CRNI - Certified Registered Nurse Infusion — Questions and Answers

Question 1: A patient is prescribed a targeted therapy infusion. Which laboratory value should be monitored MOST closely during treatment?

Serum albumin
Prothrombin time
Complete blood count with differential (Correct answer)
Serum calcium levels

Correct answer: Complete blood count with differential

Targeted therapies frequently cause myelosuppression, making CBC with differential essential for monitoring neutropenia, thrombocytopenia, and anemia.

Question 2: A patient on home PN reports cloudy urine and elevated blood glucose despite stable TPN formula. What should the CRNI assess?

Medication interaction with the PN formula
Possible catheter-related infection causing hyperglycemia as an early sign (Correct answer)
Electrolyte imbalance from PN composition changes
Dehydration from inadequate oral intake

Correct answer: Possible catheter-related infection causing hyperglycemia as an early sign

New-onset hyperglycemia in a patient on stable PN is a common early indicator of infection, particularly catheter-related bloodstream infection.

Question 3: Which action BEST demonstrates evidence-based practice in infusion nursing?

Following the same protocols used for the past 10 years because they have proven effective
Consulting current INS standards and peer-reviewed literature when updating protocols (Correct answer)
Implementing a new technique because a colleague recommends it
Adopting a vendor's recommended practice because they provide in-service training

Correct answer: Consulting current INS standards and peer-reviewed literature when updating protocols

Evidence-based practice requires integrating current best evidence from peer-reviewed literature and professional standards into clinical decision-making.

Question 4: Which action by the nurse demonstrates correct handling of oral antineoplastic agents per safe handling guidelines?

Crushing tablets and mixing into applesauce for easier administration
Placing crushed tablets in a standard medication cup without PPE
Wearing gloves when handling the oral medication and disposing in a hazardous waste container (Correct answer)
Administering at the bedside without additional precautions if the tablet is uncoated

Correct answer: Wearing gloves when handling the oral medication and disposing in a hazardous waste container

Oral antineoplastics require PPE (minimum chemotherapy-rated gloves) during handling and must be discarded as hazardous pharmaceutical waste per NIOSH and ONS guidelines.

Question 5: Which assessment finding indicates the patient is experiencing third-spacing of fluid?

Weight loss with dry mucous membranes
Hypertension with bounding pulses
Polyuria with increased specific gravity
Peripheral edema with low urine output and hypotension (Correct answer)

Correct answer: Peripheral edema with low urine output and hypotension

Third-spacing causes fluid to shift from the intravascular space into interstitial tissues, resulting in edema, intravascular depletion (hypotension), and decreased urine output.

Question 6: A patient is prescribed intravenous potassium chloride (KCl) 20 mEq to be added to a 100 mL bag of 0.9% Sodium Chloride. Which action by the nurse is most critical to ensure patient safety during preparation and administration?

Administering the infusion via gravity drip to avoid pump alarms.
Using a peripheral catheter smaller than 22-gauge to minimize vein irritation.
Pushing the KCl directly from a syringe into the patient's IV line for faster effect.
Ensuring the potassium chloride is thoroughly mixed in the solution bag before infusion. (Correct answer)

Correct answer: Ensuring the potassium chloride is thoroughly mixed in the solution bag before infusion.

It is critical to invert and agitate the IV bag after adding potassium chloride to ensure it is evenly distributed throughout the solution. Failure to mix properly can result in the patient receiving a concentrated bolus of potassium, which can cause life-threatening cardiac arrhythmias and death. Administration via an infusion pump is mandatory for this high-alert medication, IV push is strictly contraindicated, and an appropriate gauge catheter is needed, but ensuring proper mixing is the most critical safety step during preparation.

Question 7: A patient with IgA deficiency requires a transfusion. Which blood product modification is most appropriate to prevent anaphylactic reaction?

Leukoreduced blood
CMV-negative blood
Irradiated blood
Washed red blood cells (Correct answer)

Correct answer: Washed red blood cells

Washed red blood cells remove plasma proteins including IgA, preventing anaphylaxis in IgA-deficient patients who have anti-IgA antibodies.

Question 8: Which organization publishes the Infusion Therapy Standards of Practice that serve as the primary reference for CRNI exam content?

Infusion Nurses Society (INS) (Correct answer)
Centers for Disease Control and Prevention (CDC)
The Joint Commission (TJC)
American Nurses Association (ANA)

Correct answer: Infusion Nurses Society (INS)

The Infusion Nurses Society (INS) publishes the Infusion Therapy Standards of Practice, which is the primary reference standard for infusion nursing.

Question 9: A patient on capecitabine (Xeloda) reports painful redness and swelling of the palms and soles. The nurse identifies this as:

Hand-foot syndrome (palmar-plantar erythrodysesthesia) (Correct answer)
Stevens-Johnson syndrome
Contact dermatitis
Raynaud phenomenon

Correct answer: Hand-foot syndrome (palmar-plantar erythrodysesthesia)

Hand-foot syndrome (palmar-plantar erythrodysesthesia) is a hallmark toxicity of capecitabine characterized by painful erythema and swelling of palms and soles.

Question 10: During massive transfusion protocol activation, which electrolyte imbalance is MOST likely to develop?

Hypermagnesemia
Hypocalcemia (Correct answer)
Hypernatremia
Hypophosphatemia

Correct answer: Hypocalcemia

Hypocalcemia develops during massive transfusion because citrate in stored blood products binds ionized calcium, reducing the patient's circulating calcium levels.

Question 11: Which vascular access device is most commonly used for home infusion therapy requiring weeks of treatment?

Short peripheral catheter
Peripherally inserted central catheter (PICC) (Correct answer)
Non-tunneled central venous catheter
Implanted port

Correct answer: Peripherally inserted central catheter (PICC)

PICCs are preferred for home infusion because they can remain in place for weeks to months and provide reliable central venous access.

Question 12: Which vesicant chemotherapy agent requires immediate intervention if extravasation occurs during IV infusion?

Methotrexate
Doxorubicin (Correct answer)
Cyclophosphamide
Bleomycin

Correct answer: Doxorubicin

Doxorubicin is a vesicant that can cause severe tissue necrosis if extravasation occurs, requiring immediate intervention including stopping the infusion and applying cold compresses.

Question 13: A patient develops urticaria and pruritus during the first 15 minutes of a platelet transfusion but has no fever, hypotension, or respiratory distress. What is the BEST initial action?

Slow the infusion rate and observe closely
Stop the transfusion, administer diphenhydramine, and restart if symptoms resolve (Correct answer)
Administer epinephrine immediately
Stop the transfusion permanently and discard the unit

Correct answer: Stop the transfusion, administer diphenhydramine, and restart if symptoms resolve

Mild allergic reactions (urticaria only) can be managed by stopping the transfusion, administering antihistamine, and restarting if symptoms resolve within 15-30 minutes.

Question 14: A patient receiving an initial infusion of a new monoclonal antibody develops urticaria, dyspnea, and hypotension. After stopping the infusion, which pharmacologic agent should the certified registered nurse infusion (CRNI) anticipate administering as the first-line treatment for this reaction?

Intravenous methylprednisolone
Subcutaneous or intramuscular epinephrine (Correct answer)
Intravenous diphenhydramine
A rapid bolus of 0.9% Sodium Chloride

Correct answer: Subcutaneous or intramuscular epinephrine

The patient is exhibiting signs of anaphylaxis, a life-threatening systemic hypersensitivity reaction. Epinephrine is the primary, first-line medication used to treat anaphylaxis. Its alpha- and beta-adrenergic effects reverse bronchoconstriction, decrease vascular permeability, and support blood pressure. Antihistamines (diphenhydramine) and corticosteroids (methylprednisolone) are important secondary treatments but do not act as rapidly or effectively on the most life-threatening symptoms.

Question 15: A 4-year-old weighing 16 kg requires maintenance IV fluids. Using the Holliday-Segar method, what is the correct hourly fluid rate?

40 mL/hr
60 mL/hr
48 mL/hr
52 mL/hr (Correct answer)

Correct answer: 52 mL/hr

Holliday-Segar: 100 mL/kg for first 10 kg (1000 mL) + 50 mL/kg for next 10 kg (300 mL) = 1300 mL/24 hr ≈ 52 mL/hr for a 16 kg child.

Question 16: A patient with a central venous catheter suddenly develops unilateral facial and arm swelling. What complication should the nurse suspect?

Catheter migration
Allergic reaction to the catheter material
Pneumothorax
Superior vena cava syndrome from catheter-related thrombosis (Correct answer)

Correct answer: Superior vena cava syndrome from catheter-related thrombosis

Unilateral facial and arm swelling suggests catheter-related deep vein thrombosis with obstruction of venous return, potentially progressing to SVC syndrome.

Question 17: What is the nurse's responsibility regarding hazardous drug spill management during an infusion?

Call environmental services and evacuate the room
Clean the spill with standard cleaning supplies and document
Cover the spill with paper towels and continue the infusion
Activate the spill kit, contain the area, and follow facility protocol (Correct answer)

Correct answer: Activate the spill kit, contain the area, and follow facility protocol

Hazardous drug spills require use of a dedicated spill kit with proper PPE and containment procedures as outlined in facility protocol.

