CRNI Infection Prevention and Control Questions and Answers 1 — Questions and Answers
Question 1: A nurse is preparing to administer an intermittent IV antibiotic through a needleless connector on a patient's central venous catheter. Which action is most critical for preventing intraluminal contamination?
- Flushing the line with 10 mL of sterile normal saline before and after the medication.
- Changing the needleless connector immediately before administering the antibiotic.
- Vigorously scrubbing the connector's surface with an appropriate antiseptic agent for a specified duration. (Correct answer)
- Wearing sterile gloves during the entire medication administration process.
Correct answer: Vigorously scrubbing the connector's surface with an appropriate antiseptic agent for a specified duration.
The "scrub the hub" practice is a cornerstone of CLABSI prevention. Evidence demonstrates that vigorous mechanical scrubbing of the needleless connector's access surface with an appropriate antiseptic (e.g., 70% alcohol, chlorhexidine) for a prescribed time (typically 5-15 seconds) is essential to remove microorganisms and prevent them from being flushed into the bloodstream during access.
Question 2: According to the Infusion Nurses Society (INS) Standards of Practice, what is the recommended maximum time an administration set used for primary intermittent infusion of a non-lipid, non-blood solution should be used?
- 12 hours
- 48 hours
- 96 hours
- 24 hours (Correct answer)
Correct answer: 24 hours
The INS Standards of Practice recommend that administration sets used for intermittent infusions be changed every 24 hours. This is because the set is repeatedly disconnected and reconnected, which increases the risk of contamination compared to a continuously infusing, closed system.
Question 3: A CRNI is preparing to insert a non-tunneled central venous catheter at the bedside. Which of the following lists all the essential components of maximal barrier precautions required to prevent a central line-associated bloodstream infection (CLABSI)?
- Sterile gloves, a sterile gown, and a standard surgical mask for the inserter.
- A large sterile drape covering the patient, sterile gloves, and a face shield for the inserter.
- A cap, mask, sterile gown, sterile gloves for the inserter, and a large sterile drape covering the patient. (Correct answer)
- Sterile gloves and a small sterile fenestrated drape for the insertion site.
Correct answer: A cap, mask, sterile gown, sterile gloves for the inserter, and a large sterile drape covering the patient.
Maximal barrier precautions are a key component of the CLABSI prevention bundle for central line insertion. This requires the inserter to wear a cap, mask, sterile gown, and sterile gloves, and to use a large sterile drape that covers the patient's body to create the largest possible sterile field and minimize exposure to airborne contaminants.
Question 4: When preparing a patient's skin for the insertion of a peripherally inserted central catheter (PICC), the CRNI uses a >0.5% chlorhexidine gluconate (CHG) with alcohol applicator. What is the most important procedural step after applying the antiseptic?
- Wiping away the excess solution with a sterile gauze pad immediately.
- Allowing the site to air dry completely before puncturing the skin. (Correct answer)
- Vigorously fanning the area to speed up the drying process.
- Applying a topical anesthetic cream over the wet antiseptic solution.
Correct answer: Allowing the site to air dry completely before puncturing the skin.
For chlorhexidine gluconate (CHG) to be effective, it must be allowed to air dry completely before the skin is punctured. This contact time is critical for the agent to achieve its maximum antimicrobial effect. Wiping, fanning, or blotting the solution can remove the agent prematurely and/or contaminate the prepared site.
Question 5: After accessing a multi-dose vial for the first time in a patient care area, what is the correct infection control practice for labeling the vial?
- Label with the date opened and the beyond-use date. (Correct answer)
- Label with the patient's name and medical record number.
- No label is needed if it is returned to the medication cart immediately.
- Label with the name of the nurse who first accessed the vial.
Correct answer: Label with the date opened and the beyond-use date.
To prevent the use of contaminated or expired medications, all multi-dose vials must be labeled with the date they were first opened and a beyond-use date (BUD). According to the CDC, the BUD is typically 28 days unless the manufacturer specifies otherwise. This ensures the vial is discarded before its sterility is compromised.
Question 6: A nurse is assessing a peripheral IV catheter site that was inserted 48 hours ago. The patient reports tenderness, and the nurse observes erythema, warmth, and a palpable venous cord. The infusion is sluggish. Which of the following complications do these findings most strongly suggest?
- Infiltration
- Local site infection
- Catheter-related thrombosis
- Phlebitis (Correct answer)
Correct answer: Phlebitis
The classic signs and symptoms of phlebitis (inflammation of the vein) are pain/tenderness, erythema (redness), warmth at the site, and a palpable venous cord along the path of the cannulated vein. These symptoms, especially the palpable cord, differentiate it from other complications like infiltration (swelling, coolness) or a local infection that may not yet involve a hardened vein.
CRNI Infection Prevention and Control Questions and Answers 1
A nurse is preparing to administer an intermittent IV antibiotic through a needleless connector on a patient's central venous catheter.
Which action is most critical for preventing intraluminal contamination?