NBCRNA Exam Comprehensive Test Bank
200 Questions with Answers and Rationales | 2026-2027
Edition | Graded A+
SECTION 1: AIRWAY MANAGEMENT (Questions 1-85)
Q1. A 45-year-old male with a known difficult airway is scheduled for an
emergent appendectomy. The patient has a Mallampati class IV, limited neck
extension, and an inter-incisor distance of 2 cm. What is the most appropriate
initial airway management strategy?
A) Direct laryngoscopy with a Macintosh blade
B) Awake fiberoptic intubation
C) Laryngeal mask airway insertion
D) Cricothyrotomy
Answer: B) Awake fiberoptic intubation
Rationale: This patient has multiple predictors of a difficult airway: Mallampati
class IV, limited neck extension, and reduced inter-incisor distance (<3 cm). The
safest approach in a patient with a known difficult airway is awake fiberoptic
intubation, which maintains spontaneous ventilation while securing the airway.
Cricothyrotomy (D) is a rescue technique for "cannot intubate, cannot ventilate"
situations. Direct laryngoscopy (A) has a high risk of failure in this patient.
Q2. What is the primary advantage of using a video laryngoscope over
traditional direct laryngoscopy?
A) Lower cost
B) Improved glottic visualization, especially in difficult airways
C) Reduced risk of aspiration
D) Faster intubation time in all patients
Answer: B) Improved glottic visualization, especially in difficult airways
,Rationale: Video laryngoscopy provides a superior view of the glottis, particularly
in patients with anatomical challenges such as limited neck mobility or large
tongue. It allows for indirect visualization, making it valuable in difficult airway
management.
Q3. A patient is being ventilated via a supraglottic airway device. Which finding
indicates that the device is NOT properly positioned?
A) Bilateral breath sounds present
B) ETCO2 waveform is present and consistent
C) Gastric insufflation with rising peak pressures
D) Oxygen saturation remains at 98%
Answer: C) Gastric insufflation with rising peak pressures
Rationale: Gastric insufflation suggests that the supraglottic airway is not sealing
properly, allowing gas to enter the stomach instead of the lungs. This can lead to
regurgitation and aspiration. Proper positioning should include bilateral breath
sounds, capnography confirmation, and stable oxygen saturation.
Q4. Which of the following is a contraindication to the use of a laryngeal mask
airway (LMA)?
A) Full stomach or known gastroesophageal reflux
B) Asthma
C) Morbid obesity
D) Hypertension
Answer: A) Full stomach or known gastroesophageal reflux
Rationale: LMAs do not protect against aspiration and should be avoided in
patients with full stomachs, GERD, or any condition that increases the risk of
regurgitation. LMAs are commonly used in patients with asthma (B) as they are
less stimulating than an ETT. Morbid obesity (C) is not a contraindication but may
require specific positioning. Hypertension (D) is not a contraindication.
,Q5. During fiberoptic intubation, the patient becomes agitated and starts to
desaturate. What is the immediate action?
A) Continue the procedure and intubate quickly
B) Remove the scope, ventilate the patient with 100% oxygen, and reassess
C) Increase the sedation and continue
D) Convert to a surgical airway immediately
Answer: B) Remove the scope, ventilate the patient with 100% oxygen, and
reassess
Rationale: The priority is to maintain oxygenation and ventilation. If the patient
becomes agitated and desaturates during fiberoptic intubation, the safest action
is to remove the scope, provide 100% oxygen, and reassess the airway plan.
Continuing the procedure (A) could lead to further desaturation and
complications.
Q6. A patient with a history of cervical spine injury requires intubation. Which
technique is safest for maintaining cervical spine alignment?
A) Direct laryngoscopy with cricoid pressure
B) Video laryngoscopy with manual inline stabilization
C) Blind nasal intubation
D) Awake fiberoptic intubation
Answer: B) Video laryngoscopy with manual inline stabilization
Rationale: In a patient with a cervical spine injury, minimizing neck movement
during intubation is crucial. Video laryngoscopy with manual inline stabilization
(MILS) provides the best balance of glottic visualization and cervical spine
protection. Awake fiberoptic intubation (D) is an alternative but may be more
challenging.
Q7. Which of the following medications is most appropriate for awake
fiberoptic intubation to reduce airway reflexes?
, A) Succinylcholine
B) Rocuronium
C) Lidocaine (nebulized or topical)
D) Atropine
Answer: C) Lidocaine (nebulized or topical)
Rationale: Lidocaine is a local anesthetic that can be applied topically or
nebulized to reduce airway reflexes during awake fiberoptic intubation.
Succinylcholine (A) and rocuronium (B) are neuromuscular blockers used for rapid
sequence intubation in anesthetized patients. Atropine (D) is an anticholinergic
used to reduce secretions.
Q8. A patient with a difficult airway is undergoing an awake fiberoptic
intubation. To minimize hypoxia during the procedure, what should be
provided?
A) High-flow nasal cannula oxygen (HFNC)
B) 50% oxygen via face mask
C) Room air
D) Positive pressure ventilation throughout the procedure
Answer: A) High-flow nasal cannula oxygen (HFNC)
Rationale: High-flow nasal cannula oxygen provides apneic oxygenation,
maintaining oxygen saturation while the airway is manipulated. It is particularly
useful during awake fiberoptic intubation where patients may have periods of
apnea.
Q9. Which of the following is the most reliable indicator of correct endotracheal
tube placement?
