CRNI CRNI Patient Assessment and Monitoring Practice Test 4 — Questions and Answers
Question 1: A patient receiving IV vancomycin develops flushing, erythema, and pruritus on the face, neck, and upper torso. What is this reaction called and what is the appropriate intervention?
- Anaphylaxis; stop infusion and administer epinephrine
- Red Man Syndrome; slow the infusion rate and premedicate with diphenhydramine (Correct answer)
- Phlebitis; discontinue IV and apply warm compress
- Extravasation; stop infusion and elevate the extremity
Correct answer: Red Man Syndrome; slow the infusion rate and premedicate with diphenhydramine
Red Man Syndrome is a rate-related reaction to vancomycin characterized by flushing and erythema of the upper body, managed by slowing the infusion and premedication with antihistamines.
Question 2: When assessing a PICC line insertion site, the nurse notes the arm circumference has increased by 3 cm compared to the baseline. What condition does this most likely indicate?
- Normal post-insertion edema
- Deep vein thrombosis (DVT) (Correct answer)
- Catheter-related bloodstream infection
- Lymphedema
Correct answer: Deep vein thrombosis (DVT)
A significant increase in arm circumference above baseline is a cardinal sign of deep vein thrombosis associated with PICC line placement.
Question 3: A patient's central venous pressure (CVP) is 2 mmHg. Which clinical finding would be consistent with this value?
- Jugular venous distension
- Peripheral edema
- Flat neck veins in the supine position (Correct answer)
- Crackles on lung auscultation
Correct answer: Flat neck veins in the supine position
A CVP of 2 mmHg is below normal (8–12 mmHg) indicating hypovolemia, which presents with flat neck veins when supine.
Question 4: Which parameter is most important to assess before administering a hyperosmolar solution such as TPN through a peripheral IV catheter?
- Catheter gauge
- Osmolarity of the solution (Correct answer)
- Patient's serum albumin level
- Infusion pump accuracy
Correct answer: Osmolarity of the solution
Solutions with osmolarity greater than 900 mOsm/L should not be administered peripherally due to risk of phlebitis and vessel damage.
Question 5: A patient has a tunneled cuffed central venous catheter. During assessment, the nurse is unable to aspirate blood from any lumen. The infusion is running without difficulty. What is the most likely cause?
- Catheter occlusion from thrombosis
- Fibrin sheath formation allowing flow but not aspiration (Correct answer)
- Catheter malposition
- Air embolism
Correct answer: Fibrin sheath formation allowing flow but not aspiration
A fibrin sheath or tail can form at the catheter tip, acting as a one-way valve that allows infusion but prevents aspiration.
Question 6: Which Glasgow Coma Scale (GCS) score finding in a patient receiving high-dose opioid infusion warrants immediate intervention?
- Eye opening to voice (E3) (Correct answer)
- Verbal response confused (V4)
- Motor response localizing pain (M5)
- Eye opening spontaneous (E4)
Correct answer: Eye opening to voice (E3)
Eye opening only to voice (E3) combined with an opioid infusion suggests sedation and respiratory depression risk requiring immediate clinical reassessment.
Question 7: A patient receiving long-term TPN is noted to have a serum phosphorus of 1.2 mg/dL. What condition does this represent and what complication is most concerning?
- Hyperphosphatemia; tetany
- Hypophosphatemia; respiratory muscle weakness (Correct answer)
- Hyponatremia; seizures
- Hypomagnesemia; cardiac arrhythmia
Correct answer: Hypophosphatemia; respiratory muscle weakness
Hypophosphatemia in TPN patients can cause refeeding syndrome, with respiratory muscle weakness being the most life-threatening complication.
CRNI CRNI Patient Assessment and Monitoring Practice Test 4
A patient receiving IV vancomycin develops flushing, erythema, and pruritus on the face, neck, and upper torso.
What is this reaction called and what is the appropriate intervention?