CRNA Interview Questions

Interpret an EKG strip and tell us what you would do for the patient - Third degree block

-AKA complete heart block -Typically have a very slow heart rate -Atropine (short term) & pacemaker

Interpret an EKG strip and tell us what you would do for the patient - First degree block

-Abnormally slow conduction through the AV node -Prolonged PR -For the majority of patients with first-degree AV block, there is no need for treatment.

What is your experience in the ICU?

-Almost 5 years in the PICU - I have worked at both Texas Childrens Main Campus and The Woodlands. I am proud to say I helped to prepare and open the brand new Woodlands campus. It was a unique experience. -1.5 years in the adult ICU, many of which were spent in COVID ICU. -Staff & traveler -Level one trauma & community settings

Interpret an EKG strip and tell us what you would do for the patient - Atrial Flutter

-Amiodarone bolus 150 mg -> -Amiodarone 1 mg/min x 6 hours -> -Amiodarone .5 mg/min x 18 hours -Antiarrhythmic: Digoxin, Pacerone, -Anticoagulants ie: Lovenox, Warfarin, Eliquis -Catheter ablation -Cardioversion

Interpret an EKG strip and tell us what you would do for the patient - Sinus Brady

-Asymptomatic: No treatment required, correct cause ie: hypothermia -Symptomatic: Atropine .5 mg Q3-5 mins up to 3 mg, pacemaker

What coronary is affected in an anterior lateral MI?

**Left anterior descending coronary artery (LAD)** -Also known as anterior wall MI, or AWMI, or anterior ST segment elevation MI, or anterior STEMI -Occurs when anterior myocardial tissue usually supplied by the left anterior descending coronary artery suffers injury due to lack of blood supply. -Poorest prognosis

Tell us about a critical patient you had and the pathophysiology behind their disease.

Urosepsis -> Septic Shock -> ARDS -> HFOV

Interpret an EKG strip and tell us what you would do for the patient - Bundle branch block

-Bundle branch block might not need treatment. When it does, treatment involves managing the underlying health condition, such as heart disease, that caused bundle branch block -Pacemaker if issues with fainting

Interpret an EKG strip and tell us what you would do for the patient - Ventricular Tachycardia

-Causes: Abnormalities of the heart that result in scarring of heart tissue (MI), CAD, congenital heart conditions, electrolyte imbalance, drugs -Treatment w/ pulse: Synchronized cardioversion 100J if unstable, Amiodarone -Treatment if pulseless: CPR, Epinephrine, defibrillation

Interpret an EKG strip and tell us what you would do for the patient - Premature Junctional Contractions

-Causes: Heart failure, dig toxicity, MI -Inverted or absent p wave -Treatment: Underlying disorder

Interpret an EKG strip and tell us what you would do for the patient - PVCs

-Causes: Stimulants, heart disease -Premature and bizarrely shaped QRS complexes that are unusually long & wide. Not preceded by a P wave, T wave is usually large and oriented in a direction opposite the major deflection of the QRS. -Treatment: Mostly benign and don't require treatment. If frequent, reduce stimulants/triggers, beta blockers, catheter ablation

Interpret an EKG strip and tell us what you would do for the patient - PACS

-Causes: Stress, stimulants, cardiac disease, dig toxicity, abnormal electrolytes -Treatment: Mostly benign and don't require treatment, reduce stimulants or triggering factors, rule out underlying heart disease

Describe a difficult patient and what you did for them.

-Clinically - Sepsis, ARDS, HFOV -Socially - Logan's parents

How can you lower ICP?

-Elevate HOB -Hyperventilate - to cause vasoconstriction -Mannitol 0.25-1g/kg (elevates blood plasma osmolality, resulting in enhanced flow of water from tissues into interstitial fluid and plasma) -Hypertonic saline -Restrict fluids -Therapeutic hypothermia, prevent shivering -Avoid fevers (increased metabolic demand & vasodilation) -Maintain normotension -Treat pain, anxiety & seizures -Sedate -Craniectomy

What do you know about our program?

