The CRNA (Certified Registered Nurse Anesthetist) is a nurse practitioner certification awarded by NBCRNA.
NBCRNA publishes the official exam outline, eligibility rules and fees — see NBCRNA's official page before you book.
Twenty CRNA (Certified Registered Nurse Anesthetist) questions, with the answers hidden until you want them — covering Procedures, Management, Pharmacology, Physiology and more. They are real cards from our 1050-card deck, not the 30 on the free preview page, so you can use both. Work through them cold, then use your score below to decide what to study next. NBCRNA publishes the official exam outline — check it for the real blueprint.
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A patient's arterial line shows a slurred upstroke and loss of the dicrotic notch after a flush test. What is the most likely cause, and how does this affect the systolic and diastolic readings?
Show answer →This is **overdamping**. Common causes include air bubbles, blood clots, or long/compliant tubing. Effect: Systolic BP is underestimated, and diastolic BP is overestimated (MAP remains relatively accurate). Strategy: NBCRNA often tests the under-over rule: Overdamping = Under-estimates SBP. Clinical pearl: Always check for air bubbles in the transducer or tubing first when the waveform appears rounded.
During a square wave test, you observe multiple oscillations (>2) before returning to baseline. What does this indicate regarding the system's damping, and how will it affect the displayed systolic pressure?
Show answer →This indicates **underdamping** (ringing). The system has a low damping coefficient and high resonance. Effect: Systolic BP is falsely elevated (overestimated), and diastolic BP may be falsely low. Strategy: Look for catheter whip or resonance as synonyms on the exam. To fix, remove unnecessary stopcocks or use shorter, stiffer tubing. MAP remains the most reliable value here.
Compare the arterial waveform morphology of a radial artery line to an aortic root measurement. What changes occur as the pressure wave moves peripherally?
Show answer →As the wave moves peripherally (distal to the heart), the systolic upstroke becomes steeper, the systolic peak becomes higher (increased SBP), the dicrotic notch occurs later and becomes less prominent, and the diastolic pressure decreases. This is due to wave reflection and decreased arterial compliance. MAP stays consistent. NBCRNA Tip: Distal sites have a wider pulse pressure than the aortic root.
A patient on mechanical ventilation (TV 8 mL/kg, SR) shows a Pulse Pressure Variation (PPV) of 15%. What is the physiological significance of this finding, and what conditions would make this parameter unreliable?
Show answer →PPV >12-13% suggests the patient is **fluid responsive** (preload dependent). Unreliable in: Spontaneous breathing, arrhythmias (AFib), low tidal volumes (<8 mL/kg), open chest (thoracotomy), or high heart rate to respiratory rate ratios. NBCRNA Tip: PPV reflects the heart-lung interaction on the Frank-Starling curve. It is a dynamic predictor of fluid responsiveness, superior to CVP.
A patient develops sudden tachycardia and rising EtCO2 (65 mmHg) despite hyperventilation during a laparoscopic cholecystectomy with Sevoflurane. What is the immediate first step in management according to 2026 MHAUS guidelines?
Show answer →The immediate first step is to discontinue the triggering agent (volatile anesthetics/succinylcholine) and hyperventilate with 100% O2 at 10+ L/min. Do NOT waste time changing the circuit or CO2 absorbent. Call for help and the MH cart. Exam Strategy: NBCRNA often tests the first action. While Dantrolene is the definitive treatment, stopping the trigger and hyperventilation are the immediate priorities. If Call for help is an option, it is often prioritized simultaneously. Use charcoal filters if available to rapidly clear residual gas.
When preparing Ryanodex (dantrolene sodium) for an MH crisis, how does the reconstitution process and dosing differ from traditional Dantrium or Revonto?
Show answer →Ryanodex is a nanocrystalline formulation. Each vial contains 250 mg and is reconstituted with only 5 mL of sterile water (compared to 20 mg/60 mL for Dantrium). The initial dose remains 2.5 mg/kg. Exam Strategy: NBCRNA emphasizes the speed of administration. Ryanodex allows for a full loading dose in one syringe within seconds. Note that Ryanodex still contains mannitol (125 mg per 250 mg vial), but significantly less than traditional formulations, which may affect diuretic expectations.
A patient experiences isolated masseter muscle rigidity (MMR) following succinylcholine administration. What is the current standard for clinical management and decision-making regarding the continuation of surgery?
Show answer →MMR is a powerful predictor of MH susceptibility (up to 30-50%). If MMR is tight (jaws of steel), the most conservative approach is to stop the procedure, especially for elective cases. If surgery must continue, switch to non-triggering agents and monitor EtCO2, HR, and temp closely. Clinical Pearl: Check CK levels and urine for myoglobin for 24 hours. If EtCO2 rises or metabolic acidosis develops, treat as MH immediately. NBCRNA focuses on the high association between MMR and MH.
During an MH crisis, the patient’s potassium is 6.8 mEq/L. Which class of medications is STRICTLY contraindicated for treating hyperkalemia or arrhythmias in this scenario?