Question 18: The body loses ions mostly through its _______ system.

digestive
integumentary
urinary (Correct answer)
respiratory

Correct answer: urinary

The urinary system, particularly the kidneys, is the primary organ system responsible for maintaining electrolyte (ion) balance in the body. The kidneys filter blood, reabsorbing essential ions like sodium, potassium, and chloride, while excreting excess ions in the urine. This precise regulation is vital for nerve function, muscle contraction, and overall cellular homeostasis.

Question 19: Which of the following laboratory values is most critical for the CRNI to monitor in a patient at high risk for refeeding syndrome during the first 72 hours of initiating parenteral nutrition?

Serum creatinine
Serum phosphate (Correct answer)
Blood urea nitrogen (BUN)
Hemoglobin and hematocrit

Correct answer: Serum phosphate

Hypophosphatemia is the hallmark biochemical feature of refeeding syndrome. When a malnourished patient begins to receive carbohydrates, insulin is released, causing a rapid shift of phosphate, potassium, and magnesium from the bloodstream into the cells for metabolism (e.g., ATP synthesis). This can lead to dangerously low serum phosphate levels, resulting in cardiac and respiratory failure. Therefore, monitoring phosphate is a top priority.

Question 20: What is the pharmacological rationale for using a 0.22-micron in-line filter during IV infusion?

To filter out air bubbles only
To remove particulate matter, microorganisms, and endotoxins (Correct answer)
To prevent drug precipitation visible to the eye only
To slow the infusion rate

Correct answer: To remove particulate matter, microorganisms, and endotoxins

A 0.22-micron filter removes particulate matter, bacteria, fungi, and endotoxins from the infusate, providing an additional safety barrier against contamination.

Question 21: What are the typical dangers of giving blood?

Low blood pressure
None of the above (Correct answer)
Bacterial infection
Low blood pressure

Correct answer: None of the above

Blood donation is a very safe procedure, with potential risks being minimal and usually temporary. While some donors might experience minor side effects like lightheadedness or bruising, serious complications such as significant low blood pressure or bacterial infection are extremely rare due to stringent screening and sterile techniques. The benefits of donating blood far outweigh these minimal risks.

Question 22: Which of the following BEST describes the concept of 'source control' in infection prevention for an IV therapy patient?

Removing or controlling the infectious source, such as removing an infected catheter (Correct answer)
Administering broad-spectrum antibiotics to eliminate all potential pathogens
Using negative-pressure wound therapy over the IV insertion site
Placing the patient in isolation to prevent spread to others

Correct answer: Removing or controlling the infectious source, such as removing an infected catheter

Source control refers to the physical removal or containment of the infectious focus—such as removing an infected catheter—to halt the ongoing seeding of pathogens into the bloodstream.

Question 23: How should the CRNI manage extravasation of a vesicant drug when the specific antidote is not available?

Inject normal saline subcutaneously around the site to dilute the drug
Apply alternating hot and cold compresses
Aspirate as much drug as possible, elevate the extremity, and consult with pharmacy and physician immediately (Correct answer)
Apply pressure to the site to prevent further spread

Correct answer: Aspirate as much drug as possible, elevate the extremity, and consult with pharmacy and physician immediately

When an antidote is unavailable, the priority is to aspirate residual drug through the catheter, elevate the extremity, and immediately consult pharmacy and the physician for alternative management.

Question 24: What is the recommended method for securing a peripheral IV catheter to prevent dislodgement?

Manufactured catheter stabilization device (engineered stabilization device) (Correct answer)
Standard adhesive tape in a chevron pattern
Elastic bandage wrapped around the extremity
Sutures at the insertion site

Correct answer: Manufactured catheter stabilization device (engineered stabilization device)

INS standards recommend manufactured engineered stabilization devices (ESDs) over tape to reduce catheter movement, decrease phlebitis, and prevent unplanned dislodgement.

Question 25: When calculating the BSA-based dose of an antineoplastic agent, which patient measurement MUST be verified immediately before administration?

Heart rate
Oxygen saturation
Blood pressure
Current weight (Correct answer)

Correct answer: Current weight

Body surface area calculations depend on accurate current weight, which must be verified before each treatment cycle as weight changes directly affect dosing.

Question 26: A patient receiving 0.9% NaCl at 200 mL/hr for 12 hours develops a pH of 7.28, HCO3 of 18, and Cl of 116. What has occurred?

Hyperchloremic metabolic acidosis (Correct answer)
Metabolic alkalosis
Respiratory acidosis
Anion gap metabolic acidosis

Correct answer: Hyperchloremic metabolic acidosis

Large volumes of normal saline cause dilutional hyperchloremic (non-anion gap) metabolic acidosis by lowering bicarbonate relative to chloride.

Question 27: A nurse is documenting a central venous catheter (CVC) dressing change. Which finding requires an incident report in addition to the medical record entry?

Patient verbalized discomfort during dressing change
Catheter tip migrated outside the SVC noted on chest X-ray (Correct answer)
Mild erythema at insertion site that was present at last assessment
Transparent semipermeable membrane dressing intact with no signs of infection

Correct answer: Catheter tip migrated outside the SVC noted on chest X-ray

Catheter tip migration outside the SVC is a safety event requiring both medical record documentation and an incident/occurrence report.

Question 28: A certified registered nurse infusion (CRNI) is preparing to insert a peripheral intravenous catheter for a scheduled antibiotic infusion. The patient, who is alert and oriented, states, "I've had bad experiences before, and I don't want the IV." Which of the following is the most appropriate initial action for the nurse to take?

Request a different nurse to attempt the insertion, as the patient may be more comfortable with someone else.
Ask a family member to convince the patient to accept the treatment.
Explain the risks of not receiving the antibiotic and proceed with the insertion.
Document the patient's refusal in the medical record and notify the prescribing provider. (Correct answer)

Correct answer: Document the patient's refusal in the medical record and notify the prescribing provider.

The most appropriate action is to respect the patient's autonomy. An alert and oriented patient has the right to refuse treatment. The nurse's primary responsibility is to honor this refusal, document it accurately, and inform the prescribing provider so that alternative treatment plans can be considered.

Question 29: Which mechanism describes the movement of water across a semi-permeable membrane from an area of lower solute concentration to an area of higher solute concentration?

Active transport
Diffusion
Osmosis (Correct answer)
Filtration

Correct answer: Osmosis

Osmosis is the passive movement of water across a semi-permeable membrane down its own concentration gradient — from a region of lower solute (higher water) concentration to higher solute (lower water) concentration — until equilibrium is reached.

Question 30: What assessment should the CRNI perform before each use of an implanted port?

Assessment is only needed at the first access
Assess the site for signs of infection, port stability, skin integrity, and swelling; confirm blood return after access (Correct answer)
Check the patient's temperature only
Only check that the port is palpable

Correct answer: Assess the site for signs of infection, port stability, skin integrity, and swelling; confirm blood return after access

Pre-access port assessment includes inspection for infection signs, palpation for stability and fluid collection, skin integrity evaluation, and blood return confirmation after accessing.

Question 31: A patient's serum sodium is 118 mEq/L. What is the maximum safe correction rate to prevent neurological complications?

Correct to normal as fast as possible
8-12 mEq/L per 24 hours (Correct answer)
15-20 mEq/L per 24 hours
4-6 mEq/L per 24 hours

Correct answer: 8-12 mEq/L per 24 hours

Sodium correction should not exceed 8-12 mEq/L in 24 hours to prevent osmotic demyelination syndrome, a devastating neurological complication.

Question 32: Which blood product requires a specific filter for administration in pediatric patients?

All cellular blood products through a standard 170-260 micron filter (Correct answer)
Platelets through a leukocyte reduction filter
Fresh frozen plasma
Albumin

Correct answer: All cellular blood products through a standard 170-260 micron filter

All cellular blood products (red blood cells, platelets, whole blood) must be administered through a standard 170-260 micron blood filter to remove clots and debris. This requirement applies equally to pediatric and adult patients and is a fundamental safety standard for transfusion therapy.

Question 33: What is the standard lockout interval for most morphine patient-controlled analgesia (PCA) programs?

5–10 minutes (Correct answer)
25–30 minutes
30–60 minutes
15–20 minutes

Correct answer: 5–10 minutes

A 5–10 minute lockout interval is standard for IV morphine PCA, allowing time to assess the effect of each demand dose before another can be delivered.

Question 34: A nurse attempts to flush a PICC line and encounters resistance. The patient reports no pain. Which action should the nurse take first?

Assess catheter position using a chest X-ray
Declot the catheter using alteplase immediately
Force the flush using a 10 mL syringe with firm pressure
Reposition the patient's arm and attempt to flush again (Correct answer)

Correct answer: Reposition the patient's arm and attempt to flush again

Repositioning the patient's arm (extending, raising, or changing position) can relieve a positional occlusion in a PICC before escalating to imaging or thrombolytic therapy.

Question 35: A nurse enters isolation to hang IV medications for a patient on contact precautions for MRSA. In what order should personal protective equipment (PPE) be donned?

Gown, gloves, mask, eye protection
Mask, gown, eye protection, gloves (Correct answer)
Gloves, gown, mask, eye protection
Eye protection, mask, gown, gloves

Correct answer: Mask, gown, eye protection, gloves

The recommended sequence is mask/respirator first, then eye protection, gown, and gloves last so that gloves cover the gown cuffs and provide the final barrier before contact.

