CRNI - Certified Registered Nurse Infusion — Questions and Answers

Question 1: A patient's TPN is abruptly discontinued. What is the immediate nursing concern?

Hypernatremia
Fluid overload
Metabolic alkalosis
Rebound hypoglycemia (Correct answer)

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 2: Which blood product requires a leukocyte-reduction filter when transfused to a pediatric patient who has had prior febrile non-hemolytic transfusion reactions?

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

Correct answer: Packed red blood cells

Leukoreduced packed red blood cells are indicated for patients with prior febrile non-hemolytic reactions, as white blood cells are the primary cause of these reactions.

Question 3: A postoperative patient receiving a continuous peripheral nerve block infusion suddenly develops confusion, metallic taste, tinnitus, and perioral numbness. What is the most likely cause?

Air embolism from catheter displacement
Hypoglycemia from poor oral intake
Opioid toxicity from concurrent IV analgesia
Local anesthetic systemic toxicity (LAST) (Correct answer)

Correct answer: Local anesthetic systemic toxicity (LAST)

Metallic taste, tinnitus, perioral numbness, and CNS symptoms are classic early signs of local anesthetic systemic toxicity (LAST) due to intravascular absorption.

Question 4: Which of the following cryoprecipitate indications is considered most appropriate?

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

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 5: An elderly patient with a history of congestive heart failure is receiving a unit of PRBCs. The nurse assesses the patient and notes new onset of a dry cough, dyspnea, and bilateral crackles in the lung bases. The patient's blood pressure is 160/92 mmHg, an increase from 134/80 mmHg pre-transfusion. The CRNI should suspect which transfusion-related complication?

Transfusion-Related Acute Lung Injury (TRALI)
Anaphylactic reaction
Transfusion-Associated Circulatory Overload (TACO) (Correct answer)
Febrile non-hemolytic reaction

Correct answer: Transfusion-Associated Circulatory Overload (TACO)

The patient's clinical presentation, including dyspnea, crackles, cough, and hypertension, in the context of a history of heart failure, is classic for Transfusion-Associated Circulatory Overload (TACO). This occurs when the patient's cardiovascular system is unable to manage the additional fluid volume from the transfusion. TRALI typically presents with hypotension, not hypertension.

Question 6: What is the significance of the INS-recommended daily necessity review for vascular access devices?

It promotes prompt removal of unnecessary catheters to reduce infection risk (Correct answer)
It determines the need for antibiotic prophylaxis
It ensures proper billing documentation
It is required for Joint Commission accreditation only

Correct answer: It promotes prompt removal of unnecessary catheters to reduce infection risk

Daily assessment of catheter necessity ensures that devices are removed as soon as they are no longer clinically needed, directly reducing the risk of device-associated infections.

Question 7: A nurse notices a patient's peripheral IV site has signs of phlebitis. What is the FIRST action the CRNI should take?

Increase the infusion rate to flush the vein
Apply a warm compress and continue the infusion
Discontinue the IV and restart at a new site (Correct answer)
Apply topical antibiotic ointment to the site

Correct answer: Discontinue the IV and restart at a new site

Phlebitis requires immediate discontinuation of the IV catheter and insertion at a new site to prevent progression to thrombophlebitis or infection.

Question 8: What is the significance of osmolality when selecting a peripheral versus central infusion route?

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

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

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

Question 9: A patient is admitted with severe dehydration secondary to gastroenteritis. The physician orders an intravenous solution to correct the fluid volume deficit. Which type of IV fluid is most appropriate for initial fluid resuscitation in this patient?

0.9% Sodium Chloride (Normal Saline) (Correct answer)
Dextrose 5% in Water (D5W)
3% Sodium Chloride
0.45% Sodium Chloride (1/2 NS)

Correct answer: 0.9% Sodium Chloride (Normal Saline)

0.9% Sodium Chloride, also known as Normal Saline, is an isotonic solution, meaning it has the same concentration of solutes as blood plasma. This makes it the ideal choice for initial fluid resuscitation in cases of dehydration because it expands the extracellular fluid volume without causing a significant shift of fluid into or out of the cells. Hypotonic solutions like 0.45% NaCl would cause fluid to move into the cells, which is not the primary goal in correcting a fluid volume deficit. D5W is initially isotonic but becomes hypotonic as the dextrose is metabolized, and hypertonic solutions like 3% NaCl are reserved for severe, symptomatic hyponatremia.

Question 10: What is the recommended action when a smart pump generates a soft limit alert for a heparin infusion?

Always cancel the infusion
Always override the alert and continue
Evaluate the programmed parameters, verify the order, and make a clinical decision to accept or modify the dose (Correct answer)
Ignore the alert if the patient seems stable

Correct answer: Evaluate the programmed parameters, verify the order, and make a clinical decision to accept or modify the dose

When a soft limit alert fires, the nurse must pause and critically evaluate the programmed parameters against the physician's order. If the order is correct and clinically appropriate despite exceeding the typical range, the override may be justified with documentation. If there is any doubt, the prescriber should be contacted before proceeding.

Question 11: What ethical principle guides the CRNI when a patient refuses recommended infusion therapy?

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

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 12: What is the CRNI's responsibility regarding informed consent for vascular access device placement?

Verbal consent is sufficient for all vascular access procedures
Informed consent is only the physician's responsibility
Ensure the patient understands the risks, benefits, and alternatives before central vascular access device placement (Correct answer)
Obtain written consent for all IV insertions including peripheral lines

Correct answer: Ensure the patient understands the risks, benefits, and alternatives before central vascular access device placement

The CRNI must ensure informed consent is obtained before CVAD placement, including explanation of risks, benefits, alternatives, and the patient's right to refuse.

Question 13: Which of the following is not a common safety measure?

Immunization (Correct answer)
Cleaning and sterilization
Hand washing
Proper disposal of the infectious hospital waste

Correct answer: Immunization

Immunization is a crucial public health measure for preventing infectious diseases, but it is not typically categorized as a 'common safety measure' in the context of daily infection control practices within a healthcare facility. Hand washing, cleaning and sterilization of equipment, and proper disposal of infectious waste are fundamental and routine safety measures implemented constantly to prevent the spread of pathogens.

Question 14: After phlebitis develops at a peripheral IV site, where should the replacement IV be inserted?

In the same vein 1 inch distal
Immediately distal to the current site
In the opposite extremity or proximal to the inflamed site (Correct answer)
In the dominant hand

Correct answer: In the opposite extremity or proximal to the inflamed site

Restarting distal to an inflamed vein risks re-exposing the new catheter to the same damaged vessel; the opposite arm or a proximal site is preferred.

Question 15: A CRNI is preparing to administer doxorubicin. Which of the following baseline assessments is MOST critical to review before initiating therapy due to this agent's primary dose-limiting toxicity?

