CRNI CRNI Patient Assessment and Monitoring Practice Test 5 — Questions and Answers
Question 1: During a peripheral IV assessment using the Visual Infusion Phlebitis (VIP) scale, a score of 3 is noted. What action should the infusion nurse take?
- Document and continue monitoring every 8 hours
- Remove the catheter immediately and culture the site
- Restart the IV at a different site and document findings (Correct answer)
- Apply a topical antibiotic and reassess in 2 hours
Correct answer: Restart the IV at a different site and document findings
A VIP score of 3 indicates medium-stage phlebitis with pain, erythema, and streaking, requiring catheter removal and resiting.
Question 2: Which assessment finding in a patient with a subclavian central line should prompt the nurse to immediately suspect catheter malposition?
- Mild discomfort at the insertion site
- Hearing a gurgling sound during infusion and arm swelling (Correct answer)
- Slight resistance when flushing with 10 mL of normal saline
- Temperature of 37.8°C (100°F)
Correct answer: Hearing a gurgling sound during infusion and arm swelling
Gurgling sounds during infusion and arm swelling suggest the catheter tip may be malpositioned into an ipsilateral vessel rather than the superior vena cava.
Question 3: A patient on continuous heparin infusion has an aPTT of 200 seconds (therapeutic range 60–100 seconds). In addition to stopping the infusion, what assessment finding is most critical to monitor?
- Blood glucose level
- Signs of active bleeding including neurological status changes (Correct answer)
- Urine output and specific gravity
- Peripheral pulse quality
Correct answer: Signs of active bleeding including neurological status changes
Supratherapeutic aPTT places the patient at risk for life-threatening hemorrhage, including intracranial bleeding detectable through neurological status changes.
Question 4: When assessing a patient for catheter-associated bloodstream infection (CLABSI), which symptom alone is sufficient to initiate a blood culture draw from the central line?
- Mild site tenderness without systemic signs
- New fever (≥38°C) with no other identified source in a patient with a central line (Correct answer)
- Slight redness at the exit site without discharge
- Patient report of feeling warm
Correct answer: New fever (≥38°C) with no other identified source in a patient with a central line
An unexplained fever in a patient with a central venous catheter is a primary indication for blood culture collection to rule out CLABSI.
Question 5: A pediatric patient receiving IV therapy develops tachycardia, increased respiratory rate, and periorbital edema. Which complication of IV therapy does this presentation most suggest?
- Septicemia
- Speed shock
- Fluid overload (Correct answer)
- Allergic reaction
Correct answer: Fluid overload
Tachycardia, increased respiratory rate, and periorbital edema are hallmark signs of fluid overload, especially in pediatric patients with less fluid reserve.
Question 6: A nurse is assessing catheter tip position after a PICC insertion. The chest X-ray report states the tip is in the 'mid-SVC.' What is the nurse's appropriate response?
- Do not use the catheter and notify the provider for repositioning
- Proceed with infusion of all prescribed therapies including vesicants
- Use the catheter only for isotonic solutions until repositioned
- Document and continue monitoring; mid-SVC is an acceptable position (Correct answer)
Correct answer: Document and continue monitoring; mid-SVC is an acceptable position
The mid to lower SVC at the cavoatrial junction is the ideal and acceptable PICC tip position for infusing all therapy types.
Question 7: Which laboratory value trend in a patient receiving prolonged IV antibiotics warrants assessment for nephrotoxicity?
- Decreasing serum albumin
- Rising serum creatinine and BUN (Correct answer)
- Elevated serum potassium with normal creatinine
- Declining hemoglobin and hematocrit
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.
CRNI CRNI Patient Assessment and Monitoring Practice Test 5
During a peripheral IV assessment using the Visual Infusion Phlebitis (VIP) scale, a score of 3 is noted.
What action should the infusion nurse take?