CRNI - Certified Registered Nurse Infusion — Questions and Answers

Question 1: When converting a patient from IV morphine to oral oxycodone, which principle guides the calculation?

Use the same total daily dose regardless of route
Use a 1:1 ratio for all opioid conversions
Double the oral dose to compensate for first-pass metabolism
Apply equianalgesic dose tables and adjust for incomplete cross-tolerance (Correct answer)

Correct answer: Apply equianalgesic dose tables and adjust for incomplete cross-tolerance

Equianalgesic tables provide conversion ratios, and a 25–50% dose reduction accounts for incomplete cross-tolerance when rotating opioids.

Question 2: A nurse is assessing a short peripheral catheter site and notes blanching, edema, and skin that is cool to the touch around the insertion point. The IV pump is not alarming. The nurse should identify these findings as signs of what complication?

Infection
Infiltration (Correct answer)
Hematoma
Phlebitis

Correct answer: Infiltration

Infiltration occurs when non-vesicant IV solution leaks into the surrounding tissue. The classic signs include localized edema, skin blanching (paleness), and coolness due to the room-temperature fluid in the subcutaneous tissue. The pump may not alarm if the flow is not significantly restricted.

Question 3: Which finding best indicates adequate fluid resuscitation in a critically ill patient?

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

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

Slow or stop the infusion and notify the provider (Correct answer)
Increase the head of bed elevation and continue monitoring
Administer a fluid bolus to improve cardiac output
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 5: A patient receiving a peripheral infusion of vincristine complains of burning at the IV site. The CRNI suspects extravasation. Which of the following interventions is critical for managing this specific type of extravasation?

Applying a cold compress to promote vasoconstriction.
Applying warm compresses and administering hyaluronidase. (Correct answer)
Administering dexrazoxane as the indicated antidote.
Vigorously massaging the area to disperse the drug.

Correct answer: Applying warm compresses and administering hyaluronidase.

The management of vesicant extravasation is drug-class specific. For vinca alkaloids, such as vincristine, the standard of care is to apply warm compresses to cause vasodilation and help disperse the drug. The specific antidote is the enzyme hyaluronidase, which is injected subcutaneously around the site to break down connective tissue and further aid in drug dispersal. Cold compresses are contraindicated as they can worsen tissue damage from vinca alkaloids.

Question 6: Dehydration results in water retention in the urine bladder.

can be returned to the circulation after moving back into the kidneys.
will still be expelled from the body in the urine. (Correct answer)
can be returned to the circulation directly.
All of the above

Correct answer: will still be expelled from the body in the urine.

Even in states of dehydration, the body must still excrete metabolic waste products, which requires a minimum amount of water to dissolve them. While the kidneys will conserve as much water as possible by producing highly concentrated urine, some water will inevitably be lost in the urine to eliminate these wastes. The urine bladder serves as a temporary storage for this waste before it is expelled.

Question 7: 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?

60 minutes to match the drug's peak effect
2 minutes to allow frequent dosing
30 minutes to prevent rapid repeated dosing
5–10 minutes to allow drug effect before the next dose (Correct answer)

Correct 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.

Question 8: A hospital's infusion team implements a phlebitis grading scale consistently across all nurses. This standardization primarily serves which quality improvement purpose?

Reducing the cost of peripheral IV supplies
Shortening the duration of IV site assessments
Eliminating the need for physician notification of phlebitis
Ensuring reliable, comparable outcome data for trend analysis (Correct answer)

Correct answer: Ensuring reliable, comparable outcome data for trend analysis

Standardizing a phlebitis grading scale (e.g., the Visual Infusion Phlebitis scale) ensures that all nurses assess and record phlebitis consistently, producing reliable, comparable data that can be trended over time to identify patterns and drive improvement initiatives.

Question 9: Which antiseptic agent and technique is recommended by INS standards for peripheral IV site preparation in adults?

Sterile normal saline, circular motion scrub outward from insertion site
70% isopropyl alcohol, 15-second scrub, allowed to air dry
2% chlorhexidine gluconate in 70% isopropyl alcohol, back-and-forth friction scrub, allowed to dry completely (Correct answer)
Povidone-iodine 10%, 30-second application, dried with sterile gauze

Correct answer: 2% chlorhexidine gluconate in 70% isopropyl alcohol, back-and-forth friction scrub, allowed to dry completely

INS standards recommend a >0.5% chlorhexidine with alcohol solution (typically 2% CHG in 70% IPA) applied with friction and allowed to dry completely before catheter insertion.

Question 10: Why must parenteral nutrition solutions be administered through a dedicated lumen?

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

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 11: When weaning a patient off long-term PN, the nurse anticipates the rate should be:

Maintained at full rate until oral intake meets 100% of needs
Tapered gradually over several hours to prevent hypoglycemia (Correct answer)
Stopped abruptly once oral intake begins
Reduced by 50% each hour until discontinued

Correct answer: Tapered gradually over several hours to prevent hypoglycemia

PN should be tapered gradually (typically over 1-2 hours) rather than stopped abruptly to prevent rebound hypoglycemia from persistent insulin secretion.

Question 12: Which action is correct when a PN bag must be changed before it is completely infused?

Add the remaining solution to the new bag
Continue running the old bag until it empties, then hang the new one
Store the partially used bag for up to 24 hours and reuse
Discard the remaining solution and hang the new bag (Correct answer)

Correct answer: Discard the remaining solution and hang the new bag

Partially infused PN bags should be discarded because PN is an ideal growth medium for microorganisms and must not be stored after being spiked.

Question 13: Which infusion pump technology uses peristaltic action to propel fluid?

Syringe pump
Gravity controller
Linear peristaltic pump using sequential finger-like compressions on the tubing (Correct answer)
Elastomeric 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 14: What is the recommended flush volume for a peripheral IV catheter in a pediatric patient weighing less than 10 kg?

10 mL normal saline
5 mL normal saline
3 mL heparin flush
1-2 mL normal saline (Correct answer)

Correct answer: 1-2 mL normal saline

For pediatric patients weighing less than 10 kg, the recommended flush volume is typically 1-2 mL of normal saline. Using larger volumes could contribute to fluid overload in small patients. The flush should be sufficient to clear the catheter lumen without exceeding safe volume limits.

Question 15: 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 16: When performing PICC tip confirmation, what landmark indicates proper placement on a chest X-ray?

In the right atrium
Lower third of the SVC at or near the caval-atrial junction (Correct answer)
Above the clavicle in the subclavian vein
At the level of the aortic arch

Correct answer: Lower third of the SVC at or near the caval-atrial junction

The ideal PICC tip position is in the lower third of the SVC at or near the caval-atrial junction, confirmed by chest X-ray before initiating infusion therapy.

Question 17: What is the purpose of pressure monitoring on an infusion pump?

To monitor central venous pressure
To measure the patient's blood pressure
To detect downstream and upstream occlusions by monitoring the pressure within the pumping mechanism (Correct answer)
To regulate fluid temperature

Correct answer: To detect downstream and upstream occlusions by monitoring the pressure within the pumping mechanism

Infusion pump pressure monitors detect abnormal resistance in the fluid path. Increased downstream pressure suggests occlusion between the pump and patient (kink, clot, closed clamp). Decreased upstream pressure indicates an empty container or upstream obstruction. Pressure thresholds can be adjusted based on the infusion type and access device.

Question 18: A nurse is setting up a multi-channel infusion pump for a patient requiring three simultaneous infusions. What is the most important safety consideration?