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

Correct answer: An echocardiogram or MUGA scan.

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

Question 16: When administering a continuous heparin infusion, the patient's aPTT is 3.5 times the control value. What is the priority nursing action?

Continue the infusion and recheck aPTT in 6 hours
Increase the infusion rate to achieve therapeutic levels
Administer protamine sulfate immediately
Hold the infusion and notify the prescriber per protocol (Correct answer)

Correct answer: Hold the infusion and notify the prescriber per protocol

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

Question 17: Which type of infusion pump is most appropriate for delivering precise low-volume continuous infusions of high-alert medications?

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

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

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

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 19: A patient receiving IV phenytoin develops burning at the peripheral IV site with a pH of the infusate measured at 12. What action should the nurse take?

Stop the infusion, assess for extravasation, and consider central line placement for continuation (Correct answer)
Dilute the phenytoin further and resume peripherally
Apply a warm compress and continue the infusion
Increase the infusion rate to minimize contact time

Correct answer: Stop the infusion, assess for extravasation, and consider central line placement for continuation

Phenytoin has a pH of approximately 12, making it highly alkaline and irritating to peripheral veins. Burning suggests chemical phlebitis or extravasation requiring IV discontinuation.

Question 20: A CRNI is assessing a patient with a serum calcium level of 7.2 mg/dL. Which of the following physical examination findings would be most consistent with this laboratory value?

Peaked T waves on ECG
Muscle flaccidity
Depressed deep tendon reflexes
Positive Chvostek's sign (Correct answer)

Correct answer: Positive Chvostek's sign

A serum calcium level of 7.2 mg/dL indicates hypocalcemia. Hypocalcemia increases neuromuscular excitability. A positive Chvostek's sign, which is the twitching of facial muscles in response to tapping over the facial nerve, is a classic sign of this increased excitability. Depressed reflexes and muscle flaccidity are associated with hypercalcemia, while peaked T waves are characteristic of hyperkalemia.

Question 21: A home infusion patient on parenteral iron therapy develops sudden facial flushing, urticaria, and chest tightness shortly after the infusion begins. What should the nurse do first?

Apply a cold compress and reassure the patient
Complete the infusion and document the reaction for the physician
Slow the infusion rate and administer diphenhydramine
Stop the infusion immediately and assess airway, breathing, and circulation (Correct answer)

Correct answer: Stop the infusion immediately and assess airway, breathing, and circulation

These signs indicate a potential anaphylactic or hypersensitivity reaction; stopping the infusion and assessing the ABCs is the immediate priority.

Question 22: Which vascular access device is MOST appropriate for a chemotherapy regimen requiring intermittent infusions over 6 months?

Implanted port (Correct answer)
Midline catheter
Short peripheral catheter with extension set
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 23: 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 70 mg/dL (Correct answer)
Below 100 mg/dL
Below 140 mg/dL
Below 180 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 24: A nurse is caring for a neutropenic oncology patient with a tunneled CVC. Which infection control measure is MOST critical in this population?

Strict aseptic technique with every catheter access due to severely impaired host defenses (Correct answer)
Changing the CVC every 3 days prophylactically
Applying antibiotic ointment to the exit site daily
Using standard precautions only, as neutropenia does not increase CRBSI risk

Correct answer: Strict aseptic technique with every catheter access due to severely impaired host defenses

Neutropenic patients lack adequate immune response, making strict aseptic technique during every catheter access essential to prevent life-threatening CRBSI.

Question 25: A patient receiving total parenteral nutrition through a CVC develops sudden fever, tachycardia, and hypotension. Blood glucose is 45 mg/dL. What complication should be suspected?

Simple hypoglycemia from insulin excess
Catheter-related bloodstream infection with hypoglycemia from sepsis (Correct answer)
TPN fluid overload
Refeeding syndrome

Correct answer: Catheter-related bloodstream infection with hypoglycemia from sepsis

Sudden fever, tachycardia, and hypotension during TPN administration suggest CRBSI, with hypoglycemia resulting from sepsis-induced glucose consumption and possible TPN interruption.

Question 26: Multimodal analgesia is a strategy that improves pain control by:

Using one analgesic at the maximum tolerated dose to achieve complete pain relief
Using only non-pharmacological interventions to reduce opioid exposure
Combining agents with different mechanisms of action to achieve additive or synergistic effects (Correct answer)
Rotating between different opioids every 24 hours to prevent tolerance

Correct answer: Combining agents with different mechanisms of action to achieve additive or synergistic effects

Multimodal analgesia combines drugs acting on different pain pathways (e.g., opioids, NSAIDs, acetaminophen, regional blocks) to improve analgesia while reducing side effects of any single agent.

Question 27: Which finding on assessment of a peripheral IV site would indicate phlebitis that requires catheter removal?

A small bruise at the insertion point with no swelling
A streak of redness extending along the vein with induration and pain (Correct answer)
Slight pallor around the insertion site
Sluggish flow rate without any local skin changes

Correct answer: A streak of redness extending along the vein with induration and pain

A red streak extending along the vein (tracking) with induration and pain indicates phlebitis, requiring immediate catheter removal and documentation per INS standards.

Question 28: Which action by the nurse demonstrates correct handling of oral antineoplastic agents per safe handling guidelines?

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

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

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

Question 29: What competency requirements must a CRNI maintain for certification renewal?

Only passing the certification exam again
Annual skills check-off by a supervisor
No specific requirements beyond initial certification
Continuing education credits, clinical practice hours, and demonstrated competency in infusion therapy as required by the INCC (Correct answer)

Correct answer: Continuing education credits, clinical practice hours, and demonstrated competency in infusion therapy as required by the INCC

CRNI certification renewal through the Infusion Nurses Certification Corporation requires ongoing continuing education, clinical practice, and competency demonstration.

Question 30: What is the significance of catheter-related thrombosis in patients with PICCs compared to other central venous catheters?

Thrombosis rates are identical across all CVC types
PICCs have lower thrombosis rates than subclavian CVCs
PICCs are associated with higher rates of upper extremity DVT compared to other CVCs (Correct answer)
PICC-related thrombosis is clinically insignificant

Correct answer: PICCs are associated with higher rates of upper extremity DVT compared to other CVCs

PICCs are associated with significantly higher rates of upper extremity deep vein thrombosis compared to subclavian or jugular CVCs, particularly in hospitalized patients.

Question 31: What electrolyte must be closely monitored during the first 72 hours of TPN initiation in a malnourished patient?

Phosphorus (Correct answer)
Sodium
Chloride
Bicarbonate

Correct answer: Phosphorus

Phosphorus is the most critically affected electrolyte in refeeding syndrome, as insulin-driven cellular uptake can cause severe hypophosphatemia leading to respiratory and cardiac failure.