Question 36: A home infusion nurse is assessing a patient's understanding of safe medication storage for a home parenteral nutrition solution. Which statement by the patient indicates correct understanding?

I will store my TPN bags in a cool, dry cabinet away from sunlight.
I will freeze extra TPN bags to extend their shelf life.
I can leave the TPN at room temperature for up to 24 hours before use.
I will refrigerate my TPN at 36–46°F and remove it 1 to 2 hours before infusion. (Correct answer)

Correct answer: I will refrigerate my TPN at 36–46°F and remove it 1 to 2 hours before infusion.

TPN must be refrigerated at 36–46°F (2–8°C) and brought to room temperature 1–2 hours before infusion to prevent discomfort and adverse reactions.

Question 37: A postoperative patient has decreased urine output, pulmonary crackles, and a serum sodium of 148 mEq/L. Which fluid overload pattern does this represent?

Isotonic fluid deficit
Hypertonic fluid excess (Correct answer)
Hypotonic fluid deficit
Isotonic fluid excess

Correct answer: Hypertonic fluid excess

Elevated sodium with signs of fluid overload indicates hypertonic hypervolemia, often from excessive saline infusion.

Question 38: During a peripheral IV assessment using the Visual Infusion Phlebitis (VIP) scale, a score of 3 is noted. What action should the infusion nurse take?

Remove the catheter immediately and culture the site
Apply a topical antibiotic and reassess in 2 hours
Document and continue monitoring every 8 hours
Restart the IV at a different site and document findings (Correct answer)

Correct answer: Restart the IV at a different site and document findings

A VIP score of 3 indicates medium-stage phlebitis with pain, erythema, and streaking, requiring catheter removal and resiting.

Question 39: What is the nursing implication of infusing hypertonic saline (3% NaCl)?

It should be infused as a rapid bolus for maximum effect
It requires central venous access and continuous cardiac monitoring (Correct answer)
It can be safely administered through a peripheral IV
It requires co-infusion with potassium replacement

Correct answer: It requires central venous access and continuous cardiac monitoring

Hypertonic saline is a high-risk infusion requiring central venous access to prevent phlebitis and continuous cardiac monitoring due to risk of rapid electrolyte shifts.

Question 40: An infusion therapy team is implementing a quality improvement (QI) program to reduce the incidence of phlebitis. Which activity is most essential to this program?

Implementing a new brand of intravenous catheter without initial data.
Surveying nurses about their satisfaction with current IV start kits.
Requiring all nurses to attend a one-time in-service on phlebitis.
Collecting and analyzing data on phlebitis rates, causative factors, and outcomes. (Correct answer)

Correct answer: Collecting and analyzing data on phlebitis rates, causative factors, and outcomes.

A fundamental principle of quality improvement is the use of data to identify problems, guide interventions, and measure outcomes. Collecting and analyzing data on phlebitis rates, potential causes (e.g., catheter size, dwell time, infusate), and patient outcomes provides the objective evidence needed to implement targeted, effective changes and track their success.

Question 41: A patient is scheduled to receive cyclic parenteral nutrition from 2000 to 0800. At 0600, the nurse discovers that 500 mL of the solution is remaining when only 200 mL should be left. What is the most appropriate action for the nurse to take?

Increase the infusion rate to ensure the full volume is delivered by 0800.
Stop the infusion at 0800 as scheduled, regardless of the volume remaining.
Administer an intravenous bolus of 50% dextrose at 0800 to prevent hypoglycemia.
Continue the infusion at the prescribed rate and document the remaining volume. (Correct answer)

Correct answer: Continue the infusion at the prescribed rate and document the remaining volume.

The nurse should never increase the rate of a parenteral nutrition infusion to "catch up." Doing so can cause severe hyperglycemia, fluid overload, and electrolyte imbalances. The safest action is to continue the infusion at the prescribed rate, document the discrepancy, and notify the provider and pharmacist. The plan for the subsequent infusion cycle may need to be adjusted.

Question 42: Which electrolyte abnormality is MOST associated with refeeding syndrome in a severely malnourished patient starting PN?

Hypernatremia
Hypercalcemia
Hypophosphatemia (Correct answer)
Hyperkalemia

Correct answer: Hypophosphatemia

Hypophosphatemia is the hallmark of refeeding syndrome, occurring as insulin shifts phosphate intracellularly when carbohydrate metabolism resumes after prolonged starvation.

Question 43: What pharmacokinetic advantage does continuous IV infusion provide over intermittent bolus dosing for time-dependent antibiotics?

Faster renal elimination
Higher peak concentrations
Sustained drug levels above the MIC for a greater percentage of the dosing interval (Correct answer)
Reduced total drug exposure

Correct answer: Sustained drug levels above the MIC for a greater percentage of the dosing interval

Time-dependent antibiotics (beta-lactams, carbapenems) achieve optimal bactericidal activity when drug concentrations remain above the MIC for extended periods, which continuous infusion achieves.

Question 44: What is the maximum recommended duration of continuous IV ketorolac (Toradol) therapy in adults?

24 hours
14 days
7 days
5 days (Correct answer)

Correct answer: 5 days

IV ketorolac is limited to 5 days due to the risk of serious GI bleeding, renal toxicity, and inhibition of platelet aggregation with prolonged use.

Question 45: What is the CRNI's responsibility regarding medication compatibility when multiple IV infusions run simultaneously?

If the drugs are in separate bags, compatibility is not a concern
Compatibility is the pharmacist's responsibility only
Only check compatibility for chemotherapy drugs
Verify Y-site and additive compatibility before co-administration using current references (Correct answer)

Correct answer: Verify Y-site and additive compatibility before co-administration using current references

The CRNI must verify both Y-site and additive compatibility using current, drug-specific references before any co-administration to prevent precipitation, degradation, or toxicity.

Question 46: A patient experiences a severe hypotensive reaction immediately after the CRNI initiates an infusion of a new antibiotic. After stopping the infusion and stabilizing the patient, the nurse discovers that the wrong medication was hung. According to the principles of professional practice, what is the nurse's priority action?

Complete an incident report and notify the nurse manager and physician. (Correct answer)
Ask a colleague to witness the disposal of the incorrect medication.
Contact the pharmacy to determine the antidote for the medication.
Document the patient's vital signs in the electronic health record.

Correct answer: Complete an incident report and notify the nurse manager and physician.

After ensuring immediate patient safety, the nurse's priority is to report the medication error through the proper channels. This includes completing an incident report and directly communicating with the nurse manager and the responsible physician. This action promotes a culture of safety, ensures transparency, and facilitates a systematic review to prevent future occurrences.

Question 47: When priming IV tubing for vesicant chemotherapy administration, what solution should be used?

Sterile water for injection
The chemotherapy drug itself
Bacteriostatic normal saline
Compatible IV fluid without the drug (Correct answer)

Correct answer: Compatible IV fluid without the drug

IV tubing should be primed with compatible IV fluid rather than the chemotherapy drug to avoid waste of expensive medication and reduce exposure risk.

Question 48: Which finding best indicates adequate fluid resuscitation in a critically ill patient?

CVP of 2 mmHg
Serum lactate of 5 mmol/L
MAP > 65 mmHg and urine output 0.5 mL/kg/hr (Correct answer)
Heart rate of 110 bpm

Correct answer: MAP > 65 mmHg and urine output 0.5 mL/kg/hr

A MAP > 65 mmHg with urine output ≥ 0.5 mL/kg/hr reflects adequate organ perfusion and resuscitation.

Question 49: A tunneled central venous catheter has a dacron cuff. What is the primary purpose of this cuff?

To reduce thrombosis at the catheter tip
To facilitate blood sampling without contamination
To secure the catheter to the skin during insertion
To act as a bacterial barrier and anchor the catheter subcutaneously (Correct answer)

Correct answer: To act as a bacterial barrier and anchor the catheter subcutaneously

The dacron cuff promotes fibrous tissue ingrowth, anchoring the tunneled catheter subcutaneously and providing a mechanical barrier against bacterial migration.

Question 50: A CRNI is educating a patient about caring for their tunneled catheter at home. Which instruction is most important regarding the exit site?

Apply antibiotic ointment to the exit site at every dressing change
Soak the exit site in warm water daily to keep it clean
Remove the dressing when showering and replace afterward
Keep the exit site dry and covered with a sterile dressing unless directed otherwise (Correct answer)

Correct answer: Keep the exit site dry and covered with a sterile dressing unless directed otherwise

The tunneled catheter exit site must be kept dry and covered with a sterile dressing to prevent infection; antibiotic ointments are not routinely recommended and soaking is contraindicated.

Question 51: Which assessment finding is most consistent with early peripheral IV infiltration?

Increased drip rate
Redness and warmth tracking along the vein
Cool, pale, swollen skin at the insertion site (Correct answer)
Fever and rigors

Correct answer: Cool, pale, swollen skin at the insertion site

Cool, pale, swollen skin indicates fluid has leaked into surrounding tissue rather than flowing through the vein.

Question 52: Per current INS guidelines, when should a peripheral IV catheter be replaced?

Every 72 hours
Every 96 hours
Based on clinical indication, not on a routine schedule (Correct answer)
Every 48 hours

Correct answer: Based on clinical indication, not on a routine schedule

INS now recommends replacing peripheral IVs based on clinical indication rather than routine timed replacement.

Question 53: Which antiseptic is recommended by INS for peripheral IV insertion site skin preparation?

