NBCRNA National Certification Examination (NCE) – National Board of
Certification and Recertification for Nurse Anesthetists (CRNA Certification
Exam) – 2026/2027 Comprehensive Study Guide | Complete Review of Airway
Management, Clinical Pharmacology, Physiology & Pathophysiology, Anesthesia
Equipment, Technology & Safety | Updated Computer-Adaptive Testing (CAT)
Preparation | Practice Questions with Detailed Rationales | Exam Prep for
Student Registered Nurse Anesthetists (SRNAs) Seeking CRNA Certification and
First-Time Success | Latest 2026–2027 Edition
SECTION 1: AIRWAY MANAGEMENT
1. An interincisor distance of how many centimeters is suggested to indicate a
difficult intubation?
• A. 3
• B. 5
• C. 7
• D. 9
Correct Answer: A. 3
Rationale: An interincisor distance less than 3 cm (approximately 2
fingerbreadths), measured from the upper to the lower incisors with maximal
mouth opening, suggests possible difficult intubation. Some studies use 4 or 4.5
cm as the cutoff.
2. A 75 kg patient with morbid obesity (BMI 42) undergoes general anesthesia.
After RSI with succinylcholine, you cannot ventilate or intubate. The next best
step is:
• A. Repeat succinylcholine 1.5 mg/kg
• B. Perform a surgical cricothyrotomy
• C. Insert a supraglottic airway (SGA)
• D. Attempt blind nasal intubation
,Correct Answer: C. Insert a supraglottic airway (SGA)
Rationale: In a cannot-ventilate-cannot-intubate (CVCI) scenario, current difficult
airway algorithms prioritize placing an SGA as a rescue device before proceeding
to a surgical airway. Obesity increases risk, but an SGA often restores ventilation.
3. Which anesthetic agent should ideally be avoided in the asthmatic patient?
• A. Desflurane
• B. Isoflurane
• C. Ketamine
• D. Propofol
Correct Answer: A. Desflurane
Rationale: Anesthetic agents should be selected for their bronchodilating effects
in the asthmatic patient. With the exception of desflurane (a potent airway
irritant), all inhalation anesthetics produce bronchodilation. Both IV agents
ketamine and propofol produce bronchodilation.
4. In preparation for a fiberoptic nasal intubation, which pharmacological agent
would provide local anesthesia as well as vasoconstrictive properties?
• A. Cetacaine
• B. Cocaine
• C. Lidocaine
• D. Phenylephrine
Correct Answer: B. Cocaine
Rationale: Cocaine is the only pharmacological agent listed that provides both
local anesthesia and vasoconstrictive properties, making it ideal for nasal
procedures. It blocks nerve conduction and causes vasoconstriction by inhibiting
catecholamine reuptake.
,5. The cuff of an endotracheal tube should be inflated to a pressure of:
• A. 10-15 cm H₂O
• B. 20-30 cm H₂O
• C. 30-40 cm H₂O
• D. 40-50 cm H₂O
Correct Answer: B. 20-30 cm H₂O
Rationale: Recommended cuff pressure is 20-30 cm H₂O (approximately 15-22
mmHg). Higher pressures risk tracheal mucosal ischemia and injury.
6. What is a complication of excessive endotracheal tube cuff pressure?
• A. Air leak
• B. Pneumonitis
• C. Pulmonary edema
• D. Tracheal mucosal injury
Correct Answer: D. Tracheal mucosal injury
Rationale: Excessive endotracheal cuff pressure may result in tracheal mucosal
injury, vocal cord dysfunction due to recurrent laryngeal nerve palsy, and a sore
throat.
7. Which gives the MOST rapid detection of accidental extubation?
• A. BP monitoring
• B. Capnography
• C. EKG
• D. Pulse oximetry
, Correct Answer: B. Capnography
Rationale: Extubation is more rapidly detected by monitoring ETCO₂ than with
pulse oximetry and other vital sign monitoring, as one would see a reading of little
to no expired ETCO₂ first.
8. Damage to which nerve causes vocal cord paralysis?
• A. Glossopharyngeal
• B. Hypoglossal
• C. Recurrent Laryngeal Nerve (RLN)
• D. Superior Laryngeal Nerve (SLN)
Correct Answer: C. Recurrent Laryngeal Nerve (RLN)
Rationale: The recurrent laryngeal nerve innervates all the muscles of the larynx
except the cricothyroid muscle (innervated by the superior laryngeal nerve).
When the RLN is damaged, the vocal cord assumes a position between adduction
and abduction, causing paralysis.
9. What is an absolute contraindication for a supraglottic airway?
• A. Increased gastric emptying
• B. Intestinal obstruction
• C. Morbid obesity
• D. Reactive airway disease
Correct Answer: B. Intestinal obstruction
Rationale: Intestinal obstruction is an absolute contraindication for a supraglottic
airway due to the increased risk of aspiration. The device does not protect the
airway from gastric contents.
