CRNI Infection Control 4 — Questions and Answers
Question 1: A CRNI is preparing to change a central venous catheter (CVC) dressing. Which disinfectant is preferred for skin antisepsis at the insertion site?
- Povidone-iodine 10%
- Chlorhexidine gluconate >0.5% with alcohol (Correct answer)
- Isopropyl alcohol 70% alone
- Hydrogen peroxide 3%
Correct answer: Chlorhexidine gluconate >0.5% with alcohol
Chlorhexidine gluconate >0.5% in alcohol is the preferred antiseptic for CVC site care per INS and CDC guidelines due to its superior residual activity.
Question 2: A patient on immunosuppressive therapy develops a fever of 38.6°C within 30 minutes of starting an IV infusion. The nurse suspects infusion-related sepsis. What is the FIRST action?
- Slow the infusion rate
- Administer antipyretics
- Discontinue the infusion and notify the provider (Correct answer)
- Obtain blood cultures from the infusion line only
Correct answer: Discontinue the infusion and notify the provider
The infusion must be stopped immediately to halt potential bacteremic exposure, and the provider notified; the suspect infusate and tubing should be saved for culture.
Question 3: When inserting a peripherally inserted central catheter (PICC), which of the following practices is required for maximal barrier precautions?
- Sterile gloves and a mask only
- Sterile gloves, gown, mask, cap, and large sterile drape (Correct answer)
- Clean gloves, mask, and sterile drape
- Sterile gloves and sterile drape
Correct answer: Sterile gloves, gown, mask, cap, and large sterile drape
Maximal sterile barrier precautions require cap, mask, sterile gown, sterile gloves, and a large sterile drape to cover the entire patient during insertion.
Question 4: A nurse notes that the antimicrobial-impregnated central line has been in place for 7 days. According to evidence-based practice, what should guide the decision to replace the catheter?
- Routine replacement every 7 days regardless of condition
- Clinical indication such as signs of infection or malfunction, not scheduled replacement (Correct answer)
- Replacement every 5 days for high-risk patients
- Replacement only when blood cultures are positive
Correct answer: Clinical indication such as signs of infection or malfunction, not scheduled replacement
Evidence-based guidelines recommend against routine scheduled replacement; catheters should be changed only when clinically indicated to reduce unnecessary risk.
Question 5: Which of the following organisms is most commonly associated with catheter-related bloodstream infections (CRBSIs) linked to hub contamination?
- Pseudomonas aeruginosa
- Coagulase-negative Staphylococci (Correct answer)
- Candida albicans
- Klebsiella pneumoniae
Correct answer: Coagulase-negative Staphylococci
Coagulase-negative staphylococci, particularly S. epidermidis, are the most common CRBSI pathogens due to their biofilm formation on catheter surfaces and hubs.
Question 6: A nurse is using a needleless connector to access a central line. What is the recommended technique to reduce intraluminal contamination?
- Wipe the connector with a dry gauze before access
- Scrub the hub with alcohol for 5–15 seconds and allow to dry (Correct answer)
- Flush the connector with saline before scrubbing
- Apply povidone-iodine and proceed immediately
Correct answer: Scrub the hub with alcohol for 5–15 seconds and allow to dry
The 'scrub the hub' technique using 70% alcohol or chlorhexidine-alcohol for 5–15 seconds with friction, followed by drying, effectively reduces microbial contamination of needleless connectors.
Question 7: A patient with a PICC line is being discharged home with long-term IV antibiotics. Which instruction is MOST important to prevent infection at the insertion site?
- Change the dressing only when visibly soiled
- Keep the site submerged in warm water during showering
- Report redness, swelling, warmth, or drainage at the site immediately (Correct answer)
- Flush the line with normal saline only once weekly
Correct answer: Report redness, swelling, warmth, or drainage at the site immediately
Early recognition and reporting of local infection signs allows prompt intervention to prevent CRBSI in home infusion patients.
CRNI Infection Control 4
A CRNI is preparing to change a central venous catheter (CVC) dressing.
Which disinfectant is preferred for skin antisepsis at the insertion site?