Question 32: 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 33: 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?

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

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 34: A patient on loop diuretics develops muscle cramps, fatigue, and a serum magnesium of 1.1 mEq/L. What electrolyte should also be checked?

Serum phosphate
Serum chloride
Serum bicarbonate
Serum potassium (Correct answer)

Correct answer: Serum potassium

Hypomagnesemia frequently coexists with hypokalemia because magnesium deficiency impairs renal potassium conservation.

Question 35: A home infusion nurse is the only clinician present when a patient's central line becomes dislodged during a scheduled visit. The nurse stabilizes the patient and attempts to reach the prescribing physician, who does not respond within 30 minutes. Under most state Nurse Practice Acts, the nurse's MOST appropriate next step is:

Contact the on-call or covering provider through the agency's after-hours protocol (Correct answer)
Discharge the patient from home infusion care and recommend the ER
Reinsert the central line using the equipment on hand to restore therapy
Continue waiting for the physician call-back before taking any further action

Correct answer: Contact the on-call or covering provider through the agency's after-hours protocol

When a primary prescriber is unavailable in an urgent situation, the nurse is obligated to escalate through the established chain of communication—typically the agency's after-hours on-call provider—rather than performing outside scope (reinserting a central line without a physician order is outside RN scope in virtually all states) or abandoning the patient.

Question 36: Which catheter tip position is considered optimal for thoracic epidural analgesia after major abdominal surgery?

L1–L2 to target the lumbar plexus
C7–T1 for broad sensory coverage
L3–L4 to cover the entire abdomen
T6–T10 to correspond to the surgical dermatome (Correct answer)

Correct answer: T6–T10 to correspond to the surgical dermatome

Placing the epidural catheter at T6–T10 targets the thoracic dermatomes corresponding to the abdominal incision for optimal analgesia.

Question 37: Which laboratory value trend in a patient receiving prolonged IV antibiotics warrants assessment for nephrotoxicity?

Rising serum creatinine and BUN (Correct answer)
Declining hemoglobin and hematocrit
Decreasing serum albumin
Elevated serum potassium with normal creatinine

Correct answer: Rising serum creatinine and BUN

Rising serum creatinine and BUN indicate declining glomerular filtration and are the primary markers of antibiotic-induced nephrotoxicity.

Question 38: A patient's PN infusion is 4 hours behind schedule. The nurse should:

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

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 39: What is the CRNI's role in antibiotic stewardship as it relates to IV therapy?

Prescribing appropriate antibiotics
Antibiotic stewardship is not within the CRNI scope of practice
Ensuring proper IV antibiotic administration, monitoring for adverse effects, and supporting timely IV-to-oral conversion (Correct answer)
Only administering antibiotics as ordered without further assessment

Correct answer: Ensuring proper IV antibiotic administration, monitoring for adverse effects, and supporting timely IV-to-oral conversion

CRNIs play a vital role in antibiotic stewardship by ensuring proper administration, monitoring therapeutic levels and adverse effects, and supporting IV-to-oral transition when appropriate.

Question 40: A patient with a subcutaneous port reports difficulty accessing the port and the nurse cannot palpate it. Which complication is most likely?

Catheter tip migration
Port rotation or flipping (Correct answer)
Fibrin sheath formation
Port pocket infection

Correct answer: Port rotation or flipping

Port rotation or flipping (the port has turned over within the pocket) makes palpation difficult and prevents needle access through the septum.

Question 41: When priming IV tubing for vesicant chemotherapy administration, what solution should be used?

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

Correct answer: Compatible IV fluid without the drug

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

Question 42: Which electrolyte imbalance is most commonly associated with prolonged nasogastric suctioning?

Metabolic acidosis
Hypokalemic metabolic alkalosis (Correct answer)
Hyperkalemia
Hypernatremia

Correct answer: Hypokalemic metabolic alkalosis

NG suctioning removes HCl and potassium, causing hypokalemia and metabolic alkalosis from hydrogen ion loss.

Question 43: Which fluid compartment contains the largest proportion of total body water in an adult?

Intracellular fluid (Correct answer)
Transcellular fluid
Interstitial fluid
Intravascular fluid

Correct answer: Intracellular fluid

Intracellular fluid (ICF) accounts for approximately 40% of body weight, or about two-thirds of total body water — far exceeding any other single compartment. Extracellular fluid (interstitial + intravascular) makes up the remaining one-third.

Question 44: According to INS Standards of Practice, how should an infusion nurse respond when evidence-based research contradicts an existing institutional policy?

Immediately implement the new evidence-based practice without notifying management
Document personal disagreement in the patient record and follow personal clinical judgment
Continue following the institutional policy until it is formally updated through governance
Advocate for policy review through appropriate channels while complying with current policy (Correct answer)

Correct answer: Advocate for policy review through appropriate channels while complying with current policy

INS Standards require nurses to practice evidence-based care and to advocate for policy changes through appropriate organizational channels (e.g., practice councils, clinical leadership) while continuing to comply with existing policy until it is formally revised.

Question 45: A CRNI is caring for a patient receiving a continuous infusion of 3% Sodium Chloride for severe, symptomatic hyponatremia. Which assessment finding requires immediate intervention by the nurse?

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

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 46: Which water quality standard must be met for final rinse water used in reprocessing reusable infusion equipment?

Any sterile water regardless of endotoxin levels
Critical water meeting AAMI standards for bacterial endotoxin levels (Correct answer)
Tap water meeting EPA drinking water standards
Distilled water only

Correct answer: Critical water meeting AAMI standards for bacterial endotoxin levels

Final rinse water for reprocessed infusion equipment must meet AAMI standards for bacterial and endotoxin levels to prevent patient exposure to pyrogenic substances.

Question 47: Which documentation standard applies to the use of restraints in patients who repeatedly remove IV access devices?

Only the nurse's note that restraints were applied
No documentation needed
Only the type of restraint used
Physician order, patient assessment, alternatives tried, least restrictive device used, regular reassessment intervals, and removal criteria (Correct answer)

Correct answer: Physician order, patient assessment, alternatives tried, least restrictive device used, regular reassessment intervals, and removal criteria

Restraint use requires comprehensive documentation including a physician order with clinical justification, assessment of patient condition, documentation of less restrictive alternatives attempted first, the specific restraint type used, regular reassessment at defined intervals (typically every 1-2 hours), neurovascular checks, and criteria for discontinuation.

Question 48: A patient develops tumor lysis syndrome 24 hours after starting chemotherapy. Which set of lab findings is characteristic?