70% isopropyl alcohol alone
10% povidone-iodine
Normal saline
>0.5% chlorhexidine gluconate in 70% isopropyl alcohol (Correct answer)

Correct answer: >0.5% chlorhexidine gluconate in 70% isopropyl alcohol

Chlorhexidine gluconate (>0.5%) in 70% isopropyl alcohol is the INS-preferred antiseptic because it provides residual antimicrobial activity.

Question 54: Which blood product is MOST appropriate for a patient with thrombocytopenic purpura who is actively bleeding with a platelet count of 8,000/mcL?

Platelet concentrate (Correct answer)
Cryoprecipitate
Fresh frozen plasma
Packed red blood cells

Correct answer: Platelet concentrate

Platelet concentrate is indicated for active bleeding with severe thrombocytopenia (platelet count below 10,000/mcL).

Question 55: During a routine dressing change for a patient's PICC line, the CRNI notes that the external catheter length has increased by 4 cm compared to the documented insertion length. The patient also reports occasionally hearing a 'gurgling' sound in their ear on the side of the catheter insertion. Which of the following is the most likely complication?

Venous thrombosis
Catheter fracture
Catheter migration (Correct answer)
Pinch-off syndrome

Correct answer: Catheter migration

An increase in the measured external length of a central line is a primary indicator of catheter migration. Symptoms such as a gurgling sound in the ear can suggest that the catheter tip has moved into the jugular vein. The infusion should be stopped and tip position must be confirmed via chest x-ray before further use.

Question 56: What legal considerations apply to the CRNI when a medication error occurs during infusion therapy?

Wait to see if the patient has any adverse effects before reporting
Do not document the error to avoid legal liability
Only report if the patient or family asks about it
Immediately disclose the error to the patient, document factually, report through institutional channels, and implement corrective actions (Correct answer)

Correct answer: Immediately disclose the error to the patient, document factually, report through institutional channels, and implement corrective actions

Legal and ethical obligations require immediate disclosure, factual documentation, institutional reporting, and corrective action following medication errors.

Question 57: Which gauge needle is recommended for accessing an implanted port to minimize damage to the port septum?

Butterfly needle of any gauge
18-gauge straight needle
20-gauge angiocatheter
Non-coring (Huber) needle (Correct answer)

Correct answer: Non-coring (Huber) needle

A non-coring (Huber) needle must be used to access an implanted port because its angled bevel cuts through the septum without removing a core of silicone material.

Question 58: A patient has been receiving continuous parenteral nutrition for three weeks. The central venous catheter becomes occluded, and the infusion is abruptly stopped. Which of the following is the nurse's priority assessment?

Signs of catheter-related infection, such as fever and chills
Signs of essential fatty acid deficiency, such as scaly dermatitis
Signs of hypoglycemia, such as diaphoresis and shakiness (Correct answer)
Signs of hypervolemia, such as crackles and edema

Correct answer: Signs of hypoglycemia, such as diaphoresis and shakiness

When a high-dextrose parenteral nutrition solution is stopped abruptly, the pancreas may continue to secrete high levels of insulin, leading to a rapid drop in blood glucose. This condition, known as rebound hypoglycemia, is the most immediate metabolic complication. The nurse must prioritize assessing for and managing signs of hypoglycemia.

Question 59: A patient receives a massive transfusion (>10 units PRBCs in 24 hours). Which electrolyte imbalance is most commonly anticipated?

Hypomagnesemia
Hyperkalemia only
Hypernatremia
Hypocalcemia (Correct answer)

Correct answer: Hypocalcemia

Citrate used as a preservative in banked blood chelates calcium, causing hypocalcemia during massive transfusion, especially when the liver cannot metabolize citrate fast enough.

Question 60: A CRNI is caring for a patient receiving a continuous infusion of 3% Sodium Chloride for severe, symptomatic hyponatremia. Which assessment finding requires immediate intervention by the nurse?

A gradual increase in serum sodium from 115 to 118 mEq/L over 6 hours.
New onset of confusion and signs of fluid overload. (Correct answer)
Patient report of a mild headache.
Urine output of 40 mL/hour.

Correct answer: New onset of confusion and signs of fluid overload.

Rapid correction of chronic hyponatremia with hypertonic saline can lead to osmotic demyelination syndrome (ODS), a severe neurological complication. The development of new neurological symptoms like confusion, coupled with signs of fluid overload (e.g., crackles in the lungs, edema), indicates that the correction may be too rapid or the patient is experiencing fluid volume excess. This is a critical situation requiring immediate cessation or slowing of the infusion and notification of the provider. A gradual increase in sodium within safe limits is the therapeutic goal. A mild headache and adequate urine output are less immediately concerning.

Question 61: Which central venous access device is MOST appropriate for a patient requiring 6 months of intermittent IV antibiotic therapy at home?

Non-tunneled CVC
Midline catheter
Peripheral IV catheter
PICC line (Correct answer)

Correct answer: PICC line

A PICC line is appropriate for prolonged intermittent therapy (weeks to months) at home because it can remain in place up to 12 months and is manageable by the patient or caregiver.

Question 62: What is the maximum hang time for a lipid-containing parenteral nutrition solution?

48 hours
12 hours
72 hours
24 hours (Correct answer)

Correct answer: 24 hours

Lipid-containing PN solutions (3-in-1 TNA) must be infused within 24 hours to minimize microbial growth risk in the lipid-rich medium.

Question 63: A nurse notices that a patient's IV infusion has been running into the subcutaneous tissue for an unknown period. The infiltrated solution was D10W. Which local complication is the primary concern?

Tissue necrosis from hyperosmolar solution (Correct answer)
Catheter-related bloodstream infection
Systemic hyperglycemia
Chemical phlebitis

Correct answer: Tissue necrosis from hyperosmolar solution

Hyperosmolar solutions such as D10W can cause tissue necrosis when infiltrated into subcutaneous tissue due to osmotic damage to local cells.

Question 64: Which disinfectant solution and technique is preferred for disinfecting needleless connectors before access?

Sterile water rinse followed by air-drying
Povidone-iodine applied and allowed to dry for 30 seconds
70% isopropyl alcohol with vigorous scrubbing for 5–15 seconds and air-dry (Correct answer)
Chlorhexidine wipe held on the connector for 60 seconds without scrubbing

Correct answer: 70% isopropyl alcohol with vigorous scrubbing for 5–15 seconds and air-dry

INS and CDC guidelines recommend scrubbing needleless connectors with 70% isopropyl alcohol for 5–15 seconds and allowing to dry to reduce microbial contamination.

Question 65: A patient on long-term home PN develops elevated AST, ALT, and alkaline phosphatase. The nurse recognizes this as:

Acute pancreatitis
Cholelithiasis from NPO status only
PN-associated liver disease (PNALD) (Correct answer)
Medication hepatotoxicity unrelated to PN

Correct answer: PN-associated liver disease (PNALD)

PN-associated liver disease (PNALD) is a well-recognized complication of long-term PN, presenting with elevated liver enzymes and potentially progressing to steatosis or cholestasis.

Question 66: A patient receiving an antineoplastic infusion develops urticaria and wheezing. After stopping the infusion, what is the priority nursing action?

Document the reaction and notify the pharmacy
Obtain vital signs and call the physician
Administer prescribed emergency medications (Correct answer)
Restart the infusion at a slower rate

Correct answer: Administer prescribed emergency medications

Urticaria and wheezing indicate an anaphylactic reaction requiring immediate administration of emergency medications such as epinephrine per standing orders.

Question 67: What is KVO (Keep Vein Open) mode on an infusion pump?

A very low flow rate (typically 0.1-3 mL/hr) that maintains catheter patency when the primary infusion is complete (Correct answer)
A high-flow emergency mode
A bolus delivery mode
A mode that turns off the pump completely

Correct answer: A very low flow rate (typically 0.1-3 mL/hr) that maintains catheter patency when the primary infusion is complete

KVO mode delivers a minimal flow rate to prevent blood from backing up into the catheter and forming a clot when the primary infusion is completed. The pump automatically switches to KVO rate rather than stopping completely, maintaining venous access until the next infusion is hung or a new order is received.

Question 68: What is the recommended minimum syringe size for flushing a central venous catheter to prevent catheter rupture?

10 mL (Correct answer)
3 mL
1 mL
20 mL

Correct answer: 10 mL

A minimum 10 mL syringe should be used for flushing central venous catheters. Smaller syringes generate higher pressures per unit area (measured in psi), which can exceed the catheter's pressure rating and cause rupture or fracture. A 10 mL syringe generates approximately 8 psi, while a 1 mL syringe can generate over 300 psi.

Question 69: What is the primary purpose of 'drug library guardrails' in a smart infusion pump?

To log infusion data for billing purposes only
To automatically calculate weight-based dosing without nurse input
To prevent infusion of incompatible medications simultaneously
To enforce pre-set dose limits that reduce programming errors and ADEs (Correct answer)

Correct answer: To enforce pre-set dose limits that reduce programming errors and ADEs

Drug library guardrails establish hard and soft dose limits that intercept programming errors at the point of care, directly reducing adverse drug events.

Question 70: Which INS-recommended element differentiates documentation of a vesicant extravasation from routine IV site documentation?