Setting all channels to the same rate
Using the same drug library profile for all channels
Ensuring all channels use the same tubing brand
Verifying each channel is programmed independently with the correct medication, dose, and rate for each specific line (Correct answer)

Correct answer: Verifying each channel is programmed independently with the correct medication, dose, and rate for each specific line

The most critical safety consideration with multi-channel pumps is ensuring each channel is independently and correctly programmed for its specific medication. Channel mix-ups — where medication A is programmed on channel B's line — can result in catastrophic dosing errors. Each channel must be traced from the medication bag through to the patient and independently verified.

Question 19: A patient with a tunneled central catheter develops pain, erythema, and warmth along the subcutaneous tunnel tract. What complication does this indicate?

Catheter-related bloodstream infection
Port pocket infection
Tunnel infection (Correct answer)
Exit-site 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 20: Which catheter material is associated with the lowest risk of phlebitis for peripheral IV access?

PTFE (Teflon)
Polypropylene
Polyurethane (Correct answer)
Stainless steel

Correct answer: Polyurethane

Polyurethane catheters have superior biocompatibility and flexibility, resulting in lower phlebitis rates compared to PTFE.

Question 21: When teaching a patient about imatinib (Gleevec) oral therapy, which instruction is most important?

Do not take with any antacids or dairy products
Take on an empty stomach to improve absorption
Avoid grapefruit juice as it increases drug levels (Correct answer)
Limit fluid intake to 1 liter per day

Correct answer: Avoid grapefruit juice as it increases drug levels

Grapefruit juice inhibits CYP3A4, the enzyme responsible for imatinib metabolism, leading to significantly increased drug plasma levels and toxicity risk.

Question 22: Opioid tolerance in a patient receiving chronic analgesic infusion therapy is best described as:

Development of psychological dependence and addiction
Decreased risk of respiratory depression with long-term opioid use
A need for progressively higher doses to achieve the same level of analgesia (Correct answer)
Increased sensitivity to the sedating side effects of opioids over time

Correct answer: A need for progressively higher doses to achieve the same level of analgesia

Tolerance is a pharmacological phenomenon where repeated opioid exposure reduces receptor responsiveness, requiring dose escalation to maintain the same analgesic effect.

Question 23: What is the primary purpose of performing a comprehensive patient assessment before initiating infusion therapy?

To assign the patient to a room
To determine the patient's insurance coverage
To complete documentation requirements
To establish baseline data, identify risk factors, and select the most appropriate vascular access and therapy plan (Correct answer)

Correct answer: To establish baseline data, identify risk factors, and select the most appropriate vascular access and therapy plan

A comprehensive pre-infusion assessment establishes baseline vital signs, laboratory values, and physical findings against which changes during therapy can be evaluated. It identifies risk factors (age, comorbidities, medications, vein condition, allergies) that influence vascular access selection, solution choice, and monitoring frequency.

Question 24: Which clinical sign best differentiates third-spacing from true dehydration?

Decreased skin turgor
Normal or elevated total body water with intravascular deficit (Correct answer)
Elevated hematocrit
Serum sodium above 145 mEq/L

Correct answer: Normal or elevated total body water with intravascular deficit

Third-spacing causes intravascular depletion despite normal or increased total body fluid, unlike true dehydration.

Question 25: Which statement best explains the mechanism of action of trastuzumab (Herceptin)?

It alkylates DNA strands causing cross-linking
It binds HER2 receptors, inhibiting cell proliferation signaling (Correct answer)
It inhibits topoisomerase II, preventing DNA unwinding
It blocks folate metabolism, reducing thymidine synthesis

Correct answer: It binds HER2 receptors, inhibiting cell proliferation signaling

Trastuzumab is a monoclonal antibody that targets HER2 (ErbB2) receptors, blocking downstream proliferative signaling in HER2-overexpressing tumors.

Question 26: A patient has a tunneled cuffed central venous catheter. During assessment, the nurse is unable to aspirate blood from any lumen. The infusion is running without difficulty. What is the most likely cause?

Fibrin sheath formation allowing flow but not aspiration (Correct answer)
Air embolism
Catheter malposition
Catheter occlusion from thrombosis

Correct answer: Fibrin sheath formation allowing flow but not aspiration

A fibrin sheath or tail can form at the catheter tip, acting as a one-way valve that allows infusion but prevents aspiration.

Question 27: A patient with Addison's disease presents with weakness, hypotension, and a serum sodium of 128 mEq/L with potassium of 6.0 mEq/L. What is the underlying fluid-electrolyte mechanism?

Aldosterone deficiency causing sodium loss and potassium retention (Correct answer)
ADH excess causing free water retention
Excess aldosterone causing sodium retention
Cortisol excess causing hyperglycemia

Correct answer: Aldosterone deficiency causing sodium loss and potassium retention

Aldosterone deficiency in Addison's disease impairs sodium retention and potassium excretion, causing hyponatremia and hyperkalemia.

Question 28: A nurse suspects air embolism in a patient with a central line who suddenly develops dyspnea, hypotension, and a 'mill-wheel' murmur. What is the immediate positioning intervention?

Semi-Fowler's position with legs elevated
Trendelenburg with the patient on their right side
Supine with head of bed elevated 30 degrees
Left lateral decubitus (Durant's maneuver) with Trendelenburg (Correct answer)

Correct answer: Left lateral decubitus (Durant's maneuver) with Trendelenburg

Durant's maneuver (left lateral decubitus Trendelenburg) traps air in the right ventricle apex, preventing it from obstructing the pulmonary outflow tract and allowing gradual reabsorption.

Question 29: Which pump feature allows the clinician to administer a loading dose followed by a continuous maintenance infusion?

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

Question 30: When calculating osmolarity to determine if a solution can safely run through a peripheral IV, what is the upper osmolarity threshold for peripheral administration?

900 mOsm/L
600 mOsm/L (Correct answer)
1200 mOsm/L
450 mOsm/L

Correct 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.

Question 31: What is the difference between a soft limit and a hard limit in a smart pump drug library?

Soft limits can be overridden by the clinician; hard limits cannot be overridden and prevent the infusion from starting (Correct answer)
Soft limits are for adults and hard limits for pediatrics
There is no functional difference between the two
Soft limits apply to rate only; hard limits apply to dose

Correct answer: Soft limits can be overridden by the clinician; hard limits cannot be overridden and prevent the infusion from starting

Soft limits generate an alert that the clinician can override with clinical justification, while hard limits represent absolute maximum or minimum values that cannot be overridden under any circumstances. Hard limits prevent the pump from delivering doses that could cause serious harm regardless of the clinical situation.

Question 32: A nurse notes that a patient's PCA pump shows zero patient-activated demands in the past 8 hours, yet the patient reports severe uncontrolled pain. What is the priority assessment?

Contact the pharmacy to replace the pump
Assess the patient, IV site patency, and tubing connections (Correct answer)
Increase the programmed demand dose immediately
Administer a loading dose from the PCA reservoir

Correct answer: Assess the patient, IV site patency, and tubing connections

Zero demand dose deliveries with reported pain suggests a mechanical problem such as an occluded IV site, kinked tubing, or pump malfunction — assessment of the patient and system integrity comes first.

Question 33: What is the primary purpose of 'drug library guardrails' in a smart infusion pump?

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

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

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

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 35: A patient is receiving a dopamine infusion at 15 mcg/kg/min. The nurse notes the patient's urine output has decreased significantly. What pharmacological effect is most likely occurring?

Beta-1 adrenergic decreased cardiac output
Direct nephrotoxicity from the dopamine infusion
Alpha-adrenergic renal vasoconstriction at high doses (Correct answer)
Dopaminergic renal vasodilation at low doses

Correct answer: Alpha-adrenergic renal vasoconstriction at high doses

At doses above 10 mcg/kg/min, dopamine stimulates alpha-adrenergic receptors causing renal vasoconstriction, which can decrease renal perfusion and urine output.