Hypomagnesemia, hypophosphatemia, metabolic alkalosis
Hypercalcemia, hypokalemia, hypernatremia
Hyponatremia, hypoglycemia, elevated BUN
Hyperuricemia, hyperkalemia, hyperphosphatemia, hypocalcemia (Correct answer)

Correct answer: Hyperuricemia, hyperkalemia, hyperphosphatemia, hypocalcemia

Tumor lysis syndrome classically presents with hyperuricemia, hyperkalemia, hyperphosphatemia, and hypocalcemia from rapid release of intracellular contents.

Question 49: What is the CRNI's responsibility regarding medication compatibility when multiple IV infusions run simultaneously?

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

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

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

Question 50: How frequently can a blood donor donate?

Every 2 months (Correct answer)
Every 3 months
At any time
Every 6 months

Correct answer: Every 2 months

The body needs time to replenish the red blood cells and iron lost during a whole blood donation. A standard interval of 56 days (8 weeks or approximately 2 months) between whole blood donations is recommended. This allows the donor's body to fully recover and maintain healthy iron levels, preventing iron deficiency anemia.

Question 51: A postoperative patient has decreased urine output, pulmonary crackles, and a serum sodium of 148 mEq/L. Which fluid overload pattern does this represent?

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

Correct answer: Hypertonic fluid excess

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

Question 52: Which symptom in a home infusion patient warrants an immediate emergency call?

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

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

Hypernatremia
Hypercalcemia
Hypophosphatemia (Correct answer)
Hyperkalemia

Correct answer: Hypophosphatemia

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

Question 54: Which electrolyte imbalance is most commonly associated with amphotericin B infusion therapy?

Hypokalemia (Correct answer)
Hypernatremia
Hypercalcemia
Hyperkalemia

Correct answer: Hypokalemia

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

Question 55: A nurse is administering IV metronidazole and notices the patient is also receiving IV phenytoin. Which drug interaction should the nurse anticipate?

No significant interaction exists between these drugs
Metronidazole decreases phenytoin absorption
Metronidazole increases phenytoin serum levels (Correct answer)
Metronidazole accelerates phenytoin metabolism

Correct answer: Metronidazole increases phenytoin serum levels

Metronidazole inhibits CYP2C9, the primary enzyme responsible for phenytoin metabolism, causing accumulation of phenytoin and increasing the risk of toxicity.

Question 56: A nurse is using a PCA pump for postoperative pain management. Which parameter DIRECTLY limits the total opioid dose the patient can self-administer over 4 hours?

4-hour dose limit (Correct answer)
Lockout interval
Basal rate
Demand dose

Correct answer: 4-hour dose limit

The 4-hour dose limit is a cumulative cap programmed into the PCA pump that prevents the patient from receiving more than the prescribed maximum opioid dose in that time period.

Question 57: A patient's serum sodium is 118 mEq/L and they are asymptomatic. What is the safest correction rate?

Correct to normal within 4 hours
Raise sodium 2 mEq/L per hour
No more than 8-12 mEq/L in 24 hours (Correct answer)
Correct to 130 mEq/L immediately

Correct answer: No more than 8-12 mEq/L in 24 hours

Correcting hyponatremia faster than 8-12 mEq/L per 24 hours risks osmotic demyelination syndrome.

Question 58: Which local anesthetic concentration is most appropriate for a patient receiving lumbar epidural analgesia where motor preservation is the priority?

Bupivacaine 0.5% to ensure dense blockade
Lidocaine 2% for rapid onset
Ropivacaine 1% for prolonged duration
Bupivacaine 0.0625–0.125% for differential sensory block (Correct answer)

Correct answer: Bupivacaine 0.0625–0.125% for differential sensory block

Low-concentration bupivacaine produces a differential block that reduces pain with minimal motor impairment, preserving ambulation.

Question 59: During a routine dressing change for a patient's PICC line, the CRNI notes that the external catheter length has increased by 4 cm compared to the documented insertion length. The patient also reports occasionally hearing a 'gurgling' sound in their ear on the side of the catheter insertion. Which of the following is the most likely complication?

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

Correct answer: Catheter migration

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

Question 60: When using the push-pause (turbulent) flushing technique, what is the primary goal?

Create turbulence to remove fibrin and drug residue from catheter walls (Correct answer)
Prevent catheter fracture
Reduce the risk of air embolism
Decrease clot formation in the bloodstream

Correct answer: Create turbulence to remove fibrin and drug residue from catheter walls

Push-pause flushing creates turbulent flow within the catheter lumen, which helps dislodge fibrin deposits and medication residue that could cause occlusion.

Question 61: What legal considerations apply to the CRNI when a medication error occurs during infusion therapy?

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

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

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

Question 62: A patient develops back pain, hemoglobinuria, and hypotension shortly after beginning a red cell transfusion. Which action takes highest priority?

Administer diphenhydramine and slow the infusion
Stop the transfusion and maintain IV access with normal saline (Correct answer)
Administer furosemide to promote urinary output
Obtain a blood culture and continue the transfusion at a slower rate

Correct answer: Stop the transfusion and maintain IV access with normal saline

These signs indicate an acute hemolytic transfusion reaction; the transfusion must be stopped immediately and IV access maintained with normal saline while notifying the blood bank and physician.

Question 63: When using a 1.2-micron in-line filter for PN administration, the nurse understands this filter is appropriate for:

Electrolyte additives only
Total nutrient admixtures (3-in-1) (Correct answer)
Lipid emulsions administered separately
Dextrose/amino acid solutions only

Correct answer: Total nutrient admixtures (3-in-1)

A 1.2-micron filter is used for total nutrient admixtures (3-in-1) because it allows lipid particles to pass through while filtering particulates and some microorganisms.

Question 64: How should a home infusion patient properly dispose of used sharps?

Flushed down the toilet
In a zip-lock bag placed in recycling
In an FDA-cleared sharps disposal container following local regulations (Correct answer)
In a sealed household trash bag

Correct answer: In an FDA-cleared sharps disposal container following local regulations

Used sharps must go into an FDA-cleared sharps container and be disposed of per state and local regulations to prevent community needlestick injuries.

Question 65: A patient's IV medication order reads dopamine 5 mcg/kg/min, titrate to MAP greater than 65. What does this titration order require from the CRNI?

Administer a bolus if MAP drops below 65
Maintain the initial rate regardless of blood pressure
Continuously monitor MAP and adjust the infusion rate within the prescribed parameters (Correct answer)
Increase the dose by 5 mcg/kg/min every hour

Correct answer: Continuously monitor MAP and adjust the infusion rate within the prescribed parameters

Titration orders require continuous hemodynamic monitoring and independent nursing adjustment of infusion rates to maintain the specified physiological parameter within prescribed limits.

Question 66: Which nursing intervention BEST prevents catheter occlusion in a patient receiving PN via a central venous catheter?

