Free Practice Questions for MAC

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Sample MAC Practice Questions

Try these sample questions to review concepts for the MAC exam. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1During induction for an urgent laparoscopic appendectomy, a patient with active vomiting has rapid oxygen desaturation after loss of consciousness. Mask ventilation is difficult despite an oral airway and two-hand technique. What is the best next action?

A.Attempt several additional direct laryngoscopies before changing the plan

B.Call for help, optimize oxygenation, and proceed immediately to a planned rescue airway strategy

C.Deepen anesthesia and wait for improved jaw relaxation

D.Cancel the case and allow spontaneous recovery without airway intervention

Explanation: A cannot-ventilate or rapidly deteriorating airway requires early help, oxygenation maneuvers, and transition to a rescue plan such as supraglottic airway placement or emergency front-of-neck access if oxygenation cannot be restored. Repeated unplanned attempts worsen hypoxemia and airway trauma.

2A patient with rheumatoid arthritis has limited mouth opening, neck pain with extension, and prior cervical fusion. Which airway plan best reduces the risk of neurologic injury and failed intubation?

A.Awake intubation with minimal cervical movement and a clearly prepared backup plan

B.Routine asleep direct laryngoscopy with aggressive sniffing position

C.Blind nasal intubation after deep inhalational induction

D.Supraglottic airway as the sole plan for a long prone procedure

Explanation: Rheumatoid arthritis can involve the cervical spine and temporomandibular joints, making neck manipulation and mouth opening hazardous. Awake intubation preserves spontaneous ventilation and allows neurologic protection while securing a predicted difficult airway.

3Immediately after extubation, an adult develops inspiratory stridor, suprasternal retractions, and falling oxygen saturation. Jaw thrust and continuous positive airway pressure do not relieve the obstruction. What should the CRNA do next?

A.Administer a small dose of succinylcholine and provide positive-pressure ventilation

B.Give naloxone because opioid excess is the most likely cause

C.Place the patient supine and observe until the spasm resolves

D.Administer furosemide before treating the upper-airway obstruction

Explanation: Persistent laryngospasm with desaturation requires prompt relief of glottic closure. A small dose of succinylcholine after failed airway maneuvers can break the spasm and permit ventilation while oxygenation is restored.

4A patient with Ludwig angina is sitting upright, drooling, and unable to tolerate lying flat. Oxygen saturation is 95% on face mask. Which approach is most appropriate?

A.Induce general anesthesia to improve cooperation before airway instrumentation

B.Proceed with awake airway management while maintaining spontaneous ventilation and surgical airway readiness

C.Give a long-acting neuromuscular blocker to prevent coughing during intubation

D.Transport to PACU because oxygen saturation is currently acceptable

Explanation: Deep neck infection can rapidly convert to complete obstruction, especially after loss of tone. Awake airway management with spontaneous ventilation, expert help, and immediate surgical airway backup is the safest strategy.

5During intubation, the laryngoscope view is poor because the epiglottis is large and floppy. Which maneuver directly lifts the epiglottis and may improve the view?

A.Place a curved blade in the vallecula and increase external pressure only

B.Use a straight blade to directly elevate the epiglottis

C.Advance the endotracheal tube blindly beneath the epiglottis

D.Deflate the cuff and rotate the tube 360 degrees

Explanation: A straight blade can directly lift the epiglottis when vallecular lifting with a curved blade is inadequate. This is a useful adjustment when the epiglottis itself obstructs the glottic view.

6A patient with a known difficult airway is extubated after a long head and neck procedure. Within minutes, the patient develops airway obstruction and rapidly increasing work of breathing. What extubation strategy would have best anticipated this risk?

A.Deep extubation to avoid coughing

B.Extubation over an airway exchange catheter with reintubation equipment immediately available

C.Removing all airway devices in the OR and transferring quickly to PACU

D.Extubation before reversal to prevent bucking

Explanation: Patients with difficult reintubation risk and postoperative airway edema benefit from a staged extubation plan. An airway exchange catheter preserves access to the trachea and can facilitate oxygenation or reintubation if obstruction occurs.

7A morbidly obese patient is preoxygenated supine before induction. Oxygen saturation falls quickly after apnea. Which change best improves oxygen reserve before the next attempt?

A.Use a ramped head-elevated position with tight-mask preoxygenation

B.Decrease inspired oxygen to avoid absorption atelectasis

C.Avoid positive airway pressure during preoxygenation

D.Place the patient in steep Trendelenburg for induction

Explanation: Obesity reduces functional residual capacity and shortens safe apnea time. Ramped or head-elevated positioning improves airway alignment and preoxygenation, and positive pressure can help recruit alveoli when appropriate.

8A patient with a wired jaw after maxillofacial trauma needs general anesthesia for wound exploration. Which preparation is most important before induction?

