CRNI CRNI Home Infusion Therapy and Patient Education 4 — Questions and Answers
Question 1: A home infusion patient reports that their PICC line dressing is soiled and the edge is lifting. The nurse is scheduled to visit in 3 days. What is the most appropriate instruction?
- Continue monitoring and wait for the nurse visit
- Remove the dressing and cover with a bandage until the nurse arrives
- Call the infusion nurse immediately for an unscheduled dressing change (Correct answer)
- Apply tape over the lifting edges to reinforce the dressing
Correct answer: Call the infusion nurse immediately for an unscheduled dressing change
A compromised dressing over a central venous access device increases infection risk and requires prompt replacement by a qualified nurse.
Question 2: When educating a patient about subcutaneous immunoglobulin (SCIG) therapy at home, which site should be included as an appropriate injection location?
- Deltoid muscle
- Gluteal muscle
- Abdomen (Correct answer)
- Antecubital fossa
Correct answer: Abdomen
The abdomen, thighs, and upper arms are the preferred subcutaneous injection sites for SCIG due to adequate subcutaneous tissue and ease of self-administration.
Question 3: 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?
- Administer acetaminophen and recheck temperature in 2 hours
- Obtain blood cultures peripherally and from the central line before notifying the physician (Correct answer)
- Remove the TPN and flush the line with saline
- Change the TPN bag and tubing immediately
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 4: Which parameter is most important to monitor when a home infusion patient is receiving vancomycin therapy?
- Serum potassium levels
- Serum creatinine and trough vancomycin levels (Correct answer)
- Complete blood count weekly
- Blood glucose every 6 hours
Correct answer: Serum creatinine and trough vancomycin levels
Vancomycin is nephrotoxic; monitoring serum creatinine and trough levels ensures therapeutic dosing while minimizing kidney injury risk.
Question 5: A caregiver is being taught to change an ambulatory infusion pump cassette for home antibiotic therapy. Which action during the teaching session indicates a need for further education?
- Washing hands before handling the cassette
- Checking the medication label against the prescription
- Touching the cassette spike before inserting it into the drug vial (Correct answer)
- Priming the tubing before connecting to the patient
Correct answer: Touching the cassette spike before inserting it into the drug vial
Touching the cassette spike contaminates it and increases the risk of infusion-related infection; strict aseptic technique must be maintained throughout.
Question 6: 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?
- Slow the infusion rate and administer diphenhydramine
- Stop the infusion immediately and assess airway, breathing, and circulation (Correct answer)
- Complete the infusion and document the reaction for the physician
- Apply a cold compress and reassure the patient
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 7: When teaching a patient about the management of an occluded implanted port, what should the nurse emphasize as the first intervention to attempt?
- Apply a warm compress to the port site
- Forcefully flush with normal saline using a 10 mL syringe
- Use a gentle push-pull technique with a 10 mL syringe of normal saline (Correct answer)
- Immediately notify the physician and request port removal
Correct answer: Use a gentle push-pull technique with a 10 mL syringe of normal saline
The push-pull technique with a 10 mL or larger syringe creates pressure gradients to dislodge a soft clot without risking catheter rupture.
CRNI CRNI Home Infusion Therapy and Patient Education 4
A home infusion patient reports that their PICC line dressing is soiled and the edge is lifting.
The nurse is scheduled to visit in 3 days.
What is the most appropriate instruction?