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

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

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

Question 67: Which anatomical site is CONTRAINDICATED for peripheral IV insertion in most adult patients?

Antecubital fossa basilic vein
Hand dorsal metacarpal veins
Forearm cephalic vein
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 68: Which solution is SAFE to co-infuse in the same IV line as packed red blood cells?

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

Correct answer: Normal saline (0.9% NaCl)

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

Question 69: A patient with chronic renal failure requires a blood transfusion. Which pre-transfusion concern is most critical related to stored PRBCs?

Risk of hypothermia from cold blood
Risk of hypocalcemia from citrate
Risk of hyperkalemia from lysed red cells in older blood (Correct answer)
Risk of air embolism from the blood bag

Correct answer: Risk of hyperkalemia from lysed red cells in older blood

Stored PRBCs release potassium as red cells lyse over storage time, posing a significant hyperkalemia risk to patients with renal failure who cannot excrete excess potassium.

Question 70: Which developmental consideration is most important when preparing a school-age child (6-12 years) for IV insertion?

Using distraction techniques only
Restraining the child immediately
Having parents leave the room
Providing a simple, honest explanation of what to expect (Correct answer)

Correct answer: Providing a simple, honest explanation of what to expect

School-age children benefit most from a simple, honest explanation of what to expect during IV insertion. At this developmental stage, children can understand cause and effect and cope better when they feel informed and involved. Deception or lack of information increases anxiety and distrust.

Question 71: What is the recommended maximum volume for a single IV push medication in a neonate?

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

Correct answer: 1 mL

In neonates, the recommended maximum volume for a single IV push medication is generally 1 mL to prevent fluid overload and minimize the risk of adverse hemodynamic effects. Larger volumes should be given as short infusions instead.

Question 72: A CRNI is calculating the osmolarity of a peripheral PN solution. Which finding would indicate it is safe for peripheral administration?

1500 mOsm/L
1800 mOsm/L
1200 mOsm/L
900 mOsm/L (Correct answer)

Correct answer: 900 mOsm/L

Peripheral PN should not exceed 900 mOsm/L to minimize the risk of phlebitis and vein damage.

Question 73: A patient on continuous IV insulin infusion has a blood glucose of 45 mg/dL. What is the priority assessment and intervention?

Stop the insulin infusion immediately, assess the patient's neurologic status, and administer IV dextrose as ordered (Correct answer)
Recheck the glucose in 1 hour
Decrease the insulin rate by half
Increase the IV fluid rate

Correct answer: Stop the insulin infusion immediately, assess the patient's neurologic status, and administer IV dextrose as ordered

A blood glucose of 45 mg/dL represents severe hypoglycemia requiring immediate intervention. The insulin infusion must be stopped, the patient assessed for neuroglycopenic symptoms (confusion, seizures, loss of consciousness), and IV dextrose (typically D50W 25 mL or D10W) administered per protocol. Glucose should be rechecked every 15 minutes until stable.

Question 74: To mitigate the risk of a febrile non-hemolytic transfusion reaction (FNHTR) in a patient who has a history of such reactions, which type of blood component modification is most appropriate?

Washed
Irradiated
Leukoreduced (Correct answer)
CMV-negative

Correct answer: Leukoreduced

Febrile non-hemolytic transfusion reactions are primarily caused by cytokines released from donor leukocytes (white blood cells) that accumulate during storage. Leukoreduction is the process of filtering out these leukocytes from the blood component before transfusion, thereby significantly reducing the risk of FNHTR. Irradiation prevents graft-versus-host disease, and washing removes plasma proteins to prevent severe allergic reactions.

Question 75: After accessing a multi-dose vial for the first time in a patient care area, what is the correct infection control practice for labeling the vial?

Label with the date opened and the beyond-use date. (Correct answer)
Label with the patient's name and medical record number.
No label is needed if it is returned to the medication cart immediately.
Label with the name of the nurse who first accessed the vial.

Correct answer: Label with the date opened and the beyond-use date.

To prevent the use of contaminated or expired medications, all multi-dose vials must be labeled with the date they were first opened and a beyond-use date (BUD). According to the CDC, the BUD is typically 28 days unless the manufacturer specifies otherwise. This ensures the vial is discarded before its sterility is compromised.

Question 76: When teaching a patient about imatinib (Gleevec) oral therapy, which instruction is most important?

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
Do not take with any antacids or dairy products

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 77: The majority of the body's water balance is controlled by two organ systems that interact with one another.

urinary and cardiovascular. (Correct answer)
urinary and respiratory.
digestive and respiratory.
cardiovascular and respiratory.

Correct answer: urinary and cardiovascular.

The urinary system (kidneys) and the cardiovascular system work in close conjunction to maintain the body's water balance. The kidneys regulate blood volume and composition by filtering blood and adjusting water and solute excretion, directly impacting blood pressure and overall fluid balance. The cardiovascular system, by circulating blood, delivers water and solutes to the kidneys and distributes hormones that influence kidney function, ensuring efficient fluid homeostasis.

Question 78: A patient receiving IV morphine via PCA has a respiratory rate of 8 breaths/min and is difficult to arouse. What is the priority nursing intervention?

Increase the lockout interval on the pump
Administer naloxone and notify the physician (Correct answer)
Discontinue PCA and switch to oral analgesics
Decrease the demand dose and continue monitoring

Correct answer: Administer naloxone and notify the physician

Respiratory depression with decreased consciousness requires immediate administration of naloxone (opioid antagonist) and physician notification, as this is a life-threatening emergency.

Question 79: What is the primary advantage of an over-the-needle catheter (ONC) over a steel needle for peripheral IV access?

Lower cost per unit
Easier insertion technique
Reduced risk of infiltration once the stylet is removed (Correct answer)
Greater flow rate

Correct answer: Reduced risk of infiltration once the stylet is removed

The flexible ONC catheter stays in the vein after the metal stylet is withdrawn, greatly reducing infiltration risk.

Question 80: According to the INS Standards of Practice, what is the primary goal of infusion therapy?

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

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

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

Question 81: A patient with a PICC line develops a fever of 38.9°C and chills during an infusion. What is the priority nursing action?

Flush the PICC line with normal saline
Stop the infusion and notify the provider immediately (Correct answer)
Slow the infusion rate and monitor
Administer antipyretics and continue the infusion

Correct answer: Stop the infusion and notify the provider immediately

Fever and chills during infusion through a central vascular access device suggest catheter-related bloodstream infection (CRBSI), requiring immediate cessation of infusion and provider notification.

Question 82: Which electrolyte is the primary determinant of extracellular fluid osmolality?

Calcium
Potassium
Magnesium
Sodium (Correct answer)

Correct answer: Sodium

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

Question 83: A patient's serum sodium is 118 mEq/L. What is the maximum safe correction rate to prevent neurological complications?