A.Confirm wire cutters or a release device are immediately available

B.Avoid suction to prevent disruption of the repair

C.Use a larger oral airway to bypass the wires

D.Plan extubation while the patient is deeply anesthetized

Explanation: Intermaxillary fixation can prevent mouth opening during vomiting, obstruction, or failed ventilation. Wire cutters or a release mechanism must be immediately available, and the team must know how to use them.

9After placement of a supraglottic airway, ventilation is inadequate and there is a large leak at low airway pressure. What is the best first response?

A.Assess depth, head position, device size, cuff volume, and placement before abandoning the device

B.Immediately increase tidal volume to overcome the leak

C.Tape the device more tightly and continue the case

D.Turn off capnography because leaks make it inaccurate

Explanation: Poor supraglottic airway function is commonly due to malposition, inadequate depth, suboptimal head position, wrong size, or cuff problems. Systematic troubleshooting can restore ventilation or identify the need for another airway.

10A patient has a hoarse voice and weak cough after thyroid surgery. Laryngoscopy shows one vocal cord immobile in a paramedian position. Which structure was most likely injured?

A.Recurrent laryngeal nerve

B.Hypoglossal nerve

C.Glossopharyngeal nerve

D.External branch of the superior laryngeal nerve

Explanation: The recurrent laryngeal nerve supplies most intrinsic laryngeal muscles and injury can cause vocal cord paresis, hoarseness, and impaired airway protection. Bilateral injury may cause severe obstruction.

About the MAC Exam

The NBCRNA MAC program is the continuing certification pathway for CRNAs. MAC Check is a longitudinal assessment covering four equally weighted core domains: Airway Management, Applied Clinical Pharmacology, Physiology and Pathophysiology, and Anesthesia Equipment, Technology, and Safety.

Exam sponsor: NBCRNA. The requirements and fees below concern the certification or admission exam, separate from our free practice resources.

Assessment

Longitudinal MAC Check: 25 questions in quarter 1 and up to 30 questions in subsequent quarters across a 4-year MAC cycle.

Time Limit

60 seconds per question plus a quarterly 5-minute time bank

Passing Score

Not pass/fail; failure to meet a performance standard may require additional MAC Ed credits

Exam / Certification Fees

Paid through NBCRNA portal as part of MAC renewal and MAC Check requirements

Exam sponsor website

Fees, eligibility, and exam policies can change. Confirm them with the exam sponsor before applying or paying.

Official sources

Our practice resources: topics covered

We aim to reflect publicly available exam outlines and topic information in our study resources. Coverage, format, and difficulty may differ from the actual exam, and we cannot guarantee that every detail is accurate or current. Confirm exam requirements, fees, and policies with the official exam sponsor.

25%

Airway Management

Airway assessment, anticipated and unanticipated difficult airway response, ventilation, oxygenation, aspiration risk, extubation, and rescue planning.

25%

Applied Clinical Pharmacology

Anesthetic drugs, analgesia, neuromuscular blockade and reversal, vasoactive support, local anesthetics, interactions, and patient-specific risk.

25%

Physiology and Pathophysiology

Disease-specific anesthesia implications across cardiovascular, respiratory, neurologic, endocrine, renal, obstetric, pediatric, and geriatric care.

25%

Anesthesia Equipment, Technology, and Safety

Machine checks, monitors, alarms, gas delivery, regional equipment, infection prevention, human factors, and patient safety systems.

Preparing for the MAC Exam

What You Need to Know

Passing score: Not pass/fail; failure to meet a performance standard may require additional MAC Ed credits
Assessment: Longitudinal MAC Check: 25 questions in quarter 1 and up to 30 questions in subsequent quarters across a 4-year MAC cycle.
Time limit: 60 seconds per question plus a quarterly 5-minute time bank
Exam / certification fees: Paid through NBCRNA portal as part of MAC renewal and MAC Check requirements Official sources

Using Our Practice Resources

Work through all 100 available questions
Review every answer and explanation
Track weak areas and revisit them
Use our AI tutor for tough concepts

MAC: Suggested Study Strategy

1Use short, spaced practice blocks because MAC Check is longitudinal and each question has a short response window.

2Review rationales immediately and connect misses to one of the four NBCRNA domains so follow-up MAC Ed can be targeted.

Frequently Asked Questions

Is MAC Check pass/fail?

NBCRNA states that MAC Check is not pass/fail. Not meeting a performance standard does not itself cause loss of certification, but may require additional MAC Ed credits.

What domains are covered on MAC Check?

NBCRNA lists four equally weighted core domains: Airway Management, Applied Clinical Pharmacology, Physiology and Pathophysiology, and Anesthesia Equipment, Technology, and Safety.