-First program in Texas to offer the BSN-DNP program -112 credits/9 semesters/36 months -100 percent of 2021 BSN-DNP nurse anesthesia program graduates passed the NCE on the first attempt. -9/10 graduating classes have achieved 100-percent pass rates on the first attempt of the NCE -The NCE first-time test-taker pass rate for the most recent five-year composite was 99.12 percent. -For the most recent graduating cohort, 100 percent of UTHealth nurse anesthesia graduates were employed as nurse anesthetists within six months of program completion. -Class size is small - about 20 people. -I have spoken to alumni and current students who have expressed how supportive the faculty is and how grateful they are for having chosen/been accepted here. These are all things that are highly attractive to me when choosing a program.

What are the interventions for cardiogenic shock?

-Fluids -Vasopressors (Dopamine) -Inotropes (Dobutamine, Milrinone for heart failure) -IABP, ECMO

Why this program over others?

-Home & Support -Alumni -Cost -Class size

Interpret an EKG strip and tell us what you would do for the patient - Second degree block type 2 (Mobitz II)

-If some p's just don't get through, then you have a Mobitz II -can rapidly progress to complete heart block so needs immediate treatment -Treatment: transcutaneous pacing, transvenous pacing

Interpret an EKG strip and tell us what you would do for the patient - Second degree block type 1 (Wenckebach)

-Longer, longer, longer, drop - then you have a Wenckebach -Generally asymptomatic and doesn't require treatment

Why should we pick you over the other candidates?

-My wide range of experience will help me to be successful both in school and on the job - I have worked with adults, with kids, and in settings ranging from level 1 trauma centers to small, community hospitals. As a SRNA and CRNA we will likely be spending time in multiple, if not all of these settings and I feel more than adequately prepared and comfortable in all of them. -I have developed excellent leadership skills through my experience as a team leader and charge nurse at Texas Children's, while also remaining humble and novice frequently as I traveled to different assignments. I think this will help me tremendously in the transition back to being a student as I am not afraid to ask questions, receive feedback and remain open to learning while in school, but I also possess the traits of a leader that will help me to be successful once I graduate and am actively working in the field. -As a traveler I have seen and worked with a wide range of equipment, a variety of personality types, and have learned to rapidly adjust to new environments, adapt new policies and procedures, and just to be flexible overall which will certainly be helpful in clinical.

Your ventilator is peak pressure alarming. What could be the problem?

-Normal plateau pressure - Kink in tubing, patient biting tube, mucous plug, bronchospasm, ETT too small -If high plateau pressure - there is an issue with lung compliance ie: developing PNA, pulmonary edema, auto PEEP, pneumothorax, right main stem, ARDS, ILD

What kind of patients and drips do you take care of?

-Patient population: Respiratory failure (adults and peds), ARDS, SIDS, s/p cardiac arrest, overdose, complex care -Pressors/Cardiac: Epi, Norepi (Levo), Vaso, Dopamine, Dobutamine, Milrinone -Sedation: Fentanyl, Versed, Precedex, Propofol, Ketamine

How do you think others see you?

-Personally, I think other people would describe me as being empathetic, patient and loyal. -Professionally, I think they would describe me as being reliable, dedicated, a good teammate and resource for others.

What is the difference between CRNA and MDA?

-Schooling: MDA is a licensed medical doctor with 12 years of schooling, CRNA requires 6-7 years of schooling -In most states, nurse anesthetists cannot administer anesthesia without the supervision of a board certified doctor (19 states removed - Texas still requires) -Similar job roles & responsibilities -Rural areas more commonly have CRNAs, hospitals have both

What does a CRNA do?

-Start with a physical assessment and review of history which will then help to make a unique, personalized plan for anesthesia. Establish rapport with their patients prior to surgery and educate them and their families extensively on risks, benefits, side effects, etc. -In surgery, they are responsible for the initial anesthetic administration/management of hemodynamics continual assessment and communication with providers. -They perform line placement, intubation, spinal/regional nerve blocks/epidural administration, and many other invasive procedures. -In the event of an emergency, they respond with medication, airway management, and life support techniques. They must remain calm, and display leadership at all times. -At the conclusion of surgery, they are responsible for evaluating the safety of lifting sedation and extubating the patient if relevant, and maintaining patient safety through to the PACU setting.