Question 36: Hydromorphone (Dilaudid) is preferred over morphine for PCA in patients with renal insufficiency primarily because:

It is significantly less potent and therefore inherently safer to use
It has a substantially longer duration of action, requiring fewer doses
Morphine's active metabolite morphine-6-glucuronide accumulates in renal failure causing toxicity (Correct answer)
It can be administered at lower infusion volumes

Correct answer: Morphine's active metabolite morphine-6-glucuronide accumulates in renal failure causing toxicity

Morphine-6-glucuronide, an active analgesic metabolite of morphine, accumulates in renal failure and can cause prolonged sedation and respiratory depression; hydromorphone's metabolite is less clinically active.

Question 37: A patient with chronic kidney disease has a serum potassium of 6.2 mEq/L and peaked T-waves on ECG. What is the priority intervention?

Infuse insulin and dextrose
Administer sodium polystyrene sulfonate
Restrict dietary potassium
Give IV calcium gluconate (Correct answer)

Correct answer: Give IV calcium gluconate

IV calcium gluconate is the priority to stabilize cardiac membranes and prevent life-threatening dysrhythmias.

Question 38: 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 hypervolemia, such as crackles and edema
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)

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 39: A patient with a peripheral IV complains of sudden, sharp pain radiating up their arm during the infusion of a room-temperature antibiotic. The infusion has slowed significantly despite no signs of infiltration or phlebitis. Which action is most appropriate to manage a suspected venous spasm?

Apply a cold compress to the area.
Apply a warm compress to the vein above the insertion site. (Correct answer)
Re-site the catheter in a larger vein immediately.
Increase the infusion rate to push past the spasm.

Correct answer: Apply a warm compress to the vein above the insertion site.

A venous spasm is a sudden constriction of the vein, often caused by the administration of cold infusates, irritating solutions, or a rapid flow rate. The primary management is to decrease the flow rate and apply a warm compress to the area to promote vasodilation and relieve the spasm. Applying a cold compress would worsen vasoconstriction.

Question 40: A patient receiving the immune checkpoint inhibitor pembrolizumab reports a new onset of profuse, watery diarrhea two weeks after their third infusion. The CRNI should recognize this as a potential sign of which common immune-related adverse event (irAE)?

A Type 1 hypersensitivity reaction.
Immune-mediated colitis. (Correct answer)
Drug-induced pancreatitis.
Cytokine release syndrome.

Correct answer: Immune-mediated colitis.

Immune checkpoint inhibitors work by enhancing the body's immune response against cancer, but this can also lead to the immune system attacking healthy organs, causing immune-related adverse events (irAEs). Colitis, or inflammation of the colon, is one of the most common irAEs and typically presents with diarrhea, which can be severe. This adverse event often has a delayed onset, occurring weeks to months after starting therapy.

Question 41: What ethical principle guides the CRNI when a patient refuses recommended infusion therapy?

Autonomy - respect the patient's right to make informed decisions about their care (Correct answer)
Non-maleficence - withhold treatment to avoid potential harm
Beneficence - override the patient's wishes for their benefit
Justice - treat all patients equally regardless of preferences

Correct answer: Autonomy - respect the patient's right to make informed decisions about their care

Patient autonomy is the fundamental ethical principle supporting a competent patient's right to accept or refuse treatment after being fully informed.

Question 42: Which drug-drug interaction is MOST dangerous when co-administering IV heparin and nitroglycerin?

Cardiovascular collapse from synergistic vasodilation
Nitroglycerin precipitation in the IV line
Increased bleeding risk from potentiated anticoagulation
Decreased heparin efficacy requiring higher doses (Correct answer)

Correct answer: Decreased heparin efficacy requiring higher doses

IV nitroglycerin can decrease heparin's anticoagulant effect, requiring increased heparin doses that may cause bleeding complications when nitroglycerin is discontinued.

Question 43: 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
Stop the PN infusion until glucose normalizes
Notify the provider to adjust the insulin sliding scale or add insulin to the PN bag (Correct answer)
Increase the PN infusion rate to dilute the glucose concentration

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 44: What is the recommended initial flow rate when beginning a blood transfusion for the first 15 minutes?

50 mL/hour
125 mL/hour
2 mL/minute or less (Correct answer)
Wide open to complete quickly

Correct answer: 2 mL/minute or less

Blood transfusions should begin at 2 mL/minute or less for the first 15 minutes to allow early detection of transfusion reactions before a significant volume is infused.

Question 45: A patient with end-stage renal disease has a serum potassium level of 6.8 mEq/L. Which of the following ECG changes should the CRNI anticipate and report immediately?

Prominent U wave
Depressed ST segment
Tall, peaked T waves (Correct answer)
Shortened PR interval

Correct answer: Tall, peaked T waves

Hyperkalemia, a serum potassium level above 5.0-5.5 mEq/L, alters cardiac membrane potential, leading to characteristic ECG changes. One of the earliest and most common findings is the appearance of tall, peaked T waves, especially as the level rises above 6.5 mEq/L. As hyperkalemia worsens, the PR interval becomes prolonged and the QRS complex widens. Prominent U waves and ST depression are associated with hypokalemia.

Question 46: A patient on long-term parenteral nutrition develops signs of air embolism. Which documentation sequence is correct?

Document after the patient is stabilized, focusing only on interventions
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)

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 47: Which assessment finding during a central venous catheter dressing change would indicate possible catheter migration?

Small amount of dried blood on the old dressing
Patient reports mild discomfort during dressing removal
Slight redness at the exit site
The external catheter length has changed from the documented insertion measurement (Correct answer)

Correct answer: The external catheter length has changed from the documented insertion measurement

A change in the external catheter length from the documented measurement at insertion is the primary indicator of catheter migration. If more catheter is visible externally, the tip may have withdrawn to a suboptimal position. If less is visible, the catheter may have advanced deeper. Either situation requires radiographic confirmation of tip position.

Question 48: 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?

The patient is developing a central line-associated bloodstream infection (CLABSI).
The patient is experiencing an expected local inflammatory reaction to the medication.
A fibrin sheath has formed at the catheter tip, causing a partial occlusion.
An extravasation may be occurring despite the presence of a blood return. (Correct answer)

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

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 49: A home infusion patient's electronic health record shows the infusion pump delivered 200 mL more than the ordered volume. What is the nurse's first documentation priority?

Document the discrepancy, patient assessment findings, provider notification, and actions taken, then complete an incident report (Correct answer)
Document only after contacting the pharmacy to confirm the order
Note the discrepancy in the next scheduled nursing note
Adjust the next dose to compensate for the overage

Correct answer: Document the discrepancy, patient assessment findings, provider notification, and actions taken, then complete an incident report

A volume discrepancy is a medication error requiring immediate patient assessment, provider notification, incident reporting, and thorough documentation of the sequence of events.

Question 50: 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
Sudden severe left upper quadrant abdominal pain (Correct answer)
Mild bone pain in the sternum

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 51: Which assessment tool is used to evaluate the degree of phlebitis at a peripheral IV site?

Braden Scale
Norton Scale
Morse Fall Scale
Visual Infusion Phlebitis (VIP) Scale (Correct answer)

Correct answer: Visual Infusion Phlebitis (VIP) Scale

The Visual Infusion Phlebitis (VIP) Scale is the standardized assessment tool for evaluating phlebitis severity at peripheral IV sites. It grades phlebitis from 0 (no symptoms) to 5 (advanced thrombophlebitis with purulent drainage), based on objective observable signs including erythema, pain, palpable cord, streak formation, and purulence.

Question 52: 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?

Urine output of 40 mL/hour.
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.

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 53: 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 70 mg/dL (Correct answer)
Below 100 mg/dL

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 54: Which vascular access device is MOST appropriate for a chemotherapy regimen requiring intermittent infusions over 6 months?