Extravasation documentation must include site photograph (when policy allows), estimated volume extravasated, extent of tissue involvement, all interventions, provider notification, and follow-up plan (Correct answer)
The pharmacist documents vesicant extravasations, not the nurse
Extravasation is documented identically to infiltration
Only the name of the vesicant drug needs to be added

Correct answer: Extravasation documentation must include site photograph (when policy allows), estimated volume extravasated, extent of tissue involvement, all interventions, provider notification, and follow-up plan

Vesicant extravasation documentation requires additional elements beyond standard site documentation because of the potential for serious tissue injury and medical-legal significance.

Question 71: When administering biologic response modifiers, which nursing assessment is MOST critical during the first 30 minutes?

Monitoring for anaphylactic reactions (Correct answer)
Assessing urine output
Blood pressure monitoring every 15 minutes
Checking blood glucose levels

Correct answer: Monitoring for anaphylactic reactions

Biologic agents such as monoclonal antibodies carry the highest risk of infusion reactions and anaphylaxis during the first 30 minutes of administration.

Question 72: Which electrolyte is the primary determinant of extracellular fluid osmolality?

Potassium
Calcium
Magnesium
Sodium (Correct answer)

Correct answer: Sodium

Sodium is the dominant cation in extracellular fluid and accounts for approximately 90% of extracellular osmolality, making it the principal regulator of ECF volume and tonicity.

Question 73: What is the recommended maximum dwell time for a peripheral IV catheter in an adult patient?

7 days
72-96 hours or based on clinical assessment (Correct answer)
48 hours
24 hours

Correct answer: 72-96 hours or based on clinical assessment

Current INS guidelines recommend replacing peripheral IV catheters every 72-96 hours or based on clinical indication, balancing infection risk with patient comfort.

Question 74: What is the maximum recommended dextrose concentration for peripheral IV infusion in pediatric patients?

5%
12.5% (Correct answer)
20%
10%

Correct answer: 12.5%

The maximum recommended dextrose concentration for peripheral infusion in pediatric patients is 12.5%. Higher concentrations are hyperosmolar and can cause vein irritation, phlebitis, and tissue necrosis if infiltration occurs. Concentrations above 12.5% require central venous access.

Question 75: Which complication is MOST specifically associated with rituximab infusion therapy?

Cardiotoxicity
Hepatotoxicity
Peripheral neuropathy
Tumor lysis syndrome (Correct answer)

Correct answer: Tumor lysis syndrome

Rituximab can cause tumor lysis syndrome, particularly in patients with high tumor burden, due to rapid destruction of B-cells.

Question 76: A nurse is assessing a peripheral IV site and notes a PICC score of 2 (slight tenderness, no erythema). What is the appropriate intervention?

Remove the catheter and resite in the opposite extremity (Correct answer)
Continue monitoring and reassess in 1 hour
Apply topical antibiotic ointment and continue infusion
Increase the infusion rate to prevent clot formation

Correct answer: Remove the catheter and resite in the opposite extremity

A VIP (Visual Infusion Phlebitis) or phlebitis score of 2 indicates early phlebitis and warrants removal of the catheter and resiting at a new location.

Question 77: A CRNI monitors blood glucose every 6 hours in a patient on PN. The glucose is consistently 220 mg/dL. The FIRST intervention should be:

Administer oral hypoglycemic agents
Increase the PN infusion rate to dilute the glucose concentration
Notify the provider to adjust the insulin sliding scale or add insulin to the PN bag (Correct answer)
Stop the PN infusion until glucose normalizes

Correct answer: Notify the provider to adjust the insulin sliding scale or add insulin to the PN bag

Persistent hyperglycemia during PN requires provider notification to adjust insulin coverage, either via sliding scale or by adding regular insulin directly to the PN formulation.

Question 78: A patient receives a blood transfusion. Which documentation set is required to meet AABB and INS standards?

Product type and volume only
Product number and start time only
Pre- and post-transfusion vital signs, product type, unit number, blood type, volume infused, start/stop times, and patient response (Correct answer)
Physician order and nursing signature

Correct answer: Pre- and post-transfusion vital signs, product type, unit number, blood type, volume infused, start/stop times, and patient response

AABB and INS standards require comprehensive transfusion documentation including identifiers, vital signs, volume, timing, and patient response to ensure traceability and safety.

Question 79: A premature infant is receiving IV fluids at 4 mL/hr. The nurse notices the infusion pump has been running at 40 mL/hr for 30 minutes. What is the excess volume infused?

18 mL (Correct answer)
12 mL
36 mL
20 mL

Correct answer: 18 mL

The excess volume is calculated by subtracting the intended volume from the actual volume delivered. Actual: 40 mL/hr × 0.5 hr = 20 mL. Intended: 4 mL/hr × 0.5 hr = 2 mL. Excess: 20 - 2 = 18 mL. In a premature infant, this excess could be life-threatening.

Question 80: A patient receiving IV insulin is ordered to have blood glucose checks every hour. At what blood glucose level should the infusion be stopped and dextrose administered per standard protocol?

Below 140 mg/dL
Below 180 mg/dL
Below 100 mg/dL
Below 70 mg/dL (Correct answer)

Correct answer: Below 70 mg/dL

A blood glucose below 70 mg/dL indicates hypoglycemia; the insulin infusion should be stopped and dextrose administered to prevent serious neurological complications.

Question 81: Most of the body's water is found in

plasma.
interstitial fluid.
lumens of organs open to the outside.
cells. (Correct answer)

Correct answer: cells.

The majority of the body's water is found within the intracellular fluid (ICF), which is the fluid contained inside cells. Approximately two-thirds of the total body water resides within cells, making it the largest fluid compartment. The remaining one-third is extracellular fluid, divided between interstitial fluid and plasma.

Question 82: When administering IV amiodarone for acute atrial fibrillation, which adverse effect requires IMMEDIATE intervention?

Sinus bradycardia with heart rate of 58 bpm
QTc interval prolongation greater than 500 ms (Correct answer)
Mild hypotension with MAP above 65 mmHg
Phlebitis at the peripheral IV site

Correct answer: QTc interval prolongation greater than 500 ms

A QTc greater than 500 ms significantly increases the risk of torsades de pointes, a life-threatening arrhythmia requiring immediate prescriber notification and possible drug discontinuation.

Question 83: Which of the following is the MOST effective strategy for preventing ventilator-associated pneumonia (VAP) in a critically ill patient receiving IV therapy?

Administering prophylactic IV antibiotics routinely
Using a humidified oxygen mask instead of the ventilator
Daily sedation interruption combined with head-of-bed elevation to 30–45 degrees (Correct answer)
Changing ventilator circuits every 24 hours

Correct answer: Daily sedation interruption combined with head-of-bed elevation to 30–45 degrees

VAP bundles include head-of-bed elevation (30–45°) and daily sedation interruptions; these are among the most evidence-supported non-pharmacologic VAP prevention measures.

Question 84: What is the recommended practice for blood sampling from a central venous catheter?

Blood should never be drawn from central lines
Use the same syringe for discard and sample collection
Draw blood directly without any preparation
Pause infusions, discard an appropriate waste volume, obtain the sample, flush, and resume infusions (Correct answer)

Correct answer: Pause infusions, discard an appropriate waste volume, obtain the sample, flush, and resume infusions

Blood sampling from CVCs requires pausing infusions, discarding a waste volume to clear the line of infusate, obtaining the specimen, and flushing afterward to maintain patency.

Question 85: A nurse is administering a critical vasopressor infusion. What is the most important pump-related safety measure?

Using the largest available tubing
Running the vasopressor as a secondary infusion
Using a dedicated pump channel with no Y-site connections and a proximal infusion site (Correct answer)
Using the fastest available infusion rate

Correct answer: Using a dedicated pump channel with no Y-site connections and a proximal infusion site

Critical vasopressor infusions should run on a dedicated pump channel without Y-site connections to prevent interruptions or unintended boluses when other medications are started or stopped. A proximal infusion site (central line preferred) minimizes dead space and drug delivery delay. Any interruption in vasopressor delivery can cause dangerous hemodynamic instability.

Question 86: A 3-year-old with sickle cell disease is receiving a simple red blood cell transfusion. After 50 mL, the child develops fever, chills, and back pain. Which transfusion reaction is most likely?

Febrile non-hemolytic transfusion reaction
Transfusion-related acute lung injury (TRALI)
Allergic (urticarial) reaction
Acute hemolytic transfusion reaction (Correct answer)

Correct answer: Acute hemolytic transfusion reaction

Fever, chills, and back pain occurring shortly after transfusion onset in sickle cell disease are classic signs of acute hemolytic transfusion reaction due to ABO incompatibility.

Question 87: Which organization publishes the Infusion Therapy Standards of Practice that serves as the primary clinical reference for infusion nursing?

Infusion Nurses Society (INS) (Correct answer)
The Joint Commission (TJC)
American Nurses Association (ANA)
Centers for Disease Control and Prevention (CDC)

Correct answer: Infusion Nurses Society (INS)

The Infusion Nurses Society (INS) publishes the Infusion Therapy Standards of Practice, which is the authoritative reference for evidence-based infusion therapy practice. Updated regularly, these standards cover all aspects of infusion nursing including vascular access, administration, patient safety, and documentation requirements.