Discuss the role of the sympathetic nervous system.

-Subdivision of the autonomic nervous system - "fight or flight" -Involved in preparing the body for stress-related activities, slows bodily processes that are less important in emergencies such as digestion -Patho: The amygdala will send a distress signal to the hypothalamus. Impulses are then transmitted through the SNS to the adrenal glands, which then pumps adrenaline into the blood stream. -Increase heart rate, Dilation of the pupil, Secretion of sweat glands, Increased alertness, Slowing down or stopping digestion, Relaxation of the bladder -There are two types of neurons within the sympathetic nervous system: the preganglionic neurons (originate in brain and spinal cord) and the postganglionic neurons (outside spinal cords), or ganglion cells. -Neurotransmitters involved: Acetylcholine, Epi, Norepi

Discuss the role of the parasympathetic nervous system.

-Subdivision of the autonomic nervous system - "rest and digest" - keeps the basic functions of your body working as they should. -PSNS starts in your brain and extends out via long fibers that connect with special neurons near the organ they intend to act on -Constricts pupils, causes salivation, slows down the heart rate, tightens the bronchi in the lungs, enacts digestion, releases bile, makes the bladder contract

Describe the techniques you have used to manage a patient airway or pulmonary status.

-Suctioning -Oral airway -Neck roll -Intubation

How does IABP work?

-The IABP consists of a thin, flexible tube called a catheter. Attached to the tip of the catheter is a long balloon. The other end of the catheter attaches to a computer console which has a mechanism for inflating and deflating the balloon at the proper time when your heart beats. -An IABP allows blood to flow more easily into your coronary arteries. It also helps your heart pump more blood with each contraction. -How it works: 1. Deflated in systole (heart contracts) so blood can be ejected with less resistance & also has a vacuum effect pulling blood forward 2. In diastole, balloon inflates & pushes blood back towards coronary arteries, improving perfusion -Indications: MI, CHF, defects, arrhythmia, myocarditis

Do you understand "opt out"?

-The federal requirement has been that CRNAs must be supervised by a physician. The November 13, 2001 rule allows states to "opt-out" or be "exempted" from the federal supervision requirement. -For a state to "opt-out" of the federal supervision requirement, the state's governor must send a letter of attestation to CMS. The letter must attest that: 1. The state's governor has consulted with the state's boards of medicine and nursing about issues related to access to and the quality of anesthesia services in the state; and 2. That it is in the best interests of the state's citizens to opt-out of the current federal physician supervision requirement; and 3. That the opt-out is consistent with state law.

Interpret an EKG strip and tell us what you would do for the patient - Atrial Fibrillation

-The signals in the upper chambers of your heart are chaotic. As a result, they quiver. -Causes: HTN, MI, CAD, heart defects, stimulants -A fib RVR treatments: -Diltiazem 0.25 mg/kg IVP 1st dose, 0.35 mg/kg 2nd dose -Diltiazem 5-15 mg/hr -Metoprolol -Amiodarone 150 mg bolus -Amiodarone gtt t 1 mg/minute x6 hours, followed by 0.5 mg/minute x18 hrs -Transition to oral meds -Blood thinners

What are your two most important achievements as a nurse?

-Transitioning into PICU -Transitioning into adult ICU

What's a TIPS

-Transjugular intrahepatic portosystemic shunt (TIPS) -Used to treat portal vein hypertension and other complications of advanced liver disease -Stent to keep the channel between the portal and hepatic veins open -Blood flow from the digestive system organs will flow through the stent and into the hepatic veins, reducing the pressure in the portal vein.