Short peripheral catheter with extension set
Implanted port (Correct answer)
Midline catheter
Peripheral IV catheter

Correct answer: Implanted port

An implanted port is ideal for intermittent long-term chemotherapy as it provides reliable central venous access with lower infection rates between treatments.

Question 55: A nurse is preparing to start an IV on a 2-year-old child. Which site is generally preferred for peripheral IV access in this age group?

External jugular
Antecubital fossa
Dorsum of the hand (Correct answer)
Scalp vein

Correct answer: Dorsum of the hand

The dorsum of the hand is generally the preferred site for peripheral IV access in toddlers because it provides good vein visibility, allows for adequate securing, and leaves the child's arms relatively free for movement. Scalp veins are typically reserved for infants under 9 months.

Question 56: Which assessment finding is most consistent with early peripheral IV infiltration?

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

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 57: A patient on total parenteral nutrition (TPN) develops sudden onset of chest pain and dyspnea 30 minutes after the infusion begins. The nurse notes a new cardiac murmur. What complication should be suspected?

Refeeding syndrome with hypophosphatemia
Catheter-related bloodstream infection
Air embolism from TPN administration (Correct answer)
Hyperglycemic hyperosmolar state

Correct answer: Air embolism from TPN administration

Air embolism can occur with TPN through central lines; presenting with chest pain, dyspnea, and a new 'mill wheel' murmur requires immediate left lateral Trendelenburg positioning and emergency intervention.

Question 58: Which pharmacokinetic principle explains why loading doses are used when initiating continuous IV infusions of drugs like lidocaine?

To overcome the blood-brain barrier more effectively
To saturate plasma protein binding sites immediately
To rapidly achieve therapeutic plasma concentrations before steady state (Correct answer)
To prevent first-pass metabolism in the liver

Correct answer: To rapidly achieve therapeutic plasma concentrations before steady state

Steady state takes approximately 4-5 half-lives to achieve; a loading dose rapidly fills the volume of distribution to produce therapeutic levels while the maintenance infusion sustains them.

Question 59: Which solution is SAFE to co-infuse in the same IV line as packed red blood cells?

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

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

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

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 61: When using a needleless connector on a pediatric central venous catheter, which technique best reduces the risk of intraluminal contamination?

Capping the connector after every use with a sterile cap
Scrubbing the hub with 70% alcohol for at least 15 seconds before each access (Correct answer)
Changing the connector every 24 hours regardless of use
Flushing with heparin before each access

Correct answer: Scrubbing the hub with 70% alcohol for at least 15 seconds before each access

Scrubbing the needleless connector hub with 70% alcohol for a minimum of 15 seconds ("scrub the hub") is the evidence-based practice to reduce intraluminal contamination.

Question 62: Which sedation assessment tool was specifically developed to monitor opioid-induced sedation in patients receiving IV analgesic infusions?

Glasgow Coma Scale (GCS)
Richmond Agitation-Sedation Scale (RASS)
Pasero Opioid-induced Sedation Scale (POSS) (Correct answer)
Ramsay Sedation Scale

Correct answer: Pasero Opioid-induced Sedation Scale (POSS)

The Pasero Opioid-induced Sedation Scale (POSS) was specifically designed to assess sedation in patients receiving opioids and guides nursing interventions based on sedation level.

Question 63: Which type of infusion pump is most appropriate for delivering precise low-volume continuous infusions of high-alert medications?

Elastomeric pump
Large volume peristaltic pump
Syringe pump (Correct answer)
Gravity drip with microdrip tubing

Correct answer: Syringe pump

Syringe pumps deliver the highest accuracy at low flow rates, making them ideal for high-alert medications like vasopressors, insulin, and neonatal infusions where precision in tenths of a milliliter per hour is critical. They use a mechanical drive that advances the syringe plunger at a precisely controlled rate.

Question 64: To minimize the risk of refeeding syndrome in a severely malnourished patient starting on parenteral nutrition, which of the following is the most important nursing intervention?

Restrict all oral fluid intake for the first 24 hours of PN therapy.
Ensure the initial PN formulation has a high concentration of dextrose.
Administer a rapid fluid bolus of 5% Dextrose prior to starting the PN.
Initiate the PN infusion at a slow rate and advance gradually over several days. (Correct answer)

Correct answer: Initiate the PN infusion at a slow rate and advance gradually over several days.

The cornerstone of preventing refeeding syndrome is to reintroduce nutrition cautiously. Initiating parenteral nutrition at a slow rate (e.g., starting with 10-20 kcal/kg/day or 100-150g of dextrose) and advancing the goal rate over 4 to 7 days allows the body to adapt metabolically. This prevents the sudden, massive intracellular shift of electrolytes (phosphate, potassium, magnesium) that characterizes this potentially fatal syndrome.

Question 65: What is the recommended tip position for a central venous catheter?

Right atrium
Superior vena cava above the right atrium
Cavoatrial junction or lower third of the SVC (Correct answer)
Subclavian vein

Correct answer: Cavoatrial junction or lower third of the SVC

The recommended tip position is at the cavoatrial junction (CAJ) or in the lower third of the superior vena cava. This position provides optimal blood flow around the catheter tip, reducing thrombosis risk, and ensures the tip is in a large vessel where hyperosmolar solutions are rapidly diluted. The tip should be parallel to the vessel wall.

Question 66: Which of the following is not a nosocomial infection risk factor?

Limited use of antibiotics (Correct answer)
Chronic diseases
Immunosuppression
Extremes of age

Correct answer: Limited use of antibiotics

Limited use of antibiotics is generally a protective factor against nosocomial infections, as it reduces the risk of antibiotic resistance and disruption of the patient's normal flora. Conversely, chronic diseases, immunosuppression, and extremes of age (very young or very old) are all significant risk factors because they compromise the patient's immune system or overall health, making them more susceptible to infections.

Question 67: A patient receiving IV vancomycin develops tinnitus and dizziness. What should the nurse assess?

Blood pressure for orthostatic changes
Serum vancomycin trough level for potential ototoxicity (Correct answer)
Lung sounds for fluid overload
Blood glucose for hypoglycemia

Correct answer: Serum vancomycin trough level for potential ototoxicity

Tinnitus and dizziness during vancomycin therapy suggest ototoxicity, which correlates with elevated serum trough levels and requires immediate level assessment.

Question 68: What is the recommended flushing protocol for an implanted venous access port that is not actively being used?

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

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 69: 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 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)
I will store my TPN bags in a cool, dry cabinet away from sunlight.

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

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)
Avoid all opioids due to opioid-receptor saturation

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 71: What is the recommended catheter tip position for administering parenteral nutrition?

Right atrium
Mid-subclavian vein
Lower third of the SVC at the caval-atrial junction (Correct answer)
Internal jugular vein

Correct answer: Lower third of the SVC at the caval-atrial junction

The ideal catheter tip position for PN administration is the lower third of the SVC at the caval-atrial junction, where high blood flow provides optimal dilution of the hyperosmolar solution.

Question 72: A patient receiving intrathecal methotrexate develops arachnoiditis. Which symptom cluster is most consistent with this complication?

Nausea, vomiting, and diarrhea
Fever, rash, and eosinophilia
Peripheral neuropathy and foot drop
Headache, nuchal rigidity, and back pain (Correct answer)

Correct answer: Headache, nuchal rigidity, and back pain

Intrathecal methotrexate-induced arachnoiditis presents with meningeal irritation signs including headache, nuchal rigidity, and back pain.

Question 73: What is the pharmacological rationale for using a 0.22-micron in-line filter during IV infusion?

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

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 74: What is the MOST common cause of fatal transfusion reactions?