Show answer →Calcium Channel Blockers (CCBs), such as verapamil or diltiazem, are strictly contraindicated when Dantrolene is administered. Rationale: Concomitant use of CCBs and Dantrolene can lead to life-threatening hyperkalemia and profound myocardial depression/cardiovascular collapse. Exam Tip: To treat MH-induced hyperkalemia, use Calcium Chloride (10 mg/kg), Insulin (0.1 units/kg) with D50 (0.5 g/kg), and sodium bicarbonate (1-2 mEq/kg). Albuterol can also be used. Bicarbonate is also essential to treat the underlying metabolic acidosis.
A patient undergoing a carotid endarterectomy experiences sudden hypertension. You choose Esmolol for its rapid onset and short duration. What is the specific metabolic pathway of Esmolol, and how does this affect its clinical use in patients with renal or hepatic impairment?
Show answer →Esmolol is metabolized via hydrolysis by red blood cell (RBC) cytosol esterases, NOT by plasma cholinesterase or organ-based enzymes. Rationale: Because it does not rely on the liver or kidneys for clearance, its half-life (approx. 9 minutes) remains consistent even in patients with hepatic or renal failure. Exam Strategy: NBCRNA frequently tests the RBC esterase metabolism to distinguish Esmolol from Succinylcholine/Remifentanil. Distractor: Do not confuse RBC esterases with pseudocholinesterase (butyrylcholinesterase).
During a craniotomy, Clevidipine (Cleviprex) is titrated to manage hypertension. What are the critical contraindications related to its formulation, and why must the infusion tubing be changed every 12 hours?
Show answer →Clevidipine is an ultra-short-acting dihydropyridine CCB formulated in a 20% lipid emulsion. Contraindications: Severe egg or soy allergies and disorders of lipid metabolism (e.g., hypertriglyceridemia). Rationale: The lipid emulsion supports rapid bacterial growth; thus, the strict 12-hour tubing change is a safety standard. Clinical Pearl: It is metabolized by non-specific tissue esterases, making its 1-minute half-life independent of organ function.
Labetalol is frequently used for intraoperative BP control. Compare its Alpha-1 to Beta blockade ratios for both IV and Oral administration. Why is the IV ratio preferred for acute hypertensive emergencies?
Show answer →IV Labetalol has an Alpha-1 to Beta blockade ratio of 1:7, while the Oral ratio is 1:3. Rationale: The higher Beta-to-Alpha ratio in the IV form allows for significant reduction in SVR (via Alpha-1 block) without the reflex tachycardia typically seen with pure vasodilators, as the potent Beta-blockade maintains a stable heart rate. Exam Tip: Remember 1:7 IV as a high-yield ratio. NBCRNA often asks about the reflex tachycardia prevention mechanism of Labetalol compared to Hydralazine.
An intubated patient's peak inspiratory pressure (PIP) rises from 20 to 35 cmH2O, but the plateau pressure (Pplat) remains at 15 cmH2O. What is the most likely cause?
Show answer →This indicates an increase in airway resistance, not a decrease in lung compliance. Equation: Resistance = (PIP - Pplat) / Flow. Common causes include ETT kinking, secretions, bronchospasm, or a small-diameter ETT. If Pplat had risen alongside PIP, it would suggest decreased compliance (e.g., pneumothorax, pulmonary edema, or Trendelenburg position). Exam Tip: NBCRNA often tests the PIP-Pplat delta to differentiate resistance from compliance issues. Clinical Pearl: Always suction and check the circuit first when PIP rises in isolation.
A 75-year-old obese patient is undergoing surgery in the supine position. Why is this patient at high risk for intraoperative hypoxemia regarding Closing Capacity (CC) and Functional Residual Capacity (FRC)?
Show answer →Hypoxemia occurs when CC exceeds FRC, leading to airway closure during normal tidal breathing (shunting). FRC decreases with general anesthesia, obesity, and the supine position. CC increases with age (CC = FRC at age 66 upright; age 44 supine). In this patient, the safety margin (FRC minus CC) is likely negative. Clinical Pearl: Use PEEP to increase FRC and maintain it above CC to prevent atelectasis. NBCRNA Distractor: They may suggest CC decreases with age, but it actually increases due to loss of elastic recoil.
According to Poiseuille's Law, if the internal diameter of an endotracheal tube is reduced by half due to secretions, by what factor does the resistance to gas flow increase?
Show answer →Resistance increases by a factor of 16. Poiseuille's Law states that resistance is inversely proportional to the radius to the fourth power (R ∝ 1/r^4). Halving the radius (1/2)^4 = 1/16; thus, resistance increases 16-fold. Clinical Application: This is why even small amounts of secretions or using a 6.0 vs 8.0 ETT significantly increases the work of breathing, especially in spontaneously breathing patients. Exam Tip: Remember the 4th power relationship for laminar flow; for turbulent flow, it is the 5th power.
According to the ACC/AHA stages of heart failure, how is a patient with a history of a myocardial infarction and a resulting EF of 35%, but who is currently asymptomatic, classified?
