AANA NBCRNA Essential Test Toolkit Exam Questions
and Approved with Distinction Marking Scheme Latest
2024/2025
What is the primary pathway of etomidate metabolism? - correct answer ester
hydrolysis driven by plasma esterases and microsomal enzymes
What drugs must be avoided with acute intermittent poryphyrias? - correct answer
etomidate, barbiturates, glucocorticoids, hydralazine
Treatment for acute intermittent poryphyrias - correct answer glucose and heme
arginate
Rank iv anesthetics from most to least plasma protein binding - correct answer
propofol, midazolam, dexmedetomidine, etomidate, ketamine
What pias are methyl isopropyl ethers? Methyl ethyl ethers? - correct answer methyl
isopropyl ether = sevoflurane
Methyl ethyl ether = isoflurane and desflurane
What pia is not metabolized to tfa? - correct answer sevoflurane not metabolized to tfa,
but is broken down to inorganic fluoride ions
What local anesthetics can cause methemoglobinemia? - correct answer benzocaine,
cetacaine (contains benzocaine), prilocaine, emla cream (contains prilocaine)
What are the three components of a local anesthetic molecule? - correct answer
benzene ring, intermediate chain (ester vs amide), tertiary amine
What local anesthetic is metabolized to o-toluidine? - correct answer prilocaine
,Maximum dose of cocaine when used as a local anesthetic in adults - correct answer
150-200 mg
What subunits must be occupied to open the nicotinic receptor at the motor end plate? -
correct answer two alpha subunits
What are the five subunits on the nicotinic receptor? - correct answer 2 alpha, 1 beta,
1 delta, 1 epsilon
What are the two pathological variants of the nicotinic receptor? - correct answer 1)
episilon replaced by gamma subunit
2) 5 alpha subunits
What causes fade during train of four stimulation? - correct answer antagonism of
presynaptic nn receptors
Why do nondepolarizers cause a phase ii block? - correct answer inhibit the
presynaptic nicotinic receptor ach mobilization is impaired
Best place to measure onset of blockade (intubation conditions) vs recovery of blockade
(return of upper airway muscle function) - correct answer onset = orbicularis oculi or
corrugator supercilii (facial nerve)
Return = adductor policis (ulnar nerve) or flexor hallucis
Its difficult to detect visual or tactile fade when the tof > ____ - correct answer 0.4
What drugs reduce pseudocholinesterase activity? - correct answer metoclopramide,
esmolol, neostigmine, echothiophate, oral contraceptives, mao inhibitors,
cyclophosphamide, nitrogen mustard
,With atypical plasma cholinesterase, pseudocholinesterase is not produced in sufficient
quantities and will prolong the duration of action for succinylcholine. T or f - correct
answer false, pseudocholinesterase is produced in sufficient quanities but the enzyme
that is produced is not functional
Who is at highest risk of myalgias after sux administration? - correct answer young
adults undergoing ambulatory surgery (women>men)
How do multiple sclerosis affect depolarizers vs nondepolarizers - correct answer
depolarizers = hyperkalemia
Nondepolarizers = sensitive
What neuromuscular disease causes a resistance to sux - correct answer myasthenia
gravis
What nmb is long-acting? - correct answer pancuronium (85 min duration)
What electrolyte disturbances potentiate neuromuscular blocking agents? (lithium,
magnesium, calcium, potassium) - correct answer increased lithium, increased
magnesium, decreased calcium, decreased potassium
What nmbs cause release of histamine? - correct answer sux, atracurium, mivacurium
What is unique about pancuronium? - correct answer has vagolytic properties making
it good for bradycardia or regurgitant lesions
Opioids decrease the incidence of myalgias. T or f - correct answer false. Pretreatment
1/10 dose of nondepolarizer, nsaids, lidocaine, and a higher dose of sux reduce the risk.
