CRNI Infusion-Related Pharmacology Questions and Answers 1

Question 1

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?

Accepted Answer

Subcutaneous or intramuscular epinephrine

Answer

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 2

A CRNI is preparing to administer an intravenous loading dose of phenytoin. Which of the following practices is essential for safe administration to prevent precipitation?

Accepted Answer

Using 0.9% Sodium Chloride as the exclusive solution for dilution and flushing

Answer

Phenytoin has a very high pH and is only compatible with 0.9% Sodium Chloride (Normal Saline). Mixing it with dextrose-containing solutions or other medications will cause a chemical incompatibility, leading to the formation of a crystalline precipitate. The intravenous line must be flushed with normal saline both before and after the phenytoin infusion to clear the line of any incompatible solutions.

Question 3

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?

Accepted Answer

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

Answer

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 4

A patient with a peripherally inserted central catheter (PICC) is receiving a continuous infusion of a vesicant chemotherapy agent. The nurse assesses the site and notes swelling, erythema, and a report of pain at the site, but there is still a brisk blood return. What is the most appropriate interpretation of these findings?

Accepted Answer

An extravasation may be occurring despite the presence of a blood return.

Answer

Extravasation, the leakage of a vesicant drug into the surrounding tissue, is a serious complication. While a lack of blood return is a key sign of catheter mispositioning, a blood return can still be present in the early stages of an extravasation, especially with central lines. This is sometimes referred to as a 'sentinel event' where the signs of infiltration/extravasation appear before blood return is lost. Given the vesicant nature of the drug and the clinical signs (swelling, pain, erythema), extravasation must be the primary suspicion and requires immediate intervention.

Question 5

A patient receiving intravenous vancomycin begins to experience flushing of the face and neck, pruritus, and a macular rash on the upper torso. The patient's vital signs are stable. The CRNI should recognize these symptoms as being characteristic of which infusion-related reaction?

Accepted Answer

Vancomycin infusion reaction

Answer

This constellation of symptoms is characteristic of Vancomycin Infusion Reaction, historically known as 'Red Man Syndrome.' It is a rate-dependent pseudoallergic reaction caused by histamine release, not a true IgE-mediated allergy like anaphylaxis. It is managed by stopping the infusion, treating with antihistamines, and restarting at a slower rate once symptoms resolve. Anaphylaxis would typically involve hypotension and respiratory distress. Speed shock involves systemic symptoms like headache and dizziness from rapid infusion of any drug. A pyrogenic reaction would involve fever and chills.

CRNI Exam Practice Test

CRNI Exam Practice Test

CRNI Infusion-Related Pharmacology Questions and Answers 1