CRNA Board Review Practice Exam
Practice Questions And Correct Answers
(Verified Answers) Plus Rationale 2026
Q&A| Instant Download Pdf
1. A 67-year-old patient with severe calcific aortic stenosis is scheduled
for open abdominal surgery. Preoperative echocardiography
demonstrates an aortic valve area of 0.7 cm², a mean transvalvular
gradient of 48 mmHg, and preserved left ventricular ejection fraction.
During induction, the patient's blood pressure decreases from 135/70
mmHg to 75/40 mmHg and the heart rate increases from 68 to 92
beats/min. Which hemodynamic strategy is most appropriate for this
patient?
A. Reduce systemic vascular resistance aggressively and allow the heart rate
to increase to maintain cardiac output
B. Maintain sinus rhythm, preserve preload and systemic vascular
resistance, and avoid significant tachycardia
C. Reduce preload substantially to decrease left ventricular wall stress and
improve forward flow
,D. Maintain a low systemic vascular resistance and intentionally increase
contractility with a beta-agonist
Answer: B. Maintain sinus rhythm, preserve preload and systemic vascular
resistance, and avoid significant tachycardia
Severe aortic stenosis produces a relatively fixed obstruction to left
ventricular outflow, making adequate preload, coronary perfusion
pressure, sinus rhythm, and systemic vascular resistance essential.
Hypotension reduces coronary perfusion and can rapidly cause myocardial
ischemia. Tachycardia is particularly undesirable because it shortens
diastolic filling and coronary perfusion time.
2. A 45-year-old patient undergoing general anesthesia develops sudden
hypotension, elevated airway pressures, distended neck veins, and
markedly decreased bilateral breath sounds on the right immediately
after placement of a central venous catheter. The oxygen saturation is
falling despite administration of 100% oxygen. Which diagnosis should
the anesthesia provider suspect first?
A. Acute pulmonary edema
B. Massive pulmonary embolism
C. Tension pneumothorax
D. Acute left ventricular failure
Answer: C. Tension pneumothorax
,The combination of sudden hypotension, increased airway pressure,
unilateral absent breath sounds, and venous distention after central
venous access is highly suggestive of tension pneumothorax. Positive-
pressure ventilation can rapidly worsen the intrathoracic pressure and
impair venous return, making immediate decompression necessary.
3. During general anesthesia, a 30-year-old patient develops a rapid
increase in end-tidal carbon dioxide from 38 to 62 mmHg despite
unchanged minute ventilation. The patient develops generalized
muscle rigidity, tachycardia, hyperthermia, metabolic acidosis, and
hyperkalemia. Which medication is the definitive treatment?
A. Calcium chloride
B. Dantrolene
C. Sodium bicarbonate
D. Magnesium sulfate
Answer: B. Dantrolene
Malignant hyperthermia is characterized by uncontrolled skeletal muscle
calcium release, resulting in hypermetabolism, rapidly increasing carbon
dioxide production, rigidity, hyperthermia, acidosis, and hyperkalemia.
Dantrolene directly reduces calcium release from the sarcoplasmic
reticulum and is the specific treatment.
, 4. A 22-year-old patient receives a rapid intravenous dose of
succinylcholine during rapid-sequence induction. Shortly afterward,
the patient develops generalized fasciculations followed by marked
muscle weakness and prolonged apnea lasting more than 90 minutes.
Which explanation best accounts for this finding?
A. Increased pseudocholinesterase activity
B. Deficiency or abnormality of plasma cholinesterase
C. Excess acetylcholinesterase activity at the neuromuscular junction
D. Increased hepatic metabolism of succinylcholine
Answer: B. Deficiency or abnormality of plasma cholinesterase
Succinylcholine is normally hydrolyzed rapidly by plasma
butyrylcholinesterase, also called pseudocholinesterase. Reduced enzyme
activity or an abnormal enzyme variant can markedly prolong
neuromuscular blockade and apnea after succinylcholine administration.
5. A patient with severe chronic obstructive pulmonary disease is
mechanically ventilated after induction of general anesthesia. The
patient has a respiratory rate of 20/min, tidal volume of 500 mL, and
an expiratory time that appears inadequate. The capnogram
demonstrates persistent elevation of the baseline between breaths.
Which ventilator adjustment is most appropriate?