Allergic anaphylaxis
ABO-incompatible transfusion due to patient misidentification (Correct answer)
Transfusion-related acute lung injury
Bacterial contamination

Correct answer: ABO-incompatible transfusion due to patient misidentification

Clerical errors leading to ABO-incompatible transfusions remain the most common preventable cause of fatal transfusion reactions.

Question 75: Which complication of parenteral nutrition is indicated by elevated liver enzymes and direct bilirubin?

Essential fatty acid deficiency
Refeeding syndrome
Parenteral nutrition-associated liver disease (PNALD) (Correct answer)
Glucose intolerance

Correct answer: Parenteral nutrition-associated liver disease (PNALD)

PNALD manifests as cholestasis with elevated liver enzymes and direct bilirubin, occurring in patients on long-term PN, particularly with excessive glucose or lipid delivery.

Question 76: A nurse notes that a unit of packed red blood cells has visible clumping and a dark, discolored appearance. What is the correct action?

Filter the unit through a leukoreduction filter before administration
Return the unit to the blood bank and do not administer (Correct answer)
Administer slowly and monitor closely for reaction
Warm the unit to dissolve the clumping and administer

Correct answer: Return the unit to the blood bank and do not administer

Visual abnormalities such as clumping or abnormal discoloration indicate potential bacterial contamination or hemolysis; the unit must be returned to the blood bank and not administered.

Question 77: Which physical assessment finding indicates possible catheter-related sepsis in a patient with a central venous catheter?

Stable vital signs with mild fatigue
Fever greater than 38.3°C with chills, tachycardia, and hypotension without another identifiable source (Correct answer)
Slight redness at the catheter site
Normal white blood cell count

Correct answer: Fever greater than 38.3°C with chills, tachycardia, and hypotension without another identifiable source

Fever above 38.3°C with chills, tachycardia, and hypotension in a patient with a CVC and no other identifiable infection source strongly suggests catheter-related bloodstream infection (CRBSI). Blood cultures (both peripheral and through the catheter) should be obtained immediately, empiric antibiotics started, and catheter removal considered.

Question 78: A nurse discovers that the wrong drug library profile was selected on a smart pump. The infusion has been running for 2 hours. What is the immediate action?

Continue the infusion since no alarm sounded
Stop the infusion, assess the patient, verify the actual medication and dose delivered, correct the drug library selection, and notify the provider (Correct answer)
Document the error only
Just change the profile without stopping the infusion

Correct answer: Stop the infusion, assess the patient, verify the actual medication and dose delivered, correct the drug library selection, and notify the provider

Using the wrong drug library profile means all safety dose limits were incorrect for the actual medication being infused. The nurse must stop the infusion to prevent further incorrect dosing, assess the patient for adverse effects, calculate the actual dose delivered, correct the profile, and notify the provider. An incident report should be filed.

Question 79: What is the primary purpose of using an isotonic crystalloid solution for IV fluid replacement?

To expand the intravascular volume without shifting fluid between compartments (Correct answer)
To promote cellular hydration through osmosis
To shift fluid from the intracellular to the intravascular space
To provide nutrition and caloric support

Correct answer: To expand the intravascular volume without shifting fluid between compartments

Isotonic crystalloids have the same osmolality as plasma, expanding intravascular volume without causing osmotic fluid shifts between compartments.

Question 80: A nurse is administering an IV push medication rapidly. The patient suddenly complains of a severe headache, dizziness, and a 'fluttering' feeling in their chest. The patient appears flushed and becomes hypotensive. The CRNI should recognize these symptoms as characteristic of which systemic infusion complication?

Speed shock (Correct answer)
Circulatory overload
Anaphylactic reaction
Pyrogenic reaction

Correct answer: Speed shock

Speed shock is a systemic reaction caused by the rapid infusion of a substance into the circulation, leading to toxic plasma levels. Classic symptoms include dizziness, headache, facial flushing, irregular pulse (fluttering), and can progress to hypotension, shock, and cardiac arrest. It is directly related to the rate of administration.

Question 81: According to INS standards, what information must be included in the infusion therapy plan of care?

Patient assessment, therapy goals, vascular access plan, monitoring parameters, expected outcomes, and patient education plan (Correct answer)
Only the physician orders
Only the infusion schedule
Medication names only

Correct answer: Patient assessment, therapy goals, vascular access plan, monitoring parameters, expected outcomes, and patient education plan

The infusion therapy plan of care must include comprehensive patient assessment findings, specific therapy goals and expected outcomes, vascular access device selection rationale, monitoring parameters and frequency, medication-specific administration requirements, patient/family education plan, and criteria for plan modification or therapy completion.

Question 82: What legal considerations apply to the CRNI when a medication error occurs during infusion therapy?

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

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 83: Cryoprecipitate is PRIMARILY indicated for which coagulation deficiency?

Factor X deficiency
Factor II (prothrombin) deficiency
Protein C deficiency
Factor VIII and fibrinogen deficiency (Correct answer)

Correct answer: Factor VIII and fibrinogen deficiency

Cryoprecipitate is rich in fibrinogen, Factor VIII, Factor XIII, von Willebrand factor, and fibronectin, making it the treatment of choice for fibrinogen and Factor VIII deficiencies.

Question 84: A nurse attempts to flush a PICC line and encounters resistance. The patient reports no pain. Which action should the nurse take first?

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

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 85: A nurse is assessing a peripheral IV site using the INS infiltration scale. Grade 3 infiltration is characterized by which findings?

No symptoms
Skin blanched, cool to touch, edema 1-6 inches, possible numbness (Correct answer)
Slight edema, cool skin, blanching
Gross edema greater than 6 inches, deep pitting edema, circulatory impairment

Correct answer: Skin blanched, cool to touch, edema 1-6 inches, possible numbness

Grade 3 infiltration on the INS scale is characterized by skin blanching, cool temperature, edema extending 1-6 inches from the insertion site, and possible numbness. This grade requires immediate catheter removal, limb elevation, and potential additional interventions depending on the infiltrating solution. Grade 4 involves tissue necrosis or circulatory impairment.

Question 86: The INS Infiltration Scale grades infiltration severity on which range?

0–4 based on clinical skin assessment findings (Correct answer)
A–D based on infusate type
1–3 based on swelling size
1–5 based on patient pain rating

Correct answer: 0–4 based on clinical skin assessment findings

The INS Infiltration Scale uses a 0–4 grading system based on findings such as skin blanching, swelling, and tissue integrity.

Question 87: Which finding during a central line dressing change requires immediate nursing intervention?

Clear, intact skin under the dressing
Slight redness that resolves with dressing removal
Transparent dressing with condensation inside
Purulent drainage at the catheter exit site (Correct answer)

Correct answer: Purulent drainage at the catheter exit site

Purulent drainage at the catheter exit site is a sign of local infection and requires immediate intervention including provider notification and possible catheter removal.

Question 88: A patient's TPN is abruptly discontinued. What is the immediate nursing concern?

Fluid overload
Rebound hypoglycemia (Correct answer)
Metabolic alkalosis
Hypernatremia

Correct answer: Rebound hypoglycemia

Abrupt TPN discontinuation can cause rebound hypoglycemia because the pancreas continues producing elevated insulin levels in response to the sudden drop in glucose infusion.

Question 89: How should a blood warming device be set for transfusion?

40 degrees C maximum
Room temperature is sufficient
45 degrees C for rapid warming
37 degrees C with a maximum of 42 degrees C (Correct answer)

Correct 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.

Question 90: Which of the following cryoprecipitate indications is considered most appropriate?

Correction of protein C deficiency
Reversal of warfarin anticoagulation
Treatment of thrombocytopenia
Replacement of factor VIII in hemophilia A when recombinant factor is unavailable (Correct answer)

Correct answer: Replacement of factor VIII in hemophilia A when recombinant factor is unavailable

Cryoprecipitate is rich in factor VIII, fibrinogen, vWF, and factor XIII, making it appropriate for hemophilia A when recombinant or plasma-derived factor VIII is unavailable.

