CRNI Exam Neonatal Infusion Therapy

Question 1

An umbilical arterial catheter (UAC) is placed in a neonate. Which position is considered the 'high' position and is preferred to avoid renal and mesenteric artery occlusion?

Accepted Answer

T6–T9 (above the diaphragm)

Answer

The 'high' UAC position (T6–T9, above the diaphragm but below the ductus arteriosus) is preferred because it avoids the origin of the celiac, superior mesenteric, and renal arteries, thereby reducing the risk of thromboembolism to those vessels compared to a 'low' position at L3–L4.

Question 2

When calculating intravenous fluid requirements for a premature neonate at 26 weeks gestation in the first 24 hours of life, which factor most significantly increases insensible water loss compared to a term neonate?

Accepted Answer

Greater skin surface area relative to body weight and immature skin barrier

Answer

Extremely premature neonates have a markedly high ratio of skin surface area to body weight and a very thin, poorly keratinized skin barrier, leading to dramatically increased transepidermal water loss (TEWL). This can require fluid intakes of 100–200 mL/kg/day in the first days of life under radiant warmers.

Question 3

Which glucose infusion rate (GIR) range is generally targeted to maintain euglycemia in a term neonate receiving parenteral nutrition in the first few days of life?

Accepted Answer

4–8 mg/kg/min

Answer

A GIR of 4–8 mg/kg/min approximates the hepatic glucose production rate in term neonates and is used as the starting target to maintain blood glucose between 50–120 mg/dL. Rates above 12–15 mg/kg/min increase the risk of hyperglycemia and fatty liver.

Question 4

A peripherally inserted central catheter (PICC) is placed in a neonate. The tip is confirmed by X-ray to be in the right atrium. What is the appropriate nursing action?

Accepted Answer

Notify the provider to reposition the catheter to the lower one-third of the superior vena cava

Answer

PICC tip placement in the right atrium is not acceptable because it increases the risk of cardiac arrhythmias and cardiac tamponade. The correct tip position for a neonatal upper-extremity PICC is the lower one-third of the SVC at the cavoatrial junction. The provider should be notified for repositioning before use.

Question 5

Neonates are at higher risk for hypocalcemia during blood transfusion with citrate-containing blood products compared with adults. What is the primary physiological reason?

Accepted Answer

Neonatal livers have immature capacity to metabolize citrate, allowing it to chelate ionized calcium

Answer

Citrate is the anticoagulant used in stored blood products; it is normally metabolized rapidly by the liver. Neonates—especially premature infants—have immature hepatic citrate metabolism, so citrate accumulates and chelates free ionized calcium, causing hypocalcemia, which can lead to cardiac dysfunction.

CRNI Exam Practice Test

CRNI Exam Practice Test

CRNI Exam Neonatal Infusion Therapy