Diagnose an ABG strip and tell us how you'd treat the patient - Metabolic Alkalosis

-Uncompensated: HIGH ph, HIGH bicarb, NORMAL pco2 -Partially Compensated: ALL HIGH -Compensated: NORMAL ph, HIGH bicarb, HIGH pco2 -Causes: Excess of bicarb (a base) in the body; medications (diuretics, laxatives, steroids, antacids), vomiting, dehydration, electrolyte imbalances -Treatment: IVF, electrolyte repletion, stop medications involved (antacid, diuretic)

Diagnose an ABG strip and tell us how you'd treat the patient - Respiratory Alkalosis

-Uncompensated: HIGH ph, LOW pco2, NORMAL hco3 -Partially Compensated: HIGH ph, LOW pco2, LOW hco3 -Compensated: NORMAL ph, LOW pco2, LOW hco3 -Causes: Excessive breathing r/t anxiety, pain, fever, trauma, PE -Treatment: Correct cause, breathe into paper bag, treat anxiety, fever, etc

Diagnose an ABG strip and tell us how you'd treat the patient - Respiratory Acidosis

-Uncompensated: LOW ph, HIGH, pco2, NORMAL hco3 -Partially Compensated: lOW ph, HIGH pco3, HIGH hco3 -Compensated: NORMAL ph, HIGH pco2, HIGH hco3 -Causes: Depressed respirations - airway disease (asthma, COPD), overdose, OSA, neuromuscular disease -Treatment: Oxygen, PPV, intubation, bronchodilators

Diagnose an ABG strip and tell us how you'd treat the patient - Metabolic Acidosis

-Uncompensated: LOW ph, LOW bicarb, NORMAL pco2 -Partially compensated: ALL LOW -Compensated: NORMAL ph, LOW bicarb, LOW pco2 -Causes: DKA, kidney disease, diarrhea, dehydration, septic shock -Treatment: Treat the cause, sodium bicarb 1-2 meq/kg, fluids

Describe an experience you had with a difficult doctor and how you handled the situation.

-Untreated hypotension ??

What vasoactive and sedative medications do you use?

-Vasoactives: Epi, Norepi (Levo), Vaso, Dopamine, Dobutamine, Milrinone -Sedation: Fentanyl, Versed, Precedex, Propofol, Ketamine

Why do you want to be a CRNA?

-Want to further my education -more independence and autonomy -more direct, involved role in my patients plan of care and outcome. -I get to take some of my favorite things about what I do now (sedation, titrating gtts, managing airways hemodynamics, intense monitoring) and do them on a larger, more involved scale, while doing less of things that I am ready to move on from (juggling multiple patients, multiple families, ADLs, going to the bathroom, etc) -More secure financial future in which I can support my family while continuing to enjoy my hobbies such as traveling.

Tell us about your strengths.

-Working under pressure & critical thinking -Empathy

Your patient needs to be intubated soon. What items do you want at the bedside?

-suction -appropriate-sized bag and mask -oxygen source -appropriate size endotracheal tubes including a size larger and one size smaller -laryngoscope and appropriate-sized laryngoscope blades (including one size smaller and one size larger) -endotracheal tube-securing equipment (tape or other) -stylet -syringe -pillow, blanket roll -stethoscope -IVF, pressure bag -pressors depending on status -sedation -appropriate sized nasogastric tubes -x-ray on standby

Minute Ventilation

-the amount of air a person breaths in a minute. The minute ventilation is calculated by the multiplication of the tidal volume and the respiratory rate. -Tidal volume (8-10 ml/kg) x RR (10-20) -To increase -> increase RR or TV -Normal MV is 6-8L min

Interpret an EKG strip and tell us what you would do for the patient - SVT

1. Vagal maneuvers (if stable) 2. Adenosine (6 mg then 12 mg or .1mg/kg then .2 mg/kg pediatrics) 3. Synchronized Cardioversion (50J then 100J for adults, 1J/kg then 2J/kg peds) 4. Catheter ablation for long term therapy (uses cold or heat energy to create tiny scars in your heart to block abnormal electrical signals) *HR > 220 in infants, >180 in children, >150 in adults*

Alveolar Ventilation

AV = (TV-dead space) * RR -the volume of air entering and leaving the alveoli per minute; dead space is not included -measured in ml/min -higher alveolar ventilation -> higher concentration of oxygen & lower concentration of carbon dioxide within alveoli. -lower alveolar ventilation - > lower concentration of oxygen & higher concentration of carbon dioxide within the alveolus

Are you prepared to be a novice again?