Show answer →This patient is ACC/AHA Stage B. Stage B represents structural heart disease (e.g., reduced EF, chamber enlargement, or valvular disease) without current or previous symptoms of heart failure. Exam Strategy: NBCRNA often tests the distinction between Stage B and Stage C. Stage C requires structural disease PLUS current or previous symptoms. Once a patient is Stage C, they never revert to Stage B, even if symptoms resolve (this is known as HF in remission). NYHA classes (I-IV) describe functional status and can fluctuate, whereas ACC/AHA stages only progress forward.
Compare the cellular-level structural remodeling seen in Heart Failure with reduced Ejection Fraction (HFrEF) versus Heart Failure with preserved Ejection Fraction (HFpEF).
Show answer →HFrEF is characterized by eccentric hypertrophy. Sarcomeres are added in series, leading to ventricular dilation, increased radius, and wall thinning (often due to volume overload or MI). HFpEF is characterized by concentric hypertrophy. Sarcomeres are added in parallel, leading to increased wall thickness and reduced chamber volume (often due to chronic hypertension or aortic stenosis). Exam Tip: Remember the Law of Laplace (Tension = [P x r] / 2h). In HFrEF, the increased radius (r) and decreased thickness (h) significantly increase wall tension and myocardial oxygen demand (MVO2). In HFpEF, the increased thickness (h) is a compensatory mechanism to normalize wall tension despite high pressures (P).
A student CRNA accidentally fills a Sevoflurane (VP 157) vaporizer with Isoflurane (VP 238). What is the expected effect on the delivered concentration of anesthetic gas to the patient, and why?
Show answer →The patient will receive a HIGHER concentration than the dial indicates. This follows the HLH rule (High vapor pressure agent in a Low vapor pressure vaporizer). Because Isoflurane is more volatile (higher VP) than Sevoflurane, the carrier gas passing through the vapor chamber will pick up more molecules than the vaporizer's splitting ratio was designed for. Exam Strategy: Memory aid HLH (High in Low = High) and LHL (Low in High = Low). NBCRNA frequently tests the safety implications of misfilling. Note that modern keyed fillers make this difficult, but the physics remains a high-yield topic. If the agents were reversed (Sevo in Iso), the output would be lower than dialed.
An anesthesia provider is practicing at a high-altitude facility (Barometric pressure 500 mmHg) using a Tec 6 Desflurane vaporizer. If the dial is set to 6%, how does the delivered partial pressure compare to sea level?
Show answer →The partial pressure will be LOWER than at sea level, potentially resulting in under-anesthesia. The Tec 6 is a dual-circuit gas blender that maintains a constant concentration (Vol%), not a constant partial pressure. Since P_gas = Vol% x P_total, and P_total (ambient pressure) is lower at altitude, the P_desflurane will be lower (6% of 500 = 30 mmHg vs 6% of 760 = 45.6 mmHg). Clinical Pearl: To maintain the same depth of anesthesia at altitude with Desflurane, you must increase the dial setting: (Required Dial = Normal Dial * 760 / Local Barometric Pressure). Note: Variable bypass vaporizers (Iso/Sevo) automatically compensate for altitude changes because they deliver a near-constant partial pressure.
Pulse oximetry relies on the Beer-Lambert law and the use of two specific wavelengths of light. Which wavelengths are utilized, and which hemoglobin species predominantly absorbs each?
Show answer →Pulse oximetry uses 660 nm (Red light) and 940 nm (Infrared light). Deoxyhemoglobin (reduced Hb) absorbs more light at 660 nm, while Oxyhemoglobin (O2Hb) absorbs more at 940 nm. The pulse oximeter measures the ratio of pulsatile (AC) to non-pulsatile (DC) light absorption at both wavelengths to calculate the R-value. Exam Strategy: NBCRNA frequently tests these specific numbers. Remember: Red = 660 (Deoxy), Infrared = 940 (Oxy). A shift in the ratio changes the calculated saturation based on pre-programmed calibration curves derived from healthy volunteers.
During manual ventilation, an SRNA squeezes the reservoir bag to deliver a breath to the patient. Which gas law explains the relationship between the decreasing volume of the bag and the resulting increase in pressure directed toward the patient?
Show answer →Boyle's Law (P1V1 = P2V2). This law states that at a constant temperature, the pressure of a given mass of an ideal gas is inversely proportional to its volume. Clinical Applications: 1. Squeezing the reservoir bag. 2. Spontaneous breathing: Diaphragm contraction increases thoracic volume, which decreases intrapulmonary pressure, causing air to flow in. 3. Measurement of functional residual capacity (FRC) via body plethysmography. NBCRNA Exam Tip: Boyle's Law is the only inverse relationship among the three primary laws. Remember: Boyle's = Bag/Bellows/Breathing. Common distractor: Charles's Law, which involves temperature and volume.
17–20 correct
Strong. Move to the hardest material and timed drilling rather than re-reading topics you already know.
12–16 correct
A normal mid-prep score. Work the topics you missed one at a time — the topic pages below are built for exactly that.
Under 12 correct
Early days. Go topic by topic instead of taking more mixed tests: pick your weakest area below and drill it until the questions feel routine.
Procedures questions
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Management questions
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Pharmacology questions
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Physiology questions
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Pathology questions
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Equipment questions
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Diagnostics questions
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