Question 91: Which infusion-specific quality indicator is most directly used to evaluate the effectiveness of a central venous access device (CVAD) care bundle?

CLABSI rate per 1,000 central-line days (Correct answer)
Phlebitis rate per 1,000 peripheral IV days
Medication error rate per infusion order
Patient satisfaction scores for IV insertion

Correct answer: CLABSI rate per 1,000 central-line days

CLABSI rate per 1,000 central-line days is the standard outcome metric tied directly to central line care bundles (hand hygiene, maximal barrier precautions, chlorhexidine skin prep, optimal site selection, and daily review). A reduction in this rate demonstrates bundle effectiveness.

Question 92: When obtaining informed consent for placement of a PICC line, which element is MOST critical for the nurse to ensure the patient understands?

The risks, benefits, and alternatives to the procedure (Correct answer)
The specific brand of catheter that will be used
The estimated cost of the procedure and insurance coverage
The nurse's level of experience with PICC insertions

Correct answer: The risks, benefits, and alternatives to the procedure

Valid informed consent requires that the patient understands the procedure's risks, benefits, and available alternatives.

Question 93: A patient's IV pump displays an 'occlusion' alarm. What should the nurse assess first?

The entire IV system from the patient's access site through the tubing to the solution container for kinks, clamps, or obstructions (Correct answer)
Only the insertion site
The pump's battery level
The drug concentration

Correct answer: The entire IV system from the patient's access site through the tubing to the solution container for kinks, clamps, or obstructions

An occlusion alarm indicates increased resistance to flow somewhere in the system. The nurse should systematically assess the entire fluid path: check the access site for infiltration or positional issues, trace tubing for kinks or closed clamps, check stopcocks, inspect the solution for crystallization, and verify filter patency. Starting at the patient and working back to the bag is the most efficient approach.

Question 94: Which blood product is MOST appropriate for a patient with thrombocytopenic purpura who is actively bleeding with a platelet count of 8,000/mcL?

Fresh frozen plasma
Cryoprecipitate
Platelet concentrate (Correct answer)
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 95: Which principle BEST describes the infusion nurse's responsibility when a manufacturer's device instructions conflict with facility policy?

Follow facility policy because it supersedes manufacturer guidelines
Escalate to risk management and suspend use until clarified (Correct answer)
Use clinical judgment to determine the safest approach for each patient
Follow manufacturer instructions as they are legally binding

Correct answer: Escalate to risk management and suspend use until clarified

Conflicts between manufacturer instructions and facility policy must be escalated to risk management to ensure patient safety and legal compliance.

Question 96: What is the primary advantage of a tunneled central venous catheter over a non-tunneled catheter?

Higher flow rates
Reduced catheter-related bloodstream infection due to the subcutaneous cuff (Correct answer)
Lower cost
Easier insertion technique

Correct answer: Reduced catheter-related bloodstream infection due to the subcutaneous cuff

Tunneled catheters have a subcutaneous Dacron cuff that promotes tissue ingrowth, creating a mechanical barrier against bacterial migration along the external catheter surface. This significantly reduces the risk of catheter-related bloodstream infection compared to non-tunneled catheters, making them suitable for longer-term use.

Question 97: What is the recommended frequency for changing administration sets used for continuous lipid emulsion infusions?

Every 24 hours (Correct answer)
Every 48 hours
Every 72 hours
Every 96 hours

Correct answer: Every 24 hours

Administration sets used for lipid emulsions (including 3-in-1 total parenteral nutrition) must be changed every 24 hours due to the risk of microbial growth in lipid-containing solutions.

Question 98: A nurse is preparing to administer fresh frozen plasma (FFP). Which of the following is the correct administration filter to use?

Leukocyte-reduction filter
Standard 170-260 micron blood filter (Correct answer)
No filter is required for FFP
0.22 micron inline filter

Correct answer: Standard 170-260 micron blood filter

All blood products, including FFP, must be administered through a standard 170-260 micron filter to remove clots and cellular debris.

Question 99: How frequently should transparent semipermeable membrane (TSM) dressings on central venous catheters be changed?

Every 14 days
Every 5-7 days or when soiled, loosened, or damp (Correct answer)
Every 48 hours
Every 24 hours

Correct answer: Every 5-7 days or when soiled, loosened, or damp

TSM dressings on CVCs should be changed every 5-7 days per INS standards, or sooner if the integrity is compromised by soiling, loosening, or moisture.

Question 100: A nurse is caring for a patient who received high-dose cisplatin 48 hours ago. Which electrolyte imbalance requires the most vigilant monitoring?

Hypomagnesemia (Correct answer)
Hyperkalemia
Hypercalcemia
Hypernatremia

Correct answer: Hypomagnesemia

Cisplatin causes renal tubular damage leading to significant magnesium wasting; hypomagnesemia is the most common and clinically significant electrolyte disturbance.

Question 101: A home infusion patient's PICC line is occluded. What is the FIRST intervention the nurse should attempt?

Infuse thrombolytics without further assessment
Forcefully flush with a 1 mL syringe to clear the clot
Immediately remove the PICC line
Gently aspirate, then attempt a pulsatile saline flush (Correct answer)

Correct answer: Gently aspirate, then attempt a pulsatile saline flush

The initial step is gentle aspiration followed by a pulsatile saline flush; forcing a flush with a small syringe generates dangerous pressure that can rupture the catheter.

Question 102: Which personal protective equipment (PPE) is required when handling antineoplastic agents according to current INS standards?

Sterile gown and single pair of gloves
Double chemotherapy-tested gloves, gown, and face shield (Correct answer)
Sterile gloves only
Standard exam gloves and mask

Correct answer: Double chemotherapy-tested gloves, gown, and face shield

Current standards require double gloving with chemotherapy-tested gloves, a protective gown, and face/eye protection when handling antineoplastic agents to prevent occupational exposure.

Question 103: Which catheter-to-vein ratio is recommended to minimize thrombosis risk when placing a PICC line?

The catheter diameter should equal the vein diameter
The catheter should occupy no more than 45% of the vein lumen (Correct answer)
The catheter should fill at least 60% of the vein lumen
No specific ratio exists; any size is acceptable

Correct answer: The catheter should occupy no more than 45% of the vein lumen

INS guidelines recommend a catheter-to-vein ratio of ≤45% to allow adequate blood flow around the catheter and reduce thrombosis risk.

Question 104: A patient's pre-transfusion type and screen reveals an unexpected antibody. What is the appropriate nursing action?

Request O-negative emergency release blood
Proceed with type-specific blood
Notify the blood bank for antigen-negative compatible units (Correct answer)
Cancel the transfusion order

Correct answer: Notify the blood bank for antigen-negative compatible units

When unexpected antibodies are detected, the blood bank must identify the antibody and provide antigen-negative, crossmatch-compatible units to prevent hemolytic reactions.

Question 105: A patient with a newly placed non-tunneled central venous catheter in the subclavian vein suddenly becomes dyspneic, hypotensive, and tachycardic during an IV tubing change. The CRNI suspects an air embolism. What is the PRIORITY nursing intervention?

Immediately obtain a stat portable chest x-ray.
Place the patient in a high-Fowler's position to ease breathing.
Administer high-flow oxygen via a non-rebreather mask.
Place the patient in the Trendelenburg position on their left side. (Correct answer)

Correct answer: Place the patient in the Trendelenburg position on their left side.

The immediate priority for a suspected venous air embolism is to trap the air in the apex of the right ventricle to prevent it from moving into the pulmonary artery and obstructing outflow. Placing the patient on their left side in the Trendelenburg position (Durant's maneuver) accomplishes this. While administering oxygen and obtaining imaging are important subsequent actions, initial life-saving positioning is the first priority.