Absolutely. I am novice every time I walk into a new travel assignment. Not in the same capacity, I obviously have the knowledge I need, but I am very much back to the beginning on learning my coworkers, my unit, where supplies are, policies and procedures, how things work. I am very used to asking for help when needed and I would be lying if I said I didn't learn something new at each place I have been to, so I am extremely open and eager to be educated.

In pre-op, a patient says they want an anesthesiologist, not a nurse. What would you do?

Ask patient to discuss their concerns and address any questions they may have. Offer reassurance by informing them of time spent in schooling and training as well as degrees held, and educating them on requirements that CRNA's are supervised by physicians in the state of Texas. Attempt to alleviate any concerns with an open, informative conversation but ultimately, respect the patients wishes.

A doctor tells you to give a medication you don't feel is beneficial. What would you do?

Ask to have a discussion about the reasoning, purpose or benefit behind giving the medication. Have open communication about my concerns or questions. Ultimately, if uncomfortable moving forward, request that the MD administer the medication themselves to protect my license.

Interpret an EKG strip and tell us what you would do for the patient - Ventricular Fibrillation

CPR, Epi (1mg adults, .01 mg/kg peds), defibrillation (120-200J adults, 2-4J/kg peds)

Interpret an EKG strip and tell us what you would do for the patient - Asystole

CPR, Epi (1mg adults, .01 mg/kg peds), defibrillation if achieve shockable rhythm (120-200J adults, 2-4J/kg peds)

Interpret an EKG strip and tell us what you would do for the patient - Sinus Arrhythmia

Common, typically doesn't require treatment

Functional group identification - Alkane

Contain ONLY C & H Contain ONLY single bonds

Functional group identification - Alkene

Contain ONLY C & H Contain at least one double bond

Functional group identification - Alkyne

Contain ONLY C & H Contain at least one triple bond

Functional group identification - Alcohol

Contains an alcohol (OH) bonded to a single bonded carbon atom

Propofol

Enhances the effects of GABA on GABAa receptors by increasing the duration that Cl ion channels are open -> hyperpolarization 2-3.5 mg/kg IVP 5-50 mcg/kg/min

What clotting factors does the liver make?

Fibrinogen, Prothrombin, factor V, VII, IX, X, XI, XII, as well as protein C and S, antithrombin, factor VIII and von Willebrand factor

What will you do if you are not accepted?

First, I would follow up to see if there was anything that you guys could tell me that I could improve on for future applications. Second, I would continue to do travel nursing for the next year to continue saving for school. I would also spend that year learning and growing in my field, obtaining certifications, and gaining experience. Lastly, I would apply again to multiple schools on the next round of admissions.

Give us an example of when you made a mistake.

Following an emergent intubation, I wasted medications at the bedside with my charge nurse. However, in the midst of the chaos and with all of the tasks that kept coming my way, I failed to waste my medications in the omnicell. It was one of those things where you go home after a long day, but something is nagging at you in the back of your head and you keep wondering what did I miss, what did I miss? Then it hit me. I handled it proactively. I texted the nurse I wasted with to let her know that we had forgotten to waste in the omnicell, and I texted my manager who gave pharmacy a heads up as well. When I returned to work the next day, I wasted in the omnicell with the same nurse from the day before, and filled out a discrepancy form for the pharmacy. Thankfully I had wasted the medications at bedside so I had a witness and there was no question about diversion, but it was definitely an unnecessary headache that had made me extremely attentive to my wastes now.

Tell me about yourself.

I am a Pediatric Intensive Care and Adult Intensive Care nurse. This is a field I've wanted to be in as long as I can remember, and was sparked by watching my mom become a nurse when I was young. I started doing health classes and clinical rotations in high school, and went straight for nursing school once I graduated. I started out on a Medical Surgical floor, and jumped at the first chance I got to enter the Pediatric and even better, PICU world. I started my PICU career at Texas Children's Downtown, and soon after transferred out and helped open up a brand new branch in The Woodlands. I was there on our very first night and witnessed our very first patient admission. While I am still PRN, after a few years I meshed my love for PICU and my love for travel and became a travel nurse. It was one of the scariest and greatest things I have ever done. Once COVID hit, I felt an immense calling to help, and so I dove head first into the adult ICU world where I grew so much more as a nurse and where I finally felt like I had what it took to pursue my dream of becoming a CRNA. I am hoping to gain admittance to a program starting next year and take the next step in my career and professional growth.

