Mixed Deck — All CRNI Topics Flashcards

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

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.

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

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.

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

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.

A patient on long-term parenteral nutrition develops signs of air embolism. Which documentation sequence is 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.

What is the most important consideration when selecting an infusion pump for pediatric therapy?

Answer: Ability to deliver in increments of 0.1 mL/hr or less

The ability to deliver fluid in very small increments (0.1 mL/hr or less) is the most critical feature of a pediatric infusion pump. This precision prevents fluid overload and ensures accurate medication dosing, which is essential given the narrow therapeutic margins in children.

A CRNI is calculating the lockout interval for a hydromorphone PCA. The onset of IV hydromorphone is approximately 5 minutes. Which lockout interval is most appropriate?

Answer: 5–10 minutes to allow drug effect before the next dose

A 5–10 minute lockout allows enough time for hydromorphone to reach peak effect before the patient can request another dose, balancing efficacy and safety.

A patient with an implanted port is scheduled for a monthly infusion. Upon accessing the port with a non-coring needle, the nurse meets resistance and is unable to flush the device. Which of the following complications should the nurse suspect?

Answer: Thrombotic occlusion.

The inability to flush an implanted port that was previously functional often indicates a thrombotic occlusion, where a blood clot has formed within the catheter or port reservoir, blocking the flow. This is a common cause of catheter malfunction. While other issues like migration or pinch-off can cause resistance, thrombosis is a primary consideration.

A nurse inserts a peripheral IV catheter and notes blood return, but upon flushing encounters resistance followed by swelling at the site. What does this MOST likely indicate?

Answer: Infiltration with the catheter in the subcutaneous tissue

Swelling upon flushing despite initial blood return indicates infiltration, where the catheter tip has migrated out of the vein into surrounding subcutaneous tissue.

When administering a continuous heparin infusion, the patient's aPTT is 3.5 times the control value. What is the priority nursing action?

Answer: Hold the infusion and notify the prescriber per protocol

An aPTT greater than 3 times the control indicates supratherapeutic anticoagulation; the infusion should be held and the prescriber notified per institutional protocol.

Which laboratory test confirms an acute hemolytic transfusion reaction?

Answer: Direct antiglobulin test (DAT)

The direct antiglobulin test detects antibodies or complement attached to the patient's red blood cells, confirming immune-mediated hemolysis.

Which alarm condition on a smart infusion pump indicates that the upstream occlusion pressure has been exceeded?

Answer: Upstream occlusion alarm

An upstream occlusion alarm fires when resistance proximal to the pump exceeds the set threshold, indicating a blockage between the fluid source and the pump mechanism.

What weight must you be in order to donate blood?

Answer: 110 pounds

To ensure the safety of both the donor and the recipient, blood donation centers have specific eligibility criteria. A minimum weight of 110 pounds (approximately 50 kg) is a standard requirement for whole blood donation. This threshold helps ensure that the donor has sufficient blood volume to safely donate a unit without experiencing adverse effects like dizziness or fainting.

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?

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.

When calculating osmolarity to determine if a solution can safely run through a peripheral IV, what is the upper osmolarity threshold for peripheral administration?

Answer: 600 mOsm/L

Solutions with osmolarity greater than 600 mOsm/L carry a high risk of causing phlebitis and should be administered via a central venous catheter rather than a peripheral IV.

What is the primary purpose of dose error reduction software (DERS) in smart infusion pumps?

Answer: To alert clinicians when programmed doses fall outside pre-established safe limits

Dose error reduction software compares the clinician-programmed infusion parameters (dose, rate, concentration) against a pre-established drug library with minimum and maximum limits. When a programmed value falls outside these limits, the pump generates a soft or hard alert, providing a critical safety net that intercepts potential medication errors before delivery begins.

Which surveillance measure is MOST useful for tracking infusion-related infections in a healthcare facility?

Answer: CLABSI rate per 1,000 central line days using NHSN definitions

CLABSI rates standardized per 1,000 central line days using NHSN surveillance criteria allow meaningful comparison across units, facilities, and over time.

How should a blood warming device be set for transfusion?

Answer: 37 degrees C with a maximum of 42 degrees C

Blood warmers should be set at 37 degrees C and must not exceed 42 degrees C, as temperatures above 42 degrees C cause red blood cell hemolysis.

Positive-pressure technique when disconnecting IV tubing is used to prevent which complication?

Answer: Blood reflux into the catheter lumen causing clot formation

Positive-pressure flushing prevents blood from flowing back into the catheter lumen upon syringe disconnection, which would lead to clot formation and occlusion.

What is the recommended frequency for assessing peripheral IV sites for signs of complications?

Answer: Every 1-2 hours for critically ill patients and at least every 4 hours for general patients

INS standards recommend IV site assessment every 1-2 hours for critically ill patients and vesicant/irritant infusions, and at least every 4 hours for stable patients.

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

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.