Question 106: What is the primary role of the infusion nurse during a home visit for IV therapy?

Assess the patient, IV access site, and equipment; verify medication and administer or reinforce education (Correct answer)
Perform venipuncture only
Deliver medications and leave without direct patient interaction
Change IV tubing and dressings only

Correct answer: Assess the patient, IV access site, and equipment; verify medication and administer or reinforce education

The home infusion nurse provides holistic care: comprehensive patient and site assessment, medication verification, administration, and patient/caregiver education reinforcement.

Question 107: A nurse is assessing a peripheral IV site and notes a PICC score of 2 (slight tenderness, no erythema). What is the appropriate intervention?

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

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 108: When selecting a site for peripheral intravenous catheter insertion in an adult patient, which of the following veins is generally the best initial choice?

A vein on the palmar side of the wrist.
The cephalic vein in the forearm. (Correct answer)
A superficial vein in the foot.
The basilic vein in the upper arm.

Correct answer: The cephalic vein in the forearm.

The veins in the forearm, such as the cephalic or accessory cephalic vein, are generally preferred for peripheral IV insertion. These sites are on a flat, long bone, which acts as a natural splint, minimizing catheter movement and reducing the risk of infiltration and phlebitis. Sites in areas of flexion like the wrist or antecubital fossa should be avoided for routine infusions, as should the lower extremities in adults due to an increased risk of thrombosis.

Question 109: How does the CRNI apply the concept of vessel health preservation to daily practice?

Use ultrasound guidance for all insertions
Vessel preservation only applies to oncology patients
Focus only on inserting new IV lines when ordered
Systematically assess, plan, and protect the patient's vascular access sites throughout the continuum of care (Correct answer)

Correct answer: Systematically assess, plan, and protect the patient's vascular access sites throughout the continuum of care

Vessel health preservation is a proactive approach to maintaining vascular integrity across the patient's lifetime through thoughtful device selection, site rotation, and early planning.

Question 110: A patient's IV infusion rate is ordered at 125 mL/hr. The nurse notices the infusion has been running at 150 mL/hr for the past 2 hours. What is the FIRST nursing action?

Recalculate the rate and document the discrepancy
Slow the infusion to the correct rate and continue monitoring
Assess the patient for signs of fluid overload, then correct the rate (Correct answer)
Stop the infusion immediately and notify the physician

Correct answer: Assess the patient for signs of fluid overload, then correct the rate

Patient safety requires assessing for harm before correcting the rate and documenting the incident.

Question 111: A patient receiving IV acyclovir complains of burning pain at the infusion site. The nurse observes swelling and pallor around the IV site. What is the priority action?

Flush the line with normal saline and continue
Apply a warm compress and slow the infusion rate
Elevate the extremity and document the finding
Stop the infusion and assess for extravasation (Correct answer)

Correct answer: Stop the infusion and assess for extravasation

Acyclovir is highly alkaline and vesicant; signs of swelling and pallor indicate possible extravasation, requiring immediate cessation of the infusion and site assessment.

Question 112: A CRNI working with a patient on contact precautions needs to transport the patient to radiology. Which action is MOST appropriate during transport?

Ensure the patient is covered or gowned and notify receiving department of precautions (Correct answer)
Remove all PPE before leaving the room to avoid alarming other patients
Apply airborne precautions as a precaution during transport
Keep the patient in their room and cancel the radiology appointment

Correct answer: Ensure the patient is covered or gowned and notify receiving department of precautions

During transport of a contact precautions patient, the patient should be covered to contain the organism, and the receiving department must be notified to prepare the area and don appropriate PPE.

Question 113: Which symptom in a home infusion patient warrants an immediate emergency call?

Sudden shortness of breath, chest pain, or fever above 38.5°C (101.3°F) (Correct answer)
Infusion completing earlier than scheduled
Slight redness at the dressing edge
Mild soreness at the IV insertion site

Correct answer: Sudden shortness of breath, chest pain, or fever above 38.5°C (101.3°F)

Sudden dyspnea, chest pain, or high fever can signal pulmonary embolism, air embolism, or catheter-related bloodstream infection requiring emergency evaluation.

Question 114: When should blood bank compatibility testing specimens be collected relative to transfusion?

Within 72 hours of the scheduled transfusion (Correct answer)
Any time before the transfusion
Within 24 hours only
Within 7 days of the scheduled transfusion

Correct answer: Within 72 hours of the scheduled transfusion

Pre-transfusion specimens must be collected within 72 hours of the scheduled transfusion for patients who have been transfused or pregnant within the past 3 months.

Question 115: A provider orders PN to be started immediately, but the pharmacy-prepared bag is not yet available. The nurse should administer:

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

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 116: What is the clinical significance of lipid emulsion cracking in a TNA solution?

It means the solution has expired
It indicates the solution is too cold
It represents irreversible destabilization with visible oil droplets that can cause fat embolism (Correct answer)
It is a normal settling that resolves with agitation

Correct answer: It represents irreversible destabilization with visible oil droplets that can cause fat embolism

Cracking indicates irreversible lipid emulsion destabilization with coalescence of oil droplets that can cause fatal fat embolism if infused.

Question 117: Which vesicant chemotherapy agent requires immediate intervention if extravasation occurs during IV infusion?

Bleomycin
Cyclophosphamide
Methotrexate
Doxorubicin (Correct answer)

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 118: Antidiuretic hormone (ADH) is released in response to which of the following stimuli?

Decreased serum potassium
Increased urine specific gravity
Increased serum osmolality (Correct answer)
Decreased serum osmolality

Correct answer: Increased serum osmolality

ADH is secreted by the posterior pituitary when osmoreceptors detect a rise in plasma osmolality. ADH promotes water reabsorption in the renal collecting ducts to dilute the plasma and restore normal osmolality.

Question 119: Which electrolyte imbalance is most commonly associated with amphotericin B infusion therapy?

Hypernatremia
Hypercalcemia
Hyperkalemia
Hypokalemia (Correct answer)

Correct answer: Hypokalemia

Amphotericin B causes renal tubular dysfunction leading to potassium wasting and hypokalemia, requiring routine electrolyte monitoring and replacement.

Question 120: A patient with a history of allergic transfusion reactions is ordered packed RBCs. What premedication is typically administered?

Methylprednisolone 125 mg IV
Acetaminophen 650 mg PO only
Diphenhydramine 25-50 mg IV (Correct answer)
Epinephrine 0.3 mg IM

Correct answer: Diphenhydramine 25-50 mg IV

Diphenhydramine is the standard premedication for patients with a history of allergic transfusion reactions, given 30 minutes before transfusion to prevent urticaria and itching.

Question 121: What is the recommended nursing action when a patient receiving IV potassium chloride reports severe burning and pain at the peripheral IV site with no other abnormal findings?

Switch to a central access device and continue therapy
Dilute the solution further and reduce the infusion rate (Correct answer)
Discontinue the infusion and restart at a new site
Apply a warm compress over the IV site and continue at current rate

Correct answer: Dilute the solution further and reduce the infusion rate

Potassium chloride is a chemical irritant; reducing the concentration and slowing the rate often relieves burning while maintaining the same access site when no extravasation is present.

Question 122: A patient's PN infusion is 4 hours behind schedule. The nurse should:

Discontinue the current bag and start a new one
Continue the infusion at the prescribed rate and notify the provider (Correct answer)
Double the rate for 2 hours to catch up
Increase the rate to make up for the lost volume

Correct answer: Continue the infusion at the prescribed rate and notify the provider

PN should never be infused faster than prescribed to avoid hyperglycemia and metabolic complications; the nurse should continue at the ordered rate and notify the provider.