How would you handle travel for clinical?

I am very used to traveling, as is my family. Travel would be no issue.

What are your hobbies?

I enjoy spending time with my family and my dogs, and really love getting outdoors whether that be taking a trip to the beach or hiking a mountain. When I have a lot of free time, I love to travel - to see new places, meet new people, try new things.

What leadership experience do you have?

I have experience as a team leader, a charge nurse and a preceptor. I have been a team lead and preceptor at Texas Children's for almost five years, and I have been a charge nurse for three years. I have also precepted some fellow travelers in extenuating circumstances while traveling myself.

How do you deal with stress?

I have learned over the last year that I deal with stress by focusing my energy on things that make me feel happy and at ease. I will spend time with family, my dogs, and get outdoors for a hike or a run. It's important to have an outlet to turn to when you need a break. Sometimes you just need to pause, take a breath, and reset before going back to it.

What are your roles and responsibilities?

I play the role of bedside nurse, charge nurse and team lead. My biggest responsibilities include providing quality patient care, keeping my patients safe, and advocating for my patients.

What do your enemies say about you?

I really make an effort to be cooperative and friendly, so fortunately I don't have many enemies that I know of. If there are any unknown enemies lurking out there, they might say that I am stubborn - I am a passionate advocate for those who need one and don't give up even when I probably should. I stand up for who and what I believe in - even if it rubs someone the wrong way.

How do you handle conflict? Give an example.

I try to handle conflict proactively, but privately. I am a pretty easy going person, so I've not had direct conflict with coworkers or superiors, though I have handled conflict with patients and families as charge nurse. On one occasion, the staff noticed a patients grandmother with passive aggressive behavior towards the staff - they said she was staring at people, giving dirty looks, making rude comments. I handled it proactively but going to her before the situation escalated, and I handled it privately by speaking to her in her room just the two of us. I was able to figure out what and who she was frustrated with, diffuse the situation and suggest a resolution in a way that ensured she felt understood and respected.

If you could be an animal, what would it be and why?

I would be an elephant. They are strong, extremely loyal, very smart and great leaders. Elephants withstand adversity. They usually stay in small groups, but they're extremely loyal to those around them.

What are your career goals?

I would definitely like to work full time as a CRNA obviously, but in addition to that I would like to contribute to teaching and research in some form to give back.

What would you do if a senior threatened you?

I would first try to understand the situation - why the threat was made, what could have happened to cause it. What I did next would depend on the severity and safety of the situation. If the "threat" was something minor and I felt comfortable enough with the senior, I would try to pull them aside for a conversation about what was going on, how I felt about it and what we can do moving forward. However if this was not an option based on the scenario, I would report to my appropriate supervisors and take action recommended from there.

If you could have a job not in the medical field, what would it be?

If money was not an obstacle, I would run a non-profit, non-kill animal shelter. If money were an obstacle, I think I would invest in rental properties, possibly even "flip" properties - I think it would be a really fun project that could ultimately end up providing passive income while I traveled or stayed home with my family.

Tell us about your weaknesses.

My biggest weakness is maintaining a good work-life balance and putting others' needs before my own. When the pandemic hit, I felt a strong calling to serve. I have worked 4-5 days per week for over a year. In addition, I have maintained a PRN job back home out of loyalty. On top of these, I took organic chemistry, studied for the GRE, and always made time for my fiance and our dogs at home.

Who is the greatest influence in your life?

My mom.

If you found a classmate was involved with a preceptor, what would you do?

Inform appropriate superiors within the institution. Boundaries are in place for a reason, and to maintain the integrity of the program and school, they must be respected and followed.