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

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

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

Question 84: A frequent nosocomial illness is not one of the following:

Pneumonia
TB (Correct answer)
UTI (Urinary tract infection)
Surgical site infections

Correct answer: TB

While Tuberculosis (TB) can be acquired in healthcare settings, it is primarily an airborne infection and not typically classified as a common nosocomial illness in the same way as UTIs, pneumonia, or surgical site infections. UTIs (often catheter-associated), pneumonia (especially ventilator-associated), and surgical site infections are among the most frequent types of healthcare-associated infections.

Question 85: During massive transfusion protocol activation, which electrolyte imbalance is MOST likely to develop?

Hypocalcemia (Correct answer)
Hypernatremia
Hypermagnesemia
Hypophosphatemia

Correct answer: Hypocalcemia

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

Question 86: A child receiving a vesicant chemotherapy infusion via a peripheral IV reports burning at the site. The nurse notes swelling and pallor. What is the priority intervention?

Stop the infusion immediately and aspirate residual drug (Correct answer)
Slow the infusion rate and reassess in 15 minutes
Apply a warm compress and elevate the extremity
Flush the line with normal saline to dilute the drug

Correct answer: Stop the infusion immediately and aspirate residual drug

Vesicant extravasation requires immediate infusion cessation and aspiration of residual drug before initiating site-specific antidote protocols.

Question 87: 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)
Cortisol excess causing hyperglycemia
Excess aldosterone causing sodium retention
ADH excess causing free water retention

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 88: A 5-year-old requires IV potassium chloride supplementation. What is the maximum recommended concentration for peripheral IV administration?

40 mEq/L (Correct answer)
80 mEq/L
10 mEq/L
20 mEq/L

Correct answer: 40 mEq/L

The maximum recommended concentration of potassium chloride for peripheral IV administration in pediatric patients is 40 mEq/L. Higher concentrations are vesicants that can cause severe phlebitis, pain, and tissue necrosis if infiltration occurs. Concentrations above 40 mEq/L require central venous access.

Question 89: What is the purpose of pressure monitoring on an infusion pump?

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

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

Nausea, vomiting, and diarrhea
Peripheral neuropathy and foot drop
Fever, rash, and eosinophilia
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 91: Which vein is the preferred site for peripheral IV insertion in adults?

Antecubital fossa
Dorsal hand veins
Forearm veins such as the cephalic or basilic (Correct answer)
Foot veins

Correct answer: Forearm veins such as the cephalic or basilic

Forearm veins like the cephalic and basilic are preferred because they are stable and away from joints.

Question 92: What pharmacokinetic advantage does continuous IV infusion provide over intermittent bolus dosing for time-dependent antibiotics?

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

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

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

Question 93: Which of the following is a contraindication to neuraxial analgesia?

Mild chronic obstructive pulmonary disease
Patient age greater than 70 years
History of previous uncomplicated epidural
INR of 2.8 in a patient on warfarin (Correct answer)

Correct answer: INR of 2.8 in a patient on warfarin

An INR ≥1.5 indicates coagulopathy, which is a contraindication to neuraxial block due to the risk of epidural hematoma.

Question 94: According to the Infusion Nurses Society (INS) Standards of Practice, what is the recommended maximum time an administration set used for primary intermittent infusion of a non-lipid, non-blood solution should be used?

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

Correct answer: 24 hours

The INS Standards of Practice recommend that administration sets used for intermittent infusions be changed every 24 hours. This is because the set is repeatedly disconnected and reconnected, which increases the risk of contamination compared to a continuously infusing, closed system.

Question 95: A nurse is documenting a central venous catheter (CVC) dressing change. Which finding requires an incident report in addition to the medical record entry?

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

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

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

Question 96: 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
The external catheter length has changed from the documented insertion measurement (Correct answer)
Slight redness at the exit site

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 97: Which standard governs the labeling of IV infusion tubing and containers?

Labeling is optional
No labeling standard exists
Only the date is required
All tubing must be labeled with medication name, date and time of tubing change, and initials; containers must have patient identification and solution information (Correct answer)

Correct answer: All tubing must be labeled with medication name, date and time of tubing change, and initials; containers must have patient identification and solution information

Standard practice requires that IV tubing be labeled with the date and time of initiation, medication name, flow rate, and the nurse's identification. Solution containers must have the patient's name, medication name and dose, rate, time of preparation, and expiration. Proper labeling prevents medication errors, ensures timely tubing changes, and facilitates line identification.

Question 98: Which filter size is required for 3-in-1 (total nutrient admixture) parenteral nutrition containing lipids?

5-micron filter
No filter is required
1.2-micron filter (Correct answer)
0.22-micron filter

Correct answer: 1.2-micron filter

A 1.2-micron filter is required for 3-in-1 TNA solutions because lipid emulsion particles (0.4-0.5 microns) cannot pass through a 0.22-micron filter.

Question 99: A nurse observes that a patient's central line dressing was last changed 8 days ago. The dressing is still intact and dry. What is the correct action?

Notify the provider before changing the dressing
Change the dressing immediately, as it is overdue per INS guidelines (Correct answer)
Reinforce the dressing with additional tape
Leave the dressing; it can remain until it becomes loose or soiled

Correct answer: Change the dressing immediately, as it is overdue per INS guidelines

INS guidelines recommend changing transparent semipermeable membrane dressings every 5–7 days and gauze dressings every 2 days; an 8-day-old dressing is overdue regardless of appearance.

Question 100: 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?

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

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 101: What is the maximum allowable hang time for a unit of packed red blood cells once it leaves the blood bank?

8 hours
2 hours
4 hours (Correct answer)
6 hours

Correct answer: 4 hours

PRBCs must be infused within 4 hours of leaving the blood bank to prevent bacterial proliferation and product deterioration.

Question 102: When preparing medications for administration through an epidural catheter, which standard is most critical?

The solution must be warmed to body temperature before administration
The medication must be diluted in bacteriostatic normal saline
Only preservative-free medications and solutions must be used (Correct answer)
A 0.22-micron filter must be used for all infusions

Correct answer: Only preservative-free medications and solutions must be used

Preservatives such as benzyl alcohol and phenol are neurotoxic and must never be used in epidural or intrathecal spaces; only preservative-free formulations are safe.

Question 103: A patient on home PN reports cloudy urine and elevated blood glucose despite stable TPN formula. What should the CRNI assess?

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

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

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

Question 104: What is the clinical significance of lipid emulsion cracking in a TNA solution?

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

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 105: What is the primary purpose of a leukocyte reduction filter during blood transfusion?

