NBCRNA EXAM COMPREHENSIVE TEST BANK -
500 QUESTIONS WITH ANSWERS AND
RATIONALES National Board of Certification and
Recertification for Nurse Anesthetists | 2026-2027
Edition | Most Recent Edition
EXAM OVERVIEW
The National Certification Examination (NCE) is administered by the National Board of
Certification and Recertification for Nurse Anesthetists (NBCRNA) to measure the
knowledge, skills, and abilities necessary for entry-level nurse anesthesia practice . The
NCE is a variable-length computerized adaptive test with 100-170 questions, and
candidates have a maximum of three hours to complete it . Questions may be multiple-
choice, calculations, drag and drop, hotspot, or graphics/videos .
Starting January 1, 2026, the NBCRNA transitioned from the Continued Professional
Certification (CPC) program to the MAC (Maintaining Anesthesia Certification)
program . The MAC Check assessment (formerly CPCA) is a 150-question performance
standard assessment required once every eight years, covering four core knowledge
domains: Airway Management (34%), Applied Clinical Pharmacology (24%), Applied
Physiology and Pathophysiology (24%), and Anesthesia Equipment, Technology, and
Safety (18%) .
The NCE passing standard is updated periodically through a standard setting process to
reflect current professional knowledge and competencies . A passing score adjustment
will take effect for all exams administered on or after July 1, 2026 . The exam is offered
exclusively at Pearson VUE testing centers .
SECTION 1: AIRWAY MANAGEMENT (Questions 1-100)
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
D) Oxygen saturation
,Answer: C) End-tidal CO₂ detection
Rationale: End-tidal CO₂ detection (capnography) is the most reliable method for
confirming proper endotracheal tube placement . While bilateral breath sounds, chest
rise, and oxygen saturation are important, they can be falsely reassuring in esophageal
intubation. Capnography provides immediate confirmation of tracheal placement and is
considered the gold standard .
2. 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: The Mallampati classification assesses the visibility of the base of the tongue,
soft palate, uvula, and tonsillar pillars, which correlates with the ease of laryngoscopy and
intubation. A Class III or IV Mallampati score predicts a more difficult intubation .
3. Which of the following 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 most common cause of upper airway
obstruction is the tongue falling back against the posterior pharyngeal wall. This is
managed with a jaw thrust or chin lift maneuver, and the placement of a nasal or oral
airway .
4. What is the appropriate size for an oropharyngeal airway in an average adult female?
A) Size 3 (80 mm)
B) Size 4 (90 mm)
,C) Size 5 (100 mm)
D) Size 6 (110 mm)
Answer: B) Size 4 (90 mm)
Rationale: An oropharyngeal airway is sized by measuring from the corner of the mouth
to the angle of the mandible. In an average adult female, the appropriate size is typically a
size 4 (90 mm). The airway should be inserted with the tip facing the hard palate and
then rotated 180 degrees as it passes the soft palate .
5. Which of the following drugs is the preferred neuromuscular blocking agent for rapid
sequence intubation in a patient with hyperkalemia?
A) Succinylcholine
B) Rocuronium
C) Vecuronium
D) Atracurium
Answer: B) Rocuronium
Rationale: Succinylcholine is contraindicated in patients with hyperkalemia because it
can cause a significant and potentially fatal increase in serum potassium. Rocuronium is a
non-depolarizing neuromuscular blocker that does not cause hyperkalemia and provides
rapid onset (60-90 seconds) in a dose of 1.2 mg/kg, making it an appropriate alternative
for rapid sequence intubation .
6. The Sellick maneuver is used to:
A) Improve laryngeal view
B) Prevent aspiration of gastric contents
C) Confirm endotracheal tube placement
D) Relieve laryngospasm
Answer: B) Prevent aspiration of gastric contents
Rationale: The Sellick maneuver (cricoid pressure) is used during rapid sequence
intubation to occlude the esophagus, reducing the risk of gastric content aspiration. It
should be applied with 20-30 Newtons of pressure on the cricoid cartilage .
7. What is the normal resting oxygen consumption for an adult?
, A) 100-150 mL/min
B) 200-250 mL/min
C) 300-350 mL/min
D) 400-450 mL/min
Answer: B) 200-250 mL/min
Rationale: Normal resting oxygen consumption for an adult is approximately 200-250
mL/min (3-4 mL/kg/min). This is an important consideration in understanding how
quickly a patient will become hypoxic during apnea .
8. In a patient with a full stomach, the risk of aspiration can be reduced by all of the
following EXCEPT:
A) Rapid sequence intubation
B) Preoxygenation
C) Cricoid pressure
D) Awake intubation
Answer: B) Preoxygenation
Rationale: Preoxygenation extends the safe apnea time but does not reduce the risk of
aspiration. Rapid sequence intubation, cricoid pressure, and awake intubation are all
strategies used to reduce aspiration risk in patients with a full stomach .
9. Which of the following indicates a difficult mask airway?
A) Mallampati Class I
B) Presence of a beard
C) BMI < 25
D) Full dentition
Answer: B) Presence of a beard
Rationale: Risk factors for difficult mask ventilation include the presence of a beard,
obesity (BMI > 30), age > 55, lack of teeth, and snoring. A Mallampati Class I is associated
with easy intubation, and full dentition actually helps with mask seal .