Question 88: A provider orders PN to be started immediately, but the pharmacy-prepared bag is not yet available. The nurse should administer:

Lactated Ringer's at the prescribed PN rate
Dextrose 10% in water (D10W) at the prescribed PN rate (Correct answer)
Normal saline at the prescribed PN rate
Nothing until the PN bag arrives

Correct answer: Dextrose 10% in water (D10W) at the prescribed PN rate

D10W is the appropriate bridge solution when PN is unavailable because it prevents hypoglycemia in patients who have been on PN and maintains carbohydrate substrate.

Question 89: A patient's central venous pressure (CVP) is 2 mmHg. Which clinical finding would be consistent with this value?

Peripheral edema
Crackles on lung auscultation
Flat neck veins in the supine position (Correct answer)
Jugular venous distension

Correct answer: Flat neck veins in the supine position

A CVP of 2 mmHg is below normal (8–12 mmHg) indicating hypovolemia, which presents with flat neck veins when supine.

Question 90: A home infusion patient reports the infusion is running much slower than prescribed. What should the nurse recommend assessing first?

Replacing the IV bag with a fresh one
Immediately increasing the drip rate
Tubing for kinks and catheter for positional obstruction (Correct answer)
Calling emergency services

Correct answer: Tubing for kinks and catheter for positional obstruction

Kinks in tubing or positional changes affecting catheter flow are the most common and easily corrected causes of slow infusion in the home setting.

Question 91: Which infusion pump technology uses peristaltic action to propel fluid?

Linear peristaltic pump using sequential finger-like compressions on the tubing (Correct answer)
Gravity controller
Elastomeric pump
Syringe pump

Correct answer: Linear peristaltic pump using sequential finger-like compressions on the tubing

Linear peristaltic pumps use a series of cam-driven fingers that sequentially compress the IV tubing in a wave-like motion, propelling fluid forward. This mechanism allows precise flow rate control using standard IV tubing. Rotary peristaltic pumps use a similar principle with rotating rollers compressing tubing around a curved track.

Question 92: A patient receiving home IV vancomycin asks why they need regular blood draws. What is the best explanation?

It is a routine requirement for all patients on home IV therapy
Blood tests verify that the IV catheter is functioning
The blood draws detect whether the IV site is infected
Vancomycin levels must be monitored to ensure therapeutic dosing and prevent nephrotoxicity and ototoxicity (Correct answer)

Correct answer: Vancomycin levels must be monitored to ensure therapeutic dosing and prevent nephrotoxicity and ototoxicity

Vancomycin has a narrow therapeutic index, requiring serum level or AUC monitoring to achieve efficacy while avoiding nephrotoxicity and ototoxicity.

Question 93: What is the standard for documenting patient education related to infusion therapy?

Only if the patient asks questions
Content taught, method of instruction, patient's understanding (demonstrated competency), and language/cultural accommodations made (Correct answer)
Only that education was provided
No documentation needed for education

Correct answer: Content taught, method of instruction, patient's understanding (demonstrated competency), and language/cultural accommodations made

Patient education documentation should include the specific content taught (therapy purpose, expected duration, potential complications, self-monitoring instructions), the teaching method used (verbal, written, demonstration), the patient's demonstration of understanding (return demonstration, teach-back), and any accommodations made for language, literacy, or cultural needs.

Question 94: Which anatomical site is CONTRAINDICATED for peripheral IV insertion in most adult patients?

Hand dorsal metacarpal veins
Forearm cephalic vein
Lower extremity foot veins (Correct answer)
Antecubital fossa basilic vein

Correct answer: Lower extremity foot veins

Lower extremity veins are generally contraindicated for peripheral IV access in adults due to the high risk of thrombophlebitis and deep vein thrombosis.

Question 95: According to the INS Standards of Practice, what is the primary goal of infusion therapy?

Providing safe, evidence-based infusion therapy that promotes positive patient outcomes (Correct answer)
Maximizing hospital revenue through IV services
Minimizing the number of venipunctures
Reducing the length of hospital stay

Correct answer: Providing safe, evidence-based infusion therapy that promotes positive patient outcomes

The INS Standards of Practice establishes that the primary goal is delivering safe, evidence-based infusion therapy focused on positive patient outcomes.

Question 96: A CRNI is preparing to administer a 3-in-1 total nutrient admixture (TNA) containing dextrose, amino acids, and a lipid emulsion. Which in-line filter is required for the safe administration of this solution?

A 0.22-micron filter
A 1.2-micron filter (Correct answer)
No filter is necessary if a dedicated lumen is used
A 5-micron filter

Correct answer: A 1.2-micron filter

A 1.2-micron filter is required for administering total nutrient admixtures (TNAs) or any lipid-containing parenteral nutrition. The lipid particles are too large to pass through a smaller 0.22-micron filter, which would cause an occlusion. The 1.2-micron filter allows the large lipid molecules to pass through while still filtering out particulate matter, larger microorganisms like Candida albicans, and precipitates.

Question 97: During biomedical equipment inspection, a technician finds the pump's flow accuracy has drifted beyond manufacturer specifications. What is the appropriate action before returning the pump to clinical use?

Increase the programmed rate to compensate for the drift
Recalibrate the pump per manufacturer protocol and retest before returning to service (Correct answer)
Return the pump to service after a simple cleaning
Place a warning label on the pump and continue use for non-critical infusions

Correct answer: Recalibrate the pump per manufacturer protocol and retest before returning to service

Pumps with accuracy drift must be recalibrated and verified to meet specifications before clinical use to ensure patient safety and regulatory compliance.

Question 98: A patient reports that their arm where the PICC was inserted is now swollen and painful three days post-removal. What complication should the nurse suspect?

Lymphedema secondary to venipuncture
Normal post-removal inflammatory response
Post-removal deep vein thrombosis (DVT) (Correct answer)
Delayed hypersensitivity reaction to dressing adhesive

Correct answer: Post-removal deep vein thrombosis (DVT)

Swelling and pain in the extremity where a PICC was removed days earlier is suspicious for DVT, a recognized complication that can persist or develop after catheter removal.

Question 99: What is the significance of osmolality when selecting a peripheral versus central infusion route?

Osmolality has no bearing on infusion route selection
Osmolality only affects medication stability
Solutions with osmolality greater than 900 mOsm/L should be infused via central venous access to prevent phlebitis (Correct answer)
Only solutions above 2000 mOsm/L require central access

Correct answer: Solutions with osmolality greater than 900 mOsm/L should be infused via central venous access to prevent phlebitis

Solutions exceeding 900 mOsm/L cause significant endothelial damage to peripheral veins, necessitating central venous administration where rapid blood flow dilutes the solution.

Question 100: What is the appropriate intervention for a suspected air embolism during central line tubing change?

Elevate the head of bed and administer oxygen
Have the patient perform Valsalva maneuver and continue the tubing change
Place the patient in left lateral Trendelenburg position and administer 100% oxygen (Correct answer)
Position the patient supine and call a code

Correct answer: Place the patient in left lateral Trendelenburg position and administer 100% oxygen

Left lateral Trendelenburg position traps air in the right atrium apex, preventing it from entering the pulmonary vasculature, while 100% oxygen helps absorb the air.

Question 101: Which electrolyte imbalance is MOST dangerous when administering potassium chloride IV?

Hypocalcemia from potassium-calcium antagonism
Hyponatremia from dilutional effect
Hyperkalemia from infusion rate exceeding renal excretion (Correct answer)
Hypokalemia from too-rapid correction

Correct answer: Hyperkalemia from infusion rate exceeding renal excretion

Hyperkalemia from excessive IV potassium infusion can cause fatal cardiac arrhythmias, making infusion rate monitoring critical.

Question 102: Which gauge peripheral IV catheter is most appropriate for the rapid infusion of blood products in an emergency?

24-gauge
22-gauge
16-gauge (Correct answer)
20-gauge

Correct answer: 16-gauge

A 16-gauge catheter has the largest lumen among common peripheral catheters, allowing the highest flow rate needed for rapid blood product administration.

Question 103: Why must parenteral nutrition solutions be administered through a dedicated lumen?

Because PN solutions are too viscous for shared lumens
To prevent contamination, incompatibilities, and interruptions that affect glucose delivery (Correct answer)
It is a preference, not a requirement
To maintain accurate calorie delivery records

Correct answer: To prevent contamination, incompatibilities, and interruptions that affect glucose delivery

A dedicated lumen prevents microbial contamination from multiple access points, drug incompatibilities, and infusion interruptions that could cause blood glucose instability.

Question 104: A nurse infusion team tracks catheter-associated bloodstream infection (CLABSI) rates and compares them to national benchmarks. Which organization publishes the most widely used CLABSI benchmark data for acute-care settings?

Centers for Disease Control and Prevention (CDC) / NHSN (Correct answer)
American Nurses Credentialing Center (ANCC)
Joint Commission on Accreditation of Healthcare Organizations
Infusion Nurses Society (INS)

Correct answer: Centers for Disease Control and Prevention (CDC) / NHSN

The CDC's National Healthcare Safety Network (NHSN) is the national surveillance system that collects and publishes CLABSI rates by facility type, providing the benchmark data used to evaluate infusion program performance.

Question 105: 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?

Notify the provider to reposition the catheter to the lower one-third of the superior vena cava (Correct answer)
Advance the catheter 2 cm further to reach the inferior vena cava
Begin infusion immediately because the right atrium is an acceptable PICC tip location in neonates
Withdraw the catheter to the subclavian vein and restart infusion

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

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 106: A patient develops hypotension, dyspnea, and bilateral pulmonary infiltrates within 6 hours of transfusion. Which complication should the nurse suspect?