Phenylephrine

MOA: A1 Agonist -> increase in SVR through systemic arterial vasoconstriction. A2 Agonist -> Minimal effects Dosage: 40-100 mcg IVP or 5-20 mcg/kg IVP for hypotension during anesthesia Titrated as a drip from .5-9 mcg/kg/min Uses: Neurogenic shock, hypotension w/ anesthesia Side effect: Reflex bradycardia

Norepinephrine

MOA: A1 agonist -> Vasoconstriction A2 agonist B1 agonist -> Increased HR & contractility to overcome increase in SVR created by A1 agonism -Immediate onset -Drug of choice for septic shock -Dosage 1-20 or 30 mcg/min -Pediatric dosage .05-2 mcg/kg/min -Side effects: Anxiety, tremors, headache, n/v, reflex bradycardia

Dobutamine

MOA: B1 agonist -> Increased HR and contractility -> Increased CO Some effects on B2 -> Can have some vasodilation Dosage: 2-20 mcg/kg/min Use: Heart failure, not used for septic shock due to potential vasodilatory effects

Dopamine

MOA: D1 & D2 agonist -> Increased renal blood flow + vasodilation B1 agonist -> Increased heart rate and contractility A1 agonist -> Vasoconstriction Dosage: 2- 20 mcg/kg/min 2-5 mcg/kg/min = dopaminergic stimulation 5-10 mcg/kg/min = beta 1 stimulation 10-20 mcg/kg/min predominant Alpha stimulation Use: Cardiogenic shock, septic shock, cardiac surgery

Vasopressin

MOA: V1 agonist -> vascular smooth muscle vasoconstriction V2 agonist -> increase reabsorption of h20 in distal convoluted tubules, increases Na reabsorption in ascending loop of Henle V3 agonist Dosage: .01-.12 u/kg/hr or .01-.48 u/kg/hr peds Uses: DI, adjunctive therapy in septic shock

Precedex

MOA: Alpha 2 agonist -> Inhibiting norepinephrine release pre-synaptically reduces/halts the transmission of pain, while post-synaptically acts to reduce sympathetic tone -> anesthesia with analgesia and anxiolysis. Dosage: 1 mg/kg .2-1.5 mg/kg/hr Uses: Sedation, ETOH withdrawal Common side effect: Bradycardia

Nicardipine

MOA: Calcium channel blocker - the inhibition of calcium into cells results in vasodilation more specific to coronary and cerebral vessels -> decreased SVR, decreased afterload, increased oxygen delivery Dosage: 5-15 mg/hr Use: Regulates blood pressure during hypertensive emergencies and post transplantation where goal blood pressures need to be tightly met.

Atropine

MOA: Muscarinic acetylcholine receptor antagonist (anticholinergic) -> Increase firing at SA node, conduction through AV node, opposes action of vagus nerve, decreases bronchial secretions Dosage: .02 mg/kg Min dose .1 mg Max dose .5 mg Use: Symptomatic bradycardia

Milrinone

MOA: Phosphodiasterase III inhibitor -> 1. increased intracellular cAMP and subsequently, increased CA ion influx into cardiac muscle cells -> increased force of contraction 2. cAMP accumulation in vascular tissue -> results in decreased CA ion influx -> vasodilation. Dosage: .25-1 mcg/kg/min Use: Heart failure S/E: Hypotension

What is your greatest work related accomplishment?

Making the transition from PICU to ICU at the peak of the pandemic - It was nerve wracking, uncomfortable and intimidating, but I was able to make a relatively seamless transition, and I have ultimately grown as a nurse and as a person because of it. There was no transition period or easing in - it went straight to critically ill, prone and paralyzed, multi organ failure patients whose life truly resting in my hands for 12 hours at a time. It required frequent and quick learning and adapting - but I feel confident that I have taken excellent care of my patients since day 1 of being in the adult ICU.