Certification and Recertification for Nurse Anesthetists (CRNA Certification
Exam) – 2026/2027 Comprehensive Study Guide | Complete Review of Airway
Management, Clinical Pharmacology, Physiology & Pathophysiology, Anesthesia
Equipment, Technology & Safety | Updated Computer-Adaptive Testing (CAT)
Preparation | Practice Questions with Detailed Rationales | Exam Prep for
Student Registered Nurse Anesthetists (SRNAs) Seeking CRNA Certification and
First-Time Success | Latest 2026–2027 Edition
SECTION 1: AIRWAY MANAGEMENT
1. An interincisor distance of how many centimeters is suggested to indicate a
difficult intubation?
• A. 3
• B. 5
• C. 7
• D. 9
Correct Answer: A. 3
Rationale: An interincisor distance less than 3 cm (approximately 2
fingerbreadths), measured from the upper to the lower incisors with maximal
mouth opening, suggests possible difficult intubation. Some studies use 4 or 4.5
cm as the cutoff.
2. A 75 kg patient with morbid obesity (BMI 42) undergoes general anesthesia.
After RSI with succinylcholine, you cannot ventilate or intubate. The next best
step is:
• A. Repeat succinylcholine 1.5 mg/kg
• B. Perform a surgical cricothyrotomy
• C. Insert a supraglottic airway (SGA)
• D. Attempt blind nasal intubation
,Correct Answer: C. Insert a supraglottic airway (SGA)
Rationale: In a cannot-ventilate-cannot-intubate (CVCI) scenario, current difficult
airway algorithms prioritize placing an SGA as a rescue device before proceeding
to a surgical airway. Obesity increases risk, but an SGA often restores ventilation.
3. Which anesthetic agent should ideally be avoided in the asthmatic patient?
• A. Desflurane
• B. Isoflurane
• C. Ketamine
• D. Propofol
Correct Answer: A. Desflurane
Rationale: Anesthetic agents should be selected for their bronchodilating effects
in the asthmatic patient. With the exception of desflurane (a potent airway
irritant), all inhalation anesthetics produce bronchodilation. Both IV agents
ketamine and propofol produce bronchodilation.
4. In preparation for a fiberoptic nasal intubation, which pharmacological agent
would provide local anesthesia as well as vasoconstrictive properties?
• A. Cetacaine
• B. Cocaine
• C. Lidocaine
• D. Phenylephrine
Correct Answer: B. Cocaine
Rationale: Cocaine is the only pharmacological agent listed that provides both
local anesthesia and vasoconstrictive properties, making it ideal for nasal
procedures. It blocks nerve conduction and causes vasoconstriction by inhibiting
catecholamine reuptake.
,5. The cuff of an endotracheal tube should be inflated to a pressure of:
• A. 10-15 cm H₂O
• B. 20-30 cm H₂O
• C. 30-40 cm H₂O
• D. 40-50 cm H₂O
Correct Answer: B. 20-30 cm H₂O
Rationale: Recommended cuff pressure is 20-30 cm H₂O (approximately 15-22
mmHg). Higher pressures risk tracheal mucosal ischemia and injury.
6. What is a complication of excessive endotracheal tube cuff pressure?
• A. Air leak
• B. Pneumonitis
• C. Pulmonary edema
• D. Tracheal mucosal injury
Correct Answer: D. Tracheal mucosal injury
Rationale: Excessive endotracheal cuff pressure may result in tracheal mucosal
injury, vocal cord dysfunction due to recurrent laryngeal nerve palsy, and a sore
throat.
7. Which gives the MOST rapid detection of accidental extubation?
• A. BP monitoring
• B. Capnography
• C. EKG
• D. Pulse oximetry
, Correct Answer: B. Capnography
Rationale: Extubation is more rapidly detected by monitoring ETCO₂ than with
pulse oximetry and other vital sign monitoring, as one would see a reading of little
to no expired ETCO₂ first.
8. Damage to which nerve causes vocal cord paralysis?
• A. Glossopharyngeal
• B. Hypoglossal
• C. Recurrent Laryngeal Nerve (RLN)
• D. Superior Laryngeal Nerve (SLN)
Correct Answer: C. Recurrent Laryngeal Nerve (RLN)
Rationale: The recurrent laryngeal nerve innervates all the muscles of the larynx
except the cricothyroid muscle (innervated by the superior laryngeal nerve).
When the RLN is damaged, the vocal cord assumes a position between adduction
and abduction, causing paralysis.
9. What is an absolute contraindication for a supraglottic airway?
• A. Increased gastric emptying
• B. Intestinal obstruction
• C. Morbid obesity
• D. Reactive airway disease
Correct Answer: B. Intestinal obstruction
Rationale: Intestinal obstruction is an absolute contraindication for a supraglottic
airway due to the increased risk of aspiration. The device does not protect the
airway from gastric contents.