Practice Questions And Correct Answers
(Verified Answers) Plus Rationale 2026
Q&A| Instant Download Pdf
1. A 67-year-old patient with severe calcific aortic stenosis is scheduled
for open abdominal surgery. Preoperative echocardiography
demonstrates an aortic valve area of 0.7 cm², a mean transvalvular
gradient of 48 mmHg, and preserved left ventricular ejection fraction.
During induction, the patient's blood pressure decreases from 135/70
mmHg to 75/40 mmHg and the heart rate increases from 68 to 92
beats/min. Which hemodynamic strategy is most appropriate for this
patient?
A. Reduce systemic vascular resistance aggressively and allow the heart rate
to increase to maintain cardiac output
B. Maintain sinus rhythm, preserve preload and systemic vascular
resistance, and avoid significant tachycardia
C. Reduce preload substantially to decrease left ventricular wall stress and
improve forward flow
,D. Maintain a low systemic vascular resistance and intentionally increase
contractility with a beta-agonist
Answer: B. Maintain sinus rhythm, preserve preload and systemic vascular
resistance, and avoid significant tachycardia
Severe aortic stenosis produces a relatively fixed obstruction to left
ventricular outflow, making adequate preload, coronary perfusion
pressure, sinus rhythm, and systemic vascular resistance essential.
Hypotension reduces coronary perfusion and can rapidly cause myocardial
ischemia. Tachycardia is particularly undesirable because it shortens
diastolic filling and coronary perfusion time.
2. A 45-year-old patient undergoing general anesthesia develops sudden
hypotension, elevated airway pressures, distended neck veins, and
markedly decreased bilateral breath sounds on the right immediately
after placement of a central venous catheter. The oxygen saturation is
falling despite administration of 100% oxygen. Which diagnosis should
the anesthesia provider suspect first?
A. Acute pulmonary edema
B. Massive pulmonary embolism
C. Tension pneumothorax
D. Acute left ventricular failure
Answer: C. Tension pneumothorax
,The combination of sudden hypotension, increased airway pressure,
unilateral absent breath sounds, and venous distention after central
venous access is highly suggestive of tension pneumothorax. Positive-
pressure ventilation can rapidly worsen the intrathoracic pressure and
impair venous return, making immediate decompression necessary.
3. During general anesthesia, a 30-year-old patient develops a rapid
increase in end-tidal carbon dioxide from 38 to 62 mmHg despite
unchanged minute ventilation. The patient develops generalized
muscle rigidity, tachycardia, hyperthermia, metabolic acidosis, and
hyperkalemia. Which medication is the definitive treatment?
A. Calcium chloride
B. Dantrolene
C. Sodium bicarbonate
D. Magnesium sulfate
Answer: B. Dantrolene
Malignant hyperthermia is characterized by uncontrolled skeletal muscle
calcium release, resulting in hypermetabolism, rapidly increasing carbon
dioxide production, rigidity, hyperthermia, acidosis, and hyperkalemia.
Dantrolene directly reduces calcium release from the sarcoplasmic
reticulum and is the specific treatment.
, 4. A 22-year-old patient receives a rapid intravenous dose of
succinylcholine during rapid-sequence induction. Shortly afterward,
the patient develops generalized fasciculations followed by marked
muscle weakness and prolonged apnea lasting more than 90 minutes.
Which explanation best accounts for this finding?
A. Increased pseudocholinesterase activity
B. Deficiency or abnormality of plasma cholinesterase
C. Excess acetylcholinesterase activity at the neuromuscular junction
D. Increased hepatic metabolism of succinylcholine
Answer: B. Deficiency or abnormality of plasma cholinesterase
Succinylcholine is normally hydrolyzed rapidly by plasma
butyrylcholinesterase, also called pseudocholinesterase. Reduced enzyme
activity or an abnormal enzyme variant can markedly prolong
neuromuscular blockade and apnea after succinylcholine administration.
5. A patient with severe chronic obstructive pulmonary disease is
mechanically ventilated after induction of general anesthesia. The
patient has a respiratory rate of 20/min, tidal volume of 500 mL, and
an expiratory time that appears inadequate. The capnogram
demonstrates persistent elevation of the baseline between breaths.
Which ventilator adjustment is most appropriate?
