CRNI Patient Assessment and Monitoring Practice Test 1 — Questions and Answers
Question 1: What is the primary purpose of performing a comprehensive patient assessment before initiating infusion therapy?
- To complete documentation requirements
- To establish baseline data, identify risk factors, and select the most appropriate vascular access and therapy plan (Correct answer)
- To determine the patient's insurance coverage
- To assign the patient to a room
Correct answer: To establish baseline data, identify risk factors, and select the most appropriate vascular access and therapy plan
A comprehensive pre-infusion assessment establishes baseline vital signs, laboratory values, and physical findings against which changes during therapy can be evaluated. It identifies risk factors (age, comorbidities, medications, vein condition, allergies) that influence vascular access selection, solution choice, and monitoring frequency.
Question 2: Which laboratory value is most critical to assess before initiating potassium chloride infusion?
- Complete blood count
- Serum potassium level and renal function (Correct answer)
- Serum glucose
- Prothrombin time
Correct answer: Serum potassium level and renal function
Serum potassium and renal function must be assessed before potassium infusion. Administering potassium to a patient with hyperkalemia or renal failure (impaired potassium excretion) can cause fatal cardiac arrhythmias. The current potassium level guides the replacement dose, and renal function determines the body's ability to handle the potassium load.
Question 3: A nurse is assessing a peripheral IV site using the INS infiltration scale. Grade 3 infiltration is characterized by which findings?
- No symptoms
- Skin blanched, cool to touch, edema 1-6 inches, possible numbness (Correct answer)
- Gross edema greater than 6 inches, deep pitting edema, circulatory impairment
- Slight edema, cool skin, blanching
Correct answer: Skin blanched, cool to touch, edema 1-6 inches, possible numbness
Grade 3 infiltration on the INS scale is characterized by skin blanching, cool temperature, edema extending 1-6 inches from the insertion site, and possible numbness. This grade requires immediate catheter removal, limb elevation, and potential additional interventions depending on the infiltrating solution. Grade 4 involves tissue necrosis or circulatory impairment.
Question 4: What assessment findings indicate a positive Allen's test before arterial line placement?
- The hand remains pale after releasing the ulnar artery
- The hand flushes pink within 5-7 seconds after releasing the ulnar artery, indicating adequate collateral circulation (Correct answer)
- The fingers become cyanotic
- No color change in the hand
Correct answer: The hand flushes pink within 5-7 seconds after releasing the ulnar artery, indicating adequate collateral circulation
A positive (normal) Allen's test shows the hand flushing pink within 5-7 seconds of releasing the ulnar artery while the radial artery remains compressed. This confirms adequate collateral blood flow through the ulnar artery, making it safe to cannulate the radial artery. A negative (abnormal) test indicates insufficient collateral flow, contraindicating radial artery cannulation.
Question 5: Which vital sign change is the earliest indicator of a systemic transfusion reaction?
- Decreased blood pressure
- Temperature increase of 1°C or more above baseline (Correct answer)
- Decreased respiratory rate
- Bradycardia
Correct answer: Temperature increase of 1°C or more above baseline
A temperature increase of 1°C or more above baseline is typically the earliest detectable sign of a transfusion reaction. Fever can indicate febrile non-hemolytic reaction, hemolytic reaction, or bacterial contamination. This is why vital signs are taken at baseline, 15 minutes into the transfusion, and then per protocol for the remainder.
Question 6: A nurse is monitoring a patient receiving total parenteral nutrition. Which laboratory panel should be monitored at least twice weekly?
- Coagulation studies
- Basic metabolic panel including glucose, electrolytes, BUN, and creatinine (Correct answer)
- Thyroid function tests
- Urinalysis
Correct answer: Basic metabolic panel including glucose, electrolytes, BUN, and creatinine
The basic metabolic panel (glucose, sodium, potassium, chloride, CO2, BUN, creatinine) should be monitored at least twice weekly during TPN therapy. Glucose levels can fluctuate significantly with TPN, electrolyte imbalances require frequent correction, and renal function monitoring ensures safe fluid and electrolyte management.
CRNI Patient Assessment and Monitoring Practice Test 1
What is the primary purpose of performing a comprehensive patient assessment before initiating infusion therapy?