CRNI Exam Legal, Regulatory, and Scope of Practice in Infusion Nursing — Questions and Answers
Question 1: A registered nurse (RN) is asked by a supervisor to delegate PICC line flushing to an unlicensed assistive personnel (UAP). According to the Five Rights of Delegation, which right is MOST clearly violated in this scenario?
- Right task (Correct answer)
- Right circumstance
- Right person
- Right supervision
Correct answer: Right task
The 'Right Task' requires that the delegated activity be one that is legally and institutionally appropriate to delegate to a UAP. Flushing a PICC line is a task that requires nursing assessment and clinical judgment; it is generally not within the UAP scope of practice and therefore fails the 'Right Task' criterion before any other consideration.
Question 2: A patient refuses a recommended PICC line insertion after the nurse has explained the procedure and alternatives. The nurse documents the refusal and the physician re-enters and inserts the line anyway without additional consent. This situation describes:
- Negligence, because the physician lacked proper technique training
- Battery, because a procedure was performed without the patient's consent (Correct answer)
- Abandonment, because the nurse did not stay in the room
- Breach of confidentiality, because refusal was documented
Correct answer: Battery, because a procedure was performed without the patient's consent
Battery is the intentional, unconsented touching of another person. Performing an invasive procedure on a competent patient who has explicitly refused constitutes battery, regardless of the provider's intent or the procedure's medical necessity. The nurse who documented the refusal has a duty to escalate and advocate for the patient's decision.
Question 3: A state Nurse Practice Act (NPA) specifies that PICC insertion by RNs requires documented competency validation. An RN who inserts a PICC without this validation causes a complication. The primary legal exposure for the employing institution is:
- Respondeat superior liability for negligent credentialing (Correct answer)
- Strict product liability for the catheter device
- Vicarious liability transferred entirely to the nurse
- No liability, because the NPA violation is the nurse's individual responsibility
Correct answer: Respondeat superior liability for negligent credentialing
Under the doctrine of respondeat superior, employers are liable for employees' acts performed within the scope of employment. Institutions also bear direct liability for negligent credentialing—failing to verify that staff have the required competencies before allowing them to perform privileged procedures. Both theories apply here.
Question 4: An infusion nurse discovers that a colleague is consistently documenting IV site assessments every 8 hours rather than the INS-recommended every 4 hours and is charting 'site without complications' without actually assessing the patient. The infusion nurse's professional and legal obligation is BEST described as:
- Ignore the situation because documentation frequency is a personal preference
- Correct the colleague's documentation retroactively to reflect the standard
- Report the unsafe practice through the appropriate chain of command or peer review process (Correct answer)
- Assume the colleague's patients are low-risk and require less frequent monitoring
Correct answer: Report the unsafe practice through the appropriate chain of command or peer review process
Nurses have a professional and ethical duty to report unsafe practice that places patients at risk. Falsifying documentation (charting assessments not performed) is both an ethical violation and potentially fraudulent documentation. The correct action is to report through institutional channels (charge nurse, risk management, peer review) rather than alter records or ignore the situation.
Question 5: The Joint Commission requires that all blood products be administered within a specified timeframe after leaving the blood bank to prevent bacterial proliferation. What is that maximum hang time?
- 2 hours
- 4 hours (Correct answer)
- 6 hours
- 8 hours
Correct answer: 4 hours
The Joint Commission and AABB standards require that blood components be infused within 4 hours of issue from the blood bank (or within 4 hours of removal from temperature-controlled storage). Beyond 4 hours, bacterial proliferation risk rises significantly and the product must be discarded, not returned.
Question 6: A home infusion nurse is the only clinician present when a patient's central line becomes dislodged during a scheduled visit. The nurse stabilizes the patient and attempts to reach the prescribing physician, who does not respond within 30 minutes. Under most state Nurse Practice Acts, the nurse's MOST appropriate next step is:
- Reinsert the central line using the equipment on hand to restore therapy
- Continue waiting for the physician call-back before taking any further action
- Contact the on-call or covering provider through the agency's after-hours protocol (Correct answer)
- Discharge the patient from home infusion care and recommend the ER
Correct answer: Contact the on-call or covering provider through the agency's after-hours protocol
When a primary prescriber is unavailable in an urgent situation, the nurse is obligated to escalate through the established chain of communication—typically the agency's after-hours on-call provider—rather than performing outside scope (reinserting a central line without a physician order is outside RN scope in virtually all states) or abandoning the patient.
CRNI Exam Legal, Regulatory, and Scope of Practice in Infusion Nursing
A registered nurse (RN) is asked by a supervisor to delegate PICC line flushing to an unlicensed assistive personnel (UAP).
According to the Five Rights of Delegation, which right is MOST clearly violated in this scenario?