Question 123: What assessment findings indicate a positive Allen's test before arterial line placement?

No color change in the hand
The hand flushes pink within 5-7 seconds after releasing the ulnar artery, indicating adequate collateral circulation (Correct answer)
The fingers become cyanotic
The hand remains pale after releasing the ulnar artery

Correct answer: The hand flushes pink within 5-7 seconds after releasing the ulnar artery, indicating adequate collateral circulation

A positive (normal) Allen's test shows the hand flushing pink within 5-7 seconds of releasing the ulnar artery while the radial artery remains compressed. This confirms adequate collateral blood flow through the ulnar artery, making it safe to cannulate the radial artery. A negative (abnormal) test indicates insufficient collateral flow, contraindicating radial artery cannulation.

Question 124: According to the CDC and INS guidelines, how frequently should administration sets used for continuous infusions be changed in the absence of lipids, blood, or propofol?

Every 24 hours
Every 48 hours
Every 7 days
No more frequently than every 96 hours, unless clinically indicated (Correct answer)

Correct answer: No more frequently than every 96 hours, unless clinically indicated

Current evidence supports changing standard IV administration sets no more often than every 96 hours (4 days) unless the line is compromised or used for blood, lipids, or propofol.

Question 125: A patient's pain is inadequately controlled with demand doses alone on PCA, with no basal infusion running. The appropriate first nursing action is to:

Contact the prescriber to reassess and modify the pain management plan (Correct answer)
Decrease the lockout interval without changing the demand dose
Independently add a continuous basal infusion to the PCA
Independently increase the programmed demand dose

Correct answer: Contact the prescriber to reassess and modify the pain management plan

Changing PCA parameters requires a physician order; the nurse's role is to assess, document, and communicate uncontrolled pain to the prescriber for a plan modification.

Question 126: A patient receiving blinatumomab develops confusion, tremors, and difficulty speaking on day 3 of infusion. The nurse's priority action is:

Administer diphenhydramine IV and slow the infusion
Obtain a STAT blood glucose level
Stop the infusion and notify the physician immediately (Correct answer)
Place the patient in Trendelenburg position

Correct answer: Stop the infusion and notify the physician immediately

Neurologic toxicity (cytokine release syndrome-related CNS effects) from blinatumomab requires immediate infusion cessation and physician notification.

Question 127: Which of the following is a critical nursing consideration specific to the administration of platelets?

Infusing the component slowly over a period of 3 to 4 hours.
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).
Ensuring the component is warmed to body temperature prior to infusion to activate the platelets.

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 128: What is the most important environmental consideration when a patient prepares IV medications at home?

A clean, uncluttered surface away from pets and air vents (Correct answer)
A room temperature above 70°F
Availability of a sink within reach
A surface close to the bathroom

Correct answer: A clean, uncluttered surface away from pets and air vents

Preparing IVs on a clean, uncluttered surface away from pets and air vents minimizes the risk of environmental contamination.

Question 129: A nurse documents 'patient tolerated infusion well' without vital signs or site assessment findings. This type of documentation is considered:

Inadequate, because it lacks objective data required by INS standards and organizational policy (Correct answer)
Compliant if cosigned by the supervising nurse
Sufficient, because it summarizes the infusion episode
Appropriate only for low-risk infusions such as normal saline flushes

Correct answer: Inadequate, because it lacks objective data required by INS standards and organizational policy

INS standards require objective assessment data including site condition and patient response; subjective summaries without clinical findings do not meet professional documentation standards.

Question 130: What is the appropriate action when a pediatric patient's IV site shows a grade 2 infiltration on the INS scale?

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

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 131: What standard precaution is considered to be the most crucial?

Environmental disinfection
Hand washing (Correct answer)
Isolation
Disinfection of equipment

Correct answer: Hand washing

Hand washing is universally recognized as the single most important and effective standard precaution for preventing the spread of infections in healthcare settings. Proper hand hygiene physically removes or inactivates transient microorganisms acquired during patient care. This action effectively breaks the chain of infection transmission between patients, healthcare workers, and the environment.

Question 132: Which anatomical site is CONTRAINDICATED for peripheral IV insertion in most adult patients?

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

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 133: According to regulatory standards, what must be documented when a medication error occurs during infusion therapy?

Only the corrective action
Nothing — errors should not be documented
Only the physician notification
The error itself, patient assessment, provider notification, corrective actions, patient outcome, and completion of an incident report (Correct answer)

Correct answer: The error itself, patient assessment, provider notification, corrective actions, patient outcome, and completion of an incident report

Medication error documentation must include a factual description of the error (what was ordered versus what was administered), immediate patient assessment findings, all providers notified, corrective actions taken, the patient's response and outcome, follow-up monitoring plan, and an institutional incident/safety report. Documentation should be factual, non-punitive, and thorough.

Question 134: Which IV fluid is most appropriate for initial resuscitation of a patient with severe burns?

0.45% NaCl
D5W
3% NaCl
Lactated Ringer's (Correct answer)

Correct answer: Lactated Ringer's

Lactated Ringer's is the preferred fluid for burn resuscitation per the Parkland formula due to its isotonic composition.

Question 135: What is the standard of care regarding the use of ultrasound guidance for peripheral IV catheter insertion?

Ultrasound guidance should be available for difficult vascular access and is recommended to improve first-attempt success rates (Correct answer)
Ultrasound guidance is only for central line insertion
Ultrasound must be used for every IV insertion
Ultrasound is optional and rarely beneficial

Correct answer: Ultrasound guidance should be available for difficult vascular access and is recommended to improve first-attempt success rates

INS standards recommend ultrasound availability for difficult vascular access, as it significantly improves first-attempt success rates and reduces patient discomfort and complications.

Question 136: 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)
Place a warning label on the pump and continue use for non-critical infusions
Return the pump to service after a simple cleaning

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 137: Hospital infection control procedures under investigation?

Occurrence of outbreaks
All of the above (Correct answer)
Routine monitoring
Strain typing

Correct answer: All of the above

Investigating hospital infection control procedures involves a comprehensive approach. This includes routine monitoring of infection rates to identify trends, strain typing to determine the source and spread of specific pathogens during outbreaks, and thorough investigation of outbreaks themselves to implement corrective measures. All these methods are essential for effective infection control.

Question 138: Which hand hygiene method is preferred before inserting a vascular access device?

Antiseptic hand scrub or alcohol-based hand rub per WHO guidelines (Correct answer)
Alcohol-based hand rub for 15 seconds
Glove use alone without hand hygiene
Soap and water wash for 15 seconds

Correct answer: Antiseptic hand scrub or alcohol-based hand rub per WHO guidelines

WHO guidelines recommend either antiseptic hand washing or alcohol-based hand rub before vascular access device insertion, with thorough technique being more important than the specific agent.

Question 139: What is the significance of catheter-to-vein ratio in vascular access device selection?

A ratio exceeding 45% increases the risk of venous thrombosis and should be avoided (Correct answer)
A 1:1 ratio is ideal for optimal flow rates
It has no clinical significance
The catheter should fill the entire vein lumen for stability

Correct answer: A ratio exceeding 45% increases the risk of venous thrombosis and should be avoided

A catheter-to-vein ratio exceeding 45% significantly increases the risk of venous thrombosis by impeding blood flow around the catheter.

Question 140: What temperature should blood products be stored at in the blood bank prior to transfusion?

Room temperature (20-24 degrees C)
1-6 degrees C (Correct answer)
Below 0 degrees C
8-12 degrees C

Correct answer: 1-6 degrees C

Packed red blood cells must be stored at 1-6 degrees C in monitored blood bank refrigerators to maintain viability and prevent bacterial growth.

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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