10. The primary purpose of preoxygenation is to:
A) Decrease gastric volume
B) Increase functional residual capacity
500 QUESTIONS WITH ANSWERS AND
RATIONALES National Board of Certification and
Recertification for Nurse Anesthetists | 2026-2027
Edition | Most Recent Edition
EXAM OVERVIEW
The National Certification Examination (NCE) is administered by the National Board of
Certification and Recertification for Nurse Anesthetists (NBCRNA) to measure the
knowledge, skills, and abilities necessary for entry-level nurse anesthesia practice . The
NCE is a variable-length computerized adaptive test with 100-170 questions, and
candidates have a maximum of three hours to complete it . Questions may be multiple-
choice, calculations, drag and drop, hotspot, or graphics/videos .
Starting January 1, 2026, the NBCRNA transitioned from the Continued Professional
Certification (CPC) program to the MAC (Maintaining Anesthesia Certification)
program . The MAC Check assessment (formerly CPCA) is a 150-question performance
standard assessment required once every eight years, covering four core knowledge
domains: Airway Management (34%), Applied Clinical Pharmacology (24%), Applied
Physiology and Pathophysiology (24%), and Anesthesia Equipment, Technology, and
Safety (18%) .
The NCE passing standard is updated periodically through a standard setting process to
reflect current professional knowledge and competencies . A passing score adjustment
will take effect for all exams administered on or after July 1, 2026 . The exam is offered
exclusively at Pearson VUE testing centers .
SECTION 1: AIRWAY MANAGEMENT (Questions 1-100)
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
D) Oxygen saturation
,Answer: C) End-tidal CO₂ detection
Rationale: End-tidal CO₂ detection (capnography) is the most reliable method for
confirming proper endotracheal tube placement . While bilateral breath sounds, chest
rise, and oxygen saturation are important, they can be falsely reassuring in esophageal
intubation. Capnography provides immediate confirmation of tracheal placement and is
considered the gold standard .
2. 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: The Mallampati classification assesses the visibility of the base of the tongue,
soft palate, uvula, and tonsillar pillars, which correlates with the ease of laryngoscopy and
intubation. A Class III or IV Mallampati score predicts a more difficult intubation .
3. Which of the following 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 most common cause of upper airway
obstruction is the tongue falling back against the posterior pharyngeal wall. This is
managed with a jaw thrust or chin lift maneuver, and the placement of a nasal or oral
airway .
4. What is the appropriate size for an oropharyngeal airway in an average adult female?
A) Size 3 (80 mm)
B) Size 4 (90 mm)
,C) Size 5 (100 mm)
D) Size 6 (110 mm)
Answer: B) Size 4 (90 mm)
Rationale: An oropharyngeal airway is sized by measuring from the corner of the mouth
to the angle of the mandible. In an average adult female, the appropriate size is typically a
size 4 (90 mm). The airway should be inserted with the tip facing the hard palate and
then rotated 180 degrees as it passes the soft palate .
5. Which of the following drugs is the preferred neuromuscular blocking agent for rapid
sequence intubation in a patient with hyperkalemia?
A) Succinylcholine
B) Rocuronium
C) Vecuronium
D) Atracurium
Answer: B) Rocuronium
Rationale: Succinylcholine is contraindicated in patients with hyperkalemia because it
can cause a significant and potentially fatal increase in serum potassium. Rocuronium is a
non-depolarizing neuromuscular blocker that does not cause hyperkalemia and provides
rapid onset (60-90 seconds) in a dose of 1.2 mg/kg, making it an appropriate alternative
for rapid sequence intubation .
6. The Sellick maneuver is used to:
A) Improve laryngeal view
B) Prevent aspiration of gastric contents
C) Confirm endotracheal tube placement
D) Relieve laryngospasm
Answer: B) Prevent aspiration of gastric contents
Rationale: The Sellick maneuver (cricoid pressure) is used during rapid sequence
intubation to occlude the esophagus, reducing the risk of gastric content aspiration. It
should be applied with 20-30 Newtons of pressure on the cricoid cartilage .
7. What is the normal resting oxygen consumption for an adult?
, A) 100-150 mL/min
B) 200-250 mL/min
C) 300-350 mL/min
D) 400-450 mL/min
Answer: B) 200-250 mL/min
Rationale: Normal resting oxygen consumption for an adult is approximately 200-250
mL/min (3-4 mL/kg/min). This is an important consideration in understanding how
quickly a patient will become hypoxic during apnea .
8. In a patient with a full stomach, the risk of aspiration can be reduced by all of the
following EXCEPT:
A) Rapid sequence intubation
B) Preoxygenation
C) Cricoid pressure
D) Awake intubation
Answer: B) Preoxygenation
Rationale: Preoxygenation extends the safe apnea time but does not reduce the risk of
aspiration. Rapid sequence intubation, cricoid pressure, and awake intubation are all
strategies used to reduce aspiration risk in patients with a full stomach .
9. Which of the following indicates a difficult mask airway?
A) Mallampati Class I
B) Presence of a beard
C) BMI < 25
D) Full dentition
Answer: B) Presence of a beard
Rationale: Risk factors for difficult mask ventilation include the presence of a beard,
obesity (BMI > 30), age > 55, lack of teeth, and snoring. A Mallampati Class I is associated
with easy intubation, and full dentition actually helps with mask seal .
10. The primary purpose of preoxygenation is to:
A) Decrease gastric volume
B) Increase functional residual capacity