Circulatory overload
Transfusion-related acute lung injury (TRALI) (Correct answer)
Allergic reaction
Delayed hemolytic reaction

Correct answer: Transfusion-related acute lung injury (TRALI)

TRALI presents with acute respiratory distress, hypotension, and bilateral pulmonary infiltrates within 6 hours of transfusion, distinguishing it from circulatory overload.

Question 107: During a lipid infusion via a peripheral IV, a patient develops a fever, chest and back pain, and dyspnea. Which rare but serious complication should the nurse suspect?

Anaphylaxis to soy-based lipid emulsion
Pulmonary embolism from catheter thrombus
Fat overload syndrome (Correct answer)
Speed shock from rapid infusion

Correct answer: Fat overload syndrome

Fat overload syndrome is a rare complication of lipid emulsions presenting with fever, hepatosplenomegaly, coagulopathy, and pulmonary symptoms caused by impaired lipid clearance.

Question 108: Which of the following is a key maintenance step for reducing the risk of a central line-associated bloodstream infection (CLABSI)?

Administering prophylactic antibiotics before accessing the line.
Scrubbing the access hub vigorously for at least 5-15 seconds prior to each use. (Correct answer)
Performing routine dressing changes every 24 hours.
Flushing all lumens with heparinized saline daily.

Correct answer: Scrubbing the access hub vigorously for at least 5-15 seconds prior to each use.

Vigorous scrubbing of the needleless connector or 'hub' with an appropriate antiseptic (e.g., chlorhexidine, 70% alcohol) and allowing it to dry is a critical evidence-based practice to prevent intraluminal contamination and subsequent CLABSI. The friction and contact time are essential to disinfect the surface effectively before accessing the line.

Question 109: A patient on chronic buprenorphine therapy is admitted for postoperative pain management. Which approach best addresses their analgesic needs?

Avoid all opioids due to opioid-receptor saturation
Switch to methadone at an equianalgesic dose
Discontinue buprenorphine and use full agonist opioids alone
Continue buprenorphine and add non-opioid multimodal analgesics plus possible supplemental opioids (Correct answer)

Correct answer: Continue buprenorphine and add non-opioid multimodal analgesics plus possible supplemental opioids

Continuing buprenorphine prevents withdrawal while multimodal agents and high-affinity full agonists (e.g., hydromorphone) can provide additional analgesia for acute pain.

Question 110: A pediatric patient receiving IV therapy develops tachycardia, increased respiratory rate, and periorbital edema. Which complication of IV therapy does this presentation most suggest?

Allergic reaction
Septicemia
Fluid overload (Correct answer)
Speed shock

Correct answer: Fluid overload

Tachycardia, increased respiratory rate, and periorbital edema are hallmark signs of fluid overload, especially in pediatric patients with less fluid reserve.

Question 111: What is the appropriate action when a pediatric patient's IV site shows a grade 2 infiltration on the INS scale?

Continue monitoring and slow the rate
Apply warm compresses and continue infusion
Only document and continue the infusion
Discontinue the IV and elevate the extremity (Correct answer)

Correct answer: Discontinue the IV and elevate the extremity

A grade 2 infiltration (slight swelling, cool to touch, with or without blanching) requires immediate discontinuation of the IV and elevation of the affected extremity. Continuing the infusion at any rate would worsen tissue damage. A new IV site should be selected.

Question 112: What is the recommended flushing protocol for an implanted venous access port that is not actively being used?

No flushing is needed when not in use
Monthly flushing with heparinized saline (Correct answer)
Weekly flushing with normal saline
Daily flushing with normal saline

Correct answer: Monthly flushing with heparinized saline

Implanted ports require monthly flushing with heparinized saline (typically 5 mL of 100 units/mL heparin) when not actively in use to maintain patency. The heparin lock prevents fibrin buildup and clot formation within the port reservoir and catheter lumen. Some newer ports may have different maintenance protocols per manufacturer guidelines.

Question 113: A patient receiving IV normal saline at 150 mL/hr develops crackles, jugular vein distension, and dyspnea. What is the priority nursing intervention?

Increase the head of bed elevation and continue monitoring
Administer a fluid bolus to improve cardiac output
Slow or stop the infusion and notify the provider (Correct answer)
Switch to a hypotonic solution

Correct answer: Slow or stop the infusion and notify the provider

These signs indicate fluid volume overload, requiring immediate reduction or cessation of the IV infusion and provider notification for diuretic orders.

Question 114: A patient with a tunneled central catheter develops pain, erythema, and warmth along the subcutaneous tunnel tract. What complication does this indicate?

Port pocket infection
Exit-site infection
Tunnel infection (Correct answer)
Catheter-related bloodstream infection

Correct answer: Tunnel infection

Erythema, warmth, and tenderness extending more than 2 cm along the subcutaneous tunnel tract beyond the exit site is diagnostic of a tunnel infection.

Question 115: What gauge IV catheter is the MINIMUM recommended size for adult blood transfusion?

18 gauge
22 gauge
20 gauge (Correct answer)
16 gauge

Correct answer: 20 gauge

A 20-gauge catheter is the minimum recommended size for routine adult blood transfusion, though 18-gauge is preferred for rapid infusion needs.

Question 116: A nurse is preparing to administer IV phenytoin. Which solution is compatible for dilution?

Normal saline (0.9% NaCl) (Correct answer)
Dextrose 5% in water (D5W)
Dextrose 10% in water
Lactated Ringer's solution

Correct answer: Normal saline (0.9% NaCl)

Phenytoin is only compatible with normal saline; dextrose solutions cause precipitation due to the drug's alkaline pH and poor aqueous solubility.

Question 117: A CRNI is assessing a patient for signs of pegfilgrastim (Neulasta) toxicity. Which complaint warrants immediate evaluation for splenic rupture?

Generalized fatigue and low-grade fever
Injection site erythema and swelling
Mild bone pain in the sternum
Sudden severe left upper quadrant abdominal pain (Correct answer)

Correct answer: Sudden severe left upper quadrant abdominal pain

Sudden severe left upper quadrant pain in a patient receiving colony-stimulating factors like pegfilgrastim must be evaluated urgently for splenic rupture, a rare but life-threatening complication.

Question 118: A nurse is preparing to administer IV potassium chloride. Which concentration is safe for peripheral IV administration without requiring central line access?

20 mEq/100 mL (Correct answer)
80 mEq/250 mL
40 mEq/100 mL
60 mEq/100 mL

Correct answer: 20 mEq/100 mL

Concentrations of 10 mEq/100 mL or less (equivalent to 20 mEq/200 mL) are generally safe peripherally; 20 mEq/100 mL is the maximum recommended concentration for peripheral infusion per most guidelines.

Question 119: A patient receiving TPN through a PICC line develops fever, chills, and positive blood cultures. What does this scenario most likely represent?

Catheter-related bloodstream infection (CRBSI) (Correct answer)
Septic thrombophlebitis of a peripheral vein
Tunnel infection at the exit site
Infusion-related phlebitis

Correct answer: Catheter-related bloodstream infection (CRBSI)

Fever, rigors, and positive blood cultures in a patient with a central line and TPN are classic signs of a catheter-related bloodstream infection (CRBSI).

Question 120: What is the rationale for using ultrasound guidance during PICC insertion?

It improves vein visualization, increases first-attempt success, reduces complications, and aids in vein-to-catheter ratio assessment (Correct answer)
It is only helpful for obese patients
It replaces the need for chest X-ray tip confirmation
It is required by law for all PICC insertions

Correct answer: It improves vein visualization, increases first-attempt success, reduces complications, and aids in vein-to-catheter ratio assessment

Ultrasound guidance provides real-time vein visualization, enabling optimal vein selection, improved first-attempt success, and reduced mechanical complications during PICC insertion.

Question 121: A patient with a PICC line reports inability to flush the catheter. After repositioning the arm, flushing is successful. What is the likely cause?

Complete catheter occlusion
Positional occlusion from catheter tip against the vessel wall (Correct answer)
Fibrin sheath formation
Catheter fracture

Correct answer: Positional occlusion from catheter tip against the vessel wall

Positional occlusion occurs when the catheter tip rests against the vessel wall, blocking flow in certain positions but resolving with repositioning.

Question 122: Which type of isolation is required for a patient diagnosed with pulmonary tuberculosis?

Droplet precautions with a surgical mask
Airborne precautions in a negative-pressure room (Correct answer)
Contact precautions in a standard room
Protective environment with HEPA filtration

Correct answer: Airborne precautions in a negative-pressure room

Pulmonary TB is transmitted via airborne nuclei (<5 microns), requiring airborne precautions in an airborne infection isolation room (AIIR) with negative pressure.

Question 123: What is the correct blood sample labeling requirement for pre-transfusion testing?

Pre-printed labels applied at the patient's bedside
Labels with patient name, MRN, date, time, and collector's initials applied at the bedside (Correct answer)
Labels with patient name and room number
Any label matching the transfusion order

Correct answer: Labels with patient name, MRN, date, time, and collector's initials applied at the bedside

Pre-transfusion specimens must be labeled at the bedside with complete patient identifiers, date, time, and phlebotomist identification to prevent specimen misidentification.