Ketamine

NMDA receptor antagonist blocking glutamate, preventing influx of cations thus preventing depolarization --> cateleptic/dissociative state. NMDA is a receptor in the CNS responsible for conduction of action potentials associated with memory. 1-5 mg/kg IVP 15-90 mcg/kg/min s/e: hallucination, confusion, HTN

Epinephrine

Nonselective alpha & beta adrenergic receptor agonist A1 - Vasoconstriction A2 B1 - Increase contractility, increased heart rate B2 - Smooth muscle relaxation -> bronchodilation, coronary arterial dilation. B3 - Increase lipolysis and thermogenesis in brown adipose tissue. Uses: Cardiogenic shock, adjunctive therapy in severe septic shock Dosage: 1 mg IVP adults, .01mg/kg IVP pediatrics .05-2 mcg/kg/min - titrate by .01-.05 q15 min

Are there any political or legal issues involving CRNA's lately?

Opt out

Functional group identification - Aldehyde

Oxygen = Carbon Carbon - One carbon chain & one hydrogen

Functional group identification - Ketones

Oxygen = Carbon Carbon - two additional carbon chains

Functional group identification - Carboxylic Acid

Oxygen = Carbon Carbon bonded to an OH group

Run a theoretical code.

PALS / ACLS

What would make you a successful CRNA?

Personality: I feel that I have the right personality to be a CRNA. Over the years, between my staff job and my traveling experience, I have gained leadership experience, as well as novice experience. I am not afraid to ask questions, be corrected and admit that I have more to learn, but I am also not afraid to speak up when I have a concern. I have a strong dedication and passion to this field and have confidence that I would fit in well and could contribute with both skills and education in the future. I love continuously learning and growing. Experience: My experience ranges from pediatrics to adults, from level 1 trauma centers to small community hospitals. I am prepared and comfortable in all environments. Most importantly, I would not have applied to this program if I had not proven to myself that I could handle fast paced, emergent situations. I did not rush to apply for this program to get it done quickly while I was young. I have always known this is what I wanted, but I waited almost 7 years because I wanted to go in with the utmost confidence that I could succeed and be the best CRNA I could be when I finished. I think going in mentally and physically prepared will make all the difference.

What are some reasons for post operative tachycardia?

Postoperative sinus tachycardia is often attributed to catecholamine release in response to surgical stress or anemia. -Pain -Hypovolemia -Anemia -Drug induced -Cardiac problem (MI, tamponade) -Pulmonary problem (Pneumothorax, PE)

Have you applied for other programs? Gotten interviews?

Texas Wesleyan - the application only closed yesterday so I've not heard back about an interview yet, however UTH is my first choice.

How do you handle criticism?

This is something I have really grown at over the years. As a baby nurse, I would feel ashamed or embarrassed when receiving criticism. Now, I just take it as a chance to learn and grow. I assess the intention of the person speaking to me, which is 99% of the time genuine and positive, and then I take what they say to me and really think on it and consider if and how I can grow from it. There is ALWAYS something to be learned. And you can't learn if you can't take criticism and coaching from a peer or superior.

How do you describe success?

To me, success is not necessarily something that comes at the end of a long road. Success can be incremental. For example, I have had many great successes on my journey to this chair today. I had the success of getting into nursing school, graduating nursing school, graduating with honors, I had the success of getting a job in the ICU and the success of becoming a travel nurse. My latest success was landing this interview and I hope to add admission to CRNA school on the list of successes soon. Ultimately, I think any good thing, or milestone that you worked toward and accomplished can be counted as a success. Success is achieving a goal - no matter how big or small, whether it is academic, personal, or physical.

Interpret an EKG strip and tell us what you would do for the patient - Sinus Tachy

Treat underlying cause; fever, anxiety, pain etc.

What is your favorite color and why?

Turquoise blue. The color of the ocean.

Tell us about volunteer or community service work you have done.

When I was full time with Texas Children's, I did some volunteer work with them. I took part in a few vaccine clinics for underserved communities, and volunteered at the hospital fun run for two years. I've also done a lot of volunteering outside of the medical field. I have spent a lot of time at my local animal shelter where I walk dogs, play with them, bathe them, and sometimes just sit with them if they are scared. I also fostered prior to becoming a travel nurse. This was and is one of my favorite things to do.