To remove bacteria from the blood product
To filter out clotted blood cells
To reduce the risk of febrile reactions and CMV transmission (Correct answer)
To prevent air embolism

Correct answer: To reduce the risk of febrile reactions and CMV transmission

Leukocyte reduction filters remove donor white blood cells, significantly reducing febrile non-hemolytic reactions and cytomegalovirus transmission risk.

Question 106: A patient with a port-a-cath presents with inability to aspirate blood but the port flushes without resistance. What is the MOST likely cause?

Pinch-off syndrome
Fibrin sheath formation at the catheter tip (Correct answer)
Port septum failure
Complete thrombotic occlusion

Correct answer: Fibrin sheath formation at the catheter tip

A fibrin sheath acts as a one-way valve, allowing infusion (antegrade flow) but preventing blood withdrawal (retrograde flow into the catheter).

Question 107: What is the primary purpose of performing a comprehensive patient assessment before initiating infusion therapy?

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

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 108: Which IV medication requires protection from light during infusion?

Nitroprusside (Correct answer)
Piperacillin-tazobactam
Metronidazole
Ceftriaxone

Correct answer: Nitroprusside

Nitroprusside is highly photosensitive and must be protected from light during preparation and infusion to prevent degradation to cyanide.

Question 109: 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:

Independently increase the programmed demand dose
Contact the prescriber to reassess and modify the pain management plan (Correct answer)
Independently add a continuous basal infusion to the PCA
Decrease the lockout interval without changing the 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 110: A CRNI is preparing to insert a non-tunneled central venous catheter at the bedside. Which of the following lists all the essential components of maximal barrier precautions required to prevent a central line-associated bloodstream infection (CLABSI)?

Sterile gloves and a small sterile fenestrated drape for the insertion site.
A cap, mask, sterile gown, sterile gloves for the inserter, and a large sterile drape covering the patient. (Correct answer)
A large sterile drape covering the patient, sterile gloves, and a face shield for the inserter.
Sterile gloves, a sterile gown, and a standard surgical mask for the inserter.

Correct answer: A cap, mask, sterile gown, sterile gloves for the inserter, and a large sterile drape covering the patient.

Maximal barrier precautions are a key component of the CLABSI prevention bundle for central line insertion. This requires the inserter to wear a cap, mask, sterile gown, and sterile gloves, and to use a large sterile drape that covers the patient's body to create the largest possible sterile field and minimize exposure to airborne contaminants.

Question 111: The pulsatile (push-pause) flushing technique is used primarily to:

Minimize patient discomfort during flushing
Reduce the speed of fluid delivery
Create turbulence that dislodges fibrin and drug deposits from the catheter lumen (Correct answer)
Prevent air from entering the catheter

Correct answer: Create turbulence that dislodges fibrin and drug deposits from the catheter lumen

The push-pause motion generates turbulent flow inside the catheter, effectively clearing fibrin and drug residue that could cause occlusion.

Question 112: 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)
Normal saline at the prescribed PN rate
Nothing until the PN bag arrives
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 113: Which blood type is considered the universal plasma donor?

Type O negative
Type AB positive
Type A positive
Type AB negative (Correct answer)

Correct answer: Type AB negative

Type AB plasma is universal donor plasma because it contains no anti-A or anti-B antibodies, making it safe for all recipients.

Question 114: What is the legal significance of documentation in infusion nursing?

Documentation is optional in most states
Documentation serves as the legal record of care provided — if it was not documented, legally it was not done (Correct answer)
Documentation has no legal significance
Documentation is only for billing purposes

Correct answer: Documentation serves as the legal record of care provided — if it was not documented, legally it was not done

In healthcare law, the medical record is the primary evidence of care provided. The standard 'if it wasn't documented, it wasn't done' means that undocumented assessments, interventions, and communications have no legal standing. Complete, accurate, timely documentation protects the nurse legally, supports continuity of care, and demonstrates adherence to standards of practice.

Question 115: What is the recommended frequency for updating smart pump drug libraries?

Annually
Drug libraries never need updating
Only when new medications are added to formulary
At least quarterly, or whenever significant drug safety information changes (Correct answer)

Correct answer: At least quarterly, or whenever significant drug safety information changes

Smart pump drug libraries should be updated at least quarterly and whenever there are changes to the formulary, new drug safety information, or analysis of override data reveals needed adjustments. Regular updates ensure dose limits reflect current evidence and practice. Compliance data from pump downloads should guide library refinements.

Question 116: What is the standard lockout interval for most morphine patient-controlled analgesia (PCA) programs?

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

Correct answer: 5–10 minutes

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

Question 117: Which complication is most commonly associated with long-term PICC use in home infusion patients?

Peripheral phlebitis
Hypokalemia
Upper extremity deep vein thrombosis (DVT) (Correct answer)
Pulmonary edema

Correct answer: Upper extremity deep vein thrombosis (DVT)

Upper extremity DVT is a well-recognized PICC complication caused by vessel wall irritation and altered blood flow around the catheter.

Question 118: Which complication is MOST specifically associated with rituximab infusion therapy?

Hepatotoxicity
Cardiotoxicity
Tumor lysis syndrome (Correct answer)
Peripheral neuropathy

Correct answer: Tumor lysis syndrome

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

Question 119: When administering IV amiodarone for acute atrial fibrillation, which adverse effect requires IMMEDIATE intervention?

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

Correct answer: QTc interval prolongation greater than 500 ms

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

Question 120: Which complication is unique to neonatal umbilical vein catheter (UVC) use?

Phlebitis
Hepatic necrosis from malposition (Correct answer)
Air embolism
Catheter occlusion

Correct answer: Hepatic necrosis from malposition

Hepatic necrosis from catheter malposition is a complication unique to umbilical vein catheters. If the UVC tip is positioned in a hepatic vein rather than the inferior vena cava, hyperosmolar solutions can cause direct liver damage and necrosis.

Question 121: A patient with a peripheral IV on continuous infusion develops a fever. The IV site appears clean without erythema or tenderness. What is the CRNI's priority assessment?

Immediately remove the IV catheter and culture the tip
Assess for systemic signs of infection and evaluate the catheter as a potential source (Correct answer)
Administer antipyretics and reassess in 30 minutes
Change the IV tubing and continue the infusion

Correct answer: Assess for systemic signs of infection and evaluate the catheter as a potential source

Fever in a patient with a peripheral IV requires a systematic assessment to evaluate whether the catheter is a potential source of catheter-related bloodstream infection (CRBSI).

Question 122: Which factor most directly affects the accuracy of a syringe pump's delivery rate?

The color of the syringe barrel
The patient's blood pressure
Correct syringe size and brand recognition by the pump (Correct answer)
The length of the extension tubing

Correct answer: Correct syringe size and brand recognition by the pump

Syringe pumps calculate flow based on the syringe's inner diameter; selecting the wrong syringe size or brand causes the pump to miscalculate volume per step, leading to dosing errors.