, What drug inhibits acetylcholinesterase via electrostatic attachment? - correct answer
edrophonium
What drug noncompetitively inhibits acetylcholinesterase? - correct answer
echothiophate/organophosphates
Pyridostigmine vs edrophonium dose - correct answer pyridostigmine = 0.3 mg/kg
Edrophonium = 1 mg/kg
Pyridostigmine crosses the bbb making it useful for treating central anticholinergic
syndrome. T or f - correct answer false, physostigmine crosses bbb (useful for
anticholinergic syndrome)
What muscarinic antagonist causes the most sedation? - correct answer scopolamine
Opioid receptor moa - correct answer opioid binds to receptor, activates g protein,
adenylate cyclase is inhibited, camp is inhibited, ca conductance is decreased, k
conductance is increased
What are the endogenous ligands of mu, kappa, and delta receptors? - correct answer
mu = endorphins
Kappa = dynorphins
Delta = enkephalins
Key side effects of kappa receptor stimulation - correct answer dysphoria,
antishivering, diuresis
and Approved with Distinction Marking Scheme Latest
2024/2025
What is the primary pathway of etomidate metabolism? - correct answer ester
hydrolysis driven by plasma esterases and microsomal enzymes
What drugs must be avoided with acute intermittent poryphyrias? - correct answer
etomidate, barbiturates, glucocorticoids, hydralazine
Treatment for acute intermittent poryphyrias - correct answer glucose and heme
arginate
Rank iv anesthetics from most to least plasma protein binding - correct answer
propofol, midazolam, dexmedetomidine, etomidate, ketamine
What pias are methyl isopropyl ethers? Methyl ethyl ethers? - correct answer methyl
isopropyl ether = sevoflurane
Methyl ethyl ether = isoflurane and desflurane
What pia is not metabolized to tfa? - correct answer sevoflurane not metabolized to tfa,
but is broken down to inorganic fluoride ions
What local anesthetics can cause methemoglobinemia? - correct answer benzocaine,
cetacaine (contains benzocaine), prilocaine, emla cream (contains prilocaine)
What are the three components of a local anesthetic molecule? - correct answer
benzene ring, intermediate chain (ester vs amide), tertiary amine
What local anesthetic is metabolized to o-toluidine? - correct answer prilocaine
,Maximum dose of cocaine when used as a local anesthetic in adults - correct answer
150-200 mg
What subunits must be occupied to open the nicotinic receptor at the motor end plate? -
correct answer two alpha subunits
What are the five subunits on the nicotinic receptor? - correct answer 2 alpha, 1 beta,
1 delta, 1 epsilon
What are the two pathological variants of the nicotinic receptor? - correct answer 1)
episilon replaced by gamma subunit
2) 5 alpha subunits
What causes fade during train of four stimulation? - correct answer antagonism of
presynaptic nn receptors
Why do nondepolarizers cause a phase ii block? - correct answer inhibit the
presynaptic nicotinic receptor ach mobilization is impaired
Best place to measure onset of blockade (intubation conditions) vs recovery of blockade
(return of upper airway muscle function) - correct answer onset = orbicularis oculi or
corrugator supercilii (facial nerve)
Return = adductor policis (ulnar nerve) or flexor hallucis
Its difficult to detect visual or tactile fade when the tof > ____ - correct answer 0.4
What drugs reduce pseudocholinesterase activity? - correct answer metoclopramide,
esmolol, neostigmine, echothiophate, oral contraceptives, mao inhibitors,
cyclophosphamide, nitrogen mustard
,With atypical plasma cholinesterase, pseudocholinesterase is not produced in sufficient
quantities and will prolong the duration of action for succinylcholine. T or f - correct
answer false, pseudocholinesterase is produced in sufficient quanities but the enzyme
that is produced is not functional
Who is at highest risk of myalgias after sux administration? - correct answer young
adults undergoing ambulatory surgery (women>men)
How do multiple sclerosis affect depolarizers vs nondepolarizers - correct answer
depolarizers = hyperkalemia
Nondepolarizers = sensitive
What neuromuscular disease causes a resistance to sux - correct answer myasthenia
gravis
What nmb is long-acting? - correct answer pancuronium (85 min duration)
What electrolyte disturbances potentiate neuromuscular blocking agents? (lithium,
magnesium, calcium, potassium) - correct answer increased lithium, increased
magnesium, decreased calcium, decreased potassium
What nmbs cause release of histamine? - correct answer sux, atracurium, mivacurium
What is unique about pancuronium? - correct answer has vagolytic properties making
it good for bradycardia or regurgitant lesions
Opioids decrease the incidence of myalgias. T or f - correct answer false. Pretreatment
1/10 dose of nondepolarizer, nsaids, lidocaine, and a higher dose of sux reduce the risk.
, What drug inhibits acetylcholinesterase via electrostatic attachment? - correct answer
edrophonium
What drug noncompetitively inhibits acetylcholinesterase? - correct answer
echothiophate/organophosphates
Pyridostigmine vs edrophonium dose - correct answer pyridostigmine = 0.3 mg/kg
Edrophonium = 1 mg/kg
Pyridostigmine crosses the bbb making it useful for treating central anticholinergic
syndrome. T or f - correct answer false, physostigmine crosses bbb (useful for
anticholinergic syndrome)
What muscarinic antagonist causes the most sedation? - correct answer scopolamine
Opioid receptor moa - correct answer opioid binds to receptor, activates g protein,
adenylate cyclase is inhibited, camp is inhibited, ca conductance is decreased, k
conductance is increased
What are the endogenous ligands of mu, kappa, and delta receptors? - correct answer
mu = endorphins
Kappa = dynorphins
Delta = enkephalins
Key side effects of kappa receptor stimulation - correct answer dysphoria,
antishivering, diuresis
