CRNI CRNI Pediatric Infusion Therapy Practice Test 5 — Questions and Answers
Question 1: Which site is generally preferred for peripheral IV insertion in an infant under 6 months of age when upper extremity veins are inaccessible?
- Femoral vein
- Scalp vein (Correct answer)
- External jugular vein
- Umbilical vein
Correct answer: Scalp vein
Scalp veins are commonly used in infants under 6 months because they are superficial, accessible, and allow the infant's hands to remain free.
Question 2: A 10-year-old receiving total parenteral nutrition (TPN) via a central line develops sudden onset of chest pain and dyspnea. The nurse should first suspect which complication?
- Hypoglycemia from TPN interruption
- Air embolism (Correct answer)
- Catheter occlusion
- Fluid overload
Correct answer: Air embolism
Sudden chest pain and dyspnea during central line infusion are classic signs of air embolism, a life-threatening complication requiring immediate intervention.
Question 3: When using a needleless connector on a pediatric central venous catheter, which technique best reduces the risk of intraluminal contamination?
- Flushing with heparin before each access
- Scrubbing the hub with 70% alcohol for at least 15 seconds before each access (Correct answer)
- Capping the connector after every use with a sterile cap
- Changing the connector every 24 hours regardless of use
Correct answer: Scrubbing the hub with 70% alcohol for at least 15 seconds before each access
Scrubbing the needleless connector hub with 70% alcohol for a minimum of 15 seconds ("scrub the hub") is the evidence-based practice to reduce intraluminal contamination.
Question 4: A 3-year-old with sickle cell disease is receiving a simple red blood cell transfusion. After 50 mL, the child develops fever, chills, and back pain. Which transfusion reaction is most likely?
- Allergic (urticarial) reaction
- Febrile non-hemolytic transfusion reaction
- Acute hemolytic transfusion reaction (Correct answer)
- Transfusion-related acute lung injury (TRALI)
Correct answer: Acute hemolytic transfusion reaction
Fever, chills, and back pain occurring shortly after transfusion onset in sickle cell disease are classic signs of acute hemolytic transfusion reaction due to ABO incompatibility.
Question 5: Which method is recommended to confirm correct nasogastric tube placement before administering medications or feedings in a pediatric patient?
- Auscultation of air insufflation over the epigastrium
- pH testing of aspirate (pH ≤ 5.5) confirmed by X-ray on initial placement (Correct answer)
- Measuring the length of the tube external to the nose
- Observing the patient for coughing or gagging
Correct answer: pH testing of aspirate (pH ≤ 5.5) confirmed by X-ray on initial placement
pH testing of gastric aspirate combined with radiographic confirmation on initial placement is the most reliable method; auscultation alone is not considered reliable.
Question 6: A pediatric patient on long-term home IV vancomycin therapy develops tinnitus and decreased hearing. Which action should the infusion nurse take first?
- Reduce the infusion rate and continue therapy
- Hold the dose and notify the prescriber immediately (Correct answer)
- Administer diphenhydramine to manage the reaction
- Document the finding and monitor at the next scheduled visit
Correct answer: Hold the dose and notify the prescriber immediately
Tinnitus and hearing loss are signs of vancomycin ototoxicity; the dose should be withheld and the prescriber notified immediately to reassess the regimen.
Question 7: When calculating osmolarity of a peripheral parenteral nutrition solution for a neonate, what is the maximum recommended osmolarity to minimize risk of phlebitis?
- 600 mOsm/L
- 900 mOsm/L (Correct answer)
- 500 mOsm/L
- 1200 mOsm/L
Correct answer: 900 mOsm/L
Solutions with osmolarity up to 900 mOsm/L are generally considered acceptable for short-term peripheral administration in neonates to reduce the risk of thrombophlebitis.
