Certified Registered Nurse Anesthetist (CRNA)

Nurse anesthetists have roots that go as far back as the 1860s when they administered anesthesia to wounded soldiers during the Civil War. A Certified Registered Nurse Anesthetist (CRNA) has the very important role of providing anesthesia to a patient about to undergo surgery. Certification for the occupation of nurse anesthetist has been a requirement since 1945. To practice as a nurse anesthetist anywhere in the United States, passing the CRNA national examination is compulsory.

In order to be eligible to take the national certification examination and to become a Certified Registered Nurse Anesthetist (CRNA), a candidate must:

  • Have a current and unrestricted license as a professional Registered Nurse (RN).
  • Complete a nurse anesthesia educational program accredited by the Council on Accreditation of
  • Nurse Anesthesia Educational Programs within two years of taking the examination.
  • Submit an examination application form.
  • Submit an official transcript of performance in an accredited nurse anesthesia educational program.
  • Submit a digitalized photo, taken within six months of the examination date, along with a signed authentication of the applicant’s identity form.
  • Never have had a license revoked, restricted, suspended, or limited by any state. The license must never have been surrendered and it cannot be the subject of a pending action or investigation.
  • Not currently suffering from a mental or physical condition that might interfere with the practice of nurse anesthesia.
  • Not currently suffering from drug or alcohol addiction or abuse.
  • Never convicted of or currently under indictment for any felony.
  • Never been the subject of any documented allegations of misconduct, incompetent practice, or unethical behavior.
  • Never been the subject of a disciplinary action, has never been placed on probation, suspended, or dismissed from a nurse anesthesia educational program for unethical behavior, questions of academic integrity, or documented evidence of cheating.
  • Sign a waiver of liability and agreement of authorization, confidentiality, and nondisclosure statement.
  • An outline of content that is covered on the examination is detailed below:

Basic sciences: 25 percent

Anatomy, physiology, and pathophysiology

• Cardiovascular
• Respiratory
• Central nervous system
• Musculoskeletal
• Endocrine
• Renal
• Hematologic
• Gastrointestinal
• Immune

Pharmacology

• General principles
• Inhalation anesthetics
• Intravenous agents
• Local anesthetics
• Muscle relaxants
• Antagonists
• Neuraxial analgesics
• Anticholinergics and cholinergic agonists
• Cyclooxygenase inhibitors
• Sympathomimetics
• Digitalis and related drugs
• Alpha and beta receptor antagonists
• Antihypertensives
• Antidysrhythmics
• Calcium channel blockers
• Bronchodilators
• Psychopharmacologic therapy
• Prostaglandins
• Histamine receptor antagonists
• Serotonin antagonists
• Insulin
• Oral hypoglycemics
• Diuretics
• Antacids
• Gastrointestinal prokinetic medications
• Anticoagulants
• Antimicrobials
• Chemotherapeutics
• Antiepileptic drugs
• Antiparkinsonian drugs
• Drugs used to treat lipid disorders
• Herbal remedies and dietary supplements
• Minerals and electrolytes
• Dantrolene
• Corticosteroids
• Tocolytics
• Uterotonics

Equipment, instrumentation, and technology: 10 percent

Anesthetic delivery systems

• High and low pressure gas sources
• Regulators and manifolds
• Flow meters, valves, and floats
• Vaporizers
• Proportioning systems
• Pressure failure safety devices
• Fail-safe devices
• Ventilators
• Carbon dioxide absorbents
• Anesthetic circuits
• Pneumatic and electronic alarm devices

Airway devices

• Face masks
• Laryngoscope
• Endotracheal tube
• Endobronchial tube
• Airways
• Tracheostomy tubes
• Laryngeal mask airway
• Intubating laryngeal mask airway
• Jet ventilation
• Lighted stylet

Monitoring devices

• Central nervous system
• Cardiovascular
• Pulmonary and airway monitoring
• Peripheral nerve stimulator
• Urinary output monitoring
• Temperature monitoring
• Maternal and fetal monitoring devices

Basic principles of anesthesia: 30 percent
(Preoperative assessment and patient preparation, and post-anesthesia care and respiratory therapy)

Fluid and blood replacement

• Fluid therapy
• Hemotherapy

Positioning

• Prone
• Supine
• Lithotomy
• Lateral
• Sitting
• Beach chair
• Trendelenburg
• Reverse trendelenburg

Interpretation of data

• Lab tests
• Diagnostic data
• Intraoperative monitoring data

Airway management

• Mask
• Intubation
• Cricothyrotomy
• Fiber-optics

Local and regional anesthesia

• Infiltration
• Topical
• Regional blocks

Post-operative pain management

• Epidural analgesia
• Infiltration nerve blocks
• Intrathecal narcotics
• PCA management
• Epidural steroids

Advanced principles of anesthesia: 30 percent

Surgical procedures and procedures related to organ systems

• Intra-abdominal
• Extrathoracic
• Extremities
• Genital and urologic
• Head
• Intrathoracic
• Neck
• Neuroskeletal
• Vascular
• Diagnostic and therapeutic

Pediatrics
• Anatomy, physiology, and pathophysiology
• Pharmacology
• Anesthesia techniques and procedures

Obstetrics
• Anatomy, physiology, and pathophysiology
• Pharmacology
• Anesthesia techniques and procedures

Geriatrics
• Anatomy, physiology, and pathophysiology
• Pharmacology
• Anesthesia techniques and procedures

Obesity
• Anatomy, physiology, and pathophysiology
• Pharmacology
• Anesthesia techniques and procedures

Chronic pain management
• Anatomy, physiology, and pathophysiology
• Pharmacology
• Anesthesia techniques and procedures

Professional issues: 5 percent
• Legal
• Research and quality improvement
• Professional practice standards
• Patient safety

CRNA Practice Questions

1. A patient has been on long-term management for CHF. Which of the following drugs is a loop diuretic that could be used to treat CHF symptoms?

A. Ciprofloxacin
B. Lepirudin
C. Naproxen
D. Bumetanide

2. A nurse anesthetist is reviewing a patient’s medication. Which of the following is considered a potassium-sparing diuretic?

A. Esidrix
B. Lasix
C. Aldactone
D. Edecrin

3. A patient’s chart indicates the patient is suffering from digoxin toxicity. Which of the following clinical signs is not associated with digoxin toxicity?

A. Ventricular bigeminy
B. Anorexia
C. Normal ventricular rhythm
D. Nausea

4. A patient has recently been diagnosed with hyponatremia. Which of the following is not associated with hyponatremia?

A. Muscle twitching
B. Anxiety
C. Cyanosis
D. Sticky mucous membranes

5. Which of the following blood therapeutic concentrations is abnormal?

A. Phenobarbital, 10 to 40 mcg/mL
B. Lithium, 4.2 to 9.7 mcg/mL
C. Digoxin, 0.3 to 0.6 ng/mL
D. Valproic acid, 40 to 100 mcg/mL

Answers

1. D: Bumex is a loop diuretic for long-term treatment of CHF.

2. C: Aldactone is a potassium-sparing diuretic.

3. C: Normal sinus rhythm is not usually noted when a client is digoxin toxic.

4. A: Muscle twitching is most often noted with hypernatremia.

5. C: The digoxin level should be between 0.7 and 22 ng/mL. All other listed ranges are accurate.

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