Question 123: A patient receiving TPN through a PICC line develops fever, chills, and positive blood cultures. What does this scenario most likely represent?

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

Correct answer: Catheter-related bloodstream infection (CRBSI)

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

Question 124: What is the primary pharmacokinetic advantage of IV patient-controlled analgesia over nurse-administered as-needed opioids?

Elimination of the risk of respiratory depression
Lower total opioid consumption over 24 hours
More consistent serum drug levels with less peak-and-trough sedation (Correct answer)
Ability to use non-opioid analgesics exclusively

Correct answer: More consistent serum drug levels with less peak-and-trough sedation

PCA maintains more stable serum opioid concentrations by allowing small frequent doses, reducing the wide peaks and troughs seen with traditional as-needed intramuscular or IV bolus dosing.

Question 125: 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 prevent first-pass metabolism in the liver
To saturate plasma protein binding sites immediately
To rapidly achieve therapeutic plasma concentrations before steady state (Correct answer)

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 126: What is the appropriate management when a patient on cyclic PN (12-hour nighttime infusion) reports morning headaches and diaphoresis?

Evaluate for rebound hypoglycemia at the end of the cycle and implement a taper-down protocol (Correct answer)
Switch to continuous 24-hour infusion permanently
Increase the PN infusion rate
Add insulin to the PN formula

Correct answer: Evaluate for rebound hypoglycemia at the end of the cycle and implement a taper-down protocol

Morning headaches and diaphoresis at the end of cyclic PN suggest rebound hypoglycemia, managed by tapering the infusion rate during the last 1-2 hours.

Question 127: What is the INS grading scale for phlebitis, and what grade requires catheter removal?

Grades 1-5; remove at grade 4
Grades 1-3; remove at grade 3
Grades 0-5; remove at grade 3 or above
Grades 0-4; remove at grade 2 or above (Correct answer)

Correct answer: Grades 0-4; remove at grade 2 or above

The INS Visual Infusion Phlebitis scale ranges from 0-4; grades 2 and above (pain with erythema or edema) indicate the catheter should be removed and restarted at a new site.

Question 128: Hospital infection control procedures under investigation?

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

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

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

Correct answer: Two licensed personnel

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

Question 130: What is the difference between a soft limit and a hard limit in a smart pump drug library?

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

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 131: A patient with SIADH has a urine osmolality of 600 mOsm/kg and serum osmolality of 260 mOsm/kg. What does this indicate?

Inappropriate ADH secretion causing concentrated urine despite dilute serum (Correct answer)
Diabetes insipidus
Osmotic diuresis
Appropriate renal water conservation

Correct answer: Inappropriate ADH secretion causing concentrated urine despite dilute serum

In SIADH, urine is inappropriately concentrated relative to a dilute serum, reflecting unregulated ADH activity.

Question 132: What temperature should blood products be stored at in the blood bank prior to transfusion?

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

Question 133: What is the significance of catheter-to-vein ratio in vascular access device selection?

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

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 134: An umbilical arterial catheter (UAC) is placed in a neonate. Which position is considered the 'high' position and is preferred to avoid renal and mesenteric artery occlusion?

Below L5 (pelvic region)
L3–L4 (lumbar region)
T6–T9 (above the diaphragm) (Correct answer)
T10–T12 (just above the renal arteries)

Correct answer: T6–T9 (above the diaphragm)

The 'high' UAC position (T6–T9, above the diaphragm but below the ductus arteriosus) is preferred because it avoids the origin of the celiac, superior mesenteric, and renal arteries, thereby reducing the risk of thromboembolism to those vessels compared to a 'low' position at L3–L4.

Question 135: What is the recommended catheter tip position for administering parenteral nutrition?

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

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 136: A patient receiving a vesicant via peripheral IV begins to complain of burning and the nurse notes swelling at the site. What is the FIRST action the nurse should take?

Notify the physician immediately
Stop the infusion and disconnect the IV tubing
Aspirate any remaining drug before removing the catheter (Correct answer)
Apply a warm compress to the site

Correct answer: Aspirate any remaining drug before removing the catheter

When extravasation of a vesicant is suspected, the nurse should stop the infusion and attempt to aspirate residual drug from the catheter before removal to minimize tissue damage.

Question 137: A patient on long-term home TPN develops a fever of 101.8°F. After assessing the central line, the nurse finds no local signs of infection. What is the next most appropriate step?

Remove the TPN and flush the line with saline
Change the TPN bag and tubing immediately
Administer acetaminophen and recheck temperature in 2 hours
Obtain blood cultures peripherally and from the central line before notifying the physician (Correct answer)

Correct answer: Obtain blood cultures peripherally and from the central line before notifying the physician

Obtaining paired blood cultures (peripheral and central) before antibiotic administration allows identification of catheter-related bloodstream infection (CRBSI).

Question 138: A CRNI is at the bedside with another licensed nurse to perform the final verification before starting a blood transfusion. They discover that the medical record number on the blood bag's compatibility tag does not exactly match the medical record number on the patient's identification band. What is the most appropriate action?

Begin the infusion at a very slow rate while a third nurse verifies the information.
Ask the patient to state their name and birthdate to resolve the discrepancy.
Do not start the transfusion and immediately return the unit to the blood bank. (Correct answer)
Correct the number on the compatibility tag with a pen and have both nurses co-sign.

Correct answer: Do not start the transfusion and immediately return the unit to the blood bank.

The bedside verification by two licensed professionals is the final critical safety check to prevent a potentially fatal ABO incompatible transfusion. Any discrepancy, no matter how small, is an absolute contraindication to starting the transfusion. The unit must not be spiked or administered and should be returned immediately to the blood bank for resolution of the discrepancy.

Question 139: A nurse notices a patient's urine has turned bright red during a blood transfusion. After stopping the transfusion, what is the NEXT priority nursing action?

Notify the physician and blood bank immediately (Correct answer)
Administer diphenhydramine IV
Restart the transfusion at a slower rate
Obtain a stat chest X-ray

Correct answer: Notify the physician and blood bank immediately

Hemoglobinuria (red urine during transfusion) signals acute hemolysis; the nurse must immediately notify the physician and blood bank and return the blood bag for analysis.

Question 140: What is the standard of care regarding the use of ultrasound guidance for peripheral IV catheter insertion?

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

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.

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%

To Pass

Checking for saved progress...

Exam Rules

You can skip questions and return to them later
Flag questions for review before submitting
No feedback shown until you submit the entire exam
Unanswered questions count as wrong — answer everything
10 pretest questions are mixed in and don't affect your score
Timer auto-submits when time runs out
Your progress is auto-saved every 30 seconds