A) Bilateral breath sounds
B) Chest X-ray confirmation
C) Continuous capnography (ETCO2) waveform
D) Fogging in the tube
200 Questions with Answers and Rationales | 2026-2027
Edition | Graded A+
SECTION 1: AIRWAY MANAGEMENT (Questions 1-85)
Q1. A 45-year-old male with a known difficult airway is scheduled for an
emergent appendectomy. The patient has a Mallampati class IV, limited neck
extension, and an inter-incisor distance of 2 cm. What is the most appropriate
initial airway management strategy?
A) Direct laryngoscopy with a Macintosh blade
B) Awake fiberoptic intubation
C) Laryngeal mask airway insertion
D) Cricothyrotomy
Answer: B) Awake fiberoptic intubation
Rationale: This patient has multiple predictors of a difficult airway: Mallampati
class IV, limited neck extension, and reduced inter-incisor distance (<3 cm). The
safest approach in a patient with a known difficult airway is awake fiberoptic
intubation, which maintains spontaneous ventilation while securing the airway.
Cricothyrotomy (D) is a rescue technique for "cannot intubate, cannot ventilate"
situations. Direct laryngoscopy (A) has a high risk of failure in this patient.
Q2. What is the primary advantage of using a video laryngoscope over
traditional direct laryngoscopy?
A) Lower cost
B) Improved glottic visualization, especially in difficult airways
C) Reduced risk of aspiration
D) Faster intubation time in all patients
Answer: B) Improved glottic visualization, especially in difficult airways
,Rationale: Video laryngoscopy provides a superior view of the glottis, particularly
in patients with anatomical challenges such as limited neck mobility or large
tongue. It allows for indirect visualization, making it valuable in difficult airway
management.
Q3. A patient is being ventilated via a supraglottic airway device. Which finding
indicates that the device is NOT properly positioned?
A) Bilateral breath sounds present
B) ETCO2 waveform is present and consistent
C) Gastric insufflation with rising peak pressures
D) Oxygen saturation remains at 98%
Answer: C) Gastric insufflation with rising peak pressures
Rationale: Gastric insufflation suggests that the supraglottic airway is not sealing
properly, allowing gas to enter the stomach instead of the lungs. This can lead to
regurgitation and aspiration. Proper positioning should include bilateral breath
sounds, capnography confirmation, and stable oxygen saturation.
Q4. Which of the following is a contraindication to the use of a laryngeal mask
airway (LMA)?
A) Full stomach or known gastroesophageal reflux
B) Asthma
C) Morbid obesity
D) Hypertension
Answer: A) Full stomach or known gastroesophageal reflux
Rationale: LMAs do not protect against aspiration and should be avoided in
patients with full stomachs, GERD, or any condition that increases the risk of
regurgitation. LMAs are commonly used in patients with asthma (B) as they are
less stimulating than an ETT. Morbid obesity (C) is not a contraindication but may
require specific positioning. Hypertension (D) is not a contraindication.
,Q5. During fiberoptic intubation, the patient becomes agitated and starts to
desaturate. What is the immediate action?
A) Continue the procedure and intubate quickly
B) Remove the scope, ventilate the patient with 100% oxygen, and reassess
C) Increase the sedation and continue
D) Convert to a surgical airway immediately
Answer: B) Remove the scope, ventilate the patient with 100% oxygen, and
reassess
Rationale: The priority is to maintain oxygenation and ventilation. If the patient
becomes agitated and desaturates during fiberoptic intubation, the safest action
is to remove the scope, provide 100% oxygen, and reassess the airway plan.
Continuing the procedure (A) could lead to further desaturation and
complications.
Q6. A patient with a history of cervical spine injury requires intubation. Which
technique is safest for maintaining cervical spine alignment?
A) Direct laryngoscopy with cricoid pressure
B) Video laryngoscopy with manual inline stabilization
C) Blind nasal intubation
D) Awake fiberoptic intubation
Answer: B) Video laryngoscopy with manual inline stabilization
Rationale: In a patient with a cervical spine injury, minimizing neck movement
during intubation is crucial. Video laryngoscopy with manual inline stabilization
(MILS) provides the best balance of glottic visualization and cervical spine
protection. Awake fiberoptic intubation (D) is an alternative but may be more
challenging.
Q7. Which of the following medications is most appropriate for awake
fiberoptic intubation to reduce airway reflexes?
, A) Succinylcholine
B) Rocuronium
C) Lidocaine (nebulized or topical)
D) Atropine
Answer: C) Lidocaine (nebulized or topical)
Rationale: Lidocaine is a local anesthetic that can be applied topically or
nebulized to reduce airway reflexes during awake fiberoptic intubation.
Succinylcholine (A) and rocuronium (B) are neuromuscular blockers used for rapid
sequence intubation in anesthetized patients. Atropine (D) is an anticholinergic
used to reduce secretions.
Q8. A patient with a difficult airway is undergoing an awake fiberoptic
intubation. To minimize hypoxia during the procedure, what should be
provided?
A) High-flow nasal cannula oxygen (HFNC)
B) 50% oxygen via face mask
C) Room air
D) Positive pressure ventilation throughout the procedure
Answer: A) High-flow nasal cannula oxygen (HFNC)
Rationale: High-flow nasal cannula oxygen provides apneic oxygenation,
maintaining oxygen saturation while the airway is manipulated. It is particularly
useful during awake fiberoptic intubation where patients may have periods of
apnea.
Q9. Which of the following is the most reliable indicator of correct endotracheal
tube placement?
A) Bilateral breath sounds
B) Chest X-ray confirmation
C) Continuous capnography (ETCO2) waveform
D) Fogging in the tube
