is scheduled for elective surgery.
Which airway assessment finding is MOST concerning for difficult intubation?
A) Mallampati Class I
B) Thyromental distance > 6 cm
C) Neck circumference > 40 cm
D) Interincisor distance > 4 cm
Answer: C
Rationale: A neck circumference > 40 cm (or > 17 inches) is a strong predictor
of difficult intubation, especially in obese patients. Mallampati Class I is
the least concerning (Class III/IV are concerning). Thyromental distance
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,< 6 cm (not > 6 cm) is concerning. Interincisor distance < 3 cm is concerning.
Question 2:
What is the MOST appropriate initial management for a patient with a known
difficult airway who requires general anesthesia?
A) Proceed with rapid sequence induction and direct laryngoscopy
B) Awake fiberoptic intubation
C) Blind nasal intubation
D) Laryngeal mask airway placement
Answer: B
Rationale: In a patient with a known difficult airway, an awake fiberoptic
intubation is the gold standard approach. It allows maintenance of spontaneous
ventilation and airway reflexes while securing the airway under direct
visualization.
Question 3:
Which of the following is a characteristic of the Mallampati airway classification?
A) Based on the visibility of the uvula, faucial pillars, and soft palate
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,B) Based on the distance between the hyoid bone and thyroid cartilage
C) Based on the range of cervical spine motion
D) Based on the size of the mandible
Answer: A
Rationale: The Mallampati classification is based on the visibility of the
uvula, faucial pillars, and soft palate when the patient opens their mouth
and protrudes their tongue. Class I = full visibility; Class IV = only hard
palate visible.
Question 4:
A patient undergoing emergency surgery develops oxygen desaturation to 85%
during induction. The anesthesia provider cannot ventilate or intubate.
What is the NEXT step?
A) Attempt a second intubation with a different blade
B) Insert a laryngeal mask airway (LMA)
C) Perform a surgical cricothyroidotomy
D) Administer 100% oxygen via face mask
Answer: C
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, Rationale: In a "cannot ventilate, cannot intubate" (CVCI) emergency, the
next step is to secure the airway surgically. A surgical cricothyroidotomy
(or needle cricothyroidotomy) is the definitive rescue maneuver when
mask ventilation and intubation have failed.
Question 5:
Which nerve provides sensory innervation to the larynx above the vocal cords?
A) Recurrent laryngeal nerve
B) Superior laryngeal nerve (internal branch)
C) Glossopharyngeal nerve
D) Hypoglossal nerve
Answer: B
Rationale: The internal branch of the superior laryngeal nerve provides
sensory innervation to the larynx above the vocal cords. The recurrent
laryngeal nerve provides sensory innervation below the vocal cords and
motor innervation to all intrinsic laryngeal muscles except the cricothyroid.
Question 6:
Which nerve provides motor innervation to the cricothyroid muscle?
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COMPLETE PRACTICE EXAM 200 QUESTIONS WITH VERIFIED
ANSWERS & RATIONALES LATEST UPDATE | COMPREHENSIVE
EXAM PREPARATION
EXAM STRUCTURE:
Domain 1: Airway Management ............................. 68 Questions (34%)
Domain 2: Applied Clinical Pharmacology ................. 48 Questions (24%)
Domain 3: Applied Physiology & Pathophysiology .......... 48 Questions (24%)
Domain 4: Anesthesia Equipment, Technology & Safety ..... 36 Questions (18%)
DOMAIN 1: AIRWAY MANAGEMENT (Questions 1-68)
Question 1:
A 45-year-old patient with a BMI of 38 is scheduled for elective surgery.
Which airway assessment finding is MOST concerning for difficult intubation?
A) Mallampati Class I
B) Thyromental distance > 6 cm
C) Neck circumference > 40 cm
D) Interincisor distance > 4 cm
Answer: C
Rationale: A neck circumference > 40 cm (or > 17 inches) is a strong predictor
of difficult intubation, especially in obese patients. Mallampati Class I is
the least concerning (Class III/IV are concerning). Thyromental distance
1|Page
,< 6 cm (not > 6 cm) is concerning. Interincisor distance < 3 cm is concerning.
Question 2:
What is the MOST appropriate initial management for a patient with a known
difficult airway who requires general anesthesia?
A) Proceed with rapid sequence induction and direct laryngoscopy
B) Awake fiberoptic intubation
C) Blind nasal intubation
D) Laryngeal mask airway placement
Answer: B
Rationale: In a patient with a known difficult airway, an awake fiberoptic
intubation is the gold standard approach. It allows maintenance of spontaneous
ventilation and airway reflexes while securing the airway under direct
visualization.
Question 3:
Which of the following is a characteristic of the Mallampati airway classification?
A) Based on the visibility of the uvula, faucial pillars, and soft palate
2|Page
,B) Based on the distance between the hyoid bone and thyroid cartilage
C) Based on the range of cervical spine motion
D) Based on the size of the mandible
Answer: A
Rationale: The Mallampati classification is based on the visibility of the
uvula, faucial pillars, and soft palate when the patient opens their mouth
and protrudes their tongue. Class I = full visibility; Class IV = only hard
palate visible.
Question 4:
A patient undergoing emergency surgery develops oxygen desaturation to 85%
during induction. The anesthesia provider cannot ventilate or intubate.
What is the NEXT step?
A) Attempt a second intubation with a different blade
B) Insert a laryngeal mask airway (LMA)
C) Perform a surgical cricothyroidotomy
D) Administer 100% oxygen via face mask
Answer: C
3|Page
, Rationale: In a "cannot ventilate, cannot intubate" (CVCI) emergency, the
next step is to secure the airway surgically. A surgical cricothyroidotomy
(or needle cricothyroidotomy) is the definitive rescue maneuver when
mask ventilation and intubation have failed.
Question 5:
Which nerve provides sensory innervation to the larynx above the vocal cords?
A) Recurrent laryngeal nerve
B) Superior laryngeal nerve (internal branch)
C) Glossopharyngeal nerve
D) Hypoglossal nerve
Answer: B
Rationale: The internal branch of the superior laryngeal nerve provides
sensory innervation to the larynx above the vocal cords. The recurrent
laryngeal nerve provides sensory innervation below the vocal cords and
motor innervation to all intrinsic laryngeal muscles except the cricothyroid.
Question 6:
Which nerve provides motor innervation to the cricothyroid muscle?
4|Page
