CRNI CRNI Central Venous Access Devices Practice Test 5 — Questions and Answers
Question 1: 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 2: When using the push-pause (turbulent) flushing technique, what is the primary goal?
- Reduce the risk of air embolism
- Create turbulence to remove fibrin and drug residue from catheter walls (Correct answer)
- Prevent catheter fracture
- 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 3: A patient with a subcutaneous port reports difficulty accessing the port and the nurse cannot palpate it. Which complication is most likely?
- Port rotation or flipping (Correct answer)
- Catheter tip migration
- 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 4: Which central venous access device is MOST appropriate for a patient requiring 6 months of intermittent IV antibiotic therapy at home?
- Non-tunneled CVC
- PICC line (Correct answer)
- Midline catheter
- Peripheral IV catheter
Correct answer: PICC line
A PICC line is appropriate for prolonged intermittent therapy (weeks to months) at home because it can remain in place up to 12 months and is manageable by the patient or caregiver.
Question 5: 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?
- Leave the dressing; it can remain until it becomes loose or soiled
- Change the dressing immediately, as it is overdue per INS guidelines (Correct answer)
- Reinforce the dressing with additional tape
- Notify the provider before changing the dressing
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 6: During infusion therapy through a multilumen CVC, which practice is essential when administering incompatible medications simultaneously?
- Alternate medications every 30 minutes through the same lumen
- Use separate lumens for each incompatible medication (Correct answer)
- Mix medications in a single syringe to save time
- Flush with heparin between each incompatible drug via the same lumen
Correct answer: Use separate lumens for each incompatible medication
Incompatible medications must be administered through separate lumens simultaneously to prevent chemical reactions that can precipitate or inactivate the drugs.
Question 7: 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?
- Trendelenburg with the patient on their right side
- Semi-Fowler's position with legs elevated
- Left lateral decubitus (Durant's maneuver) with Trendelenburg (Correct answer)
- Supine with head of bed elevated 30 degrees
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.
CRNI CRNI Central Venous Access Devices Practice Test 5
A nurse attempts to flush a PICC line and encounters resistance.
The patient reports no pain.
Which action should the nurse take first?