Question 124: A patient on long-term parenteral nutrition develops signs of air embolism. Which documentation sequence is correct?

Complete an incident report first, then add a nursing note at the end of the shift
Document only if the patient survives the event
Immediately document the time symptoms were identified, patient position changes, oxygen applied, provider notified, and patient response as events unfold (Correct answer)
Document after the patient is stabilized, focusing only on interventions

Correct answer: Immediately document the time symptoms were identified, patient position changes, oxygen applied, provider notified, and patient response as events unfold

Contemporaneous documentation of the time of symptom recognition, emergency interventions, and patient response creates an accurate record and is essential for legal and quality review.

Question 125: A patient receiving IV vancomycin develops flushing, erythema, and pruritus on the face, neck, and upper torso. What is this reaction called and what is the appropriate intervention?

Extravasation; stop infusion and elevate the extremity
Red Man Syndrome; slow the infusion rate and premedicate with diphenhydramine (Correct answer)
Phlebitis; discontinue IV and apply warm compress
Anaphylaxis; stop infusion and administer epinephrine

Correct answer: Red Man Syndrome; slow the infusion rate and premedicate with diphenhydramine

Red Man Syndrome is a rate-related reaction to vancomycin characterized by flushing and erythema of the upper body, managed by slowing the infusion and premedication with antihistamines.

Question 126: A nurse is caring for a patient with an implanted port. Which needle type must be used to access an implanted port?

Spinal needle
Non-coring (Huber) needle (Correct answer)
Butterfly needle
Standard hypodermic needle

Correct answer: Non-coring (Huber) needle

Non-coring (Huber) needles have an angled bevel that displaces the port septum without cutting it, preserving septum integrity for repeated access.

Question 127: What is the evidence-based approach to managing a suspected catheter-related bloodstream infection when the organism is coagulase-negative Staphylococcus?

No treatment needed as it is likely a contaminant
Attempt catheter salvage with antibiotic lock therapy and systemic antibiotics if the patient is stable (Correct answer)
Immediate catheter removal and 14 days of IV antibiotics
Switch to a new central line at a different site immediately

Correct answer: Attempt catheter salvage with antibiotic lock therapy and systemic antibiotics if the patient is stable

Coagulase-negative Staphylococcus CRBSI may be managed with catheter salvage using antibiotic lock therapy plus systemic antibiotics if there are no complications.

Question 128: A nurse is performing a central line dressing change. In which order should the antiseptic be applied?

From periphery toward the insertion site
Applied and immediately wiped off
In a circular motion from the insertion site outward, using friction for 30 seconds (Correct answer)
In a back-and-forth scrubbing motion

Correct answer: In a circular motion from the insertion site outward, using friction for 30 seconds

Chlorhexidine should be applied in a circular motion starting from the catheter insertion site and moving outward to prevent dragging bacteria toward the site. The solution should be applied with friction for at least 30 seconds and allowed to air dry completely (approximately 2 minutes) before applying the new dressing.

Question 129: Which solution is SAFE to co-infuse in the same IV line as packed red blood cells?

Lactated Ringer's solution
Normal saline (0.9% NaCl) (Correct answer)
Total parenteral nutrition (TPN)
Dextrose 5% in water (D5W)

Correct answer: Normal saline (0.9% NaCl)

Only 0.9% normal saline is compatible for co-infusion with PRBCs; dextrose solutions cause hemolysis and lactated Ringer's contains calcium that can cause clotting.

Question 130: What is the primary purpose of using an antimicrobial-impregnated central venous catheter?

To improve flow rates
To reduce catheter-related bloodstream infection through sustained antimicrobial activity (Correct answer)
To extend the catheter's mechanical lifespan
To reduce thrombosis risk

Correct answer: To reduce catheter-related bloodstream infection through sustained antimicrobial activity

Antimicrobial-impregnated catheters (coated with chlorhexidine/silver sulfadiazine or minocycline/rifampin) reduce CRBSI by preventing bacterial colonization on the catheter surfaces. They are recommended for patients expected to have CVCs for more than 5 days in facilities with high CRBSI rates despite adherence to other prevention bundles.

Question 131: Which of the following is a critical nursing consideration specific to the administration of platelets?

Ensuring the component is warmed to body temperature prior to infusion to activate the platelets.
Using a dedicated administration set and infusing rapidly, typically over 30 to 60 minutes. (Correct answer)
Administering the component through a micro-aggregate filter (20-40 microns).
Infusing the component slowly over a period of 3 to 4 hours.

Correct answer: Using a dedicated administration set and infusing rapidly, typically over 30 to 60 minutes.

Platelets are fragile and must be administered through a standard 170-260 micron filter, not a micro-aggregate filter. To maintain their viability and function, they should be infused relatively quickly, usually over 30-60 minutes. Platelet-specific administration sets with shorter tubing are often used to minimize component loss due to adherence to the tubing surface. Slow infusion can decrease platelet efficacy.

Question 132: A patient on immunosuppressive therapy develops a fever of 38.6°C within 30 minutes of starting an IV infusion. The nurse suspects infusion-related sepsis. What is the FIRST action?

Slow the infusion rate
Obtain blood cultures from the infusion line only
Discontinue the infusion and notify the provider (Correct answer)
Administer antipyretics

Correct answer: Discontinue the infusion and notify the provider

The infusion must be stopped immediately to halt potential bacteremic exposure, and the provider notified; the suspect infusate and tubing should be saved for culture.

Question 133: A CRNI is preparing to administer doxorubicin. Which of the following baseline assessments is MOST critical to review before initiating therapy due to this agent's primary dose-limiting toxicity?

A peripheral nerve conduction study.
An echocardiogram or MUGA scan. (Correct answer)
Serum creatinine and BUN.
Pulmonary function tests.

Correct answer: An echocardiogram or MUGA scan.

Doxorubicin, an anthracycline, is well known for its significant risk of causing cumulative, dose-related cardiotoxicity, which can lead to irreversible congestive heart failure. Therefore, it is a standard of care to assess the patient's baseline cardiac function, specifically the left ventricular ejection fraction (LVEF), using an echocardiogram or a MUGA scan before starting treatment and to monitor it periodically.

Question 134: When verifying blood product identification at the bedside, how many licensed personnel must participate?

One nurse is sufficient
Two licensed personnel (Correct answer)
One nurse and one physician
Two nurses and the patient

Correct answer: Two licensed personnel

Two licensed personnel must independently verify blood product identification at the bedside to ensure the correct product is administered to the correct patient.

Question 135: Which nursing intervention BEST prevents catheter occlusion in a patient receiving PN via a central venous catheter?

Flushing only when resistance is felt during infusion
Using heparinized saline at 100 units/mL routinely after each infusion
Clamping the catheter between infusions without flushing
Flushing the catheter with preservative-free normal saline before and after PN infusion (Correct answer)

Correct answer: Flushing the catheter with preservative-free normal saline before and after PN infusion

Flushing with preservative-free normal saline before and after PN helps clear the catheter of residue and prevents fibrin and lipid buildup that can cause occlusion.

Question 136: Transfusion-related acute lung injury (TRALI) is most commonly associated with transfusion of which blood product?

Cryoprecipitate
Platelets
Packed red blood cells
Fresh frozen plasma from multiparous female donors (Correct answer)

Correct answer: Fresh frozen plasma from multiparous female donors

TRALI is most associated with plasma-containing products from multiparous donors who have developed HLA or HNA antibodies that react with recipient leukocytes.

Question 137: Which complication is specific to massive transfusion of cold blood products?

Hypothermia-induced cardiac arrhythmias (Correct answer)
Iron overload
Graft-versus-host disease
Citrate toxicity

Correct answer: Hypothermia-induced cardiac arrhythmias

Rapid infusion of cold blood products can cause hypothermia, leading to cardiac arrhythmias, coagulopathy, and impaired oxygen delivery.

Question 138: What is the maximum recommended dwell time for a peripheral IV catheter in adults according to INS standards?

No set time limit if site is without complications (Correct answer)
96 hours
72 hours
48 hours

Correct answer: No set time limit if site is without complications

INS 2021 standards recommend removing peripheral IV catheters based on clinical indication rather than a routine time-based replacement schedule, provided the site shows no signs of complications.

Question 139: 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:

No liability, because the NPA violation is the nurse's individual responsibility
Vicarious liability transferred entirely to the nurse
Respondeat superior liability for negligent credentialing (Correct answer)
Strict product liability for the catheter device

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 140: Which pump feature allows the clinician to administer a loading dose followed by a continuous maintenance infusion?

Piggyback mode
Ramp mode
Bolus-to-continuous mode (loading dose with automatic transition to maintenance rate) (Correct answer)
KVO mode

Correct answer: Bolus-to-continuous mode (loading dose with automatic transition to maintenance rate)

Many smart pumps offer a loading dose feature that delivers a specified bolus amount over a set time, then automatically transitions to the programmed continuous maintenance rate. This is particularly useful for medications like heparin, aminophylline, or vasopressors that require an initial higher dose followed by continuous infusion.

CRNI - Certified Registered Nurse Infusion

The CRNI certification exam, administered by the Infusion Nurses Certification Corporation (INCC), validates specialized competency in infusion therapy nursing practice including vascular access, pharmacology, infection prevention, and patient assessment.

140

Questions

150 min

Time Limit

70%

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