CRNI Exam Legal, Regulatory, and Scope of Practice in Infusion Nursing

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?

Accepted Answer

Right task

Answer

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:

Accepted Answer

Battery, because a procedure was performed without the patient's consent

Answer

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:

Accepted Answer

Respondeat superior liability for negligent credentialing

Answer

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:

Accepted Answer

Report the unsafe practice through the appropriate chain of command or peer review process

Answer

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?

Accepted Answer

4 hours

Answer

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.

CRNI Exam Practice Test

CRNI Exam Practice Test

CRNI Exam Legal, Regulatory, and Scope of Practice in Infusion Nursing